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Percutaneous Coronary Intervention (stent)
What is angioplasty and stenting?
Angioplasty and stenting are procedures used to treat people with coronary heart disease. These procedures open narrowed or blocked arteries in the heart. They are usually done simultaneously, but sometimes, angioplasty is done without stenting.
Before the procedure, you will have a test called a “coronary angiogram.” This test assesses how many of your heart arteries are blocked and how serious the blockages are. For this test, the doctor puts the thin plastic tube (called a “catheter”) into a small cut at the top of your thigh or wrist – usually on the right side. He/she then slides the tube through your blood vessels to your heart and injects dye into the catheter. The dye shows up on special X-ray pictures. The catheter is inserted through a short tube in the artery called a “sheath”.
Depending on the results, your doctor is likely to do angioplasty with stenting. For this procedure, the doctor will advance a plastic tube with a tiny balloon at the end of it to your heart. After it reaches the narrowed or blocked artery, the doctor will inflate the balloon. This opens up the artery and helps restore blood flow to the heart. Usually, the doctor places a stent where the blockage was.
In blood vessels that have a significant amount of hard calcium, preventing the insertion of balloons and stents, the doctor may need to drill through the calcium and hard plaque. This technique is known as rotablation. The balloon and stent can then be safely ‘tracked’ into the artery of concern.
A heart stent is a tiny metal tube that helps prop open an artery in the heart. Most heart stents are coated with a medicine that helps keep the artery from getting narrow or blocked again.
Additional emergency procedures that are rarely needed: During the procedure, should the heart slow down too much or the doctor is concerned about the heart slowing down too much, he may insert a temporary pacemaker, usually via the groin via the vein, usually on the right. This procedure is not done routinely and will only be done of needed.
Sometimes, if blood pressure drops, or if the doctor feels that it is necessary, a special pump may be inserted to maintain blood pressure. This is called an intra-aortic balloon pump. Again, this device is rarely needed, but must be mentioned for your information. The risks are noted below.
Should a significant amount of blood collect around the heart, particularly when performing very complex intervention, a small drain may need to be inserted to drain the blood. This is called pericardiocentesis. This may be a lifesaving procedure, sometimes needed in the cath lab.
Why might I need angioplasty and a stent?
Your doctor might recommend angioplasty and a stent if you have coronary heart disease and:
- Chest pain (“called angina”) that does not get better when you take medicines
- One or more heart arteries that are very narrow
- People who are having a heart attack or had a heart attack a short time ago, also sometimes need angioplasty and stent placement
How do I prepare for the procedure?
You may have a light breakfast on the morning of the procedure. You must continue with all of your usual medication. However, if you are taking warfarin, Xarelto or Pradaxa, you should stop this medication approximately 3-5 days prior to the coronary angiogram. The other blood thinning medication must be continued as usual (Aspirin etc.).
What happens after the procedure?
After the procedure, your doctor will remove the tube from your body and put pressure on the cut or seal the hole in the artery with a special device called an Angioseal to prevent bleeding. You will need to rest in the hospital, lying flat for minimum of 4 hours. You will need to stay in the hospital overnight. It is very likely that you will be discharged the following day. Thereafter you will need to rest and take things easy for approximately a week. You will not be allowed to drive for the next 5 days after the procedure. Your doctor will make a follow-up appointment to see you in about 6 weeks for a review.
Are there any special medications that I need to take?
If you got a stent, your doctor will prescribe aspirin and another tablet called clopidogrel to prevent the stent from blocking up with blood clot. Clopidogrel needs to be used for a minimum of 6 months in patients who have not had a heart attack or for a minimum of 12 months in those who have had a heart attack or where otherwise recommended by your doctor. It is imperative that this medication is not stopped as this will result in the stent blocking (stent thrombosis) up with blood clot. This will result in a large heart attack and you may become very unwell and can even cause death.
What problems can happen after the procedure?
The most common problems are bleeding, bruising, and soreness in the area where the tube was put in.
These problems can last for a week or two but will get better and thereafter you will not even notice it.
Other problems can happen during or after a cardiac cathetrization, but they are rare. They include:
- Heart attack
- Stroke (when a part of the brain goes without blood for too long)
- Death
- A small tear (dissection) in the inside of a coronary artery or major blood vessel (aorta), which usually heals by itself. Some people with this problem need another procedure or (in rare cases) surgery to fix the tear.
- A blood clot can form inside the stent (stent thrombosis). This can block blood flow to the heart and cause a heart attack or even death. It can happen as early as 1 day or as late as 1 year or later. But most clots happen in the first 30 days after the procedure. It is more likely to occur if the patient does not use clopidogrel.
- Emergency coronary artery bypass graft surgery.
- The area where the tube / sheath is inserted in the leg or arm, may rarely cause major bleeding, a tear in artery with an outpouring of blood around the blood vessel, called an aneurysm. This may need to be surgically corrected.
- Complications of the radial artery access: Excessive bleeding and haematoma, false aneurysm, arm ischaemia, stroke, compartment syndrome, nerve damage or severe pain.
Please do not feel alarmed about the mention of these risks. They are indeed rare and it is the doctors' responsibility to mention them to you. However, feel reassured that the doctors take the utmost of care to prevent them occurring.
A cardiac catheterization does involve a small amount of radiation. The small amount of radiation from 1 cardiac catheterization is unlikely to cause any long-term problems.
When should I call my doctor or nurse?
Call your doctor or nurse if any of the following happen after your angioplasty and stent
- The area where the tube went in bleeds alot.
- Severe arm pain with the radial artery route. Some mild pain is acceptable, but not excessive.
- You get a fever or have pain, swelling, or redness where the tube went in. These symptoms could mean that you have an infection.
- Your leg is weak or numb.
- You have a recurrence of chest pain. In the 1st instance, you should use nitroglycerin spray. However, if the symptoms do not settle, you should contact your doctor or the nurse.