Stent Placement

Stent placement, a part of a percutaneous coronary intervention (PCI) or angioplasty, is a non-invasive procedure (no incisions required / small puncture / low to moderate sedation) performed to provide an artery with extra support as a way to reduce its chances from re-narrowing.

The narrowing of arteries is caused by a waxy substance called plaque, which builds up inside the blood vessels.This plaque buildup is known as atherosclerosis. As plaque continues to build, the narrowing gets worse. This decreases the blood flow to certain organs. In addition, the plaque may rupture, and lead to a blood clot. This can totally block the artery and cause a heart attack, stroke, tissue death, and other serious and life-threatening problems.

However, prior to arriving at this procedure, your doctor will recommend various types of medications and suggest lifestyle changes. However, if these do not improve your health, or if you have a heart attack or stroke, your doctor may suggest an angioplastywith stent support. The stent will provide support to the artery’s inner wall, reduce chances of the artery becoming narrowed or blocked again, and provide support to the artery if torn or injured during PCI.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

Types of Stents

• Drug-Eluting Stents (DES): A type of stent that is drug coated. The drug is slowly released over time as a way to help prevent the growth of scar tissue in the artery lining. By doing so, the artery will remain smooth and open. These types of stents are often preferred over bare-metal stents, as they are more likely to keep the blockage from re-occurring. However, DES require longer treatment with anti-platelet medications to prevent the stents from closing because of blood clotting
• Bare Metal Stents: A type of stent that has no drug coating. These types of stents only act as extra support to keep arteries open after they’ve been widened by an angioplasty procedure. As the artery heals, tissue grows around the stent, holding it in place. However, sometimes an overgrowth of scar tissue within the stent may lead the blockage to reoccur.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

Before the procedure, your doctor might perform a variety of diagnostic tests, including:

• Blood tests
• X-Rays
• Angiogram
• Echocardiogram (ECHO)
• Electrocardiogram (EKG/ECG)
• Stress test

What to Expect During the Procedure

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Stent placement usually takes 30 minutes to two hours, but the preparation and recovery time may add several hours. This procedure is usually performed in the cardiac catheterization laboratory. Check with your doctor about the details of your procedure. In general , during a coronary stent placement:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your hand or arm which will administer medications, fluids, and blood-thinning medications.
• Prior to starting the procedure, you will receive a local anesthetic to numb the insertion site. The insertion site is usually a blood vessel (artery or vein) in your groin or wrist area.
• Once the local anesthetic has taken effect, a small needle is used to access the coronary artery and occasionally a small cut is made in the skin.
• A catheter (containing a balloon at its tip) is inserted into the artery and guided to the coronary artery in your heart. You might feel pressure at the insertion site, but you shouldn’t feel any sharp pain. Tell your doctor if you do.
• A small amount of contrast dye is injected through the catheter, which helps the doctor visualize the blockage on X-ray images.
• Once the blockage is identified, the balloon is deployed and inflated. This will open up the affected coronary artery.
• In most cases, a stent will be placed in the artery before or after the balloon is inflated. The inflation of the balloon will open the artery and fully expand the stent.
• Once the procedure is complete, the balloon is deflated and removed. The catheter is also removed and the insertion site is closed off with the use of a sterile bandage or sutures.

What to Expect After the Procedure

After the procedure, you may be taken to the recovery room for observation or returned to your hospital room for 1 to 2 days. Other recommendations include:

General Guidelines

• A nurse will monitor your vital signs, the insertion site, and circulation and sensation in the affected leg or arm.
• You must stay in bed for several hours as recommended by your doctor.
• Tell your nurse right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
• You'll be encouraged to drink water and other fluids to help flush the dye from your body.
• Your doctor will give you instructions to follow during your recovery.
• A cardiac rehabilitation program may be suggested.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.