Procedures

Coronary Angiography and Percutaneous Coronary Intervention (PCI)

  • Interventional Cardiology

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About this procedure

This guide provides information about a Coronary Angiography and Percutaneous Coronary Intervention (PCI) procedure. It includes details about what is involved, how to prepare and what to expect during and after the procedure. Please use this in addition to information from your doctor and nurse.

A PCI procedure is performed in an angiography suite at IntraCare in Epsom. Your cardiologist will be assisted by our team of nurses and other highly skilled personnel.

Both IntraCare and Allevia Hospital will be involved with your care for this procedure. Allevia Hospital is responsible for your admission, preparation and aftercare in the Cardiac Investigation Unit (CIU).

What is coronary artery stenosis?

Coronary artery stenosis is the narrowing of a coronary artery. Just as an engine needs petrol, the heart needs blood to do its job of pumping blood around the body. Slow build-up of fatty plaque within the artery wall can cause an artery to narrow, reducing blood flow. This can cause symptoms referred to as ‘angina’ such as chest discomfort, jaw ache, or arm pain. Sudden changes in the plaque may cause angina to worsen or may cause a heart attack.

What is a coronary angiography?

Coronary angiography is an examination of the coronary arteries and identifies the presence, extent and location of coronary artery narrowings. Some coronary narrowings are severe and need treatment and some are mild and do not need treatment. Sometimes a test called an FFR (fractional flow reserve) is undertaken to be able to determine whether the narrowing needs treatment or not. Pressure is measured upstream and downstream from the narrowing during infusion of a medicine called adenosine. The test result can guide the decision about whether the narrowing requires a stent or not. This infusion can make a patient feel ‘peculiar’ for a few minutes.

Before the procedure

Pre-procedure phone call

A nurse from IntraCare will call you 24–48 hours prior to your procedure to discuss the following information:

  • Your admission time.
  • When you should stop eating and drinking.
  • Medication instructions.
  • Allergies (including medications, contrast dye, dressings/plasters and food).
  • Answer any further questions.

Fasting instructions

To ensure your safety during the procedure, it is important that you follow the fasting guidelines below:

Food – Stop 6 hours prior to procedure. Do not consume any of the following within 6 hours of your planned procedure time:

  • Solid food
  • Milk-based products
  • Soluble fibre
  • Jelly

Fluids – Clear (transparent) fluids are encouraged up to 2 hours before your planned procedure time. These include:

  • Water
  • Clear juices
  • Cordials
  • Black tea or coffee

Avoid fluids containing milk, pulp, or jelly.

Sip-Til-Send (STS) Protocol*

  • Unless advised otherwise, you can sip up to 200ml of water per hour in the 2 hours before your planned procedure time.

* Your nurse will confirm during your pre-procedure phone call whether this protocol is suitable for you.

Anticoagulation (blood thinner)

  • If you take Aspirin/Cartia and/or Clopidogrel you may continue to take these.
  • Please inform the staff if you take any other blood thinners (e.g. Warfarin, Dabigatran/Pradaxa, Rivaroxaban, Apixaban). Your cardiologist will advise if you need to stop this medication temporarily for a few days before the procedure.
  • If you are taking Warfarin, our nurses will review your INR levels prior to your procedure and advise any medication changes if necessary.

Other regular medications

Please continue to take these unless advised otherwise by your cardiologist. If you are taking a diuretic or water pills (e.g. frusemide, spironolactone), you may need to withhold this on the morning of the procedure. It is important that you let us know if you are taking the following medications: Liraglutide (Victoza™, Saxenda™) Dulaglutide (Trulicity™), Semaglutide (Ozempic™, Wegovy™), Tirzepatide (Mounjaro™).

Reminders for the day of your procedure

  • If you are on regular medication, please bring this with you in its original packaging.
  • Please leave all your jewellery and valuables at home. You are welcome to bring your mobile phone in with you.
  • We recommend wearing loose-fitting clothing and shoes that are easy to slip on/off.
  • You are encouraged to bring a friend or a family member as a support person before and after your procedure.

  • This is commonly a day stay procedure, but please bring an overnight bag with you in case you are required to stay overnight.

  • The planned procedure time is an estimate only and may vary. We will keep you informed of any unexpected delays on the day.

Informed consent

As with any procedure, there are potential risks involved. Your cardiologist and anaesthetist will explain the procedure, discuss possible risks and answer any questions you may have. Your whānau or support person are welcome to be part of this discussion. You will then be asked to sign the consent form. This will occur either at an earlier appointment, or on the day of your procedure.

Your procedure

A small intravenous needle (IV line) will be inserted into a vein in your arm. This will be used to administer medication to help you relax and to keep you comfortable during the procedure. We may need to remove hair with clippers at the access site for sterile preparation. Please avoid shaving the area yourself as this may cause minor abrasions to the skin, increasing the risk of infection.

Once you are in the angiography suite, devices for monitoring blood pressure, heart rate, and oxygen levels will be fitted to ensure your safety during the procedure.

