Drug-Eluding Medicated Stents

Why is the doctor performing this procedure?

To open up a coronary (heart) artery that is narrowed or blocked by plaque build-up (atherosclerosis), and to maintain that opening by permanently placing a metal stent within the heart artery. When the stent is coated with certain medications, the likelihood that the artery will remain open over time increases.

What is the procedure?

A stent is a mesh-like metal cylinder. A medicated stent is coated with medicine that decreases scar formation on the stent, which decreases the risk of the artery re-narrowing after stent placement (called restenosis).

Medicated stent placement is often part of a PTCA (angioplasty) procedure. As in angioplasty, a catheter is inserted into an artery— usually in the groin—but sometimes in the arm or wrist. The catheter is advanced to the heart, and a series of x-ray pictures (coronary angiogram) are taken to clearly visualize the heart artery that is narrowed. Then a balloon-tipped catheter is advanced to the heart, and into the narrowed coronary artery. Inside the artery, the balloon is inflated and deflated several times, compressing the plaque against the artery wall and widening the artery so blood flow improves. This balloon-tipped catheter is removed. A balloon-tipped catheter, with a medicated stent attached, is advanced to the narrow area that was just opened. The balloon is inflated, expanding the medicated stent into the inner layer of the artery. The balloon is removed, but the medicated stent stays in place, acting as a scaffold to keep the artery open. The inner lining of the artery will heal around the stent. The medication on the stent decreases scarring in the stent, helping to keep the artery open.

X-ray pictures are repeated, and if the medicated stent has been successfully placed, the catheters are removed. If your groin was used as an insertion site, the catheter and sheath may be removed when the procedure is done, or may be left in place for a while.  If the sheath is left in place, you must lie flat (keeping your let straight) until the sheath is removed. When the sheath is removed, pressure and/or a sealing device may be used to close the opening in the artery. A dressing will be placed over the insertion site. Pressure is applied to the puncture site (to stop bleeding) while the patient rests quietly.

Where is the procedure performed?

In the Cardiac Catheterization Lab.

How long does this procedure take?

Angioplasty with medicated stent placement usually takes 1-2 hours.