Coronary Stents

Trouble with Your Heart
Your doctor has probably told you that you have coronary artery disease. This means that blood vessels that feed your heart are narrowed or blocked. Coronary artery disease can cause angina (pressure, tightness, or pain in your chest, arm, neck, or jaw). Coronary artery disease can also lead to a heart attack or even death. To help treat this heart problem, your doctor may want you to consider a coronary stent implant.

What is a Stent?
A stent is a small metal coil or mesh tube that is placed in a narrow artery through a catheter (a long, thin tube) to help improve blood flow to your heart. The stent permanently holds the passageway open and helps reduce the rate of restenosis, renarrowing of the artery. After the stent placement, you may need to say in the hospital for one to five days and temporarily take anticoagulant medication to help prevent blood clots.

Making Heart Healthy Changes
A stent can help in the treatment of coronary artery disease. But it is not a 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 from getting worse and may even improve the health of your heart.

How your Heart Works
To understand how stents help treat coronary artery disease; you need to know how your heart works. Your heart is a muscle that pumps blood throughout your body. To work right, your heart needs a steady supply of oxygen. The coronary arteries supply your heart with the oxygen-rich blood it needs.

Coronary Arteries: Your Heart's Oxygen Supply
Coronary arteries are blood vessels that wrap around the surface of the heart. The left main coronary artery splits into two branches: The left anterior descending and the circumflex. These branches supply blood to the front, left side, and back of the heart. The right coronary artery supplies blood to the right side and back of the heart.

Healthy Artery
When the lining of the coronary artery is healthy and has no blockages, blood flows through easily. As a result, your heart muscle gets the oxygen it needs to do its job. When you exert yourself, your heart beats faster and harder and needs more oxygen. A healthy artery can easily supply extra oxygen-rich blood.

Damaged Artery
Coronary artery disease begins when the artery wall is damaged by things like high blood pressure or smoking. Plaque (a fatty material) builds up in the damaged artery lining. This is atherosclerosis, sometimes called hardening of the arteries. The plaque buildup begins to narrow the passageway carrying blood to the heart. At this stage, you probably won't feel any symptoms of coronary artery disease.

Narrowed Artery
As plaque buildup increases, your artery has a hard time supplying extra oxygen-rich blood to your heart during exertion. This is when you may feel angina - pressure, tightness, achiness, or pain in your chest, jaw, neck, back, or arm. Angina does not usually cause permanent damage to heart muscle, but angina is a warning sign that you may be at risk for a heart attack.

Blocked Artery
Plaque may tear, completely blocking the artery or a blood clot may plug the narrowed opening. When this happens, blood flow stops. Without oxygen-rich blood, part of the heart muscle is damaged and stops working. This is a heart attack (myocardial infarction). You may feel crushing pressure or pain in or around your chest. A heart attack lasts longer than angina and permanently damages heart muscle.

Your Stent Procedure
Your doctor may have recommended that you have a stent implant as part of your treatment for coronary artery disease. If you understand the risks and know what to expect during the stent placement, you'll feel more relaxed and confident about your decision to have this procedure.

Understanding Your Risks
The risks of stents are fairly low and are usually outweighed by the benefits to your heart. Possible risks include:

• Tearing or cracking of the artery lining.
• Bleeding from the insertion site.
  
• Blood clot formation on the stent.
  
• Problems related to the x-ray contrast fluid (allergic reaction to iodine or kidney damage).
  
• Heart attack, stroke, or death. Rarely, a complication occurs that makes emergency bypass surgery necessary.

Before the Procedure
Be sure to tell your doctor 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 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. An IV (intravenous) line is inserted into your vein to give you fluids. You'll also be given medication to help you relax. You will be awake during the procedure, which usually takes one to two hours.

During the Procedure
Before the stent is placed:

• The skin is numbed where the catheter will be inserted.
• An introducing sheath is inserted into the artery in your groin, or possibly your arm.
• A guiding catheter (a thin, 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 doctor to see your artery on an angiogram (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 doctor will first compress the plaque buildup against the artery wall during a procedure called balloon angioplasty.

The Balloon Catheter is Inflated
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 doctor if you do.

The Stent Catheter Is Positioned
The metal coil or mesh stent is placed on another balloon catheter and positioned in the artery at the spot where the plaque was compresses.

The Stent Is Expanded
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.

