Angioplasty and Stent Education Guide
Table of Contents
Treatingcoronaryarterydisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Whatiscoronaryarterydisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Coronaryarterydiseasetreatmentoptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Whatarecoronaryarterystents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Whatarethedifferenttypesofcoronary stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Howdoesthedrugcoatingandpolymerworkonadrug-elutingstent . . . . . . . . . . 8
Risksoftreatmentoptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Beforeyourcoronaryarterystentingprocedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Duringatypicalcoronaryarterystentingprocedure . . . . . . . . . . . . . . . . . . . . . . . . 12
Afteratypicalcoronaryarterystentingprocedure . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Frequentlyaskedquestions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
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Treating coronary artery disease
Yourdoctormaywantyoutohaveastentplacedinyourcoronary
artery .Thisistohelptreatyourcoronaryarterydisease .Thisguide
explainstheprocedureandwhatyoucanexpectfromstarttofinish .
Aglossaryattheendofthisguidedefinescommonmedicalterms
aboutthisprocedure .
Youwillalsolearnstepsyoucantaketoliveahealthierlifewith
coronaryarterydisease .
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Coronary Artery Disease (CAD)isthenarrowingofthearteriesintheheart .Thisnarrowingcanalsobecalledstenosis .Itisusuallycausedbyabuildupoffatorcalciumdepositscalledplaque .Overtime,thisplaquecanbuildtoatotalblockageoftheartery .Thisprocessiscalledatherosclerosis .
Whentheheartdoesn’treceiveenoughbloodflowduetoblockageintheartery,itmaycausemildtoseverechestpainorpressure .Thispainorpressurecanalsospreadtothearmsorjaw .Ifthearteriesarecompletelyblocked,itcanresultinaheartattack .Anyonewhoexperiencessymptomsshouldpromptlycall911 .Morethan13millionAmericanssufferfromCADeachyear .However,thetreatmentofCADhaschangedinrecentyears,andmanyCADpatientsareabletoreturntoanormallifestyleshortlyaftertreatment .
Who is at risk?Ifyouhaveahistoryofhighcholesterol,diabetes,smoking,highbloodpressure,beingoverweightorafamilyhistoryofCAD,youhaveanincreasedchanceofdevelopingblockageinyourcoronary arteries .Asyougetolder,youhaveagreaterchanceofdevelopingCAD .Inaddition,womenwhohavereachedmenopausehaveagreaterchanceofhavingCAD .
How do I know if I have Coronary Artery Disease?ThereareanumberofteststhatyourdoctorcanperformtohelpdetermineifyouhaveCAD .Atestthatmeasurestheelectricalactivityinyourheartiscalledanelectrocardiogram (ECG or EKG) .Astress testcanbedonetomeasuretheelectricalactivityinyourheartwhileyouareexercising .Thesetestsmayshowyourdoctorifpartofyourhearthasbeendamagedorisnotreceivingenoughblood .Todirectlydetermineifyourarteriesmaybeblockedornarrowing,yourdoctormayscheduleaprocedurewithacardiologist .Thisprocedureiscalledacoronary angiogramandisperformedinaCardiacCatheterizationLabbyinsertingadyeintoyourcoronary arteries .Bydoingthisprocedure,thecardiologistcanseeyourcoronary arteriesonanX-rayscreenandcanmakeadecisionofhowbesttotreatyou .
What is coronary artery disease
Right Coronary
Artery
Posterior Descending
Artery
Aorta Left Coronary
Artery
Circumflex Artery
Left Anterior
Descending Artery
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Therearemanydifferenttreatmentoptionsfortreatingcoronaryarterydisease .Theoptionsfocusonincreasingbloodflowtotheheart,alongwithchangestoyoureverydaylifestyle,includingdiet,physicalactivityandmedications .Thetypeoftreatmentyourdoctorrecommendsforyoudependsonyoursymptomsandhowmuchdamagehasbeendonetoyourheart .
TreatmentOptionsforCoronaryArteryDiseasemayinclude:
1 .Medications
2 .Balloon angioplasty
3 .Coronaryarterystenting
4 .Coronary artery bypass graft surgery (CABG)
1. Medications
Nitroglycerinmaybegiventorelievechestdiscomfortduetocoronaryblockages .Itdoesnottreattheblockageitself .Yourcardiologistmayprescribeanumberofmedications(aspirin,beta-blockers,cholesterolmedications,etc .)tothinyourbloodandtohelppreventblockageofthearteries .
