Coronary Stenting Overview

What is a Stent?

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 ( 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 © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor may do the following:

• Blood tests
• Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
• Chest x-ray —a test that uses radiation to take a picture of structures inside the body

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 procedure.
• 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 (tube) 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 tube will be slipped over the wire and threaded up to the blockage.

The doctor will be taking x-ray pictures during the procedure to know where the wire and catheter are. Dye will be injected into the arteries of your heart. This will allow the doctor to view the arteries and blockages.

Once 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 the nurse's 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)

Do not stop taking aspirin and clopidogrel (or prasugrel) without first talking to your cardiologist.

• Ice may help decrease discomfort at the insertion site. You may apply ice for 15-20 minutes each hour, for the first few days.

• To lower your risk for further complications of heart disease, you can make lifestyle changes. These include eating a healthier diet, exercising regularly, and managing stress.

• You may need to undergo periodic stress tests to monitor for any recurrent blockages.

• Be sure to follow your doctor’s instructions .

Always inform new doctors or other medical personnel 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.

RESOURCES:

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

National Library of Medicine
http://www.nlm.nih.gov/

CANADIAN RESOURCES:

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

Heart and Stroke Foundation of Canada
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 Jun 15;37(8):2170-2214.

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 . Accessed January 12, 2009.

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 are angioplasty and coronary stents? University of Maryland Medical Center website. Available at: http://www.umm.edu/patiented/articles/whatangioplastycoronarystents000003_10.htm . Accessed January 12, 2009.

11/7/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 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]