Placing a coronary stent is a minimally invasive procedure that takes about one to two hours. A cardiologist threads a thin tube through a blood vessel in your wrist or upper thigh, guides it to the blocked artery in your heart, and expands a tiny mesh scaffold to hold the artery open. You’re typically awake the entire time.
Where the Catheter Goes In
The procedure starts with the cardiologist inserting a small hollow tube called a sheath into one of two access points: the radial artery in your wrist or the femoral artery near the top of your thigh. The wrist approach has become the preferred option at most hospitals. A study comparing the two found that wrist access produced zero bleeding complications at the insertion site, compared to 4% with the thigh approach. Patients who had the wrist approach also went home sooner, averaging 3 days total in the hospital versus 4.5 days for those with thigh access.
A large meta-analysis of seven major trials found that wrist access reduced the risk of major bleeding by 51% and vascular complications by 62% compared to thigh access. Your cardiologist may still choose the thigh if your wrist arteries are too small or if the anatomy of the blockage requires it, but for most people the wrist is the default.
Step by Step Inside the Artery
Once the sheath is in place, here’s what happens next:
- Catheter insertion. A long, flexible tube (the catheter) is threaded through the sheath and advanced through your blood vessels until it reaches your heart.
- Imaging the blockage. A contrast dye is injected through the catheter, and the cardiologist uses real-time X-ray imaging called fluoroscopy to see exactly where the artery is narrowed or blocked. The dye makes your blood vessels visible on the screen.
- Balloon inflation. A tiny balloon at the tip of the catheter is positioned inside the narrowed section and inflated. This compresses the plaque against the artery wall, widening the opening. You may feel mild pressure or discomfort when this happens.
- Stent deployment. The stent, a small wire mesh tube wrapped around the balloon, expands as the balloon inflates and locks into place against the artery wall. When the balloon is deflated and withdrawn, the stent stays behind as a permanent scaffold.
- Final check. More contrast dye is injected and additional images are taken to confirm blood is flowing freely through the stent. In some cases, the cardiologist uses intravascular ultrasound, a tiny imaging probe inside the artery, to verify the stent is fully expanded and properly positioned.
Fluoroscopy alone works well for most stent placements, but ultrasound guidance becomes especially important for tricky locations like where arteries branch. One trial found that using this additional imaging significantly reduced the rate of problems at the stent site compared to relying on X-ray alone.
What You Feel During the Procedure
You receive sedation to help you relax, but most people stay awake throughout. The level of sedation varies depending on your health and the complexity of the procedure. In some cases, general anesthesia is used, though this is less common. You’ll feel pressure at the insertion site in your wrist or thigh, and possibly a brief ache when the balloon inflates inside the artery. The catheter itself moving through your blood vessels is something you generally don’t feel.
Bare-Metal vs. Drug-Coated Stents
All stents work as mechanical scaffolding, physically propping the artery open. The key difference between the two main types is what happens in the months after placement.
Bare-metal stents are simple mesh tubes with no coating. They hold the artery open effectively, but the body sometimes responds by growing new tissue over the stent, gradually re-narrowing the artery. This is called restenosis.
Drug-coated stents (also called drug-eluting stents) are wrapped in a thin polymer layer that slowly releases medication to suppress this tissue regrowth. The drugs used all belong to a family of compounds that slow cell proliferation. These stents have largely replaced bare-metal ones for most patients because they significantly reduce the chance of the artery narrowing again.
How Successful the Procedure Is
For standard blockages, the procedure restores blood flow in the vast majority of cases. Even for the most challenging type of blockage, a complete chronic occlusion, dedicated specialists achieve procedural success rates above 90%. Serious in-hospital complications are rare, occurring in roughly 0.5% of cases in large studies. For more typical, less complex blockages, success rates are higher still.
Recovery and Getting Back to Normal
Most people return to normal activity and work within a few days to a week. If the catheter went through your wrist, you can usually walk around the same day. With thigh access, you’ll need to lie flat for several hours afterward to let the insertion site close properly, which is one reason the hospital stay tends to be a bit longer.
The insertion site may be sore or bruised for a few days. Your care team will tell you when it’s safe to lift heavy objects or exercise again, which depends on which access point was used and how complex the procedure was.
Medications After a Stent
After a stent is placed, you’ll take two blood-thinning medications together to prevent blood clots from forming inside the stent. This combination therapy is critical because a clot forming on the stent (stent thrombosis) can cause a heart attack. The typical duration depends on your situation.
For people who received a drug-coated stent for stable heart disease, guidelines recommend this dual therapy for 6 to 12 months. If the stent was placed during a heart attack or acute episode, the recommendation is at least 12 months. Studies comparing shorter courses (3 to 6 months) against 12 months found no significant difference in death rates or stent clotting for newer-generation stents, so your cardiologist may adjust the timeline based on your bleeding risk. After the dual therapy period ends, most people continue taking a single blood thinner long term.
Preparing Before the Procedure
You’ll receive specific instructions about when to stop eating and drinking before your scheduled procedure, along with guidance on which medications to take, skip, or adjust. If you take blood thinners or diabetes medications, these often need to be modified in the days leading up to the procedure. The details vary by hospital and by your individual health profile, so follow the instructions your care team gives you.