Coronary artery disease treatment options
Coronary artery disease treatment options continued
2. Angioplasty
Aprocedureknownasangioplastycanalsotreatarterynarrowing .Athintubeknownasaguidecatheterisinsertedintothearteryatthegroinorwrist .Asmallballoonlocatedonthetopofasecondcatheterismovedthroughtheguidecathetertothesiteofthenarrowing .Theballoonistheninflatedtoreducetheblockage .Theballoonisdeflatedandremovedaftertheangioplastyisdone .Thepatientremainsawakewhilethecardiologistperformstheprocedure .Theproceduremayendhereoryoucouldhaveabare-metalordrug-elutingstentimplantedtohelpkeepthearteryopen .
3. Coronary artery stenting
Duringthisprocedureasmallmeshtubeisimplantedintothearterytowidenthearteryandrestoreadequatebloodflowtotheheart .Thismeshtubeiscalledastent .Oncethestentisplacedintothecoronaryartery,itisexpandedwiththeinflationofaballooncatheter .Thestentisleftinthearterytokeepitopenandhelppreventfurthernarrowingofthecoronaryartery .
4. Coronary artery bypass graft surgery (CABG)
Thissurgeryisalsocalledaheartbypassoropenheartsurgery .Yoursurgeonwillneedtotakeashortlengthofarteryfromyourinnerchestwalland/oraveinfromyourlegandsurgicallyattachitaboveandbelowtheblockedareaoftheheartartery .
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Plaque Before Treatment
Balloon Angioplasty Procedure
Result After Angioplasty
Plaque Before Treatment
Stent Procedure
Result After Stent Procedure
Side View of Coronary Artery
Coronaryarterystentsaresmallmeshtubesthatcanhelptoreduceblockageofacoronaryartery .Thestentisimplantedintoanarteryandexpandedtofitthesize,shapeandbendofthecoronaryartery .Thestentisproppedopentohelppreventanymoreblockages .Oncethestentisinplace,thestentwillremaininyourartery .Overtime,thearterywallwillhealaroundthestentasitcontinuestosupporttheartery .
Why are stents used?Manypatientswhoundergoballoon angioplastytreatmentwillexperienceare-narrowingoftheartery .Thisre-narrowingiscalledrestenosis .Thisre-narrowingofthecoronaryarterycanhappenmoreoftenfollowingaballoon angioplastyprocedurethanforpatientswhoreceiveastent .There-narrowingcanbecausedbyacombinationoffactorsincludingtheblockagereformingornewtissuegrowthwithinthetreatedarea .
Coronary artery with angioplasty
What are coronary artery stents
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What are coronary artery stents continued
Coronary artery with stenting
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What are the different types of coronary stents?
Therearetwokindsofstents,bare-metalanddrug-coated .Bare-metalstentsprovidesupporttohelpkeepthearteryopenafterangioplasty .Adrug-coatedstentisabare-metalstentwithaspecialdrugcoatingaddedtohelpreducethechanceofthearterybecomingblockedagain .Thedrugisreleasedfromthestentovertheperiodoftimeduringwhichre-blockageismostlikelytooccur .Thestentsweredesignedtobeveryflexible,allowingthemtofittheshapeofyourartery .
BostonScientificoffersbare-metalanddrug-elutingstents .Dependinguponyourspecificneeds,yourdoctormaychoosetoplaceabaremetal,drug-elutingorsomecombinationofthesestents .Therearedifferencesbetweenthetwostenttypes(suchastheneedforlonger-termdualantiplatelettherapywithdrug-elutingstents)thatyoushoulddiscusswithyourdoctor .PleasereferencetheIONPatientInformationGuideformoredetailsaboutthestent .
How does the drug coating and polymer work on a drug-eluting stent?
Polymer CoatingThestentiscoatedwithaproprietarypolymer,whichwasdevelopedspecificallyfordrug-elutingstents .Thepolymercarriesandprotectsthedrugbeforeandduringtheprocedure .Oncethestentisimplanted,ithelpscontroldrugreleaseintothecoronaryarterialwall .Thiscontributestoevenandconsistentdistributionofthedrugfromthestent .
Drug ReleaseThedrug-elutingstentiscoatedwithadrugandpolymerandhasbeendesignedtoallowforaconsistentandcontrolledreleaseofthedrugfromthestentsurfaceintothearterywalls .Boththeamountofdrugandreleaseratehavebeendeterminedsothathealingcanoccurwhileallowingtheprocessesleadingtorestenosistobeminimized,thusreducingtheneedforadditionaltreatmentinthestentedarea .
