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Coronary Stenting

By

Catherine Spader, RN

What is coronary stenting?

Coronary stenting is a procedure to place a stent, mesh tube, inside a coronary artery to keep it open. Coronary arteries are blood vessels that supply blood to your heart muscle. Coronary stenting is performed with other procedures, such as angioplasty, that open narrowed or blocked coronary arteries. Coronary stenting is a treatment for coronary artery disease (CAD), which is a risk factor for a heart attack. 

Coronary stenting is only one method of treating narrowed or blocked coronary arteries. It may not be the best option for all patients. Discuss all of your treatment options with your doctor to understand which options are best for you.  

Other procedures that may be performed

Your doctor may perform other procedures in addition to coronary stenting. These include:

  • Angiography makes pictures or images, called an angiogram, of the heart’s blood vessels.

  • Atherectomy involves inserting a catheter into a vessel in your groin or arm. Your doctor will thread the catheter into the artery that needs treatment using a guide wire. Your doctor will then scrape or drill away the plaque with special catheter instruments to open the artery.

  • Coronary angioplasty involves inserting a catheter into a vessel in your groin or arm. Your doctor will thread the catheter into the coronary artery that needs treatment using a guide wire. Your doctor will then expand a balloon on the tip of the catheter wire to open the artery.

Coronary stenting can improve angioplasty and atherectomy results by further widening the artery and smoothing the artery walls. This reduces the chance of blood clots and other problems.

Why is coronary stenting performed?

Your doctor may recommend coronary stenting to treat coronary artery disease (CAD). Coronary stenting, usually combined with coronary angioplasty, reduces the risk of death in some people with CAD.

CAD occurs when fatty deposits build up on coronary artery walls and harden into a substance called plaque. As plaque builds on coronary artery walls, the artery narrows and hardens. 

Eventually, a serious blockage can occur and blood will not flow through the coronary artery properly. The blockage increases the risk that a blood clot forms and totally blocks the coronary artery (heart attack). 

You may be a candidate for coronary stenting if:

  • You have angina (chest pain) and shortness of breath with mild or moderate exertion. Angina and shortness of breath are symptoms of CAD.

  • You have had a heart attack.

  • You have a coronary bypass graft that has closed or narrowed.

  • You have only one or two blocked or narrowed coronary arteries. If more coronary arteries are involved, your doctor may recommend coronary bypass grafting instead of coronary angioplasty and stenting.

  • Your doctor determines that the plaque will respond to coronary angioplasty and stenting and that it can be reached with a catheter.

  • Your symptoms do not respond to medications.

  • Your symptoms interfere with daily activities.

Who performs coronary stenting?

The following specialists perform coronary stenting.  

  • Cardiologists specialize in diagnosing and treating conditions of the heart and its blood vessels.

  • Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging.

  • Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.

How is a coronary stenting performed?

Your coronary stenting will be performed in a cardiac catheterization laboratory, often abbreviated “cath lab.” A cath lab is a room in a hospital or clinic that has special X-ray machines and video screens. Your doctor uses this special equipment during your procedure. The procedure takes 30 minutes to an hour, but can take longer when combined with a coronary angioplasty. 

Coronary stenting generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.

  2. Your team will insert an intravenous (IV) line to provide fluids and medications.

  3. Your team will attach devices to monitor your heart rate, blood pressure, and other functions.

  4. You will have a blood test to verify normal kidney function and blood clotting.

  5. You will have a light sedative to make you drowsy and relaxed. Some patients have deeper sedation or anesthesia through the IV. In this case, you are more relaxed and unaware of the procedure and may not remember it. Doctors sometimes use general anesthesia.

  6. You will have medication to prevent blood clots from forming in your arteries. You may also have medications to prevent spasms in your arteries.

  7. Your doctor will determine the location to insert the catheter. The procedure team will shave and clean the area before your doctor numbs it and makes a small incision.

  8. Your doctor will insert a catheter and guide wire through the incision and feed it into the heart vessel that needs treatment. X-rays guide the wire to the exact location.

  9. Your doctor will inject a contrast agent through the catheter. The contrast agent improves the quality of the X-ray images.

  10. Your doctor will open or widen your coronary artery by inflating a balloon several times. After the artery is open, the balloon inflates again to expand the mesh-like stent. The stent forms a skeleton-like support that keeps the artery open.

