In the most basic sense, humans are wired for two settings: Worry and Don't Worry. All day we are quickly assessing things in our life and placing them on one of these two lists. A coronary angioplasty seems to fall right in between.
It's not a surgery (Worry) but it's more than a simple check-up or blood test (Don't Worry.) You probably know that implanting a coronary stent is remarkably safe and gets safer almost every year (Don't Worry), but the thought of being at the hospital for most of a day can be unsettling (Worry.) When an event in life is undefined, that's when it can cause apprehension.
To ease the anxiety over an upcoming angioplasty, we've created a chronological step-by-step guide for the day of your stent procedure. While we can't know everything that will happen, the vast majority of angioplasties follow a very similar script.
On the morning of your angioplasty or stent procedure you'll probably wake up in your own bed. That's because outpatient procedures have become common and are deemed to be as safe as staying overnight in the hospital. Dress comfortably, but leave jewelry at home. (Wear your hearing aids if you use them regularly.) Your doctor will have most likely asked you to avoid eating or drinking before the stent procedure. If you need to take some doctor-approved medication, do so with a small sip of water. Gather your regular medications into one bag and bring them with you.
At the Hospital
After some preliminary paperwork, you'll be taken to a prep room. This is where you will change into a gown and a nurse will clean and possibly shave the area where the catheter will be inserted. In the U.S., the stent procedure is most often done through the thigh, but the wrist is starting to be used more often and is the more popular choice in other countries. An intravenous line will be started and pain medication and a light sedative will be administered to make sure you are comfortable. You will then be placed on a gurney and taken to the catheterization lab (cath lab).
Four or five people will be present in the cath lab: the doctor, the doctor's assistant, a nurse, and one or two technicians who will operate the X-ray equipment. You will lie on a special table, with the sticky pads of an electrocardiograph placed on your chest. A local anesthetic will be applied to the entry site and, once numb, a needle puncture made in the skin.
A thin soft-tipped wire and catheter is inserted and guided through the artery—the doctor is following the path on the video X-ray—to the site of the blockage. A catheter is inserted and follows the wire to the blockage where dye is introduced to give the doctor a better view. (This image is called an "angiogram.") The dye might make you feel warm, and can possibly leave you with a metallic taste in your mouth or a slight headache, but these pass quickly.
The Main Event
A coronary angioplasty or stent procedure typically takes between 30 and 90 minutes, depending on how many stents are implanted and if any complications arise. You will be awake the whole time, although slightly sleepy from the sedative and pain medication. The doctor will be giving you some simple instructions during the process, such as "take a deep breath" or "cough."
Once the doctor has a clear picture of the obstructions, he will thread a second catheter, called a "balloon catheter" along the guide wire to the coronary artery. At the end of this catheter is a special balloon inside a metallic stent. When in place, the balloon is inflated and the stent expands, compressing the plague against the walls of the artery and creating an opening for blood to flow.
After gently retracting the catheter, the nurse will close the incision with a simple bandage. (It's too small to need stitches.) You will be taken to a recovery room to lie still while the blood vessels seal.
Nurses will monitor your heartrate and blood pressure as well as the incision (which may be sore for several days.) At this point you are allowed to eat or drink whatever you like. This recovery period is generally two to six hours.
After that, the angioplasty is officially over and the stent procedure can be happily filed into the Don't Worry category.