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Risks of treatment options
Youshouldnothaveadrugelutingstentplacedinyourcoronaryarteryifyouhaveanyofthefollowingconditions:
• Youareallergictothedrugorrelateddrugs
• Youareallergictothepolymer
• Youareallergictostainlesssteelorplatinumchromium
• Youareunabletotakemedicinesthatmakeyourbloodtakelongertoclot (alsocalledanticoagulants)
• Youareunabletotakemedicinesthatmakeyourbloodcellsslipperyandmakeit moredifficultforyourbloodtoclot(alsocalledantiplatelets)
• Youhaveablockagethatwillnotallowproperplacementofthestent
• Youareallergictothedyeusedduringtheprocedure(alsocalledcontrastagent)
• Yourdoctordecidesthatyouarenotabletohavetherequiredmedicationprior tostentplacement
Yourdoctorandthemedicalstaffwillmonitoryouduringandaftertheprocedureforcomplications .Ifacomplicationdoesoccur,yourdoctorwilldecidewhattypeoftreatmentyoumayneed .
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Theplacementofstentsinarteriesisdonetotreatblockagesandtotrytopreventre-narrowing .
As with any stent procedure, there is a chance that complications may occur, including, but not limited to, the following:• Airbubbles,tissueorclotswhichcanblock theartery(emboli)• Allergicreactiontothedrug• Allergicreactiontothepolymer• Allergicreactiontothemetalusedtomakethe stent(stainlesssteelorplatinumchromium)• Allergicreactiontothecontrastdye(which couldcausekidneyfailure)• Aneurysm• Bleeding(whichmayrequireablood transfusion)• Bruisingattheaccesssite• Bruisingwhichoccursonabloodvessel (pseudo-aneurysm)• Chestpainordiscomfort• Collectionofbloodintheliningoftheheart• Coronaryspasm• Death• Emergencybypasssurgery• Heartattack• Highorlowbloodpressure• Inadequatesupplyofbloodtotheheart• Infectionand/orpainattheaccesssite• Injuryortearingofartery• Irregularheartbeat(arrhythmia)• Movementofthestenttoanunintended location• Pluggingofthestentwithbloodclots
• Re-narrowingofthetreatedartery(restenosis)• Shock/pulmonaryedema• Sideeffectsduetocontrastdye,heparinor othermedications• Strokeorotherneurologicalproblems• Totalblockage(occlusion)oftheartery• Unnaturalconnectionbetweenveinandartery (asterio-venousfistula)• Arterialtraumarequiringsurgicalrepairor reintervention• Worseningofheartandlungfunction
There is a chance that complications may occur relating to the drug (based on studies of patients who used the drug for a prolonged period of time) or the polymer which include:• Abnormallivertestlevels• Allergicorimmunologicreactiontothedrug• Allergicreactiontothepolymerorpolymers withsimilarchemicalstructures• Anemia• Bloodtransfusion• Changesinbloodprofile(decreaseinthenumber ofwhiteandredbloodcellsandplatelets)• Changesofthetissueinthearterialwallincluding inflammation,cellinjuryandcelldeath• Disturbancesofthegastrointestinal(GI)tract andstomach• Lossofhair• Musclepain/jointpain• Nervediseaseinarmsandlegs
Theremaybeotherpotentialadverseeventsthatareunforeseenatthistime .
Risks of treatment options continued
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Before your coronary artery stenting procedure:
• Tellyourdoctoraboutanymedicationsyouaretaking .
• Letyourdoctorknowaboutanyallergiesyouhave .Itisimportantheor sheknowsaboutallergiestocontrastdye,iodine,cobalt,chromium, nickel,titanium,stainlesssteel,platinumorplastics .
• Tellyourdoctorifyoucannottakeaspirinorbloodthinningmedicines . Thesemedicationsareusuallyprescribedbeforeandafteryour procedure .
• Makesureyouunderstandthepossiblerisksandbenefitsofyour coronarystentprocedure .
Below is a typical checklist. Your doctor may ask you to go through this before your procedure:
• Donoteatordrinkanythingaftermidnightonthenightbefore yourprocedure .
• Followtheinstructionsyoureceivefromyourdoctorandnurses .
• Takeallyourmedicationswithyou .
• Youmaybegivenasedativetorelaxyoubeforestartingyourstent procedure .Thesedativecanmakeyousleepy .
