Coronary stent:
how it is placed and what happens afterward

Article written and reviewed by Dr Luca Moretti

A coronary stent is a small metal mesh structure that is expanded inside a coronary artery during angioplasty to keep a narrowed or occluded segment open. It is not implanted through open-chest surgery: the cardiologist reaches the coronary artery through a catheter introduced most often through the wrist and, in some cases, through the groin. The stents used today are generally drug-eluting, meaning they locally release a medication that reduces the tissue growth responsible for restenosis.
The stent improves blood flow in the treated segment, but it does not eliminate coronary artery disease or replace medications and prevention. After implantation, one of the most important aspects is taking the prescribed antiplatelet therapy correctly and not stopping it without medical advice.

After stent implantation, it is particularly important to:

• take antiplatelet drugs exactly as prescribed;
• not stop treatment before surgery or procedures without consulting your doctors;
• check the access site at the wrist or groin during the first few days;
• resume activity gradually according to the instructions received;
• continue treatment for cholesterol, blood pressure, and other risk factors;
• call emergency services immediately in the event of severe chest pain or pain compatible with a new ischemic event.

Stent implantation is one of the techniques used for myocardial revascularization. It may be performed urgently during a heart attack or electively when a coronary stenosis is considered responsible for ischemia or symptoms and PCI is an appropriate strategy.

How a coronary stent is placed

Coronary angioplasty, or PCI, begins in a manner similar to coronary angiography. After local anesthesia, a catheter is introduced through an artery and guided to the coronary arteries. A very thin wire is passed across the narrowing; the devices required for treatment are advanced over this wire. The stent is mounted on a balloon and, when it reaches the correct position, the balloon is inflated to expand the stent against the artery wall.
The balloon is then deflated and removed, while the stent remains permanently in the coronary artery. In many procedures, the cardiologist also uses intravascular imaging or other techniques to check the dimensions, expansion, and apposition of the stent, especially in more complex cases.

During balloon inflation, blood flow may be reduced for a few seconds and some people feel pressure or chest pain. The team continuously monitors the ECG, blood pressure, and clinical condition. In acute coronary syndromes, PCI aims to reopen the artery responsible for the event quickly; in chronic forms, it is used mainly when revascularization is indicated on the basis of symptoms, ischemia, anatomy, and patient characteristics.
Not every stenosis needs to be treated, and not every person with coronary artery disease benefits from the same strategy. The choice among medical therapy, PCI, and bypass surgery is made within the overall context of treatment of ischemic heart disease.

What happens in the hours and days after angioplasty

After the procedure, the catheter is removed and the access site is compressed or closed. It is normal to notice a small bruise or feel some tenderness in the area. After an elective uncomplicated PCI, some patients can be discharged the same day, while others stay overnight; after angioplasty performed for a myocardial infarction, the length of hospital stay depends on the extent of the event and clinical stability.
Before discharge, instructions are provided about the dressing, access site, physical activity, and medications. After radial access, significant effort with the affected arm should be avoided for a short period; after femoral access, restrictions may differ. The exact timing should follow the center's instructions.

Some fatigue during the first few days may be normal, especially if the procedure took place during an emergency hospitalization. In the absence of a heart attack or complications, the return to normal activities is often rapid; if the stent was implanted during an acute coronary syndrome, recovery depends mainly on the cardiac event rather than on the physical presence of the stent.
Persistent bleeding, rapidly increasing swelling at the access site, a cold or numb limb, fainting, or significant malaise require assessment. New, severe, or persistent chest pain, especially if similar to the pain that led to hospitalization, should be regarded as a possible emergency.

Medications after a stent: why antiplatelet drugs should not be stopped on your own

The surface of the stent is initially in contact with blood and can promote clot formation. To reduce this risk, antiplatelet therapy is prescribed. Many patients take two antiplatelet drugs for a period, the so-called dual antiplatelet therapy or DAPT, followed later by treatment with a single antiplatelet drug.
The duration is not the same for everyone. In chronic coronary syndromes after PCI, the standard strategy in European guidelines generally consists of aspirin plus clopidogrel for about 6 months; when bleeding risk is high or ischemic risk is low, a shorter duration may be chosen. After an acute coronary syndrome, the standard strategy generally remains DAPT for 12 months, but here too the cardiologist may shorten, modify, or extend treatment according to individual risk.

These durations are clinical reference points, not instructions for changing treatment on your own. Prematurely stopping one of the antiplatelet drugs can increase the risk of stent thrombosis, a rare complication that can nevertheless cause a severe heart attack. If surgery, an endoscopic procedure, or dental treatment with bleeding risk is necessary, the clinician performing the procedure must know that a stent is present and which medications are being taken.
In addition to antiplatelet drugs, statins and other medications may be prescribed to control blood pressure, heart rate, angina, diabetes, or ventricular function. The stent treats one segment of the artery, whereas preventive pharmacological treatment acts on overall cardiovascular risk.

Life after a stent: activity, follow-up, and the risk that the artery narrows again

The stent does not require mechanical maintenance and normally does not need to be replaced. With modern drug-eluting stents, the risk of restenosis, meaning renewed narrowing in the treated segment, is much lower than with the first devices but is not zero. A gradual return of angina weeks or months later therefore deserves assessment, without automatically assuming that the stent is the cause.
Stent thrombosis is different from restenosis: it is the formation of an acute clot inside or near the stent and may present as an acute coronary syndrome. Adherence to the prescribed antiplatelet therapy is one of the key measures for reducing its risk.

After an uncomplicated elective PCI, many people can gradually return to work and daily activities within a few days, whereas physically demanding jobs may require more time. If angioplasty was performed for a heart attack, the reference becomes the post-infarction recovery program and cardiac rehabilitation.
Stopping smoking, controlling cholesterol, blood pressure, and diabetes, following a heart-healthy diet, and maintaining appropriate physical activity remain necessary even when symptoms have disappeared. A stent treats a specific lesion; it does not make a person immune to progression of atherosclerosis elsewhere.

Frequently asked questions about coronary stents

Does the stent remain in the heart forever?
Yes. Once expanded in the coronary artery, the stent normally remains permanently in place and is progressively incorporated into the vessel wall.
How long does dual antiplatelet therapy last?
It depends on the reason for PCI and individual risk. As a reference, about 6 months is the standard after PCI for chronic coronary syndrome and 12 months after acute coronary syndrome, with the possibility of shorter or longer strategies decided by the cardiologist.
Can antiplatelet drugs be stopped before another procedure?
Not on your own. The decision must balance bleeding risk and thrombotic risk and, especially in the first months after stent implantation, may require coordination with the cardiologist.

Can you return to a normal life after a stent?
In most cases yes. After elective PCI, recovery is often rapid; after a heart attack, timing instead depends on cardiac damage, ventricular function, any complications, and the rehabilitation pathway.
Does chest pain after a stent mean it has closed?
Not necessarily. However, severe, persistent pain or pain similar to that of the heart attack requires urgent assessment because, although rare, stent thrombosis is an emergency.