• Coronary Stenting

    Definition

    In coronary stenting, a mesh, metal tube is placed in an artery in the heart. The tube is called a stent. It helps to keep the artery open. It is placed after an artery has been cleared of blockage during an angioplasty.
    There are 2 types of stents. One is called a drug-eluting stent. It is coated with a medicine that is slowly released. The medicine helps decrease the rate of reblockage in the artery. The other type of stent is called a bare-metal stent. It does not contain any medicine. Your doctor will discuss which stent option is best for you.
    Coronary Artery: Stent Procedure
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    Reasons for Procedure

    This procedure is done to hold open a previously blocked artery in the heart. This will allow more normal blood flow through that artery.
    After the stenting, your artery should be more open. This will allow better blood flow to feed the heart muscle. It may mean that you will no longer have chest pain. Your tolerance for exercise may increase.

    Possible Complications

    If you are planning to have a stent, your doctor will review a list of possible complications. These may include:
    • Bleeding at the point of the catheter (tube) insertion
    • Damage to the walls of arteries, causing you to need additional procedures or surgery
    • Heart attack or abnormal heart beats known as arrhythmia
    • Allergic reaction to x-ray dye
    • Blood clot formation
    • Infection
    • Stroke
    Sometimes the procedure is not successful or the artery narrows again. You may require repeat angioplasty or coronary artery bypass grafting (CABG).
    Factors that may increase the risk of complications include:

    What to Expect

    Prior to Procedure

    You may have the following done prior to the procedure.
    • Your doctor may need to test your bodily fluids. This can be done with blood tests.
    • Your heart activity may need to be recorded. This can be done with electrocardiogram (ECG, EKG).
    • Pictures may need to be taken of your bodily structures. This can be done with a chest x-ray.
    Leading up to your procedure:
    • Talk to your doctor about your current medicines. Certain medicines may need to be stopped before the procedure, such as warfarin (Coumadin). Metformin (Glucophage) or glyburide and metformin (Glucovance) should also be stopped the morning of the procedure.
    • Aspirin should be taken before and continued through the procedure. Your doctor may also prescribe clopidogrel (Plavix) for you to take before the procedure.
    • The night before, eat a light meal. Do not eat or drink anything after midnight.
    • You may be asked to shower the morning of your procedure. You may be given special antibacterial soap to use.
    • Arrange for a ride to and from the hospital.
    • Arrange for help at home for the first few days after your procedure.

    Anesthesia

    Local anesthetic will be given. It will numb the area of the groin or arm where the catheter will be inserted. You will also receive sedation and pain medicine. They will help keep you comfortable through the procedure.

    Description of Procedure

    The area of the groin or arm where the catheter will be inserted is shaved, cleaned, and numbed. A needle will be inserted into the artery. A wire will be passed through the needle and into the artery. You will receive blood-thinning medicine during the procedure. The wire will be guided through until it reaches the blocked artery in the heart. A soft, flexible catheter will be slipped over the wire and threaded up to the blockage.
    The doctor will be taking x-rays during the procedure to know where the wire and catheter are positioned. Dye will be injected into the arteries of your heart. This will allow the doctor to view the arteries and blockages.
    After the blockage is reached, a small balloon at the tip of the catheter will be rapidly inflated and deflated. This will stretch the artery open.
    The collapsed stent will be inserted. The balloon will be inflated again to expand the stent to its full size. The stent will be left in place to hold the vessel walls open. The deflated balloon, catheter, and wire will be removed. After the procedure is complete and the blood thinning medicine has worn off, the catheter in the artery will be removed. Pressure will be applied for 20-30 minutes to control bleeding.
    A bandage will then be placed over the groin area.

    Immediately After Procedure

    You will need to lie still and flat on your back for a period of time. A pressure dressing may be placed over the area where the catheter was inserted to help prevent bleeding. It is important to follow directions.

    How Long Will It Take?

    30 minutes to 3 hours

    Will It Hurt?

    The local anesthetic should numb the area where the catheter is inserted. You may feel a burning sensation when the area is anesthetized. You may also feel pressure when the catheters are moved. Some people have a flushed feeling or nausea when the dye is injected. You may feel some chest pain during inflation of the balloon.

    Average Hospital Stay

    0-2 days

    Post-procedure Care

    At Home
      You may be sent home on blood-thinning therapy. This may include one or more of the following:
      • Aspirin
      • Clopidogrel
      • Prasugrel (Effient)
    • Ice may help decrease discomfort at the insertion site. You may apply ice for 15-20 minutes each hour, for the first few days.
    • You can make lifestyle changes to lower your risk for further complications of heart disease. These include eating a healthier diet, exercising regularly, and managing stress.
    • You may need to undergo periodic stress tests to monitor for blockages.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Be sure to follow your doctor’s instructions.
    Always inform new doctors or other healthcare professionals that you have a coronary stent in place. Some medical procedures need to be modified or avoided for people with coronary stents, particularly MRI scans.
    Always inform new doctors or other healthcare professionals that you have a coronary stent in place. Some medical procedures need to be modified or avoided for people with coronary stents, particularly MRI scans.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occur:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Your arm or leg becomes painful, blue, cold, numb, tingly, swollen, or increasingly bruised
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Pain that you cannot control with the medicines you have been given
    • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
    • Cough, shortness of breath, or chest pain
    • Joint pain, fatigue, stiffness, rash, or other new symptoms
    • Extreme sweating
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Heart Association http://www.heart.org

    National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca

    Heart and Stroke Foundation http://ww2.heartandstroke.ca

    References

    American College of Cardiology Task Force. American College of Cardiology/Society for Cardiac Angiography and Interventions clinical expert consensus document on cardiac catheterization laboratory standards: a report of the American College of Cardiology Task Force on clinical expert consensus documents. J Am Coll Cardiol. 2001;37(8):2170-2214.

    Braunwald E. Heart Disease: A Textbook of Cardiovascular Medicine. 5th ed. Philadelphia, PA: WB Saunders; 1997.

    Bravata DM, Gienger AL, McDonald KM, et al.Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007;147:703-716.

    Camenzind E. Treatment of in-stent restenosis—back to the future? N Engl J of Med. 2006;355:2149-2151.

    Kasper DL, Braunwald E, Hauser S, Longo D, Jameson JL, Fauci AS. Harrison's Principles of Internal Medicine. 16th ed. McGraw-Hill Professional; 2004.

    Shuchman M. Trading restenosis for thrombosis? New questions about drug-eluting stents. N Engl J of Med. 2006;355:1949-1952.

    What is a stent? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/stents/. Accessed February 6, 2013.

    11/7/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Bravata DM, Gienger AL, McDonald KM, et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007 Nov 20. [Epub ahead of print].

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