Complications as a result of PCI

Dr. Najjar, you were going to explain to us what the potential complications that people might possibly experience while having PCI or coronary intervention during and after. Yes, it's a really important question because everything that we do to a patient has the possibility of a complication so we need to understand that and take that on board before we embark on a procedure like that. There are a number of different things that can happen and we think of them in two main ways. If we're doing a diagnostic only procedure, the risks of a procedure is about one in a thousand. That means if you took a thousand people and did an angiogram, one of those people would have a problem. If we're moving on to intervention and actually performing a stenting procedure, then that risk actually increases to one in a hundred, so that's a 1% risk. Now that sounds quite frightening, but much of the risks are fairly benign. I'll go through them now. Most commonly the risks are of bruising and bleeding at the site of puncture. So if we are doing the procedure through the hand then that means bruising and bleeding at the site where we place our needles. If your case requires a procedure done through the leg, bruising and bleeding can be more serious and there are some bleeding complications that can be life threatening and that's really important to know and that's why in the modern era when we do procedures through the leg we use a combination of x-rays and and ultrasounds to be able to make a safe puncture. There are other more serious complications that can occur, and that can be something that happens to a blood vessel. Now, blood vessels can be injured in the arm or around the aorta, and these injuries can be the ones that self-heal and don't require any treatment, or they can be the ones that require us to do something to the artery. Now, many tears that happen in the arm, for example, will heal on their own without much action, and similar for those that happen around the aorta, but there are equally those numbers that we have to consider for emergency surgery. And that's really important to know. There are other complications that can happen around the heart. The heart arteries themselves can tear, which we call dissection, or they can perforate. That means a hole actually forms within the artery. These are emergency situations that require treatments, and they require treatment almost immediately. And as an interventional cardiologist, we're well-versed in treating these issues because modern treatment for almost all of these issues is to place a stent to seal the tear or the dissection. There are some other issues that can occur. Sometimes when we're treating a heart, the heart can really struggle and blood supply can go down. That can trigger a heart attack. Again, the modern treatment of a heart attack is to use blood thinners and to place a stent if appropriate. Finally, another important complication is the risk of a stroke. This seems to be associated with the age and much older patients who've got very, very furred up arteries around the heart and the aorta have a higher risk of this, but it can also occur in other patients because small clots can occur. To prevent that from happening, we thin the blood, and we often give very powerful blood thinners before doing the procedure and during the procedure itself. There are some very small risks of needing urgent surgery, and luckily, the risk of that happening in most angiogram or angioplasty procedures is very low indeed, much less than one in 1,000, and there is a very small risk of passing away, and that's important to understand, And that sometimes is linked to the severity of the illness. So patients who have a lot of illness and a lot of disease, for example, may be more likely than another person to pass away from an angiogram procedure. But again, thankfully, that is a rare occurrence. Thank you.