Coronary Stent

A recent cardiac catheterization has revealed that you have a narrowing or blockage in one or more of the coronary arteries that supply blood to your heart muscle. Poor blood flow or lack of blood flow to your heart muscle causes chest discomfort and may lead to a heart attack. Due to characteristics of the blockage and coronary artery wall, your doctor has recommended a coronary stent.

Coronary stent insertion is an intervention that is used in association with balloon angioplasty to open up a blocked coronary artery. After implantation, the coronary stent becomes a permanent implant to hold the artery open and prevent it from closing back down. The coronary stent is a small, slotted stainless steel tube that comes in different sizes to match the size of your artery.

Before the Procedure
Preparation for coronary stent insertion is similar to the preparation for cardiac catheterization. If the stent insertion is planned prior to your admission, your doctor may instruct you to take aspirin or other blood thinners for several days prior to the procedure.

These medications are important to decrease the chance of clots forming and sticking to the newly inserted stent. Do not have anything to eat or drink after midnight the night before the procedure. Ask your physician which medications you should take the morning of the stent insertion.

When you arrive at the hospital, you will be placed in a hospital room where preparation for the procedure will take place. You will be asked to sign consent forms for the procedure. An IV will be placed in your arm for medications to be given during the procedure.

Procedure
In the cardiac catheterization lab, you will be started on a blood thinner called Heparin through your IV. The stent catheters will be passed through the catheters (or sheaths) in your femoral artery from the angiogram.

The doctor initially advances a long, thin guidewire through the sheaths and up across the blockage in the coronary artery. Next, a small balloon catheter will be threaded onto the guidewire and positioned in the center of the blockage. The balloon is slowly inflated. This initial widening of the blockage is necessary to pass the stent catheter through the blockage. You may experience chest discomfort whenever the balloon is inflated. The balloon temporarily blocks blood flow to a portion of the heart muscle. Tell the doctor if you experience any discomfort. The balloon is deflated and removed.

Next, the stent catheter is threaded onto the guidewire. The stent is placed around a deflated balloon. The stent catheter is positioned in the center of the blockage. The balloon is slowly inflated and the stent expands, spreading the blockage apart. When the balloon is deflated, the stent remains expanded. The stent presses slightly into the wall of the coronary artery, keeping it open. One or more stents may be necessary to cover the length of the blockage. The balloon catheter and guidewire are then removed. Repeat angiography is taken to verify that the artery is open, the stent is in place, and that no clots are sticking to the stent. You will then be taken back to your hospital room.

After the Procedure
The sheaths in your groin are left in place as a precautionary measure should you develop chest discomfort or need to return to the cardiac catheterization lab for further angiography. The IVs from the procedure will be continued for at least twenty-four hours.

You will be started on more blood thinning medication after the procedure. The lining of the artery wall where your stent is placed will slowly enclose the stent, permanently incorporating it into the vessel wall. Until the stent is covered, there is a chance that a blood clot will form and stick to the stent. Your doctor will regulate the amount and types of blood thinning medications you will receive.

Upon return to your room, the sheath in your groin will remain intact for several hours. While this sheath is in place, it will be important for you to keep your leg straight but your head may be elevated up to a 45 degree angle. Once the sheath is removed, pressure will be held on your femoral artery until no bleeding is noted at the puncture site. You will be required to lay flat with your leg straight between four to eight hours to allow the artery to heal. You may not raise your head up, sit up, stand up or bend your leg during this time period. Your nurse will assist you with any needs you may have and frequently check your vital signs, the puncture site for bleeding and whether pulses in your feet are present. If no bleeding is noted from the catheter site, you may slowly raise your head and then get up and walk the hallways after the completed hours of bedrest. You will be discharged the following day on blood thinning medication provided you are tolerating activity and the catheter site has healed.

Discharge

Medications It is very important that you take your medications exactly as your doctor has instructed. Medications you will take at home include aspirin and Ticlid, and occasionally Coumadin. These medications prevent blood clots from forming and sticking to the stent. However, only Coumadin requires frequent blood tests to regulate the dosage. The blood test is called Protime or PT, if Coumadin is prescribed, and you will need to be checked frequently on an outpatient basis. Your doctor will tell you how much Coumadin to take based on the results of the PT and strict instructions will be given to you prior to discharge.

These blood thinning medications may make you bruise more easily or bleed from a cut longer than normal. Notify your doctor with any bleeding that does not stop or if you notice any blood in your urine or stool. You may also be taking other medications for your heart when you return home. Do not stop taking any of your medications without first checking with the doctor who placed the stent.

Diet Prior to discharge, a dietitian will meet with you and instruct you on a low-fat, low-cholesterol cardiac diet. You will need to follow the dietary recommendations that the dietitian has suggested. In addition, you should avoid eating too many foods that are high in Vitamin K if you are taking Coumadin. These foods diminish the effects of Coumadin. The following foods are high in Vitamin K:

High Vitamin K Content
brussels sprouts
green tea
turnip greens
chick peas
cauliflower
kale
spinach
beef and pork liver
broccoli

Medium Vitamin K Content
coffee
rolled oats
cabbage
iceberg lettuce
cheddar cheese
asparagus
chicken liver

Alcohol and liquid diet supplements should also be avoided because they can affect the action of the Coumadin.

Exercise To allow time for your artery to heal, you will need to avoid lifting objects heavier than five pounds for the first several days at home. You should go for a walk several times a day when you return home. Begin walking the same distance you did in the hospital. Try to increase the distance every day. Any shortness of breath, chest discomfort, or weakness indicates that your heart is not ready for the amount of exercise you are doing. If these symptoms occur, stop and rest. If the symptoms do not go away with rest, call your doctor.

Your doctor will tell you when you can return to work and your regular daily activities. The Cardiac Rehabilitation exercise program may be prescribed for you after you have your first office visit with your doctor.

Note After stent placement, you should not have any MRI tests for six months due to the high magnetic field. It may displace the position of the stent.