Coronary Intravascular Stent Placement

WHAT YOU SHOULD KNOW:

• Coronary intravascular stent placement is a procedure that is done to place a stent into a blood vessel in your heart. Coronary arteries are blood vessels in the heart that carry blood and oxygen. These arteries can become narrow, or get blocked by plaque. Plaque is fat and tissue that builds up on the inner walls of an artery. When this happens, blood and oxygen cannot flow to areas of the heart as well. Decreased blood flow to the heart can cause severe (very bad) chest pain, or a heart attack. An angioplasty is a procedure that is done to open blocked coronary arteries. Coronary intravascular stent placement is done at the same time as an angioplasty.
  
  
• During coronary intravascular stent placement, a stent is placed into the artery that has been opened by angioplasty. A stent is a small mesh tube that is made out of metal. You may need to have a stent placed in one or more of your coronary arteries. A drug-eluting stent (DES) is a stent that is coated with medicine. This type of stent may help prevent new plaque from forming in the area of the artery where the stent is placed. The DES stent changes shape to fit the shape of your artery, and releases medicine slowly over time. Coronary intravascular stents are not removed, and often remain in your blood vessel for life. A coronary intravascular stent may allow more blood and oxygen to reach all areas of your heart. When enough blood and oxygen get to your heart, your chest pain may decrease or go away.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may have an allergic reaction to the anesthesia, dye, or the stent. This can cause a skin rash, trouble breathing, or kidney problems. You may bleed more than usual during the procedure, and need to have a blood transfusion. You may need to have more than one stent placed, or caregivers may need to do other surgery, such as open heart surgery, while the stent is being placed. During or after surgery, blood clots may form, or plaque may break off. The blood clot or plaque may block your artery. The artery that was used for the procedure may not properly close. If this happens, there may be bleeding, or a blood-filled cavity called a pseudoaneurysm may form. You may need treatment or surgery to correct this problem. You may get an infection after the procedure. You may have chest pain, or your blood pressure may go too high or low during or after the procedure. You may get an irregular heartbeat, or have a heart attack or a stroke.
  
  
• After your procedure, the wall of your coronary artery may grow weak, tear, or rupture (burst). If these problems happen, you may need more surgery. Fluid or blood may pool in the space behind your heart, and lead to heart failure. Other organs, such as your lungs and kidneys, may stop working. These problems can be life-threatening. Even after the procedure, the artery may grow narrow again. The stent may move out of place, or get blocked. If you do not have this procedure, your coronary arteries will stay blocked. You may have new or more chest pain, and you may have a heart attack. Call your caregiver if you are worried or have questions about your procedure, condition, or care.

WHILE YOU ARE HERE:

Before the procedure:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Blood thinners: This medicine helps prevent clots from forming in the blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
  
  
• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Preparing for the procedure: You are taken on a stretcher to the room where your procedure will be done. You are then moved to a table or bed where you will lie on your back. An area on your arm or your groin is selected to insert the catheter. The hair is removed from this area, and it is cleaned using germ-killing soap to help prevent infection.
  
  
• Local anesthesia: This is medicine that is given as a shot into your skin. It is used to numb the area where the catheter will be inserted into your skin.
  
  
• Fluoroscopy: This is a special type of x-ray that shows movement of joints, organs, and parts of the body. Body parts are shown on a screen for the caregiver. This test may be used to make sure the catheter is being placed correctly.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

During the procedure:

• Your caregiver inserts a device called a sheath through your skin until it reaches your artery (blood vessel). The sheath is used to hold your artery open as a catheter (tube) is placed in it. The stent that will be used to open your blocked artery is attached to a catheter. It is threaded through your artery until it reaches the area of the coronary artery that is blocked. Dye is put through the catheter to help caregivers see your blocked artery better on fluoroscopy. The stent is put in place to hold the blocked artery open.
  
  
• If you are having an angioplasty, a catheter with a balloon inside it is used. Once the catheter reaches the blocked area of the artery, the balloon is filled. This opens the artery by pressing plaque against its inner walls. The stent is placed and left inside the artery to hold it open. One or more stents may be put in your coronary arteries during the procedure. Stents may be placed in more than one area of the same coronary artery. When the stent is in place, the catheter and sheath are removed. The place where the catheter went into your skin may need to be closed with a few stitches, and covered with bandages.

After the procedure:

You will be taken to a room where you can rest until you are awake. To help prevent bleeding and other problems, pressure or a weighted device will be placed on the area of your groin or arm where the catheter was inserted. You may need to lie flat and still in bed for a few hours after the procedure. Do not get out of bed until your caregiver says it is OK. Talk to your caregiver about the medicine that you need to take at home. Learn why you need to take these medicines. Ask for written information about your medicines.

• Nitroglycerin: This medicine may also be called nitro. Nitroglycerin opens the arteries to your heart so the heart gets more oxygen. Nitroglycerin can be given in an IV, by mouth, or put on your body as a patch or paste.
  
  
• Anti-platelet medicine: Anti-platelet medicines are needed after the procedure to thin your blood. This type of medicine helps prevent blood clots from forming and blocking your arteries. Aspirin and clopidogrel are the names of these medicines. When using anti-platelet medicines, you will bruise and bleed more easily than normal. Ask caregivers for more information about these medicine.

Blood sugar tests:

Caregivers will monitor your blood sugar closely after your procedure. This may help decrease your chance of getting an infection.

Foley catheter:

This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.