Coronary Stent Implantation

What is a coronary stent?

A coronary stent is a mesh-like tube placed in the coronary arteries during a coronary stent implantation, to keep the arteries open in the treatment of coronary heart disease. A specialist doctor called a cardiologist typically performs stent implantation procedures.

Coronary artery disease occurs when the coronary arteries supplying the heart with oxygen, become narrow with fatty deposits laid inside the walls. This blockage can cause pain in the chest (also known as “angina”) or a heart attack.

When should I see a specialist for a coronary stent implantation?

Medical therapy is recommended as first-line therapy in patients who have stable angina (where the pattern of pain is predictable). If you have any of the following, you may wish to discuss with your specialist about a coronary stent implantation.

● Symptoms getting worse
● Drugs not working as well as before
● Known high-risk coronary anatomy
● Worsening left ventricular (LV) dysfunction

Did you know?

A systematic review shows that compared to a coronary artery bypass graft, treatment of left main coronary artery disease with coronary stent implantation using a newer generation drug eluting stent, might be a safe alternative. However, this option is associated with more repeat procedures to open up the vessel¹.

What are the risks of a coronary stent implantation?

Complications from coronary stent implantation are rare. The following complications could occur during or just after an implantation:

● Bleeding
● Blood vessel damage
● Allergic reaction from the contrast dye
● Arrhythmias
● Heart attack
● Blood clots
● Stroke

The longer-term risk is the artery getting narrow again.

The risk of complications is higher if you are older, have chronic kidney disease, are experiencing heart failure at the time of the procedure, have extensive heart disease, or have multiple blockages in your coronary arteries.

How should I prepare for my appointment?

As the cardiologist will ask you for your past medical and family history, be prepared with the following information
● Current symptoms that you are experiencing including those that seem unrelated
● Current or previous medical conditions including any treatments such as diabetes or stroke
● Results of previous laboratory tests such cholesterol tests
● List of medications, vitamins or supplements currently being consumed.
● Be prepared to discuss your diet and your smoking and exercise habits. If you don’t already follow a diet or exercise routine, discuss getting started with one.

If possible, bring someone along with you to help remember what the doctor tells you.

To enable you to decide on whether you would want a coronary stent implantation, you may wish to ask the cardiologist the following questions.
● How many arteries are blocked?
● What is the extent of the blockages?
● What are the signs that I need to go to a hospital or seek treatment right away?
● Are there any alternatives to the treatments suggested?
● I have other health conditions. How do I manage them together?

What can I expect during a coronary stent implantation?

A coronary stent implantation is done under a local anaesthetic. A needle is punctured in the artery over the groin or wrist. The cardiologist will guide a long thin tube known as a catheter to the heart. A contrast dye is injected to obtain X-ray images of the coronary arteries. A small guide wire is threaded through the blockage followed by a balloon catheter with a stent surrounding it. As the balloon inflates to compress the fatty deposits and enlarge the lumen of the artery, the stent is expanded and deployed. When the balloon is removed, the stent remains in place.

What happens after my coronary stent implantation?

Most patients spend one night in the hospital. You are likely to be advised to drink plenty of fluids to flush the contrast dye from your system and avoid any heavy lifting or strenuous exercise for at least a week. This allows the area in the coronary artery as well as the groin or arm arteries to heal.

You are likely to be prescribed aspirin indefinitely to prevent future thrombotic events (for example, unstable angina or heart attack). In addition, an additional anti-platelet agent may given in conjunction with aspirin for one year to prevent blood clots from forming.

You may be prescribed a cardiac rehabilitation programme with monitored exercise to help improve your cardiovascular health.

1. Zhang X-L, Zhu Q-Q, Yang J-J, et al. Percutaneous intervention versus coronary artery bypass graft surgery in left main coronary artery stenosis: a systematic review and meta-analysis. BMC Med. 2017;15(1):84. doi:10.1186/s12916-017-0853-1.