title: Management of patients undergoing percutaneous coronary revascularization.
abstract: While performance of percutaneous coronary intervention (PCI) remains the domain of specialized cardiologists, patients undergoing PCI are cared for by noninvasive cardiologists, internists, and primary care physicians. Therefore, patient care is optimized when the entire patient care team understands procedural risks and complications as well as optimum patient management before, during, and after PCI. Before PCI, patients with contrast dye allergies should be identified and pretreated with steroids and an H1-blocker. Hydration should be initiated and maintained before and after the procedure to minimize the risks for contrast nephropathy. Periprocedure, patients should be monitored clinically for evidence of ischemia. In patients with significant groin, flank, abdominal, or back pain, as well as those with decrease in hematocrit or unexplained hypotension, the diagnosis of groin or retroperitoneal hematoma should be considered and promptly evaluated. Groin tenderness, pulsatile mass, or bruit should prompt evaluation for possible femoral pseudoaneurysm or arteriovenous fistulae. After the procedure, all patients treated with coronary stents should receive aspirin plus clopidogrel. Patients who develop typical anginal symptoms between the 1st and 6th to 8th months after PCI are likely to have restenosis and can be evaluated by an imaging study or repeated catheterization.
authors.affiliation: Section of Cardiology 3C-330, Houston Veterans Affairs Medical Center (111-B), 2002 Holcombe Boulevard, Houston, TX 77030.
authors.forename: Glenn N
authors.initials: GN
authors.lastname: Levine
authors.forename: Morton J
authors.initials: MJ
authors.lastname: Kern
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
authors.forename: Lloyd W
authors.initials: LW
authors.lastname: Klein
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Kereiakes
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Sanborn
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D003287:Contrast Media / Q000009:adverse effects; D023921:Coronary Stenosis / Q000628:therapy; D006801:Humans; D010348:Patient Care Team
chemical_list: D003287:Contrast Media