Coronary Stenting
Definition |
Body Parts Involved |
Reasons for Procedure |
Complications |
What to Expect |
Outcome |
Call Doctor If
Definition
The placement of a stent, which is a mesh, metal tube placed in an artery in the heart (a coronary artery) to help keep the artery open after an angioplasty procedure
Parts of the Body Involved
- Coronary arteries
- An artery in the groin
- Arteries leading to the heart
Reasons for Procedure
To hold open a blocked artery in the heart, thus allowing more normal blood flow through that artery.
Risk Factors for Complications during the Procedure
- Obesity
- Smoking
- Bleeding disorder
- Age: 60 or older
- Recent pneumonia
- Recent heart attack
- Diabetes
- Angina
- Calcification of blood vessels
What to Expect
Prior to Procedure
Your doctor will likely 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
In the days leading up to your procedure:
- The night before, eat a light meal and do not eat or drink anything after midnight
- You may be asked to shower the morning of your procedure, and 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
During Procedure:
- IV fluids
- Sedation
- Anesthesia
- You may be given the blood thinner heparin, to decrease the risk of blood clots
Anesthesia - Local anesthesia injected into the area in your groin where the catheter will be inserted
Description of the Procedure - The area of your groin where the catheter will be inserted is shaved, swabbed with an antibacterial solution, and numbed with local anesthetic. The doctor inserts a needle into a groin artery, and a wire is passed through the needle. The wire is guided through the arterial system until it reaches the blocked artery in the heart. Next, a soft, flexible catheter tube is slipped over the wire and threaded up to the blockage.
This procedure is monitored using a continuous x-ray image called fluoroscopy. Dye can be shot through the catheter into the arteries of the heart, to light them up and to make any blockages more visible via fluoroscopy. Once the blockage is reached, a small balloon at the tip of the catheter is inflated and deflated a number of times, stretching the artery open. The collapsed stent, a small metal mesh tube, is then inserted through the arterial system to the area of the blockage. The balloon is inflated to expand the stent to its full size. The stent is left in place to hold the vessel walls open, and the deflated balloon, catheter, and wire are removed. A bandage is placed over the groin area.
After Procedure - You'll need to lie flat on your back, keeping your leg still for about six hours after the procedure. You may have a sandbag placed over the area in your groin where the catheter was inserted to put pressure on the artery and prevent bleeding.
How Long Will It Take? 30 minutes to 3 hours
Will It Hurt? The local anesthetic should adequately numb your groin, so that insertion of the needle, wire, catheter, and stent should not be painful. However, you may feel some chest pain during inflation of the balloon.
Possible Complications:
- Bleeding
- Perforation of the artery in the heart, requiring immediate emergency bypass surgery
- Spasm of the artery, requiring either immediate stent placement or emergency coronary artery bypass graft surgery (CABG)
- Heart arrhythmia
- Heart attack
- Stroke
- Blood clots may form and travel through the arteries, causing stroke, heart attack, kidney damage, breathing difficulties, damage to an arm or leg, or intestinal damage
Average Hospital Stay:0-2 days
Postoperative Care:
- To minimize pain and soreness, place ice on your groin for 15-20 minutes each hour, for the first two days. After this time, switch to a heating pad or hot water bottle.
- Take blood-thinning medications as prescribed by your doctor. This may be aspirin or another medication, such as warfarin.
- To lower your risk of recurrent blockages in your coronary arteries and further heart disease, make lifestyle changes, including eating a healthier diet, exercising regularly, and managing stress.
- You may need to undergo periodic stress tests to identify any recurrent blockages early.
- 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.
Outcome
Your artery should be considerably more open, allowing better blood flow to feed the heart muscle. This may mean that you'll no longer have chest pain that you previously experienced, or it may mean that your tolerance for exercise will increase. Sometimes, however, the procedure isn't successful, or the artery narrows again, in which case you may require repeat angioplasty or coronary artery bypass graft surgery.
Call Your Doctor If Any of the Following Occurs
- Chest pain
- Your arm or leg becomes painful, blue, cold, numb, tingly, swollen, or increasingly bruised
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the insertion site in your groin
- Signs of infection, including fever and chills
SOURCES:
American Heart Association
Heart Disease: A Textbook of Cardiovascular Medicine, 5th ed. W.B. Saunders, 1997.
Last reviewed March 2001 by Medical Review Board