Before your coronary artery stenting procedure
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During a typical coronary artery stenting procedure
1 .YouwillbetakentoanareaofthehospitalcalledtheCardiacCatheterizationLaboratory .Whileinthecathlab,youmaybegivenasedativethatwillmakeyoufeelsleepyduringtheprocedure .
2 . Asmallpunctureismadeinyourarmorgroin .Aneedleisusedtogainaccesstoyourarteryandaguidecatheterandguidewirearefedthroughthearteryandmovedupintothecoronaryartery .AllofthisisdoneusingX-raysforaguide .
3 . Thediseasedarteryfirstneedstobeenlargedtomakeroomforthestent .Todothis,thedoctorplacesasmall,deflatedballoonovertheguidewireandthroughthecathetertotheblockedareaofthecoronaryartery .Whentheballoonisinthecorrectposition,itisinflated .Thispushestheplaquebuildupasideandreopensthearterytorestorebloodflow .
4 . Theballoonisdeflatedandremoved,andasmallmetalmeshtubecalledastentisadvancedintothesameblockedareaofthearteryandexpandedagainstthearterywalltofittheshapeofyourartery .Yourdoctormaychoosetoexpandthestentbyusinganotherballoon .Thisistomakesurethestentisinbettercontactwiththeartery .
5 . Ifyourdoctorplacesadrug-elutingstentintoyourartery,adrugwillbereleasedfromthestentoveraslowperiodoftime .
6 . Afterthestentisimplanted,thecatheterandwireareremovedandthepuncturesiteisclosed .Thestentremainsinplacepermanentlyandisdesignedtohelpkeepthearteryopenandpreventfuturenarrowingofthecoronaryartery .
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After a typical coronary artery stenting procedure
• Youmayfeelsleepyfromthesedativegiventoyou .Thiswillwearoff overthenextfewhours .
• Youwillbetakentoaunitwherenursesanddoctorscanmonitoryou .
• Youwillbeaskedtostayinbedforseveralhours .Youwillbeaskedto keepyourarmorlegstraightsotheentrysitecanheal .
• Youmayneedtostayinthehospitalbeforeyoucangohome .
• Youshouldfollowyourdoctor’srecommendationsandletthemknow ifyouareexperiencinganyofthefollowing:
– Chestpain
– Shortnessofbreath
– Suddenweaknessorparalysisoftheface,armorleg
– Pain,bleedingorinfectionattheentrysiteinyourarmorleg
– Anyotherunexplainedsymptoms
• Youcanreturntonormalactivitiesgradually .Checkwithyourdoctor aboutphysicalactivities .
• Youshouldnotstoptakingyourmedicationsunlessyouareaskedto stopbythedoctorwhoimplantedyourstent .
• Youshouldkeepallofyourfollow-upappointments,including bloodtesting .
• YoushouldcarryyourStentImplantCard .
• YoushouldalwaysshowyourdentistormedicaldoctoryourStent ImplantCard .
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Yourcardiologistmayprescribeanumberofmedicationstothinthebloodandpreventbloodclotsfromformingandadheringtothesurfaceofthestent .ThesemedicationswillincludeaspirinandbloodthinningdrugssuchasPlavix®,Ticlid®orEffient®(Prasugrel) .Itisextremelyimportantthatyoufollowyourdoctor’sinstructionsonwhatmedicationstotake .If you stop taking these medications before being instructed to do so by your cardiologist, the chances of blood clot formation on the stent, subsequent heart attack or even death are increased.
Ifyouplantohaveanytypeofsurgeryordentalworkwhichmayrequireyoutostoptakingthesemedicationsprematurely,youandyourcardiologistshoulddiscusswhetherornotplacementofastentistherighttreatmentforyou .
Ifsurgeryordentalworkisrecommendedwhichwouldrequireyoutostoptakingthesemedicationsprematurelyafteryou’vereceivedthestent,youandyourdoctorshouldcarefullyconsidertherisksandbenefitsofthisadditionalsurgeryordentalworkversusthepossiblerisksfromearlydiscontinuationofthesemedications .
Ifyoudorequireprematurediscontinuationofthesemedicationsbecauseofsignificantbleeding,thenyourcardiologistwillbecarefullymonitoringyouforpossiblecomplications .Onceyourconditionhasstabilized,yourcardiologistwillprobablyputyoubackonthesemedications .
Follow-Up Examinations
Youwillneedtoseethecardiologistwhoimplantedyourstentforroutinefollow-upexaminations .Duringthesevisits,yourdoctorwillmonitoryourprogressandevaluateyourmedications,theclinicalstatusofyourcoronaryarterydisease,andhowthestentisworkingforyou .