Blood Flow Is Improved
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 completely cover it.

After the Procedure
After the stent implant, you'll be taken to a cardiac care unit or a special recovery room. If there are no complications, you'll probably go home one to five days after the procedure. Your doctor gives you instructions on medications and follow-up care. He or she may also schedule follow-up visits.

Recovering in the Hospital
The introducing sheath is left in place for several hours or overnight. If the groin site was used, lie flat and don't move your leg until about six to ten hours after the sheath is removed. The nurse frequently checks your pulse and blood pressure and checks the insertion site for bleeding. You'll remain attached to a heart monitor and an IV line that provides fluids and medications for several hours after the procedure. Frequent blood tests will help your doctor adjust the dosage of your anticoagulant medication. Your activity level will be restricted for the first few days while you're recovering.

Going Home
Your doctor will give you instructions for caring for yourself and taking medications. Ask a family member or friend to drive you home from the hospital so you don't strain the insertion site.

Call Your Doctor If:

• The insertion site is increasingly painful, swollen, red, bleeding, or draining, or if you develop a fever.
• You notice any other bleeding, blood in your urine, or black or tarry stools.
  
• You have angina.
  
• You have severe pain, coldness, or a bluish color in the leg or arm where the catheter was inserted.
  
• You have unexplained bruising.

Medications
Your doctor may prescribe aspirin, anticoagulant medication, or similar medications for about two months to help prevent blood clots from forming on your stent. When taking anticoagulants, a blood test called prothrombin time (PT) must be done regularly to ensure that the dosage is not too high or too low. Certain foods and alcoholic beverages may change the way your anticoagulants work. While taking anticoagulants, avoid activities that may cause injuries and bleeding. Be sure to inform other health care providers and your dentist that you are taking anticoagulants. Check with your doctor before taking any other medications, even over-the-counter drugs. Don't stop taking any medication unless your doctor tells you to.

Back to Work
You should be able to return to work about one to two weeks after your procedure. Try not to overdo it at first. Avoid activities like heavy lifting, which can put extra strain on your heart.

Follow-up Visits
In addition to regular checkups and blood tests, your doctor usually schedules 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.

Your Artery May Narrow Again
If you start to feel symptoms like the ones you had before your stent implant, tell your doctor. To treat the problem, your doctor may recommend further testing or additional procedures.

Other Treatments for Coronary Artery Disease
Stent implants are one of several treatments for coronary artery disease. Medications, bypass surgery, and some other procedures also treat the condition. Your doctor can discuss the risks and benefits of these treatments with you. None of these is a cure, however. Narrowing can return or increase if unhealthy habits aren't changed.

Medications
Many drugs can reduce your heart's demand for oxygen and relieve symptoms of angina. They do this by slowing your heart rate, expanding your blood vessels, or lowering your blood pressure or cholesterol levels. However, the artery is still narrowed.

Bypass Surgery
Bypass surgery creates a new route for blood to flow to your heart muscle. A blood vessel from your leg or chest creates a detour around the blockage in the artery. Blood then flows easily to your heart, bypassing the clogged section of your artery. The surgery usually requires about a week's stay in the hospital. It may take up to three months before you're fully recovered.

Other Procedures
Other procedures can be used to treat coronary artery disease, but they are not appropriate for everyone. During angioplasty, your doctor may use a balloon catheter, without a stent, to compress the plaque and widen the passageway. During artherectomy, fatty material is removed from artery walls using a special catheter.

Changes for a Healthy Heart
Stents and other treatments don't make coronary artery disease go away. To possibly improve your condition, or at least help keep it from getting worse, you may need to make some changes in the way you live. First find out your risk factors-the habits and conditions that can lead to coronary artery disease. Some risk factors can't be changed, but there are things you can do. Sometimes, lifestyle changes may even be an alternative to medical and surgical procedures.

Break the Smoking Habit
If you smoke, quitting is one of the best things you can do to keep coronary artery disease from getting worse. Smoking reduces oxygen flow to your heart, speeds plaque buildup, and increases your risk for a heart attack. Quitting helps reverse these risks. Even if you've tried to quit before, don't give up. Many smokers try quitting four or five times before they succeed.

Plan to Quit

• Start by making a firm decision to quit
  
• Ask your doctor about stop-smoking programs or aids such as nicotine patches and gum.
  
