CORONARY STENTS      

Often when patients come to the emergency room with chest pain and rule in by EKG or positive Cardiac Enzymes for having an acute myocardial infarction ( AMI ) they are whisked away to the cath lab for angioplasty to determine if the patients have any blocked coronary arteries.

There is an initiative developed by the American Heart Association that has hospitals working to decrease the time from admission to the Emergency Room, quick diagnosis of ischemia of the heart and transport to the cath lab.  It has been shown that the shorter this time is the better the outcome for the patient.  Often one will find that Emergency Rooms actually have a detailed plan in place for these kinds of patients, in order  to increase the effectiveness of the treatment to these patients and thus provide them with a better overall outcome.

While in the Cath lab the patient undergoes percutaneous transluminal coronary angioplasty ( PTCA ).  This is a procedure where a sheath is usually placed in the femoral artery, enabling the doctors to ascertain via a catheter-guided balloon, passed through this sheath, if there are any blockages in the many coronary arteries in the heart.  If there are any blockages that are able to be treated immediately this balloon opens the blocked artery and then a stent is placed in this blocked artery to keep the area open.  A stent is a wire-mesh tube that expands to hold the blocked artery open.  Upon discharge from the hospital the patient is given a card with information regarding this stent that they are instructed to keep with them at all times.  This enables the patient to be able to let other health care professionals that treat them to have information regarding the stenting the patient went through and also can be useful in airports as the stent is made of wire mesh.

Stent placement has now become the first choice of treatment for blocked coronary arteries.  It is considered a revascularization procedure and increases the blood flow to the heart muscle via the blocked arteries by opening them thus decreasing the possibility of either damage to the muscle, or increased damage if damage has already occurred.

There are mainly two types of stents.  Drug-eluding stents that are coated with medication that helps with preventing the reocclusion of the stent itself because of tissue growth at the area.  There are also stents that are not drug-eluding.

Removal of the sheath that was used to access entry to the heart with the balloon and stent is not a procedure without risk.  The sheath is in a large artery and there is always potential for bleeding.  The hospital where I work has a very detailed procedure for the d/c of the arterial sheath.  The nurse must be very attentive to the site where the sheath has been placed, assessing for development of any hematomas; and attentive to distal pulses to the distal extremity (usually the foot assessing the dorsalis pedis pulse/posterior tibial pulse) to make sure that blood flow to the extremity has not been blocked by the sheath or any complications caused in the area of the sheath.  Also monitoring vital signs closely is important as the bleeding can be internal causing what is called a retroperitoneal bleed.  This situation can be life threatening and prompt attention to a drop in blood pressure or a drop in the hemoglobin/hematocrit can potentially help save a patient’s life.

Other areas of this web site will address other aspects of coronary artery disease explaining the arteries of the heart where  stents may be placed and medications that the patient may be prescribed after receiving a stent to a coronary artery.

**Please keep in mind that this web site is an introduction to critical care nursing and does not subscribe to any specific mode of action that would be against the policy of the hospital where you work.