This procedure may be done immediately following your
catheterization or you may be sent home and instructed to return for the
procedure. You will be asked not to eat or drink anything after midnight on the
night before your procedure. It is important that you follow these and any other
instructions carefully.
If you have had a cardiac catheterization procedure,
angioplasty is similar in many ways. Your heart rhythm will be monitored, an
intravenous line will be inserted in your arm, your arm or groin area will be
shaved and cleaned and the procedure will be performed through that area. As
with cardiac catheterization, it is important for you to follow your doctor's
instructions during the procedure.
Balloon Angioplasty, Step by Step
It is not uncommon to experience some discomfort or a pressure sensation in your
chest when the balloon is inflated. During the procedure you will be asked to
remain very still. You will be asked how you are feeling; be sure to let your
doctor know if you experience any discomfort.
After a local anesthetic is given, a tiny incision may be
made and a long, thin tube called a catheter sheath introducer is inserted into
the artery. Then, a narrower and longer tube, called a guiding catheter, is
passed through the sheath to the heart.
Contrast dye (x-ray dye) is injected through the guiding
catheter to allow the doctor to see the arteries of your heart on an x-ray
machine called fluoroscope.
While observing the arteries on the x-ray screen, the doctor
threads a guidewire through the guiding catheter and advances it to the diseased
artery.
A balloon catheter is inserted over the guidewire and
positioned at the site of blockage.
Once the balloon catheter is in place, the balloon is
expanded. As the balloon expands, it compresses the fatty deposits (plaque)
against the lining of the artery. The balloon may be expanded one or more times
before it is removed. X-ray pictures are taken so that the doctor can monitor
your artery as the blood flow is improved.
Once the balloon catheter is removed, the fatty deposits
remain compressed, and blood flow is restored to your heart. The balloon
procedure may last from 30 to 90 minutes, but varies from patient to patient.
A coronary stent is a small, slotted, metal tube that is mounted on a balloon
catheter. It is inserted into your artery after a wider channel has been created
by a balloon, and is positioned at the site of the blockage. When the balloon is
inflated, the stent expands and is pressed into the inner wall of the artery.
The balloon is then deflated and removed with the stent
remaining in place. The stent acts as a scaffold that helps to hold the artery
open, which improves blood flow and relieves symptoms caused by the blockage.
A stent is a permanent implant that remains in your artery.
Over the next month, your cells will form a natural covering which will hold the
stent securely in place. Stents will not rust or move once they are inserted
inside your artery.
Persons allergic to 316L stainless steel may suffer an
allergic response to this implant. It is important to notify your physician if
you have any metal allergies. Although you may be instructed to avoid having an
MRI (Magnetic Resonance Imaging) within 8 weeks after your stent implantation,
tests have shown that this procedure will not affect the stent or make it move -
waiting 8 weeks will allow for adequate tissue coverage to occur over the stent.
Metal detectors found in airports and appliances such as
microwave ovens also will not affect the stent or make it move.
There are two categories of stents currently available:
uncoated stents and drug-coated. A drug-coated stent is coated with the
anti-coagulant drug called heparin. A drug-coated stent allows for the placement
of that particular drug at the stent implantation site.
Preparation for a Coronary Stent
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 cannot take aspirin
If you are taking any other medications
If you have any drug allergies
If you have a history of bleeding problems
If you have any metal allergies (i.e. 316L stainless steel).
How is a coronary stent implanted?
A coronary stent may be placed after the initial balloon procedure, which is
done to create a wider opening for the stent. You will have the same feelings
when the stent is put in place as when the balloon was expanded during the
procedure.
The stent, which is mounted on balloon catheter, is inserted
into the artery and place at the site of the initial blockage.
When the balloon and stent are positioned, the balloon is
inflated. The stent expands and becomes firmly pressed into the inner wall of
the artery. One or more stents may be used at the site that was narrowed or
blocked.
X-ray pictures are taken so that the doctor can see the stent
in your artery. Additional balloon inflations may be needed to fully expand the
stent.
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.