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Coronary Intravascular Stent Placement
What you need to know about coronary intravascular stent placement:
Coronary intravascular stent placement is a procedure to place a stent in an artery of your heart that has plaque buildup. Plaque is a mixture of fat and cholesterol. A stent is a small mesh tube made of metal that helps keep your artery open. Your healthcare provider may place a bare metal stent or a drug-eluting stent (DES) in your artery. A DES is coated with medicine that is slowly released and helps prevent more plaque buildup in the area where the stent is placed. The stent remains in your artery for life. You may need more than one stent.
How to prepare for your procedure:
- Your healthcare provider will talk to you about how to prepare for your procedure. He may tell you not to eat or drink anything after midnight on the day of your procedure. He will tell you what medicines to take or not take on the day of your procedure. Arrange to have someone drive you home when you leave the hospital.
- You may need blood tests and a stress test before your procedure. Talk to your healthcare provider about these or other tests you may need. Contrast liquid will be used during your procedure to help healthcare providers see your heart better. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid.
What will happen during the procedure:
- You may be given an antibiotic through your IV to help prevent a bacterial infection. You will be given medicine in your IV to help you relax or make you drowsy. You will also get local anesthesia that will numb the area where the catheter will be placed. You will be awake during the procedure so healthcare providers can give you instructions. You may be asked to cough, hold your breath, or to tell them how you feel during the procedure.
- A catheter (long, thin tube) will be put into an artery in your wrist, groin, or neck. The catheter will be gently guided through this artery to your heart and into the narrowed or blocked artery. Healthcare providers will use x-rays and contrast liquid to find the area where the stent needs to be placed. You may feel warm as the contrast liquid is put into the catheter. This feeling should go away quickly.
- A guidewire will then be placed into the catheter. The balloon catheter will be guided into the narrowed or blocked artery using the guidewire. Healthcare providers will inflate the balloon several times for short periods. The inflated balloon pushes the plaque against the artery walls. This opens them and allows more blood flow to your heart. Another balloon catheter with a stent is then inserted into the artery. The balloon is inflated. This expands the stent and pushes it into place against the artery wall. The stent will be left in your artery to help keep it open.
What will happen after the procedure:
- The catheter and guidewire will be taken out of the artery and a pressure bandage will be put on the area. Your healthcare provider may apply a collagen plug or other closure device to stop the bleeding. Healthcare providers will put pressure on the bandaged area to help stop the bleeding.
- You will be taken to a room to rest. Healthcare providers will monitor you closely for any problems. You will then be taken to your hospital room. You may need to lie still and flat for 3 to 6 hours after the procedure to prevent bleeding. Do not get out of bed until your healthcare provider says it is okay.
Risks of the procedure:
- You may develop a hematoma (swelling caused by collection of blood) or bleed more than expected from your catheter site. The contrast liquid used during this procedure may cause an allergic reaction or kidney problems. You may develop an infection.
- Your artery may be injured when the catheter is inserted. During or after your procedure, blood clots may form, or plaque may break off. The blood clot or plaque may block your artery and cause a heart attack or stroke. The stent could collapse, or a clot could form on the stent. This could cause the artery to become blocked again. You may need another procedure to open your artery.
Call 911 for any of the following:
- You have any of the following signs of a heart attack:
- Squeezing, pressure, or pain in your chest that lasts longer than 5 minutes or returns
- Discomfort or pain in your back, neck, jaw, stomach, or arm
- Trouble breathing
- Nausea or vomiting
- Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing
- You have any of the following signs of a stroke:
- Numbness or drooping on one side of your face
- Weakness in an arm or leg
- Confusion or difficulty speaking
- Dizziness, a severe headache, or vision loss
Seek care immediately if:
- Your arm or leg feels warm, tender, and painful. It may look swollen and red.
- Your leg or arm becomes numb or turns white or blue.
- The area where the catheter was placed is swollen, red, or has pus or foul-smelling fluid coming from it.
- You start to bleed from your catheter site again.
Contact your cardiologist if:
- You have a fever or chills.
- You have questions or concerns about your condition or care.
- Medicines may be given to prevent blood clots around your stent, lower your blood pressure, and decrease cholesterol in your blood. You may also be given medicine to relieve chest pain.
- Take your medicine as directed. Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
- Avoid unnecessary stair climbing for 48 hours, if a catheter was put in your groin.
- Do not place pressure on your arm, hand, or wrist, if the catheter was placed in your wrist. Avoid pushing, pulling, or heavy lifting with that arm.
- If you need to cough, support the area where the catheter was inserted with your hand.
- Ask your cardiologist how long you need to limit movement and avoid certain activities.
- You may feel like resting more after your procedure. Slowly start to do more each day. Rest when you feel it is needed.
Ask your cardiologist about how to care for your incision wound. Ask when you can get into a tub, shower, or pool.
Do not smoke:
Nicotine and other chemicals in cigarettes and cigars can cause heart and lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
Your cardiologist may recommend that you attend cardiac rehabilitation (rehab). This is a program run by specialists who will help you safely strengthen your heart and reduce the risk for more heart disease. The plan includes exercise, relaxation, stress management, and heart-healthy nutrition. Healthcare providers will also check to make sure any medicines you are taking are working.
Follow up with your cardiologist as directed:
If you need an MRI, wait at least 6 to 8 weeks after stent placement, or as directed. Write down your questions so you remember to ask them during your visits.
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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.