PCI Concepts
Balloons, stents, atherectomy, IVUS/OCT, and FFR/iFR — concepts, complications, and the all-important DAPT.
Learning Objectives
- 1.Understand the components and tools of PCI conceptually.
- 2.Know the antiplatelet (DAPT) implications after stenting.
- 3.Recognize PCI complications, especially stent thrombosis.
Overview
Percutaneous coronary intervention opens narrowed coronaries. You won’t perform it, but you’ll manage the medications and watch for the complications — and the antiplatelet plan is where APPs add real safety value.
The toolkit (concepts)
- •Balloon angioplasty — dilates the lesion (may be standalone or pre/post-stent).
- •Stents — drug-eluting stents (DES) are standard; they keep the vessel open.
- •Atherectomy — modifies heavily calcified plaque so a stent can be placed.
- •Intravascular imaging (IVUS/OCT) — optimizes sizing/placement.
- •Physiology (FFR/iFR) — decides whether an intermediate lesion needs treatment.
DAPT after stenting (high-yield)
- •Dual antiplatelet therapy (aspirin + a P2Y12 inhibitor) prevents stent thrombosis.
- •Duration is individualized (ischemic vs bleeding risk; ACS vs stable) — confirm the plan.
- •Interrupting DAPT early (e.g., for surgery) risks stent thrombosis — coordinate carefully.
Complications
- •Stent thrombosis (acute closure) → recurrent ACS, often dramatic — emergency.
- •Restenosis (gradual re-narrowing) → recurrent angina over months.
- •Access-site and contrast complications (as in cath).
Escalate
Recurrent chest pain after PCI, especially with DAPT interruption, can be stent thrombosis — an emergency. Escalate immediately.
Scope
This is conceptual understanding for follow-up, complication recognition, and escalation. APPs do not perform these procedures, program devices beyond recognition/triage, or read raw images — those are the proceduralist’s/imager’s role.
Common beginner mistakes
- •Letting a patient stop DAPT prematurely after a stent.
- •Dismissing post-PCI chest pain.
- •Confusing acute stent thrombosis with gradual restenosis.
Nurse / MA workflow connection
- •Nurses reinforce DAPT adherence and post-cath calls; MAs flag stopped antiplatelets and recurrent symptoms.
Mini cases
A patient stented last week stops clopidogrel for a dental cleaning and develops crushing chest pain.
Concern?
Show answer
Acute stent thrombosis from premature DAPT interruption — an emergency. Activate the ACS pathway and escalate immediately. This is exactly why DAPT must not be stopped without coordination.
Six months post-stent, gradually returning exertional angina.
Likely mechanism?
Show answer
In-stent restenosis (gradual re-narrowing). Evaluate ischemia and refer back to cardiology — different tempo and mechanism than acute stent thrombosis.