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Description: Coronary Stenting Definition The placement of a stent, which is a mesh, metal tube placed in an artery in the heart (a coronary artery) to help keep the artery open after an angioplasty procedure. ***

Parts of the Body Involved An artery in the groin Arteries leading to the heart Coronary arteries Reasons for Procedure To hold open a blocked artery in the heart, thus allowing more normal blood flow through that artery.

Risk Factors for Complications During the Procedure Angina Obesity Age: 60 or older Allergies to medications, shellfish, or x-ray dye Bleeding disorder Calcification of blood vessels Diabetes Kidney disease Recent heart attack Recent pneumonia Smoking What to Expect Prior to Procedure:

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Coronary Stenting Definition The placement of a stent, which is a mesh, metal tube placed in an artery in the heart (a coronary artery) to help keep the artery open after an angioplasty procedure. ***

Parts of the Body Involved An artery in the groin Arteries leading to the heart Coronary arteries Reasons for Procedure To hold open a blocked artery in the heart, thus allowing more normal blood flow through that artery.

Risk Factors for Complications During the Procedure Angina Obesity Age: 60 or older Allergies to medications, shellfish, or x-ray dye Bleeding disorder Calcification of blood vessels Diabetes Kidney disease Recent heart attack Recent pneumonia Smoking What to Expect Prior to Procedure:

Your doctor will likely do the following:

Blood tests Chest x-ray Electrocardiogram (ECG, EKG) – a test that records the heart's activity by measuring electrical currents through the heart muscle In the days leading up to your procedure:

Arrange for a ride to and from the procedure. Arrange for help at home for the first few days after your procedure. The night before, eat a light meal and do not eat or drink anything after midnight. You may be asked to shower the morning of your procedure, and you may be given special antibacterial soap to use. During the Procedure:

Anesthesia IV fluids Sedation You may be given the blood thinner heparin, to decrease the risk of blood clots Anesthesia - Local anesthesia injected into the area in your groin where the catheter will be inserted

Description of the Procedure - The area of your groin where the catheter will be inserted is shaved, swabbed with an antibacterial solution, and numbed with local anesthetic. (This procedure can also be performed, though less commonly, through an artery in the arm.) The doctor inserts a needle into a groin artery, and a wire is passed through the needle. The wire is guided through the arterial system until it reaches the blocked artery in the heart. Next, a soft, flexible catheter tube is slipped over the wire and threaded up to the blockage.

This procedure is monitored using a continuous x-ray image called fluoroscopy. Dye can be injected through the catheter into the arteries of the heart, to make any blockages more visible via fluoroscopy. Once the blockage is reached, a small balloon at the tip of the catheter is quickly inflated and deflated, stretching the artery open. The collapsed stent, a small metal mesh tube, is then inserted through the arterial system to the area of the blockage. The balloon is inflated to expand the stent to its full size. The stent is left in place to hold the vessel walls open, and the deflated balloon, catheter, and wire are removed. A bandage is placed over the groin area.

After Procedure - You'll need to lie flat on your back, keeping your leg still for about six hours after the procedure. You may have a sandbag placed over the area in your groin where the catheter was inserted to put pressure on the artery and prevent bleeding.

How Long Will It Take? 30 minutes to three hours

Will It Hurt? The local anesthetic should adequately numb the area where the catheter is inserted, so the entry site shouldn't be painful. However, you may feel a burning sensation when the area is anesthetized, and may feel pressure when the catheters are manipulated. Some people have a flushing feeling or nausea when the dye is injected. Also, you may feel some chest pain during inflation of the balloon.

Possible Complications:

Allergic reaction to x-ray dye Bleeding at the point of catheter insertion Blood clots may form and travel through the arteries, causing stroke, heart attack, kidney damage, breathing difficulties, damage to an arm or leg, or intestinal damage Heart arrhythmia (abnormal heart beats) Heart attack Infection Perforation of the artery in the heart, requiring immediate emergency bypass surgery Spasm of the artery Stroke Average Hospital Stay: 0-2 days

Postoperative Care:

Always inform new doctors or other medical personnel that you have a coronary stent in place. Some medical procedures need to be modified or avoided for people with coronary stents, particularly MRI scans. Take blood-thinning medications as prescribed by your doctor. This may be aspirin or another medication, such as warfarin. To lower your risk of recurrent blockages in your coronary arteries and further heart disease, make lifestyle changes, including eating a healthier diet, exercising regularly, and managing stress. To minimize pain and soreness, you can place ice on your groin for 15-20 minutes each hour, for the first two days. After this time, switch to a heating pad or hot water bottle. You may need to undergo periodic stress tests to identify any recurrent blockages early. Outcome Your artery should be considerably more open, allowing better blood flow to feed the heart muscle. This may mean that you'll no longer have chest pain that you previously experienced, or it may mean that your tolerance for exercise will increase. Sometimes, however, the procedure isn't successful, or the artery narrows again, in which case you may require repeat angioplasty or coronary artery bypass graft surgery.

Call Your Doctor If Any of the Following Occurs Chest pain Cough, shortness of breath, chest pain, or severe nausea or vomiting Extreme sweating or nausea Redness, swelling, increasing pain, excessive bleeding, or discharge from the insertion site in your groin Signs of infection, including fever and chills Your arm or leg becomes painful, blue, cold, numb, tingly, swollen, or increasingly bruised *** Please Note: In April 2003 the FDA approved a new type of coronary stent, called a drug-eluting stent. This new type of stent is coated with a drug that is slowly released and helps decrease the rate of re-blockage in the artery in which it is inserted. Early experience with the stent suggested that there may be an increased early risk of clotting with the stent, but a report from the FDA in November 2003 did not find an increased risk over that of regular stents. Long-term benefits using this type of stent looks promising, though since it is a new therapy, safety monitoring in a larger group of patients will continue. Talk to your doctor about whether this new type of stent might be right for you.

Last reviewed: November 2003 by Rhonda Kaufman, MD.

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