What does coronary angioplasty and stenting do?

An angioplasty is a non-surgical treatment designed to open clogged arteries. This procedure is done during a heart catheterization (angiogram) after the doctor has seen the angiogram (picture) that shows where the arteries are blocked. Angioplasty, with or without stenting, opens the arteries to restore blood flow. Stenting involves implanting a metal mesh tube (stent) into an artery during an angioplasty. The stent provides scaffolding to hold the vessel open to improve the flow of blood to the heart.

Preparing for Cardiac Catheterization

• Unless otherwise instructed by your doctor, continue to take your medications at your regular time. Be sure to tell your doctor if you take a blood thinner such as Coumadin® or Plavix®.
• If you have diabetes and take medication for it, please check with your doctor about the dose that you should take the morning of the procedure.
• It is important that your stomach be empty for the test. Your doctor will inform you when you need to stop eating and drinking, usually at least eight hours before the beginning of the procedure. Take your medications at your usual time with a sip of water.

At the Hospital

• Your physician and the nursing staff explain the procedure and answer your questions. You and your family may view a videotape that may help answer some of your questions about the procedure. You will be asked to sign a consent that allows the doctor to do the procedure.
• You will be asked to change into a hospital gown. You may wear glasses, dentures and hearing aids during the procedure. Rings may also be worn. Please remove any necklaces or dangling jewelry.
• An IV (intravenous catheter) will be inserted into a vein in your arm.
• Your physician may order specific lab tests, along with an electrocardiogram and a chest X-ray.
• You may receive medication about one half hour before the test. This should help you relax and may make your mouth feel dry. More education can be given to you in the catheterization lab. Please inform the staff if you feel anxious or are having any pain. We will also offer guided imagery tapes to help relieve your anxiety.
• Before leaving for your cardiac catheterization, ask for assistance to use the bathroom to empty your bladder.

During Cardiac Catheterization with Angioplasty or Stent Placement

• A cardiac catheterization takes approximately two hours from the time you leave your room until the time you return to your room. After completing your cardiac catheterization, the cardiologist may decide to proceed directly to an angioplasty. This will increase the amount of time you spend in the catheterization lab. Nursing staff will tell your family where they may wait.
• Once you are in the lab, the staff will connect you to several pieces of equipment. This allows the doctor and the staff to keep a careful watch on your blood pressure, heart rhythm (ECG), and oxygen saturation level during the test.
• The staff shaves and washes a small area of your groin where the cardiologist will insert the catheter.
• The cardiologist numbs the area where the catheter will be inserted. You may briefly feel a burning sensation as the medication is given. The feeling should go away quickly.
• After the area is numbed, the catheter is placed in your artery. You may feel pressure at the site where the doctor is working, but should not have any pain. If you feel pain, please inform the doctor or nurse right away. They will give you more medication.
• You will not feel the catheter as it moves through your arteries. Your arteries have no nerve endings to sense touch.
• You may be awake during the catheterization and may watch the X-ray monitor if you wish. At times, the X-ray tube will block your vision of the monitor. If you are interested, the staff will show you pictures of your heart at the end of the procedure.
• A cardiac catheterization should not be a painful procedure. Please let the staff know if you are having any pain. They can give you medication to keep you comfortable.
• One part of the test allows your doctor to evaluate the pumping action of the left ventricle. When the picture is taken, you may have a warm sensation for a few seconds. Some patients feel as if they have urinated. It is a sensation caused by the X-ray dye used in the lab.
• If the cardiologist sees a blockage or narrowing during the catheterization, he may decide to perform a balloon angioplasty or stent placement at the same time, or recommend that the procedure be performed later.
• Coronary angioplasty, also called PTCA, is used to treat blockages in the coronary arteries. A small balloon attached to a catheter is placed at the site of the blockage. The cardiologist then inflates the balloon, for no more than one minute at a time, to compress the fatty deposits within the arterial wall. This opens the artery, which increases blood flow to the heart. This may be repeated several times per blockage. After the inflations are completed, the balloon is removed.
• A coronary stent is a mesh tube made from stainless steel. It provides a rigid support to the narrowing in the artery that helps it stay open. Various types of stents are used. Your cardiologist will decide which is best for you.
• The stent rides on an angioplasty balloon. The balloon is attached to a catheter and placed at the site of the blockage. When the balloon is inflated, the stent is pressed up against the wall of the artery, forcing the blockage up against the wall and holding it there. The balloon is then removed. The stent remains there permanently and helps prevent the narrowing from coming back.
• Some patients have chest pain or pressure when the balloon is inflated. Although chest pressure during angioplasty and stent placement is not unusual, it is important that you tell the staff when you are having pain. Medication can be given to help keep you comfortable.
• During the procedure, you will receive blood thinners through your IV.
• You may receive oxygen through tubing placed in your nose.
• Patients who have angioplasties and/or stents can usually go home the day after the procedure.

