What is coronary stenting?

Coronary stenting is a procedure to place a stent, mesh tube, inside a coronary artery to keep it open. Coronary arteries are blood vessels that supply blood to your heart muscle. Coronary stenting is performed with other procedures, such as angioplasty, that open narrowed or blocked coronary arteries. Coronary stenting is a treatment for coronary artery disease (CAD), which is a risk factor for a heart attack. 

Coronary stenting is only one method of treating narrowed or blocked coronary arteries. It may not be the best option for all patients. Discuss all of your treatment options with your doctor to understand which options are best for you.  

Other procedures that may be performed

Your doctor may perform other procedures in addition to coronary stenting. These include:

  • Angiography makes pictures or images, called an angiogram, of the heart’s blood vessels.
  • Atherectomy involves inserting a catheter into a vessel in your groin or arm. Your doctor will thread the catheter into the artery that needs treatment using a guide wire. Your doctor will then scrape or drill away the plaque with special catheter instruments to open the artery.
  • Coronary angioplasty involves inserting a catheter into a vessel in your groin or arm. Your doctor will thread the catheter into the coronary artery that needs treatment using a guide wire. Your doctor will then expand a balloon on the tip of the catheter wire to open the artery.

Coronary stenting can improve angioplasty and atherectomy results by further widening the artery and smoothing the artery walls. This reduces the chance of blood clots and other problems.

Why is coronary stenting performed?

Your doctor may recommend coronary stenting to treat coronary artery disease (CAD). Coronary stenting, usually combined with coronary angioplasty, reduces the risk of death in some people with CAD.

CAD occurs when fatty deposits build up on coronary artery walls and harden into a substance called plaque. As plaque builds on coronary artery walls, the artery narrows and hardens. 

Eventually, a serious blockage can occur and blood will not flow through the coronary artery properly. The blockage increases the risk that a blood clot forms and totally blocks the coronary artery (heart attack). 

You may be a candidate for coronary stenting if:

  • You have angina (chest pain) and shortness of breath with mild or moderate exertion. Angina and shortness of breath are symptoms of CAD.  
  • You have had a heart attack.
  • You have a coronary bypass graft that has closed or narrowed.
  • You have only one or two blocked or narrowed coronary arteries. If more coronary arteries are involved, your doctor may recommend coronary bypass grafting instead of coronary angioplasty and stenting.
  • Your doctor determines that the plaque will respond to coronary angioplasty and stenting and that it can be reached with a catheter.
  • Your symptoms do not respond to medications.
  • Your symptoms interfere with daily activities.

Who performs coronary stenting?

The following specialists perform coronary stenting.  

  • Cardiologists specialize in diagnosing and treating conditions of the heart and its blood vessels.
  • Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging. 
  • Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.

How is a coronary stenting performed?

Your coronary stenting will be performed in a cardiac catheterization laboratory, often abbreviated “cath lab.” A cath lab is a room in a hospital or clinic that has special X-ray machines and video screens. Your doctor uses this special equipment during your procedure. The procedure takes 30 minutes to an hour, but can take longer when combined with a coronary angioplasty. 

Coronary stenting generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.
  2. Your team will insert an intravenous (IV) line to provide fluids and medications.
  3. Your team will attach devices to monitor your heart rate, blood pressure, and other functions.
  4. You will have a blood test to verify normal kidney function and blood clotting.
  5. You will have a light sedative to make you drowsy and relaxed. Some patients have deeper sedation or anesthesia through the IV. In this case, you are more relaxed and unaware of the procedure and may not remember it. Doctors sometimes use general anesthesia.
  6. You will have medication to prevent blood clots from forming in your arteries. You may also have medications to prevent spasms in your arteries.
  7. Your doctor will determine the location to insert the catheter. The procedure team will shave and clean the area before your doctor numbs it and makes a small incision.
  8. Your doctor will insert a catheter and guide wire through the incision and feed it into the heart vessel that needs treatment. X-rays guide the wire to the exact location.
  9. Your doctor will inject a contrast agent through the catheter. The contrast agent improves the quality of the X-ray images.
  10. Your doctor will open or widen your coronary artery by inflating a balloon several times. After the artery is open, the balloon inflates again to expand the mesh-like stent. The stent forms a skeleton-like support that keeps the artery open.   
  11. Your team may take additional X-rays to verify that blood is flowing as expected. Your doctor will then remove the wire and balloon leaving the stent in place.
  12. You will need to lie with your leg or arm straight for six hours following the procedure. This decreases the risk of bleeding from the incision site.