Coronary Stent Implantation
The procedure of coronary stent implantation (or PCI – percutaneous coronary intervention) is a treatment option in the management of coronary artery disease. Also known as ischemic heart disease, this condition involves the build-up of plaque in the arteries of the heart, leading to reduced blood flow through the heart.
It’s one of the most common heart conditions, and its symptoms often present as stable angina - recurring exertional chest pain (or breathlessness) and a feeling of uncomfortable pressure in the chest. In some instances, where there has been a limited response to medical therapy or due to the location of disease, I would recommend coronary angiography and perform coronary stent implantation if appropriate.
However, it’s important to clear up some misconceptions about this procedure.
Stent implantation is all about improving your symptoms and quality of life. One of the most common misconceptions about coronary stent implantation in stable disease (as opposed to heart attacks) is that stents cure the furrings of arteries, prevent further heart attacks, and make you live longer. That’s not necessarily the case.
Rather than solve those issues, the aim of stent implantation for stable angina is to improve recurring symptoms, make you feel a lot better, and reduce the amount of medication needed to cope with angina.
You may read alarming things in the newspapers and see conflicting information, or read stories that apply to different people in different situations. So I aim to clarify things for you specifically, so we can give the best treatment for you.
I perform a lot of procedures and interventions, but I devote a lot of my time explaining the pros and cons of the interventions, addressing any concerns and managing expectations.
So I might actually recommend against stent implantation, depending on your circumstances. But if we decide that you would benefit from such an intervention, and you’re in agreement, you’d be booked in to hospital for a day case procedure.
Firstly, I'd spend a good part of our initial appointment explaining what the concerns are about your condition and its treatments, what the investigations are for and why we do them, and what the resultant action will be depending on their outcome.
Before embarking on a procedure, we'll spend some time exploring a few concepts. Firstly, why it is that we do this procedure and not something else, and how this fits in with your overall management plan including medical therapy and lifestyle modifications. That’s important to clarify, especially if you’re worried or were expecting a different course of action.
We’ll talk about what the benefits are from a stent implant, and how they might improve your quality of life. We’ll also explore what the risks are, both in general and specifically for your condition; and finally, what the alternatives are to stent implantation - there may be other options available. Stent implantation might be the right choice for you, but I’ll always go through what the other alternatives could be, so we have all the possibilities covered.
We’ll cover everything else including the ‘if's, 'but's, 'what if's and 'when's, so there are no surprises, and you always know what to expect further along the journey.
On the day of the procedure, you’ll arrive at the hospital first at the specified time. You’ll have some routine observations performed and final checks to ensure that you are still agreeable to the procedure (consent) and that you are being treated with the correct medications.
The procedure itself will be performed under a local anaesthetic for your comfort (which means you’ll be awake for the procedure but won’t feel pain) and is achieved by inserting a small plastic tube, called a catheter, into the wrist that facilitates the advancement of wire, balloons and stents into the heart arteries. We use an x-ray video device to monitor its progress.
The stent is a short tube made of wire mesh. When it’s in place, a very small balloon in it is gently inflated, so the stent widens the artery. The balloon is then deflated and removed. The stent is then left in place permanently to help the blood to flow more freely through the arteries.
The procedure normally takes an hour or so and is not unduly uncomfortable.
Immediately after the procedure, you should be able to sit up, rest for a short while, and you’d hope to be on your way home within four hours of the process.
You’d also be able to eat and drink straight afterwards, too, so you won’t have to go without for too long at all. The only thing I’d recommend during the following week is to avoid strenuous activities like heavy lifting or exercise.
I’d then follow up in a few weeks with you afterwards to see how you’re feeling and how you’ve recovered. This would ideally be in person but can also be done over the telephone.
We’d also review your medications and ongoing management of your condition, to see how they’re working for you. This helps to reduce the risk of further recurrences of your condition, and improve the process of your recovery. If there are any issues, I’d take this opportunity to recommend further courses of action. Should all be well, you can be on your way, getting back to your usual routine with a much-improved quality of life.