High-Risk PCI: When Open-Heart Surgery Isn’t an Option

Coronary artery disease — blocked heart arteries — is the most common type of heart disease. According to the Centers for Disease Control and Prevention, it affects one in 20 American adults over age 20. Interventional cardiologists use a procedure called percutaneous coronary intervention (PCI) to clear arteries in patients with this condition.

To help patients with severe artery blockages and weakened heart muscles, St. Elizabeth Healthcare offers high-risk PCI. Interventional Cardiologist Mohanjit Brar, MD, explains this procedure and how it improves outcomes for patients with advanced coronary artery disease. Here’s what you should know.

What is High-Risk Percutaneous Coronary Intervention?

Percutaneous Coronary Intervention (PCI), sometimes called angioplasty, is a minimally invasive, catheter-based procedure. With this technique, interventional cardiologists use a small balloon to open blocked arteries. Then, they place a stent that improves blood flow. The procedure becomes high-risk PCI when a patient faces other health complications. Other factors can include:

• Aortic or mitral valve disease.
• Chronic kidney disease.
• Fragility.
• Hardened plaque in the arteries.
• Heart failure.
• Multiple blockages.
• Older age.
• Weak heart muscle.

In some cases, providers perform a protected PCI. These patients have multiple blockages or severely weakened heart function. For this procedure, an Impella^® pump takes over pumping blood throughout the body. Doing so helps the patient’s heart rest and recover.

Who Is a Good Candidate for High-Risk PCI?

Interventional cardiologists often recommend high-risk PCI for “no-option patients.” These individuals have failing bypass grafts from a previous open-heart surgery. They typically struggle with heart failure symptoms like shortness of breath or lingering chest pain.

Alongside the factors listed above, high-risk PCI candidates can have:

• Chronic total occlusion (a complete, long-term artery blockage).
• Complex blockages where arteries branch apart.
• Left main disease (blockage in the left main coronary artery).
• Peripheral artery disease (a condition that reduces blood flow to the arms or legs).

What Are the Benefits and Risks of High-Risk PCI?

Complete revascularization — improving blood flow to all the arteries — is the main goal of high-risk PCI. Opening these blood vessels offers several other benefits, including:

• Improved ability to exercise.
• Improved heart function (stronger pumping and heart failure relief).
• Less chest pain.
• Lower heart attack risk.
• Reduced risk of death.

But the procedure does introduce some risks. Some patients can experience blood vessel injury, cardiac arrest or stroke. The contrast dye that helps providers see blood vessels during the procedure can increase the risk of kidney damage.

How Does High-Risk PCI Improve Care with Advanced Tools and Techniques?

Interventional cardiologists use a variety of advanced tools to perform high-risk PCI. Specialized drills soften and break through hardened calcium that blocks veins. A lithotripsy catheter breaks down and removes calcium deposits. Laser catheters burn and soften calcium deposits from the inside. Doing this makes it easier to place a stent to keep the blood vessel open.

What Can You Expect from High-Risk PCI and Recovery?

High-risk PCI recovery depends on the complexity of a patient’s condition and how long the procedure lasts. For most patients, providers remove the Impella pump that supports heart function at the end of the procedure. But if a patient is very sick or the procedure takes a long time, they may leave the pump in place for a day. Patients typically go home the day after the pump is removed and rest for another seven to 10 days.

Leading-Edge Care at St. Elizabeth

St. Elizabeth takes a team-based approach to heart care and high-risk PCI. Interventional cardiologists, heart surgeons and heart failure specialists partner with each patient. Together, they design a personalized care plan that meets their unique needs.

Our heart providers deliver the most complete, advanced cardiac care from diagnosis to treatment to preventive therapies. We take the time to talk with patients about their condition, explaining heart images and each procedure’s risks and benefits.

We use innovative devices to stabilize and strengthen each patient’s heart. Our providers also explore other hybrid techniques that rely on minimally invasive and catheter-based approaches to fix arteries, boost patient outcomes and improve recovery.

“We want fellow cardiologists, heart surgeons and primary care providers to know our heart team is here for their patients with tough blockages who may not be candidates for open-heart surgery,” Dr. Brar says. “We merge the best possible techniques and technologies to provide the most advanced options for patients.”

Learn more about the Heart and Vascular Care team of trailblazing experts at St. Elizabeth Healthcare.

Medically reviewed by Mohanjit Brar, MD on 10/21/2025.