Peripheral Stent Implantation

A stent is a tiny tube that is inserted into a blocked passageway to keep it open.

A stent is a mesh wire which acts as a scaffolding to keep an artery open to ensure blood flow.

A blocked artery can occur anywhere in the body. Blockages are due to the formation of fatty plaques known as atherosclerosis. When this plaque ruptures, a clot will form leading to further obstruction of the artery. When this condition affects the peripheries vessels it is known as peripheral vascular disease.

Most blockages are treated with balloon angioplasty and stenting. Angioplasty is the stretching of an artery to widen it, followed by stent placement. This is known as percutanteous transluminal angioplasty (PTCA).

Since the restenosis (re-narrowing) rate is high in angioplasty, a stent is often placed to ensure blood flow through the artery.

Peripheral stents come as bare metal stents.

As plaque builds up in the arteries, it becomes more difficult for blood to reach the body’s tissues. When the tissue is deprived of the oxygen rick blood it needs, symptoms may occur.

If taking anticoagulants such as Coumadin, you may be asked to stop 5 days before the procedure.

If you are diabetic and taking oral medications, you may be asked not to take it the morning of your procedure. If you are taking insulin, you may be asked to take half the dose you normally take.

Avoid using any medications used for erectile dysfunction including Viagra, Cialis, and Levitra) 4 days before the procedure.

Check with Dr. Jamnadas several days before the procedure to determine which medications you may need to stop.

The procedure will be carried out at the hospital in the Cardiac Catheterization Laboratory (Cath Lab).

During the procedure you will lay awake on a table on your back.

Several electrodes will be attached to your arms, legs, and chest. These electrodes have leads that will connect to an electrocardiogram (EKG) machine that records the electrical activity of the heart throughout the test.

An I.V. will be inserted into your arm or hand. From this I.V. a sedative will be given to you to help you relax.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the catheter will be inserted. The catheter can be inserted either into the radial (wrist), brachial (inside your elbow), carotid (neck), or most commonly the femoral (groin) artery.

Image from CVI’s on-site Cath Lab

Illustration of the radial approach for catheterization.

The radial approach may be better suited for you rather than the femoral approach for the following reasons:

A small incision is made in the skin, and a needle is used to enter the artery. A guide wire is threaded into the artery. A short plastic tube known as a sheath is slipped over the guide wire and into the artery.

The guide wire is then removed. Once the sheath is in place, the catheter can be inserted.

Bare metal stents act as a scaffolding to keep an artery open, but suffer from a 30-40% restenosis rate. This is due to a process called intimal hyperplasia which is attributed to a keloid. A keloid is an overgrowth of the inner lining of the blood vessel that covers over the stent. However, this reparative process lasts no more than 6 minutes. After 6 minutes, if an artery has not re-narrowed at the site of the stent, it is unlikely to re-narrow.

Restenosis is the recurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow.