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.

Getting Ready

Before the procedure:

• Dye will be used during your procedure to let caregivers see your arteries better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any medicine, food, or metal.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are taking herbs or food supplements. Tell him if you have a medical condition, such as a thyroid problem, diabetes, or bleeding problems.
  
  
• You may need to take medicine to thin your blood, such as aspirin. This medicine helps prevent blood clots from forming, and helps prevent platelets from sticking inside your artery. Platelets are blood cells that join together to heal a damaged blood vessel. If you are taking aspirin, do not take non-steroidal anti-inflammatory drugs (NSAIDs). Ask your caregiver if you need to stop using any of your current medicines.
  
  
• If you are female, tell your caregiver if you know or think you might be pregnant. Tell your caregiver if you are breastfeeding.
  
  
• You may need to have blood and urine tests and a chest x-ray. You may also need an electrocardiogram (ECG) and other tests to check how your heart is working. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before the procedure:

• Ask caregivers about directions for eating and drinking.
  
  

The day of the procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You will be taken to the room where your procedure will be done. Caregivers will remove hair and clean your arm or groin area where a catheter will go in to help prevent infection. You will be given anesthesia medicine to numb your skin. 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 will be put through the catheter to help caregivers see your blocked artery better on fluoroscopy (real-time x-ray). 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 will be used. Once the catheter reaches the blocked area of the artery, the balloon is filled. This opens the artery by pressing plaque against the inner walls. The stent will be 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 will be 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your procedure on time.
  
  
• You have a fever.

Seek Care Immediately if

• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing
  
  

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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.