Stent Implantation
How Is a Coronary Stent Implanted?
A coronary stent may be implanted following balloon angioplasty, before the guiding catheter and sheath are removed.
If you know in advance that you will be receiving a coronary stent, your doctor will ask you to follow certain instructions, in addition to those listed for balloon angioplasty. For several days before the procedure, you will be asked to take aspirin and other prescribed medications.
Be sure to let your doctor know:
- If you are taking any other medications
- If you have any drug allergies
- If you have a history of bleeding problems
- If you cannot take aspirin
You may be given a urinary catheter prior to the procedure. This precaution will decrease the need for moving on and off a bedpan after the procedure, which will reduce the chance of bleeding at the puncture site.
Stent Implantation Step-by-Step
The stent, which is mounted on a balloon catheter, is inserted into the artery and directed to the site of the previous obstruction.
When the balloon and stent are precisely in place, the balloon is inflated and the stent expands. One or more stents may be used in the vessel to span the length of the lesion.
The balloon catheter is deflated and removed, along with the guidewire and guiding catheter.
The stent will remain in place permanently, keeping the artery open.
What Happens After the Procedure?
After angioplasty with stent implantation, you may be moved to a recovery room or special care unit for several hours, until you are ready to return to your room. At this time, the sheath may be removed from your groin and pressure will be applied to the puncture site until the bleeding has stopped. The nurses will monitor your heart rhythm and blood pressure very closely and will check your puncture site for bleeding. When you return to your room, you may eat and drink, and your family can visit. Drink all of the fluids that are offered, because they will help to flush the contrast dye through your kidneys and out of your body.
During the first few days after you receive your stent, your activities will be restricted. You must lie flat until the day following your procedure, and you will not be allowed to bend the leg that was used. A soft restraint may be placed around your ankle to remind you not to move or bend that leg. You may also be required to take medication that will help keep the blood flowing smoothly through your stent. Your blood may be tested frequently to monitor the coagulation so the medication dosage can be regulated. After a few days, your doctor will allow you to gradually increase your activities.
After You Go Home
You will stay in the hospital for up to three to eight days before being discharged to the care of your family doctor. If you experience any discomfort, pain, or bleeding of any kind after returning home, you should contact your doctor or the hospital. Your family doctor will monitor your progress. After six months, you may be asked to return to the hospital for a follow-up stress test.
Eventually, you should be able to return to your normal activities, but ask your doctor before doing anything that is physically strenuous. You should alert any doctor treating you that you have a coronary stent implant. Your doctor or nurse will give you a small wallet-sized card containing additional information about your stent. Carry this card with you at all times.
Your Medications Are Important
Within about four weeks, the lining of the artery will slowly grow over the stent, incorporating it into the artery wall. During this time you may be treated with medications to thin the blood and to prevent blood clots from adhering to the metal surface of the stent. For at least one month after you leave the hospital, you may be asked to take these three medications:
Aspirin an antiplatelet, which helps thin the blood to prevent blood clots
Coumadin (sodium warfarin) a blood thinner to prevent blood clots
Persantine (dipyridamole) an antiplatelet, which helps thin the blood to prevent blood clots
Your physician may also prescribe other medications.
It is extremely important to follow your medication regimen exactly. You can use the chart at the end of this booklet to help you keep track of your medication regimen.
During the time that you are taking Coumadin, your doctor will probably administer a blood test to determine how fast your blood is clotting on a weekly basis. In the meantime, you should let your doctor know about any lifestyle changes that you make during this time. You should avoid having any dental work while you are taking Coumadin and, if dental work is needed, be sure to tell your dentist that you are taking Coumadin You should thoroughly review the information packet on Coumadin given to you by your physician or nurse.
Follow these instructions:
- You must follow your medication regimen exactly.
- Do not stop taking any of the prescribed medications unless you are instructed to do so by the doctor who implanted your stent, and only this doctor.
- If you experience any side effects of the medications, such as headaches, nausea, vomiting, or rash, notify your doctor immediately.
- After stent implantation, immediately report any change in angina symptoms such as severity or frequency to your physician. If you report to an emergency room/center, show them your wallet card, which identifies you as a stent implant patient.
- Keep all appointments for follow-up care including laboratory testing.
- Do not have a Magnetic Resonance Imaging (MRI) medical scan within 8 weeks of stent implantation without clearance from your cardiologist.
- Elective surgery should be postponed while you are on Coumadin Before urgent or emergency surgery is done while taking the Coumadin, your cardiologist should be consulted.
- Do not use antacids routinely unless prescribed by your physician, as they decrease the absorption of aspirin and other medications.
Your Diet Can Make a Difference
Your doctor will probably encourage you to reduce the fats and cholesterol in your diet, to avoid smoking, and to adopt a controlled exercise program.
In addition, you should avoid eating excessive amounts of foods that are high in vitamin K. Vitamin K decreases the effectiveness of Coumadin, one of the blood thinning agents you may be taking. The manufacturer of Coumadin recommends that your diet contain a daily intake of between 70 and 140 micrograms of vitamin K.
Coumadin is also affected by antibiotics, non-prescription medications, vitamins, a change in your eating habits, and especially by alcohol consumption. You may need to have your clotting time (PT/INR tests) measured every week while on the Coumadin
Even after your full recovery, your doctor will want to check your progress from time to time. It is important to keep your appointments. And you can reduce your risk of future disease by making healthy lifestyle choices. |
