Coronary stents

A diagnosis of coronary artery disease can be frightening to anyone. But to begin treating it and making lifestyle changes to prevent its occurrence in the future, it’s helpful to better understand what it is.

Coronary artery disease means that the blood vessels that feed your heart are narrowed or blocked. Coronary artery disease can cause the pressure, tightness or pain in your chest, arm, neck or jaw that is known as angina. 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 long, thin tube called a catheter to help improve blood flow to your heart. The stent permanently holds the passageway open and helps reduce the rate of restenosis, or re-narrowing of the artery. After the stent placement, you may need to stay 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 that helped create your heart problems in the first place. Some common lifestyle habits, also known as risk factors, include smoking, eating too much fat and salt and not getting enough exercise. Making changes to reduce these 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, it’s helpful to know how your heart works. Your heart is a muscle that pumps blood throughout your body. To work properly, your heart needs a steady supply of oxygen. The coronary arteries supply your heart with the oxygen-rich blood it needs.

Coronary arteries supply the heart with oxygen

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

Blood flows easily through a healthy coronary artery. As a result, your heart muscle gets the oxygen it needs to do its job. When you exert yourself during exercise, for example, your heart beats faster and harder and needs more oxygen. A healthy artery can easily supply the additional oxygen-rich blood the heart requires.

Diseased artery

Coronary artery disease begins when things like high blood pressure or smoking damage the artery walls. A fatty material called plaque builds up in the damaged artery lining. This is called atherosclerosis, sometimes known as hardening of the arteries. The plaque buildup begins to narrow the passageway carrying blood to the heart. When plaque begins to accumulate in the artery, you probably won’t feel any symptoms of coronary artery disease.

Narrowed artery

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

Blocked artery

When plaque tears from the artery wall or a blood clot forms, an artery may become completely blocked. 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, or myocardial infarction. If this happens, you may feel crushing pressure or pain in or around your chest. A heart attack lasts longer than angina and permanently damages the 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 in the stent.
• An allergic reaction or kidney damage related to the X-ray contrast fluid.
• Heart attack, stroke or death. A rare 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, or 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

A few steps are required before the stent is implanted. They include:

• 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 thin, flexible tube known as a guiding catheter 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.
• 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.

Once those initial steps are taken, the implantation of the stent proceeds like this:

The balloon catheter is inflated

A balloon-tipped catheter is positioned at the narrowed 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 feel any discomfort.

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 compressed.

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 re-narrowing of the artery. Blood flow to the heart muscle increases. New tissue will slowly grow over the stent and eventually cover it completely.

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 will give you instructions on medications to take and follow-up care. He or she also may 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 as the insertion point, you will be instructed to lie flat and don’t move your leg for several hours after the sheath is removed. A nurse will frequently check your pulse and blood pressure, and examine 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. 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, including any medications to take. Ask a family member or friend to drive you home from the hospital, so you don’t strain the insertion site. Be sure to call your doctor if:

• The insertion site is increasingly painful, swollen, red, bleeding or draining. Also call 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 and similar medications for at least several months to help prevent blood clots from forming in your stent. Check with your doctor before taking any other medications, even over-the-counter drugs. Don’t stop taking any medication prescribed unless your doctor tells you to.

Back to work

You should be able to return to work within several days after your procedure. Try not to overdo it at first. You will be given instructions on how long to avoid certain activities like driving and heavy lifting.

Follow-up visits

In addition to regular checkups and blood tests, your doctor usually schedules some other tests within the first six months after your procedure, including an exercise stress test. These tests verify that 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 are 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, dilating 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 narrowed section of your artery. The surgery usually requires about a weeks stay in the hospital. It may take up to three months to fully recover after the procedure.

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, but no stent, to compress the plaque and widen the passageway of the artery. During artherectomy, fatty material is removed from artery walls using a special catheter.

Lifestyle changes for a healthy heart

Stents and other treatments don’t make coronary artery disease go away. To boost the odds of improving your condition – or to at least help keep it from getting worse – you may need to make some changes in the way you live. First, pinpoint your risk factors, which are the habits and conditions that can lead to coronary artery disease. Some risk factors, particularly those that may have been inherited, can’t be changed. But there is much you can do. Sometimes, lifestyle changes may even be an alternative to medical and surgical procedures.

Break the smoking habit

Quitting smoking 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.

Steps to quit smoking

• Start by making a firm decision to quit.
• Ask your doctor about programs to stop smoking or aids, such as nicotine patches and gum.
• Contact the American Heart Association or American Lung Association about methods and programs to help smokers quit.
• Pick a program and select a date to stop smoking. 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 non-smoking 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 coronary heart disease risk factors. An improved diet 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

• 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, lemon, garlic and onion.
• Avoid fast food, which generally contains higher amounts of salt.

Eat more fiber

• Eat lots of fresh fruits and vegetables.
• Oats, beans, bran, whole-grain bread and wheat germ are excellent sources of fiber.
• When you increase the fiber in your 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 an activity that makes your heart and lungs work harder than they do when you’re at rest or walking normally. This aerobic exercise can improve the way your heart and lungs use oxygen. Make it fun by exercising with a friend and choosing an 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 10 minutes.
• When you feel comfortable, add a few minutes each week.
• Slowly increase the frequency and duration of your exercise to most days of the 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 that stent implants are not a cure for heart disease. You also know your risk factors for heart disease and what you have the power to 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.

It’s always a good time to get started

Don’t get overwhelmed by trying to make too many changes at once. First, choose one goal you can achieve easily. Give yourself a reward when you’ve succeeded, then move on to another goal.

Don’t forget

• Always 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 healthcare team to help you make healthy changes.
• See your doctor for regular follow-up appointments.
• Don’t hesitate to ask your healthcare 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, programs to quit smoking 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. The organization provides a wealth of literature, support groups and other services to those determined to live a heart-healthy life.