Percutaneous Coronary Intervention (PCI)

Catheter-based diagnosis and treatment of coronary artery disease — angiography, angioplasty, and stent placement. The dominant interventional cardiology procedure globally. Usually performed in a dedicated cardiac cath lab, though complex structural cases (TAVR, MitraClip) move to hybrid ORs. Indications span stable angina (selective), NSTEMI, STEMI (primary PCI within 90-min door-to-balloon target), and chronic total occlusion (CTO) revascularization.

Clinical pathway

1. Vascular access — radial (default in most centers; lower bleeding risk, faster ambulation) or femoral.
2. Diagnostic angiography — contrast injected into coronary arteries via guiding catheter; fluoroscopic cineangiograms show stenoses and their severity.
3. Lesion assessment — visual + functional (FFR pressure wire, iFR, RFR), and/or imaging (OCT, IVUS) in many cases.
4. Intervention if indicated — balloon angioplasty + drug-eluting stent deployment. Rotational / orbital atherectomy first for calcified lesions; intravascular lithotripsy (IVL) for severely calcified.
5. Final angiography — confirm result, document for report.
6. Closure — radial band, femoral manual compression, or closure device.

Typical systems

• Philips Allura Xper FD10 (single-plane, legacy / large refurb base)
• Philips Azurion 7 (current)
• Philips Azurion 5
• Siemens Artis zee
• Siemens Artis Q
• GE Innova 2100-IQ

Room + procedure characteristics

• Procedure time: 30–90 min routine; longer for complex multi-vessel, CTO, or bifurcation cases.
• Room requirements: cath lab with radiolucent table, hemodynamic monitoring (Sensis / Xper IM / Mac-Lab), contrast injector, crash cart and emergency capacity.
• Team: interventional cardiologist + cath tech + RN + scrub nurse.
• Fluoroscopy dose: variable; DAP tracked per procedure, reported in state / institutional dose registry.

Equipment considerations that bite

• Detector size — small-FOV / FD10-class is standard for cardiac PCI; large-FOV is over-spec'd for routine cardiology.
• Dose-management software — ClarityIQ / CARE / AutoEx — long-fluoro CTO cases benefit most. Career-cumulative operator dose is the program-level metric.
• Hemodynamics integration — Sensis (Siemens), Xper IM (Philips), Mac-Lab (GE) are licensed modules; a "fully working cath lab" with broken hemodynamics is a stopped room.
• Tube class — high-PCI-volume programs burn cardiac tubes faster than diagnostic-only rooms; budget shorter tube life.
• IVUS / OCT / FFR integration — third-party modalities (Boston Scientific, Abbott, Philips Volcano) need dedicated cart space and console integration.
• Image-record storage — DICOM cine storage volume for routine PCI is significant; PACS sizing matters.

Operational reality

• Door-to-balloon time for STEMI is the program-level performance metric — 90 min target. Cath-lab readiness, on-call team rotation, and EMR integration all bear on it.
• Volume concentration — PCI is one of the highest-volume interventional procedures. Programs above ~400 PCIs / year often justify dedicated cath rooms.
• TAVR / structural heart cannibalization — high-volume PCI programs are absorbing structural cardiac into shared rooms; equipment and staffing implications follow.
• Refurb economics — FD10 cardiac rooms are abundant; the dose-suite licensing tier is the most-watched price-determining variable on premium deals.

Related

• Diagnostic Cardiac Catheterization
• TAVR (structural heart adjacent)
• EP Ablation (adjacent, different lab)
• Cardiac SPECT (non-invasive ischemia workup)
• Cardiac Rubidium PET
• Interventional X-Ray
• Azurion Field Guide
• Allura Xper Field Guide
• Siemens Artis Field Guide
• Cath Lab Director
• ClarityIQ
• DAP