After Cardiac Catheterization with Angioplasty or Stent Placement

• Because you receive blood thinners during the procedure, it may be necessary to leave the catheter in your groin for several hours after the procedure. This allows your blood clotting time to return to normal so the staff may safely remove the catheter.
• Nursing staff will check your blood pressure, pulse and dressing frequently. In addition, they will perform a test to see how long it takes your blood to clot. Once your blood clotting time is close to normal, the catheter in your groin will be removed. This will be done in your hospital room in your bed.
• Nursing staff will monitor your ECG or electrical rhythm of your heart. A small box connected to patches on your chest allows constant monitoring of your heart rhythm.
• It is important that you keep your leg straight. Avoid bending at the hip and keep your head down on the pillow. This prevents pressure on the artery and helps prevent bleeding.
• The head of your bed can be raised slightly to take some of the pressure off your back. Please ask the nurse for help.
• It is important that you are comfortable. Please let the nursing staff know if you need to reposition yourself, if you are having pain, or if you have to go to the bathroom. Pain and discomfort raises your blood pressure, which puts more strain on the puncture site and can increase your risk for bleeding.

When You Return to Your Room

• We will ask you to remain in bed from two to eight hours after your procedure to give the puncture site time to heal.
• The head of your bed may be raised slightly. The nurse will let you know how far you can sit up.
• It is important that you keep your leg straight. Avoid bending at the hip and keep your head down on the pillow. This prevents pressure on the artery and helps prevent bleeding.
• If you feel pain, warmth or wetness at the site where the doctor was working, please call your nurse immediately.
• Staff members will encourage you to drink fluids in order to clear the X-ray dye from your system. You may also eat.
• While you are on bedrest, you will have to use a bedpan or urinal if you need to go to the bathroom.
• It is important that you are comfortable. Please let nursing staff know if you need to reposition yourself, if you are having pain, or if you have to go to the bathroom. Pain and discomfort raises your blood pressure, which puts more strain on the puncture site and can increase your risk for bleeding.

After Discharge from the Hospital

• You may have skin discoloration at the incision site for several weeks. You may also notice tenderness and a small lump, the size of a grape, in that area. This is the natural healing process and will disappear within a few weeks.
• No ointment or special care is needed at the incision site.
• You may shower, but no tub baths or hot tubs until your doctor gives his approval.
• Your cardiologist will give you instructions about the level of exercise and activity you can do after your procedure and when you can return to work. Typically, it is recommended that during the first week after your procedure, you do nothing strenuous and lift no more than 10 pounds.
• We refer most patients receiving angioplasty or stent implantation at Meriter to a cardiac rehabilitation program for monitored exercise and risk factor modification. A member of our team will discuss the program with you after your procedure.
• Check your puncture site for swelling or bleeding. If bleeding occurs, lie down and place pressure on the puncture site with the heel of your hand. If bleeding does not stop, call 911.
• If chest pain returns, rest and take nitroglycerin (if prescribed for you) as directed. If discomfort or pain persists, call 911.
• Notify your physician if you:
  • Have increased swelling, drainage, redness or pain in your groin or leg.
  • Experience changes in the color, feeling or temperature beyond the puncture site.
  • Continue to have pain, lightheadedness, shortness of breath or fatigue.

How will I feel after the angioplasty?

Your doctor will talk to you about the amount of improvement in the artery opening and the possibility of your symptoms returning, medications, restrictions, and changes in daily habits to reduce the risk of more arteries narrowing. You'll also be informed when to return for follow-up visits.

8/3/2008