Coronary Artery Stent

What is a stent?

A stent is a tiny device made of surgical stainless steel. Your healthcare provider will use a thin tube called a catheter to place the stent inside an artery to hold the artery open and allow more blood to flow through the blood vessel.

When are coronary stents used?

A stent may be used when you have coronary arteries that are narrowed or blocked by plaque. The coronary arteries are the blood vessels that carry oxygen and nutrients to the heart muscle. Plaque is a buildup of fats, cholesterol, and other substances on the inside walls of the arteries. The stent may be placed in your artery when you have a procedure called angioplasty to open your artery.

Examples of alternatives to this procedure are:

• balloon angioplasty, which uses a catheter and balloon to stretch and unblock the artery
• atherectomy, which uses a shaver to remove plaque
• coronary bypass surgery, which is an operation that opens the chest and uses arteries from the chest, or veins from the legs or arms, to make a path around blocked areas in the heart

Ask your healthcare provider about your choices for treatment.

How do I prepare for this procedure?

• Talk with your healthcare provider about what medicines you should take before the procedure. Your provider may prescribe medicine to prevent blood clots from forming during the procedure.
• Plan for your care and transportation after the procedure and during recovery at home.
• Your provider will ask you not to eat or drink anything after midnight on the night before the procedure.

What happens during the procedure?

You will be given medicine in a vein that will help you relax. You will also be given a shot of local anesthetic to numb the area where the catheter will be inserted.

Someone at the hospital will shave and wash the area where the catheter will be inserted (arm or groin) to help prevent infection.

The stent comes tightly wrapped around a deflated balloon at the tip of the catheter. The catheter will be inserted into a blood vessel either at the elbow or groin. The catheter is then pushed through the blood vessel to the blockage in the artery. Inflating a balloon at the tip of the catheter stretches the narrowed artery and expands the stent. After the stent is fully expanded, the balloon is deflated, and the catheter and balloon are withdrawn. The stent stays behind to hold open the blood vessel.

What happens after the procedure?

You will go back to your hospital room and rest in bed for a few hours. You will most likely be able to go home the next day. In some cases, you may be able to go home the day you have the procedure. You can usually go back to your normal activities within a day or two.

The stent will stay in your blood vessel. Over time, it may get covered with tissue from the inner lining of your artery. Blood may begin to form a clot on the surface of the stent. You will be given blood-thinning drugs to stop blood clots from forming on the stent. Usually the blood thinners are a combination of aspirin and a medicine called clopidogrel (Plavix), which you will take for a period of time after the procedure.

Many stents are designed to release a drug from a special coating on the stent. The drug prevents scar tissue from growing and blocking the artery. The drug slows the growth of normal tissue as well as scar tissue. You may need to take blood thinners for at least 3 to 6 months if you have this kind of stent.

Your healthcare provider will probably advise you to take a low dose of aspirin every day for the rest of your life.

What are the benefits of this procedure?

• The procedure can restore blood flow in the artery without major surgery. It can be performed without using general anesthesia.
• Stents decrease the chance that the blockage will come back after angioplasty.
• Stents can prevent or treat a lot of damage to the blood vessel during angioplasty.
• Stents have made emergency coronary bypass surgery during angioplasty far less common.
• Coronary stents can be used during an acute heart attack to quickly restore blood flow to the heart muscle and limit damage from the attack.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• Anesthesia has some risks. Discuss these risks with your healthcare provider.
• It is sometimes hard to place the stents properly in arteries where the arteries twist and turn. The artery may close in spite of the stent if it is not put in exactly the right place. Coronary stents cannot be used when the artery being treated is small or very curved or twisted.
• For some people, arteries may become blocked again after the stent is put in.
• Sometimes a blood clot may form on the stent within a few days or weeks after it is put in place. Blood-thinning medicines are important to help prevent this. You should never stop your medicines, such as Plavix, without consulting your healthcare provider first.
• You may bleed a lot and need medicine or a blood transfusion.
• The artery may be damaged. For example, the catheter might poke a hole in the artery during the procedure. Emergency surgery or repair of the hole would then be needed.
• There is a risk of injury to the groin or arm where the catheter was inserted.

Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.

When should I call 911 or my healthcare provider?

Call 911 for emergency help right away if:

• You have chest discomfort (pressure, fullness, squeezing, or pain) that lasts more than 5 minutes or goes away and comes back.
• You have chest discomfort with lightheadedness.
• Your chest pain goes beyond your chest to one or both arms or to your neck or jaw.
• You have chest discomfort and are sweating a lot or having trouble breathing or are sick to your stomach.
• You have shortness of breath.
• Your arm or leg becomes blue and cold.

Call your provider right away if:

• You have constant or worsening pain or numbness in your arm or leg.
• You have a fever.
• You have bleeding, excess bruising, or a lot of swelling where the catheter was inserted.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.