«Table of Contents Coronary Artery Disease (CAD) Your Heart What is CAD? What are the Symptoms of CAD? What are the Risk Factors of CAD? How Can My Doctor Tell if I Have CAD? .8 Your Treatment Options ...»
After the catheters are inserted, your doctor will inject a contrast dye through the guiding catheter into your artery to view the narrowing. Your doctor will watch the injection on an X-ray monitor, much like a TV screen. While these X-rays are being taken, your doctor may ask you to take a deep breath and hold it for a few seconds. You may also be asked to cough after the X-ray picture is completed, to help speed the removal of the contrast dye from the arteries.
Using the guiding catheter, a balloon catheter is positioned in the narrowing in the coronary artery and the balloon is then inflated. This compresses the plaque and widens the coronary artery. This procedure is called pre-dilatation.
The stent mounted on a balloon catheter is delivered to the narrowing in the coronary artery by a delivery catheter.
The balloon is then inflated and this expands the stent, pressing it against the coronary artery wall.
Your doctor may choose to expand the stent further, by using another balloon so that the stent can make Step 2 better contact with the artery wall. This is known as post-dilatation.
Once in place, the XIENCE stent will remain as a permanent implant in your coronary artery.
Immediately after Procedure You will be asked to lie flat for four to six hours following the procedure and to not bend your leg or arm, depending on which area your doctor used to insert the catheters. Pressure will also be placed on the area.
A vascular closure device may be used to seal the incision site in your groin or arm. You will be allowed to get up and walk around sooner if this type of device is used. Your hospital stay may range from one to three days.
Medications will be prescribed for you before and after stent placement. Antiplatelet medications such as aspirin and thienopyridine medications (such as Plavix or Effient) are the most commonly prescribed.
They help prevent a blood clot (thrombus) from forming and blocking the stent lumen. Your doctor or nurse will give you instructions about your medications before you leave the hospital.
CAUTION: If you have any chest pain, or discomfort or bleeding from your incision site, call your doctor immediately. If your doctor is unavailable, call for an ambulance to take you to the nearest hospital emergency room.
40 Your Drug-Eluting Stent Procedure (continued) Take All Medications as Instructed After you leave the hospital, your cardiologist will instruct you to take a daily dose of aspirin and another antiplatelet drug such as Plavix or Effient.
Your doctor will tell you how long you should continue taking the antiplatelet drugs. It is very important that you take these medications exactly as
your doctor instructs you:
• Follow your medication schedule exactly to avoid possible complications after you receive your stent. Do not miss any doses.
• Call your doctor if you cannot keep taking your medications because of side effects such as rash, bleeding, or upset stomach.
• CAUTION: Do not stop taking your prescribed medications unless you are instructed to do so by the doctor who performed your stent procedure.
• CAUTION: Notify your cardiologist or family doctor if you are scheduled to see the dentist while on antiplatelet medication. Your doctor may prescribe antibiotics to avoid the potential of an infection. You should review with your doctor any recommendations from your dentist to stop your prescribed medications.
41Your Drug-Eluting Stent Procedure(continued)
• CAUTION: Before undergoing implantation of a drug-eluting stent, if you plan to have any type of surgery that may require you to stop taking antiplatelet medications, you and your cardiologist should discuss whether or not placement of a drug-eluting stent is the right treatment choice for you.
If surgery or dental work that would require you to stop taking antiplatelet medications is recommended after you have received the stent, you and your doctors should carefully consider the risks and benefits of this surgery or dental work versus the possible risks from early discontinuation of these medications.
If you do require discontinuation of antiplatelet medications because of significant bleeding, your cardiologist will carefully monitor you for possible complications. Once your condition has stabilized, your cardiologist may put you back on these medications.
42Your Drug-Eluting Stent Procedure(continued)
Follow-up Care You will be discharged to the care of your cardiologist or family doctor. You should be able to return to your normal activities soon.
CAUTION: Notify your doctor immediately if you experience chest pain (angina), or notice any changes such as more severe or frequent chest discomfort, especially in the first month after a procedure. These symptoms may indicate a re-narrowing in your coronary arteries.
Your doctor will ask you to return for follow-up visits. The first visit is usually two to four weeks after your stent is implanted, with follow-up visits every six months for the first year. Be sure to keep all appointments for follow-up care, including blood tests.
43Your Drug-Eluting Stent Procedure(continued)
Keep Your ID Card Handy CAUTION: Show your identification card if you report to an emergency room. This card identifies you as a patient who has had a stent implanted.
If you require a magnetic resonance imaging (MRI) scan, tell your doctor or MRI technician that you have a stent implant. Test results indicate that XIENCE stents are MR conditional. Patients with single or overlapped XIENCE stents can undergo
MRI scans safely under the following conditions:
• Static magnetic field of 1.5 or 3 Tesla • Spatial gradient field of 2500 Gauss/cm or less • Maximum whole-body-averaged specific absorption rate (SAR) of 2.0 W/kg (normal operating mode) for 15 minutes of scanning for each sequence.
The stent(s) should not migrate in this MRI environment, and MRI may be performed immediately following the implantation of the XIENCE stent(s). Prior to undergoing an MRI scan, inform your doctor that you have a XIENCE stent.
44 Preventing CAD
Coronary artery disease can be treated effectively, but it has no cure. You can help to prevent your coronary artery disease from progressing by carefully following your doctor’s advice. Your doctor may prescribe medications to help control your blood pressure, diabetes, and / or high cholesterol. Your doctor may also recommend some lifestyle changes.