Medications
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Frequently Asked Questions
Can the stent move or rust? Oncepositionedbyyourdoctor,thestentdoesnotmoveonitsown .Itismanufacturedsothatitwillnotrust .
Can I walk through metal detectors with a stent? Yes,withoutanyfearofsettingthemoff .
How soon can I go back to work? Themajorityofpeoplereturntoworkwithinafewdaysfollowingtheprocedure .
What if I still have pain? Ifyouexperiencepain,immediatelyinformyourcardiologistorthecenterwheretheprocedurewasperformed .
Can I undergo MRI or scanner testing with a stent? MRIsafetytestinghasshownthatthecoronarystentisMRConditionalandthatapatientwithacoronarystentmaysafelyundergoanMRIscanundercertainconditionslistedontheStentImplantCard .PriortoundergoinganMRIscan,informyourdoctororMRtechnologistthatyouhaveacoronarystentandshowthemyourStentImplantCard .
Can I play sports? Yourdoctorwilltellyouwhatsportsyoucanplayandwhenyoucanstartthem .
What should I change in my diet? Yourdoctormayprescribealow-fat,low-cholesteroldiettohelpreducethelevelsoffatinyourbloodandreduceyourrisk .
Angina PectorisSymptomsexperiencedwhentheheartmuscleisnotreceivingadequateoxygen(mayincludechest,arm,jaworbackpain,shortnessofbreath,nausea,vomiting) .
AngioplastyAminimallyinvasivetreatmenttoopenblockedcoronary arteries .Alsoknownaspercutaneous transluminal coronary angioplasty (PTCA) .
AtherosclerosisAdiseaseinwhichtheflowofbloodtotheheartisrestrictedwithplaquedepositsand,therefore,lessoxygenandothernutrientsreachtheheartmuscle .Thismayleadtochestpain(angina pectoris)ortoaheartattack(myocardial infarction) .
Balloon AngioplastyOpeningtheblockedarterybyusingaballooncatheterthatisinflatedinsidetheartery .
CatheterAsmall,thinplastictubeusedtoprovideaccesstopartsofthebody,suchasthecoronary arteries .
Coronary AngiogramAtestinwhichcontrastdyeisinjectedintothecoronary arteriesallowingthedoctortoseethearteriesonanX-raymachine .
Coronary ArteriesThearteriesthatsurroundtheheartandsupplybloodcontainingoxygenandnutrientstotheheartmuscle .
Coronary Artery Bypass Graft Surgery (CABG)Openheartorbypasssurgery .Asectionofanarteryorveinfromyourchestorlegisharvestedandsurgicallyattachedtoacoronaryarterybelowtheblockedareaoftheheart .
Coronary Artery Disease (CAD)Diseaseaffectingthecoronary arteriesthatsurroundtheheartandsupplybloodtotheheartmuscle .
Electrocardiogram (ECG/EKG)Atestthatrecordschangesintheelectricalactivityoftheheart .Mayshowwhethersectionsoftheheartmusclehavebeendamagedduetoinsufficientbloodoroxygenflowtotheheart .
Glossary
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Glossary continued
In-Stent RestenosisRecurrentblockageornarrowingofapreviouslystentedareainanartery .
LumenTheinnerchannelofanartery .
Magnetic Resonance Imaging (MRI) Anon-invasivewaytotakepicturesofthebody .MRIusespowerfulmagnetsandradiowaves,unlikex-raysandcomputedtomographic(CT)scanswhichuseradiation .
Myocardial InfarctionPermanentdamagetothehearttissueandmuscleduetotheinterruptionofthebloodsupplytothearea .Commonlyreferredtoasaheartattack .
Percutaneous Transluminal Coronary Angioplasty (PTCA)SeeAngioplasty .
PlaqueAccumulationorbuildupofcholesterol,fattydeposits,calciumandcollageninacoronaryvesselthatleadstoblockagesinthecoronary arteries .
RestenosisRecurrentblockageorre-narrowingofapreviouslytreatedartery .
StentAnexpandablemetaltubularstructure(lattice)thatsupportsthevesselwallandmaintainsbloodflowthroughtheopenedartery .
Stress TestAtestthatrecordstheheart’selectricalactivitywhilethepatientexercises .Mayshowwhetherpartsoftheheartmusclehavebeendamagedandifthereisinsufficientbloodoroxygenflowtotheheart .
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