| SURGERIES OF THE HEART |
Coronary Stenting
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Coronary Stenting is 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.
REASONS FOR THE 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
* Age: 60 or older
* Allergies to medications, shellfish, or x-ray dye
* Obesity
* Smoking
* Bleeding disorder
* Recent pneumonia
* Recent heart attack
* Diabetes
* Kidney disease
* Angina
BEFORE THE PROCEDURE
The doctor will likely do the following:
* Blood tests
* Electrocardiogram (ECG, EKG) – a test that records the heart's activity by measuring electrical currents through the heart muscle.
* Chest x-ray
In the days leading up to the procedure:
* The night before, eat a light meal and do not eat or drink anything after midnight.
* The patient may be asked to shower the morning of the procedure, and the patient may be given special antibacterial soap to use.
* Arrange for a ride to and from the procedure.
*Arrange for help at home for the first few days after your procedure.
DURING THE PROCEDURE
* IV fluids
* Sedation
* Local Anesthesia
* The patient may be given the blood thinner heparin to decrease the risk of blood clots
* Pulse oximetry to monitor blood oxygen levels
PROCEDURE
The area of the 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 THE PROCEDURE
The patient will need to lie flat on the back, keeping the leg still for about six hours after the procedure. The patient may also have a sandbag placed over the area in the groin where the catheter was inserted to put pressure on the artery and prevent bleeding.
TIME TAKEN FOR THE PROCEDURE
30 minutes - three hours
POSSIBLE COMPLICATIONS
* Allergic reaction to x-ray dye
* Bleeding at the point of catheter insertion
* Perforation of the artery in the heart, requiring immediate emergency bypass surgery
* Spasm of the artery
* Heart arrhythmia (abnormal heart beats)
* Heart attack
* Stroke
* 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
* Infection
POSTOPERATIVE CARE
* To minimize pain and soreness, the patient can place ice on the groin for 15-20 minutes each hour for the first two days. After this time, switch to a heating pad or hot water bottle.
* Take blood-thinning medications as prescribed by the doctor. This may be aspirin or another medication, such as warfarin.
* To lower the risk of recurrent blockages in the coronary arteries and further heart disease, the patient should make lifestyle changes, including eating a healthier diet, exercising regularly, and managing stress.
* The patient may need to undergo periodic stress tests to identify any recurrent blockages early.
* The patient should always inform new doctors or other medical personnel that he/she is having a coronary stent in place. Some medical procedures need to be modified or avoided for people with coronary stents, particularly MRI scans.
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| Last Modified :
Tuesday, May 12, 2009 |
Compiled and edited by the Editorial team and
approved by Expert panel of h4heart.com
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