Among the healthy choices you can make:
Stop smoking. If you smoke, quitting is the single most important thing you can do to lower your risk of coronary artery disease. Chemicals in cigarette smoke may make it easier for plaque to build up on your artery walls. And smoking increases your heart rate and blood pressure, raising your risk of heart attack and stroke. If you are ready to quit, ask your doctor for advice – he or she can recommend smoking cessation aids to help you quit.
Increase your activity and eat a healthy diet. A sedentary lifestyle increases your risk. Your doctor can recommend an activity program tailored for your situation. Regular exercise can help you lower your blood pressure and blood cholesterol and reach a healthy weight. It can also help you manage the daily stresses of modern life more easily. Choose a healthy diet. A diet low in saturated fats and 45 Preventing CAD (continued) cholesterol, and rich in lean protein, fresh fruits, vegetables, and whole grains, can help you achieve a healthy weight, as well as help you control your blood pressure, and cholesterol levels.
Manage your stress. Stress is an inescapable aspect of modern day living, but you can help lessen its negative health effects by practicing the “relaxation response.” Research has shown that relaxation techniques can improve your ability to cope with stressful events while decreasing your heart rate, blood pressure, and stress hormone levels.
46 Frequently Asked Questions How long will the stent stay in my body?
Stents are designed to stay in your body permanently.
What are the restrictions or cautions after I’ve received a stent?
If you require magnetic resonance imaging (MRI), tell your doctor or MRI technician that you have an implanted stent.
When can I resume my regular activities?
Your doctor will advise you. Many patients can return to work and follow their normal routine about a week after their stent procedure.
Will my stent set off the metal detector at airport security checkpoints?
No, your stent implant will not trigger alarms at security checkpoints.
Will I be able to feel the stent inside me?
No, you will not be able to feel the stent once it has been implanted in your artery.
Could I have recurring symptoms?
Yes, it is possible that you will experience symptoms again, either due to a new blockage in the region treated with the stent or due to a blockage at another place in your coronary arteries. Your doctor will monitor your progress.
How can I help prevent a recurrence of symptoms?
While there is no sure way to prevent a recurrence of symptoms, you can reduce the risk through exercise, not smoking, and eating a healthy diet. Your doctor can advise you about lifestyle changes.
Angina: Chest pain caused by inadequate supply of blood to the heart.
Angioplasty (also referred to as PTCA): A minimally invasive procedure in which a balloon dilatation catheter is passed through to the blocked area of an artery. Once inflated the catheter compresses the plaque against the blood vessel wall and enlarges the vessel opening. An angioplasty can also be performed with placement of a stent.
Anticoagulant: A medication to prevent or slow the clotting of blood.
Antiplatelet: A substance to reduce clumping of platelets in the blood. An antiplatelet medicine helps thin the blood to prevent clot formation.
Atherosclerosis: A disease that causes narrowing or blockage of arteries caused by a build-up of fat (cholesterol) within the artery wall. The build-up is sometimes referred to as “plaque.” Cardiac Catheterization Laboratory (Cath Lab): A sterile X-ray theater in which heart catheterization is performed.
49Definition of Medical Terms(continued)
Catheter: A thin, hollow, flexible tube used to access the coronary arteries during an angiogram or during an angioplasty procedure. This catheter can be used to inject medication, fluids, or contrast dye during your procedure. Catheter is also used to describe the device used to deliver the balloon or stent during an angioplasty procedure.
Coronary Angiography (or Heart Catheterization or Cardiac Cath): A test in which contrast dye is injected to create images of the coronary arteries and the chamber of the heart. This allows the doctor to see the extent of the disease in the coronary arteries and make a decision on how to best treat the blockages.
Coronary Arteries: The blood vessels that carry oxygenated blood from the aorta to the heart muscle. There are four major coronary arteries: the left main, the right coronary artery, the left anterior descending, and the circumflex.
Coronary Artery Bypass Graft Surgery (CABG):
Open-heart surgery to treat CAD.
50Definition of Medical Terms(continued)
Coronary Artery Disease (CAD): The formation of blockages or atherosclerotic plaques within coronary arteries that result in restricted blood flow to the heart muscle.
Electrocardiogram (ECG / EKG): A test that records changes in the electrical activity of the heart.
An ECG / EKG may show whether parts of the heart muscle are damaged due to decreased blood flow to the heart muscle.
Femoral Artery: The main artery of the thigh, supplying blood to the leg.
Fluoroscope: An X-ray device that creates an image of the body that can be viewed on a TV monitor. This permits the doctor to obtain real-time images of the internal structures of a patient.
In-stent Restenosis: Recurrent blockage or narrowing of a previously stented vessel.
Local Anesthetic: A substance used to numb the area to which it is applied.
Lumen: The inner channel or cavity of a vessel or tube. In a blood vessel, it is the opening through which blood flows.
51Definition of Medical Terms(continued)
Myocardial Infarction (MI): Also called a heart attack. Permanent damage of an area of the heart tissue, due to interruption in the blood flow to the heart muscle (myocardium).
Magnetic Resonance Imaging (MRI): A noninvasive diagnostic procedure used to obtain images of internal body structures through the use of magnets and radio waves.
Percutaneous: Performed through the skin.
Plaque: An accumulation or build-up of fatty deposits, calcium, white blood cells, and other substances in the wall of an artery that results in narrowing of the vessel lumen.
Restenosis: A recurring blockage caused by the excessive growth of scar tissue inside the artery or stent, following an interventional procedure such as angioplasty.
Stent: A metallic mesh tube that is implanted into an artery during an angioplasty, providing a scaffold to help hold the artery open, ensuring blood flow to the heart muscle.
Transluminal: Through the inside opening of a vessel or artery.
This product is intended for use by or under the direction of a physician. It is important to read thoroughly the instructions for use, warnings, and potential complications associated with the use of this device.
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