Procedures at Cardiovascular Clinical Associates

Coronary Stents

Trouble with Your Heart:

Your doctor has probably 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 a heart attack or even death. To help treat this heart problem, your doctor may want you to consider a coronary stent implant.

What Is a Stent?:

A stent is a small metal coil or mesh tube that is placed in a narrowed artery through a catheter (a long, thin tube) to help improve blood flow to your heart. The stent permanently holds the passageway open and helps reduce the rate of restenosis, re-narrowing 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.

How Your Heart Works:

To understand how stents help treat coronary artery disease, you need to know how your heart works. Your heart is a muscle that pumps blood throughout your body. To work right, your heart needs a steady supply of oxygen. The coronary arteries supply your heart with the oxygen-rich blood it needs.

Coronary Arteries:

Coronary arteries are blood vessels that wrap around the surface of the heart. The left main coronary artery splits into two branches: the left anterior descending and the circumflex. These branches supply blood to the front, left side, and back of the heart. The right coronary artery supplies blood to the right side and back of the heart.

Healthy Artery:

When the lining of the coronary artery is healthy and has no blockages, blood flows through easily. As a result, your heart muscle gets the oxygen it needs to do its job. When you exert yourself, your heart beats faster and harder and needs more oxygen. A healthy artery can easily supply extra oxygen rich blood.

Damaged Artery:

Coronary artery disease begins when the artery wall is damaged by things like high blood pressure or smoking. Plaque (a fatty material) builds up in the damaged artery lining. This is atherosclerosis, sometimes called hardening of the arteries. The plaque buildup begins to narrow the passageway carrying blood to the heart. At this stage, you probably won't feel any symptoms of coronary artery disease.

Narrowed Artery:

As plaque buildup increases, your artery has a hard time supplying extra oxygen-rich blood to your heart during exertion. This is when you may feel angina-pressure, tightness, aches, or pain in your chest jaw, neck, back, or the arm. Angina does not usually cause permanent damage to heart muscle, but angina is a warning sign that you may be at risk for a heart attack.

Blocked Artery:

Plaque may tear, completely blocking the artery, or a blood clot may plug the narrowed opening. When this happens, blood flow stops. Without oxygen-rich blood, part of the heart muscle is damaged and stops working. This is a heart attack (myocardial infarction). You may feel crushing pressure or pain in or around your chest A heart attack lasts longer than angina and permanently damages heart muscle.

Your Stent Procedure:

Your doctor may have recommended that you have a stent implant as part of your treatment for coronary artery disease. If you understand the risks and know what to expect during the stent placement you'll feel more relaxed and confident about your decision to have this procedure.

Before the 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. An IV (intravenous) 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 one to two hours.

During the Procedure:

Before the stent is placed: The skin is numbed where the catheter will be inserted. An introducing sheath is inserted into the artery in your groin, or possibly your arm. A guiding catheter (a thin, 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 (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 balloon angioplasty.

The Balloon Catheter Is Inflated:

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 Stent Catheter Is Positioned:

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 Stent Is Expanded:

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.

Blood Flow Is Improved:

The stent permanently holds the artery open and helps reduce the rate of restenosis, or re-narrowing of the artery. Blood flow to the heart muscle increases. New tissue will slowly grow over the stent and eventually completely cover it.

After the Procedure:

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 one to five days after the procedure. Your doctor gives you instructions on medications and follow-up care. He or she may also schedule follow-up visits.

Recovering in the Hospital:

The introducing sheath is left in place for several hours or overnight. If the groin site was used, lie flat and don't move your leg until about six to ten 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 for several hours after the procedure. Frequent blood tests will help your doctor adjust the dosage of your anticoagulant medication. Your activity level will be restricted for the first few days while you're recovering.

Medications:

Your doctor may prescribe aspirin, anti-coagulant medication, or similar medications for about two months to help 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.

Back to Work:

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 extra strain on your heart.
Living Well After Stents:
By now you know stent implants are not a cure for heart disease. You also know your risk factors for heart disease and what you can change. Now it's time to make those heart healthy changes. It's the best thing you can do for your heart and the people who care about you.