Consultants In Cardiology - Coronary Stents

Making Heart Healthy Changes

A stent can help in the treatment of coronary artery disease, but it is not a cure. You need to change any
unhealthy habits (also called risk factors) that helped creat 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 the risk factors can help keep your heart condition from getting worse and may even
improve the health of your heart.

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: Your heart’s oxygen supply

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. 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, is
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 oxygen-rich blood to your heart
during exertion. This is when you may feel angina – pressure, tightness, achiness or pain in your
chest, jaw, neck, back or 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 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.

Understanding Your Risks

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 make emergency bypass surgery necessary.

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 the 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 wires are then removed.

Blood Flow Is Improved

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. Now the 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.

Going Home

Your doctor will give you instructions for caring for yourself and taking medications. Ask a family
member or friend to drive your 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

Medications

Your doctor may prescribe aspirin, anticoagulant 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
healthcare 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 medications unless
your doctor tells you to.

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.

Follow-up Visits

In addition to regular checkups and blood tests, your doctor usually schedules some other tests,
including and exercise stress test, within the first six months after your procedure. These tests check to
see whether your artery has remained open.

Your Artery May Narrow Again

If you start to feel symptoms like the ones you had before your stent implant, tell your doctor. To treat the
problem, your doctor may recommend further testing or additional procedures.