The procedure

You will be lightly sedated but awake throughout. You will feel the local anaesthetic injection into your wrist or groin, then a tiny plastic tube called a catheter is introduced. You should not feel pain at the entry site, but there still may be some non-painful sensations, such as pressure. You should inform the interventional cardiologist doing the procedure if you are experiencing any pain.

Your cardiologist uses X-ray imaging to guide the catheter to the top of each coronary artery, where contrast dye is injected into. When the contrast dye is injected, X-ray images of the coronary arteries are obtained and narrowings can be identified. If a narrowing suitable for stenting is found, the interventional cardiologist may then insert a stent. This procedure is referred to as Percutaneous Coronary Intervention (PCI).

Through the guiding catheter, a wire about the thickness of a hair is passed across the narrowing. A stent (a fine mesh metal alloy tube that comes squashed down on a balloon) is directed across the narrowing along the wire.

The balloon is inflated to expand the stent and artery. The stent is pushed into the artery wall holding the artery open.

The balloon is deflated and removed, leaving the expanded stent in place. Once expanded, the stent cannot move.

Drug eluting stents

Drug eluting permanent stents are the most frequently inserted stents with excellent results achieved over years. These stents are coated with a medication to prevent or substantially reduce the chance of re-narrowing and the need for repeat treatment.

After your procedure

You will be transferred from IntraCare to CIU, where the Allevia Hospital team will look after you during your recovery. If appropriate, you will usually be discharged home after 4-6 hours. Prior to your discharge, the nursing staff will give you advice about your medication, procedure site care and resuming your normal daily activities.

Recovery and discharge

  • Following your procedure, it is important that you do not drive for 48 hours. Please ensure you have a family member or friend to drive you home from the hospital, as you may still be under the effects of sedation.
  • You will need to arrange for someone to be at home with you on the day of your discharge and overnight to support you in your recovery.
  • Due to the sedation, you may feel lethargic afterwards with reduced concentration. For this reason, for 24 hours after your procedure:
    • Do not do any activity requiring strength, concentration, or full alertness.
    • Do not make any legal decisions or sign legal documents.
  • Due to the nature of stenting, it is common to experience some chest discomfort for a few days.

Resuming travel and activities

  • You will be able to return to work within a week of having the procedure unless your job involves heavy lifting (>5kg).
  • You can begin light exercise after 1 week.

Medication

Your cardiologist will discuss any medication changes with you, if necessary. If you have any questions regarding your medications after your procedure, please contact your cardiologist.

Follow up appointment

You will be seen in clinic at The Heart Group approximately 1–3 months following your procedure. If you have minor concerns prior to your follow-up appointment, please arrange to see your general practitioner (GP) or contact IntraCare.

Radial (wrist) site care

If one of the puncture sites during the operation is through the wrist, it is normal to experience some minor bruising and/or feel a small pea-sized lump under the skin at the puncture site. This will disappear in time or remain as permanent scar tissue. This is nothing to be concerned about.

Please follow these instructions in CIU and the first few days at home:

  • A dressing will be applied to the procedure site in the CIU. Keep the dressing clean and dry. If it becomes wet or soiled, replace it with a new dressing. You may stop using the dressing 3 days after your procedure.
  • Keep the site clean and do not rub the wound. Until the site has healed, gently pat it dry after showering.
  • If the site looks red, swollen, inflamed, and/or infected, please see your general practitioner (GP).
  • You may take paracetamol if your arm is sore. Should your arm continue to be painful, please phone IntraCare on (office hours) or (after hours).
  • Do not lift with the affected arm or do any strenuous activity.

Femoral (groin) site care

It is normal to experience some bruising at the puncture site. During the first 5-7 days after your procedure:

  • Do not do any heavy lifting (>5kg) or strenuous exercise.
  • If you do need to cough or sneeze, you can hold gentle pressure over the puncture site during this to decrease the risk of it bleeding.
  • Do not sit in a bath, hot tub or spa until the skin has healed (5-7 days).
  • Do not cross your legs while sitting.
  • You may resume walking if your puncture site is not painful.
  • If applicable, remove the dressing on your groin once the skin has healed (approximately 3 days).

Haematoma

It is not uncommon for a small haematoma to develop following this procedure. A haematoma is a collection of blood under the skin that is sometimes painful. A small hard lump (similar in size to a pea) may also be felt under the skin and remain for several weeks.

  • If a large lump (haematoma) occurs, lie down, and get another person to press down firmly on the centre of the haematoma for approximately 10 minutes.
  • If after releasing pressure, the haematoma reoccurs, keep applying the pressure and go to your local accident and emergency department.

Bleeding

  • It is common for there to be a small amount of ooze. If this occurs, lightly press on the area for 5-10 minutes.
  • If there is significant bleeding, you should lie flat, and another person will need to apply firm pressure for 10 minutes. If this does not stop the bleeding, call an ambulance.
Seek immediate medical attention (dial 111 for an ambulance) if there is excessive bleeding from the puncture site or if you are experiencing severe chest pain.
Please show this page and your discharge summary if visiting a GP, afterhours or hospital.

If you have any concerns, please contact IntraCare:

In case of emergency, always call 111.

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