A stent is a tiny mesh tube that is inserted into a blocked or narrowed artery to keep it open and improve blood flow to the heart muscle. Stents are commonly used to treat coronary artery disease and chest pain (angina). Some people wonder if getting a stent will hurt. This article provides an overview of how stents work, the stent procedure, potential side effects like chest discomfort, and what kind of pain medications are used to make stent placement more comfortable.
What is a stent and how does it work?
A stent is a small, expandable, metal mesh tube that a cardiologist inserts into a blocked coronary artery during a procedure called angioplasty. The tube acts as a scaffold to keep the artery open. This allows blood to flow freely again, oxygenating the heart muscle and relieving symptoms of coronary artery disease like angina.
There are two main types of stents:
Bare metal stents
These are made of stainless steel mesh. They help hold the artery open but don’t release any medication.
These stents are coated with medications that help prevent the artery from becoming blocked again. The coating slowly releases the medication over time.
During angioplasty, the cardiologist will first thread a long, thin tube called a catheter through a blood vessel, often in the leg or wrist. The catheter is threaded up to the site of the blockage. A tiny balloon is then inflated at the blockage to push the plaque outward against the artery wall. This compresses the plaque and widens the artery. The stent is then positioned over the inflated balloon and expanded. It remains in the artery permanently to prop it open.
Over time, the artery lining grows over the mesh so the stent is incorporated into the artery wall itself. The procedure restores blood flow to the heart muscle.
Does a stent procedure hurt?
Many people wonder if they’ll have pain or discomfort during a stent procedure. Here’s an overview of what to expect:
During the procedure
You’ll be awake but sedated. The cardiologist will numb the area in your wrist or groin where the catheter is inserted. You may feel some pressure or minor discomfort when the catheter is threaded up to your heart. However, you shouldn’t feel any significant pain. Tell your doctor right away if you have pain so they can provide more sedation medication.
When the tiny stent is expanded, you may feel some minor chest pain or pressure. But again, you shouldn’t have severe pain because of the sedation medications given. Any discomfort is temporary during the procedure itself.
After the procedure
It’s common to have some mild chest discomfort, tightness or pain for a day or two after the stent placement. This is because the artery wall was stretched and the plaquecompressed during the procedure.
Your doctor may recommend over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as needed.
Ongoing chest pain
In some cases, people may continue to have angina type chest pain even after the stent procedure. This might mean there are remaining blockages in the arteries that could need treatment.
But in many cases, ongoing discomfort after stent placement has a different cause:
– Inflammation from irritation of the artery lining during the procedure. This usually gets better within a few weeks.
– Small tears or damage to the artery walls from the angioplasty balloon inflation. Again, this often improves with time.
– Spasms of the artery walls. The walls may go into periods of tightening (vasospasm) and relaxation after the trauma of angioplasty.
– The heart muscle being hypersensitive after the restored blood flow. This is called reperfusion injury. The discomfort typically decreases over 2-4 weeks.
If chest pain persists more than a month after the stent, talk to your cardiologist. You may need medications to treat spasms or hypersensitized nerves. Very rarely, the stent itself can cause pain needing further intervention.
What pain medications are used before, during and after stent placement?
Doctors use various medications to minimize any pain and make you comfortable during the stent procedure:
Before the procedure
You may get medications to help you relax when you arrive at the hospital, such as:
– A benzodiazepine like lorazepam (Ativan) or alprazolam (Xanax) – reduces anxiety
– Diphenhydramine (Benadryl) – relieves nervousness and helps you relax
During the procedure
The cardiologist will use a local anesthetic to numb the insertion site area. This prevents any pain when the catheter is inserted.
You’ll also be given mild sedation through an IV line, usually with these medications:
– Midazolam (Versed) – provides sedation
– Fentanyl – a narcotic pain reliever
– Propofol – sedation medication
The doctor can give more medication if you have any discomfort.
After the procedure
If you have chest discomfort when you wake up, you may get:
– Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for mild pain
– Nitroglycerin tablet or paste – dilates coronary arteries
– Opioid pain medication like oxycodone (Percocet) for more severe pain
Most of the anesthetic and sedation medications wear off within hours after the procedure. Drink plenty of fluids to help flush them from your system.
While individual experiences vary, most people have minimal pain during coronary stent placement due to sedation and pain medication. Some people may have mild chest discomfort for a short time after the procedure as the artery heals. Ongoing intense pain is uncommon. Talk to your doctor if you have any concerns about feeling comfortable before, during or after getting a heart stent.