Understanding Coronary Stents

Your doctor may have told you that you have coronary artery disease. This means that blood vessels that feed your heart are narrowed or blocked. Coronary artery disease can cause angina (pressure, tightness or pain in your chest, arm, neck or jaw). Coronary artery disease can also lead to heart attack or even death. To help treat this heart problem, your doctor may want you to consider a coronary stent implant.

A stent is a small metal coil or mesh tube that is placed in a narrowed artery through a catheter (a long, thin, soft, tube) to help improve blood flow to your heart. The stent permanently holds the permanently holds the passageway open and helps reduce the rate of restenosis (renarrowing of the artery). After the stent placement, you may need to stay in the hospital for one to five days and temporarily take anticoagulant medication to help prevent blood clots.

If you understand the risks and know what to expect during your stent placement, you'll feel more relaxed and confident about your decision to have this procedure.

Be sure to tell your doctor if you have ever had any bleeding problems or allergic reactions to iodine, which is found in shellfish and the x-ray contrast fluid. The night before your stent implant, you may be asked not to eat or drink anything after midnight. You may be given routine blood tests, an ECG or EKG (electrocardiogram), and a chest x-ray prior to your procedure. A nurse prepares the patch of skin where the catheter is inserted by first shaving it, then washing with an iodine solution. An intravenous (IV) line is inserted into your vein to give you fluids. You'll also be given medication to help you relax. You will be awake during the procedure, which usually takes 1 to 2 hours.

The skin is numbed where the catheter is inserted, so you won't be in pain. An introducing sheath is inserted into the artery through your groin, or possibly your arm. A guiding catheter (a thin, soft, flexible tube) is inserted through the sheath and moved to the artery that is blocked. X-ray contrast fluid is injected through the catheter to allow your doctor to see your artery on an angiogram (video x-ray picture). A guide wire is inserted and positioned through the blockage. The guide wire is used to position the balloon and stent catheters. Before placing your stent, the doctor will first compress the plaque buildup against the artery wall during a procedure called a balloon angioplasty.

	A balloon-tipped catheter is positioned at the narrow part of the artery. The balloon is inflated to compress the plaque against the artery wall. You may feel chest discomfort when the balloon is inflated. Tell your doctor if you do.
	The metal coil or mesh stent is placed on another balloon catheter and positioned in the artery at the spot where the plaque was compressed.
	The balloon is then inflated, which causes the stent to expand. The expanded stent further compresses the plaque against the arterial wall. Another balloon may be used to fully widen the stent. The catheters and guide wire are then removed.
	The stent permanently holds the artery open and helps reduce the rate of restenosis, or renarrowing of the artery. Blood flow to the heart muscle increases. New tissue will slowly grow over the stent and eventually cover it completely.

The risks of stents are fairly low and are usually outweighed by the benefits to your heart. Possible risks include:

•   Tearing or cracking of the artery lining
•   Bleeding from the insertion site
•   Blood clot formation on the stent
•   Problems related to the x-ray contrast fluid (allergic reaction to iodine or kidney damage)
•   Heart attack, stroke or death. Rarely, a complication occurs that makes emergency bypass surgery necessary

After the stent implant, you'll be taken to a cardiac care unit or a special recovery room. If there are no complications, you'll probably go home 1 to 5 days after the procedure. Your doctor gives you instructions on medications and follow-up care, including any follow-up visits.

While you are recovering in the hospital, the introducing sheath will be left in several hours or overnight. If the groin site was used, you will have to lie flat and not move your leg for 6 to 10 hours after the sheath is removed. The nurse frequently checks your pulse and blood pressure and checks the insertion site for bleeding. You'll remain attached to a heart monitor and an IV line that provides fluids and medications over several hours after the procedure. Frequent blood tests will help your doctor adjust the dosage of your anticoagulant medication. Your activity level well be restricted for the first few days you are recovering.

Your doctor will give you instructions for caring for yourself and taking medications. Ask a family member or friend to drive you home from the hospital so you don't strain the insertion site. Call your doctor if:

•   The insertion site is increasingly painful, swollen, red, bleeding, or draining, or, if you develop a fever.
•   You notice any other bleeding, blood in your urine, or black or tarry stools.
•   You have angina.
•   You have severe pain, coldness or a bluish color in the leg or arm where the catheter was inserted.
•   You have unexplained bruising.

Your doctor may prescribe aspirin, anticoagulant medication, or similar medications for about two months to prevent blood clots from forming on your stent. When taking anticoagulants, a blood test called prothrombin time (PT) must be done regularly to ensure that the dosage is not too high or too low. Certain foods and alcoholic beverages may change the way your anticoagulants work. While taking anticoagulants, avoid activities that may cause injuries and bleeding. Be sure to inform other health care providers and your dentist that you are taking anticoagulants. Check with your doctor before taking any other medications, even over-the-counter drugs. Don't stop taking any medication unless your doctor tells you to.

You should be able to return to work about one to two weeks after your procedure. Try not to overdo it at first. Avoid activities like heavy lifting, which can put an extra strain on your heart.

In addition to regular checkups and blood tests, your doctor will usually schedule some other tests, including an exercise stress test, within the first six months after your procedure. These tests check to see whether your artery has remained open. If you start to feel symptoms like the ones you had before the stent implant, tell your doctor. To treat the problem, your doctor may recommend further testing or additional procedures.

A stent can help in the treatment of coronary artery disease, but it is not a true cure. You need to change any unhealthy habits (also called risk factors) that helped create your heart problems in the first place. Some risk factors are smoking, eating too much fat and salt and not getting enough exercise. Making changes to reduce risk factors can help keep your heart condition form getting worse and may even improve the health of your heart.

If you have any questions or concerns, be sure to ask your doctor.