Coronary artery stents are placed inside one or more arteries in the heart when a person with heart disease experiences chest pain or a heart attack. The American Heart Association reports that over 70 percent of people who undergo angioplasty, a procedure to open up blocked coronary arteries, receive stents. Shaped like small wire mesh cylinders, stents improve blood flow through blocked coronary arteries.
Bleeding
Karen Majorowicz, author of Acute Coronary Syndrome: An Overview for Nurses published in the February 2010 "Continuing Medical Education Resource," states that coronary artery stent complications frequently occur during the first 24 hours following placement. A serious complication following stent placement, bleeding may occur as a result of medications patients receive or from hemorrhage at the surgical puncture site. To place a stent, interventional cardiologists insert a catheter, like a large intravenous catheter, into a femoral artery and feed the catheter up into the heart. Following removal of the catheter the patient can bleed from the puncture site. Bright red arterial blood can be seen and/or a large hematoma, or bruise, forms around the insertion site.
Patients receive clot buster medications, blood thinners and drugs that prevent clot formation. The combination of drugs increases a patients risk for bleeding. Patients undergo baseline lab work to assess platelet count and hemoglobin. Lab is checked post procedure to monitor for blood loss and risk of hemorrhage.
Clot Formation
A clot can form at the catheter insertion site in the femoral artery occluding blood flow to the lower part of the leg. This poses a medical emergency and the clot needs to be removed either surgically or by pharmacologic agents. Clots may also form in the newly placed stent. Most stents have a special coating of an anti-inflammatory agent, such as a steroid, to minimize clot formation in the artery. The AHA states that, in addition to these drug-eluting stents, patients take blood thinners and clopidogrel to prevent clot formation. A stent can reocclude the first day post placement or up to a year after insertion.
Stroke
According to Donna D. Ignatavicius and Linda Workman, authors of "Medical-Surgical Nursing: Critical Thinking for Collaborative Care," coronary artery stent complications include strokes called cerebral vascular accidents. During stent placement into an artery plaque can break free and travel through the circulatory system and lodge in the brain. Symptoms such as weakness, confusion or altered speech present during the recovery period.
Renal Failure
Coronary artery stent placement occurs under fluoroscopy. Fluoroscopy uses radio-opaque dye to visualize the coronary arteries. Patients who have impaired kidney function, experience low blood pressure during or following the procedure, are dehydrated or suffer an allergic reaction to the dye can go into renal failure. Caregivers closely monitor urine output following stent placement.
References
- American Heart Association: Stent Procedures
- "CME Resource: Continuing Medical Education"; Acute Coronary Syndrome: An Overview for Nurses; Karen Majorowicz; February 2010
- "Medical-Surgical Nursing: Critical Thinking for Collaborative Care"; Donna D. Ignatavicius & M. Linda Workman; 2006