• Contact the American Heart or Lung association about quitting methods and programs.
  
• Pick a quitting program and a quit date that feel right for you. Then quit.

Get Support

• Tell your friends and family that you're quitting and let them know what they can do to help.
  
• Find someone to quit with you.
  
• Join a stop-smoking support group.
  
• Spend more time with nonsmoking friends.
  
• Write down all the reasons why you're quitting and read them when you feel the urge to smoke.

Don't Give Up

• Be persistent.
  Quitting takes time and determination.
  
• Avoid places where people are smoking.
  
• Identify daily routines that give you the urge to light up. Then change them, if possible.
  
• Stock up on sugarless gum, vegetable sticks, or hard candy for when you feel like having a cigarette.

Eat Heart Healthy Food
Changing the way you eat can reduce many of your risk factors. It can lower your cholesterol, blood pressure, and weight. Your diet does not have to be bland and boring to be healthy. Just follow these steps: Eat less fat and salt, and eat more fiber. Your whole family can benefit from healthy eating habits.

Eat Less Fat

• Eat fewer fatty cuts of meat and more chicken and fish.
  
• Avoid butter and lard, and use less margarine.
  
• Avoid foods containing palm and coconut oil or hydrogenated oils.
  
• Eat fewer high-fat dairy products like cheese, ice cream, and whole milk.
  
• Get a heart-healthy cookbook and try some new, low-fat recipes.

Eat Less Salt

• Don't add salt to food when cooking, and keep the saltshaker off the table.
  
• Don't use high-salt ingredients such as MSG, soy sauce, baking soda, and baking powder.
  
• Instead of salt, season your food with herbs and flavorings such as lemon, garlic, and onion.
  
• Avoid fast food, which may contain higher amounts of salt.

Eat More fiber

• Eat fresh fruits and vegetables.
  
• Oats, beans, bran, whole-grain bread, and wheat germ are excellent sources of fiber.
  
• When you increase the fiber in our diet, remember to drink more water to prevent constipation.

Exercise for a Healthy Heart
Like any muscle, your heart performs better with regular exercise. Exercise also reduces stress, lowers your cholesterol, and helps you lose weight. Before you start exercising, talk with your doctor to make sure the activity you've chosen is right for you. He or she may recommend a supervised exercise program at a local hospital or community center.

Choose an Aerobic Activity
Choose a nonstop activity that makes your heart and lungs work harder than they do when you rest or walk normally. This aerobic exercise can improve the way your heart and lungs use oxygen. Make it fun by exercising with a friend and choosing and activity you enjoy. Here are some ideas:

• Bicycling
  
• Swimming
  
• Stair-climbing
  
• Walking
  
• Dancing
  
• Jogging

Exercise Regularly
If you haven't been exercising regularly, start slowly. Here are some tips:

• Begin exercising three times a week for five to ten minutes.
  
• When you feel comfortable, add a few minutes each week.
  
• Slowly build up to exercising four or five times each week for 20-40 minutes.
  
• Plan your exercise sessions in advance, and write them on your calendar.
  
• If you get angina when you're exercising, stop what you're doing, take your angina medication, and call your doctor.

Living Well after Stents
By now you know stent implants are not a cure for heart disease. You also know your risk factors for heart disease and what you can change. Now it's time to make those heart-healthy changes. It's the best thing you can do for your heart and the people who care about you.

Get Started!
Don't get overwhelmed by trying to make too many changes at one time. First choose one goal you can achieve easily. Look at this sample plan for ideas, and then fill out your own plan below. Give yourself a reward when you've succeeded, then move on to another goal.

Don't Forget:

• Take your medications as prescribed.
  
• Know what your risk factors are and take simple steps to change them.
  
• Enlist the support of your family, friends, and health care team to help you make healthy changes.
  
• See your doctor for regular follow-up appointments.
  
• Ask your health care team if you have any other questions about heart disease.

Get Started with Your New Life
After your stent implant, it may be tempting to return to old habits. But to help prevent more heart problems you need to make some heart-healthy changes. These changes can be easier to make with help from friends, family, and your community. Here are some suggestions:

• Call your community center or hospital for information on exercise facilities; stop smoking programs, and low-cholesterol cooking classes.
  
• Ask family or friends to join you when you exercise or take a class.
  
• Contact your local branch of the America Heart association. They provide literature, support groups, and other services.