CORONARY STENTING PROCEDURE

When the blood vessels on the heart become narrow, the patient has coronary artery disease. The primary cause of this disease is fat deposits blocking the arteries (atherosclerosis). These deposits blocking the arteries reduce the oxygen supply to the heart muscle. Solutions are balloon angioplasty or stenting.

BALLOON ANGIOPLASTY

This is a technique used to dilate an area of arterial blockage with the help of a catheter that has an inflatable small balloon at its tip.
The balloon catheter is introduced through the skin of the groin, or sometimes the arm. The guide wire (a thin wire with a flexible tip) is inserted into through the catheter and into the coronary artery. The tip of the wire is then guided across the blockage. The cardiologist controls the movement and direction of the guide wire by manipulating the end that sits outside the patient. This wire now serves as a "guide" over which the balloon catheter can be delivered.
The tip of the balloon catheter is then passed over the guide wire and positioned across the lesion or blockage. A deflated balloon is located on the tip of the catheter shaft. It is inflated by connecting it to a special handheld syringe pump. A mixture of saline and contrast material is used to inflate the balloon. The contrast material helps to visualize the balloon when it is inflated. The balloon catheter also has metallic markers (either at the center or on either side of the balloon). This helps the cardiologist to know the location of the balloon.
Then the balloon is inflated. As the balloon is inflated, it compresses the plaque that makes up the coronary blockage.

But in many cases, balloon angioplasty is unsuccessful because the vessel closes again after the procedure. This is called restenosis. The solution is coronary stenting.

CORONARY STENTING

Coronary stenting prevents restenosis by forming a rigid support. The stent used for stenting is a stainless steel mesh tube. The stent will be placed inside the artery and will stay in place to keep the vessel open.
The stent has various sizes to match the size of the artery. Coronary stenting usually follows balloon angioplasty, which requires inserting a balloon catheter into the femoral artery in the upper thigh. When this catheter is positioned at the location of the blockage in the coronary artery, it is slowly inflated to widen that artery, and is then removed.
The stent catheter is then threaded into the artery and the stent is placed around a deflated balloon. When this is correctly positioned in the coronary artery, the balloon is inflated, expanding the stent against the walls of the coronary artery.
The balloon catheter is removed, leaving the stent in place to hold the coronary artery open.

IMPORTANT

Because the stent is a foreign object in the body, this will increase the risk of thrombosis. Thrombosis is the development of a blood clot in the vessels. This thrombosis may clog a blood vessel and stop the flow of blood. Anticlotting medication is given to prevent this complication.
A cardiac angiography will follow to insure that the stent is keeping the artery open.
The patient should remain flat and still for awhile to allow the femoral artery to heal from the insertion of the catheter. Medication to control blood clotting should be taken after the patient is discharged from the hospital. With time, the patient should begin light exercise, like walking.

CONCLUSIONS

For most people, coronary stenting greatly increases blood flow through the previously blocked artery. A better ability to exercise is provided. To maintain good results, lifestyle modifications should be done (no tobacco products, lowering the cholesterol level, maintaining a healthy weight and getting regular exercise).
Successful coronary stenting means you might not have to undergo a more invasive surgical procedure called coronary artery bypass surgery. In that procedure, an artery or a vein is removed from a different part of your body and sewn to the surface of your heart to take over for the blocked coronary artery.
Recovery from bypass surgery is usually longer and may be more painful.

CORONARY STENTING ADVANTAGES

Doesn't require a major incision
Doesn't require general anesthesia
Major complications are uncommon