Before stenting, patients will discuss their medical history with their physician and disclose any medications being taken. Certain medications may need to be discontinued or reduced at some point prior to the procedure. Aspirin may be recommended in order to help reduce the chance of blood clots forming at the stent site. Because local anesthesia is used, patients will be asked to refrain from eating and drinking after midnight before the procedure (patients with diabetes should consult with their physician regarding food and insulin intake).

The stenting procedure takes place in a catheterization laboratory, which is usually cool and softly lit. To the patient, the “cath lab” may resemble an operating room with its many monitoring devices, video displays and x-ray cameras.

The patient will lie down on a table under an x-ray camera. He or she will be given a mild sedative and remain awake but relaxed for the duration of the procedure. Once the patient is comfortable, heart monitoring begins, an intravenous line (I.V.) is established and the area where the sheath is to be inserted may be shaved, is sterilely prepped, and is locally anesthetized. The majority of stent procedures are performed via the femoral artery in the groin. However, the brachial artery in the arm or the radial artery in the wrist can be utilized as well.

The injection of the local anesthesia may result in a brief period of minor discomfort. This is normal and should be no cause for concern. An anticoagulant is then administered through the I.V. to prevent blood clot formation within the artery during the procedure. In selected stent procedures, the use of additional anticoagulants (e.g., intravenous antiplatelet drugs) has been shown to lower complication rates dramatically and possibly reduce restenosis. Statin drugs may also be recommended before stenting.

When the coronary arteries are being treated, the guiding catheter is advanced through the sheath to the heart and positioned near the origin of the coronary artery. The physician will inject dye (contrast medium) through the catheter. The dye can be seen on a special x-ray (fluoroscope) and serves as a road map for the procedure.

The physician and other attending medical staff may ask the patient to perform tasks such as coughing, turning the head, taking a deep breath or not speaking for a while. Throughout the procedure, heart rate will be monitored.

A guide wire is then passed through the catheter into the coronary artery and to the narrowing of the coronary artery. In most cases, the physician then performs a balloon angioplasty.

The stent is next carried to the site on a balloon-tipped catheter. The balloon is inflated for several seconds to several minutes, expanding the stent, which adheres to the wall of the artery. The balloon catheter is removed while the stent remains permanently fixed to the artery. Approximately four to six weeks after the stent is inserted, it will become completely covered by a thin layer of arterial tissue. The length of time this takes depends on the type of stent that is used. For example, bare metal stents may take a few weeks while drug eluting stents appear to take several months, which is felt to be a possible cause of late thrombosis.