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Coronary Artery Stents

A diagnosis of coronary artery disease (CAD) means that blood vessels that feed your heart are narrowed or blocked.  CAD can cause angina (pressure, tightness or pain in your chest, arm, neck or jaw).  CAD can also lead to heart attack or even death. To help treat this heart problem, your physician may want you to consider a coronary stent implant.

A stent is a small metal coil or mesh tube that is placed in a narrowed artery through a catheter (a long, thin, soft, tube) to help improve blood flow to your heart.  The stent permanently holds the passageway open and helps reduce the rate of restenosis (re-narrowing of the artery).  After the stent placement, you may need to stay in the hospital for one to five days and temporarily take anticoagulant medication to help prevent blood clots.  If you understand the risks and know what to expect during your stent placement, you'll feel more relaxed and confident about your decision to have this procedure.

Be sure to tell your physician 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 by first shaving it, then washing with an iodine solution.  An intravenous (IV) line is inserted into your vein to give you fluids.  You'll also be given medication to help you relax.  Normally, patients remain awake during the procedure, which usually takes 1 to 2 hours.  The skin is numbed where the catheter is inserted, so you won't be in pain. 

An introducing sheath is inserted into the artery through your groin, or possibly your arm.  A guiding catheter (a thin, soft, 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 physician to see your artery on an angiogram (video 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 physician will first compress the plaque buildup against the artery wall during a procedure called a balloon angioplasty.

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 your physician if you do.

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 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 wire are then removed.

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. New tissue will slowly grow over the stent and eventually cover it completely.

In addition to regular checkups and blood tests, your physician will usually schedule some other tests, including an exercise stress test, within the first six months after your procedure.  These tests check to see whether your artery has remained open.  Contact your physician if you start to feel symptoms like the ones you had before the stent implant.   Further testing or additional procedures may be required to treat the problem.

A stent can help in the treatment of coronary artery disease, but it is not a true cure. You need to change any unhealthy habits (also called risk factors) that helped create 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 risk factors can help keep your heart condition form getting worse and may even improve the health of your heart.  If you have any questions or concerns, be sure to ask your physician.

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