STENT PLACEMENT

When a blockage within an artery is severe enough to warrant intervention, a stent may be used to help open the blockage and reduce the chance the blockage will recur. A stent can be placed into any artery – The coronary or peripheral (such as renal, carotid, or lower extremities) arteries are most common.

A stent is a wire mesh tube used to keep open an artery that’s recently been cleared using angioplasty. To implant, the stent is collapsed to a small diameter and put over a balloon catheter. It’s then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently to hold it open, to improve blood flow to the heart muscle, and to relieve symptoms (usually chest pain). It is possible to redevelop plaque within a stented artery (called restenosis), so precautions are taken to reduce the risk of this happening, such as medication use.

Patients who’ve had a stent procedure must take one or more blood-thinning agents. Examples are aspirin, Plavix, Effient, or Brilenta. Aspirin is used indefinitely. The other medications are used either short-term or long-term, depending on a patient’s cardiac history.

What to Expect: Stenting is performed in the hospital. You will have either already undergone a cardiac catheterization that revealed a coronary artery blockage or will undergo a cardiac catheterization in combination with probable angioplasty and stenting. Once you arrive at the hospital, you will be required to disrobe. A hospital gown will be provided. You will be administered medication for relaxation; however, you will not be under general anesthesia. Small electrode pads will be placed onto your chest to monitor your heart rate and rhythm (similar to an EKG) throughout the procedure. A blood pressure cuff will be placed on your arm to monitor your blood pressure throughout the procedure. An IV (intravenous) catheter will be inserted, most likely into a vein in your arm. Your groin area or wrist will be cleansed with a sterilized wash and some may require the area be shaved. A small plastic tube called an introducer sheath will be thread into the artery. Through this sheath, a long, flexible, soft plastic tube or guiding catheter is advanced and the tip positioned into the opening or mouth of the coronary artery. Once the catheter tip is seated within the opening of the coronary artery, x-ray movie pictures are recorded during the injection of the contrast material or “dye”. After evaluating the x-ray movie pictures, your cardiologist estimates the site of the coronary artery blockage and selects the type of balloon catheter and wire that will be used during the case. The tip of the wire is then guided across the blockage and advanced beyond it. The wire now serves as a “guide” or rail over which the balloon catheter can be delivered. The tip of the balloon catheter is then passed over the guide wire and positioned across the lesion or blockage. While the balloon is inflated, it compresses plaque that makes up the coronary blockage. The stent is then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently to hold the artery open. Once your cardiologist finds the results satisfactory, the balloon is deflated and the wire and balloon are withdrawn. Final angiograms or movie x-ray pictures are taken. The guiding catheter is then withdrawn. Most patients are discharged home the next morning. You will need someone to drive you home. You will be scheduled for a follow-up appointment with your cardiologist in 1 to 2 weeks. Most patients are instructed not to return to work until after their follow-up appointment. No exercise or strenuous activity until after your follow-up appointment.

Preparation: If your procedure is schedule in the morning, you will be asked not to eat or drink anything after midnight. If your procedure is scheduled in the afternoon, you will be asked not to eat or drink anything for four hours prior to testing. Patients are instructed to take their cardiac medications the morning of the procedure with a few sips of water. It is very important that you take your aspirin the morning of the procedure and Plavix if you are prescribed Plavix. If you are on Coumadin, you will be instructed to hold your Coumadin for five days prior to your procedure. If you are an insulin dependent diabetic and your procedure is before noon, take only half of your morning dose with juice. If your procedure is after noon, take the whole dose with a light breakfast. Glucophage should be held the day of the procedure and will be held for 48 hours after the procedure due to potential interaction with the dye. Other oral diabetic medications, such as Micronase and Glucotrol, should be held the day of the procedure. It is always best to review all of your medications with your cardiologist prior to your procedure. It is essential that you notify your physician of any allergies to shellfish, iodine, or IV dye. Lab testing is usually required within one week of the procedure.

Locations: Catheterization is performed at the hospital.

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