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PCI for Complex Bifurcation Occlusions

When you have a blocked or narrowing in a coronary artery, a procedure called Percutaneous Coronary Intervention (PCI), can open the artery or arteries so that blood can flow normally. A diagnosis of certain conditions for many coronary artery, heart valve and congenital heart conditions can also be made at the same time as the Percutaneous Coronary Intervention (PCI).

These blockages occur due to fatty build-up in the arteries – diminishing your blood flow. This form of coronary artery disease (CAD) is called atherosclerosis can cause chest pain (angina), shortness of breath, dizziness, fatigue and nausea, pain in your neck or arm, an irregular or fast heartbeat and result in a heart attack if left untreated.

At WakeMed, we offer a minimally invasive PCI procedure to clear arteries and restore normal blood flow.

The challenges of a bifurcation blockage 

If you have a bifurcation blockage, the procedure is more challenging. Heart arteries are similar to a tree – with branches. Side-branch vessels running from the main coronary artery often develop plaque that clogs the area. When this happens, the narrowing is called a bifurcation blockage or bifurcation lesion. These repairs can be more difficult to treat since stents are not formed with a design that fits the area.

Our cardiologists are trained to open the blockage typically using a single stent. If two stents are used to open the region, there is more risk for blood clots. You will be advised on modifying your blood thinning medication to avoid clot formation.

Once at the site, a single stent is inserted and a guide wire is wound through the main artery, along with one that is run through the stent to reach the branch. This allows for what is known at a “kissing balloon” dilation after opening the stent.

How to prepare for a PCI 

Do not eat or drink after midnight on the evening before the procedure. Take your regular medications, but only have a small amount of water to take pills. If you take blood thinners or have diabetes, talk with your doctor about any special instructions.

You will mostly likely be able to go home the same or next day. You will not be allowed to drive yourself home, so please bring a driver. You will be able to resume driving and normal activities based on your cardiologist’s recommendations.

Over the coming weeks, you will see improvement in your overall health, including increased energy and ability to exercise, improved breathing and reduced chest pain. You may also be advised to increase or modify your blood thinner if two stents are used in the procedure.