  11. Your team may take additional X-rays to verify that blood is flowing as expected. Your doctor will then remove the wire and balloon leaving the stent in place.

  12. You will need to lie with your leg or arm straight for six hours following the procedure. This decreases the risk of bleeding from the incision site.

Will I feel pain?

Your comfort and relaxation are important to you and your care team. You may feel a pinch or prick during the IV placement and brief stinging during injection of the local anesthetic. You may also feel pressure as your doctor makes the incision and inserts the catheter. 

It is common to feel some discomfort when the balloon inflates to expand the stent. You should expect to have enough sedative and pain medications to keep you comfortable and relaxed. Tell your doctor if you have any discomfort.

What are the risks and potential complications of coronary stenting?

Complications after coronary stenting are uncommon, but any procedure involves risks and possible complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery. 

Complications of coronary stenting include: 

  • Adverse reaction or problems related to sedation or medications such as an allergic reaction and problems with breathing

  • Bleeding

  • Blood clots within your arteries

  • Damage to an artery from the catheter or balloon

  • Exposure to ionizing radiation, which may be harmful in excessive doses

  • Heart attack

  • Infection

  • Kidney injury from the contrast agent, especially if you have kidney problems

  • Recurrence of artery narrowing or blockage

  • Sudden vessel occlusion. This is a total blockage of the artery at the site of the coronary stenting. Sudden vessel occlusion is a rare complication that requires immediate medical attention.

Reducing your risk of complications

You can reduce the risk of some complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery

  • Informing your doctor if you have kidney disease or diabetes

  • Informing your doctor or radiologist if you are nursing or there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my coronary stenting?

You are an important member of your own healthcare team. The steps you take before coronary stenting can improve your comfort and outcome. 

You can prepare for coronary stenting by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Following all instructions about eating and drinking before coronary stenting

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

  • With certain types of contrast dyes, you should not take metformin (Glucophage), an oral medication for diabetes, for 48 hours before and after your coronary stenting. You doctor will give you specific instructions about taking your medications.

Questions to ask your doctor

Preparing for coronary stenting can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before coronary stenting and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need coronary stenting? Are there any other options for diagnosing or treating my condition?

  • Will I also need coronary angioplasty or atherectomy?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the procedure? When can I return to work and other activities?

  • What kind of assistance will I need at home? Will I need a ride home?

  • How should I take my mediations?

  • How will you treat my pain?

  • What other tests or treatments might I need?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my coronary stenting?

Knowing what to expect after coronary stenting can help you get back to your everyday life as soon as possible.

How will I feel after the coronary stenting?

You may have mild drowsiness from the sedative medications after coronary stenting. It is unlikely that you will have pain, but it is common to have mild tenderness and bruising at the catheter incision site. Tell your doctor if you are uncomfortable.

Your activities will be restricted following coronary stenting. You may need to lie down with your arm or leg straight for six hours following coronary stenting. You may also take new medications after coronary stenting to help prevent blood clots and spasms in your arteries. Follow your doctor’s instructions for eating, drinking, resting, and taking medications after coronary stenting.

When can I go home?

You will probably stay overnight in the hospital for observation after coronary stenting, even if you did not have general anesthesia. You will go home when your doctor decides that your condition is stable. 

You will need a ride home and to take it easy for a few days. Avoid heavy lifting and strenuous exercise for about 10 days after coronary stenting. Follow your doctor’s advice for returning to exercise and other activities.

When should I call my doctor?

It is important to keep your follow-up appointments after coronary stenting. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Chest pain

  • Color change in the arm or leg that was used to insert the catheter

  • Dizziness

  • Fever

  • Numbness or a feeling of coolness in the arm or leg that was used to insert the catheter

  • Pain that is not controlled by your pain medication

  • Unusual swelling, redness or warmth around your incision

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 10, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Angioplasty and Stenting. Massachusetts General Hospital. http://www.massgeneral.org/imaging/services/procedure.aspx?id=2265.
  2. Angioplasty and Stenting. Society of Interventional Radiology. http://www.sirweb.org/patients/angioplasty-stent/.
  3. Angioplasty and Vascular Stenting. American College of Radiology. http://www.radiologyinfo.org/en/info.cfm?pg=angioplasty.
  4. Coronary Stents. A.S.M. Systems. http://www.heartsite.com/html/stent.html.

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