What are stents and when are they used?

To understand what stents are and for what purpose they are used in surgical procedures, we first must understand what coronary artery disease and atherosclerosis are.

What is coronary artery disease?

Coronary artery disease develops when the arteries supplying blood to your heart (coronary arteries) become clogged, damaged, or diseased due to the build-up of cholesterol (plaque) and calcium deposits. Build-up of plaque causes the passageway of your arteries to narrow and block over time, reducing the blood flow to the heart muscles. This condition of coronary arteries hardening from cholesterol or plaque deposits in the inner walls is called atherosclerosis.

Symptoms

A cardiologist may suspect atherosclerosis if the patient suffers from symptoms similar to a heart attack or angina. These include:

• Crushing chest pain or a burning sensation in the chest
• Shortness of breath
• Pain in the shoulder or arms
• Sweating
• Neck or jaw pain (in women)

Surgical procedures to restore and improve blood flow

The first line of treatment for atherosclerosis or coronary artery disease is attempted through medication. However, more aggressive treatment may be required in cases when patients suffer from serious symptoms. They include:

• Coronary artery bypass surgery:

  The surgeon creates a graft from another blood vessel in the body to bypass the blocked coronary artery. Stitching the blood vessel above and below the narrowed or blocked artery allows blood to flow around it. This open-heart surgery is reserved for patients with multiple blocked coronary arteries.

• Angioplasty and stent placement (percutaneous coronary revascularisation):

  For the elderly or patients with other health conditions who cannot bear the strain of open-heart surgery, the minimally-invasive procedure known as percutaneous coronary revascularisation (PCI) or, simply, angioplasty with stents is employed. We will discuss this procedure in greater detail below.

What is angioplasty with stents and how is it used?

During a PCI or an angioplasty with stent placement procedure, the heart surgeon inserts a long, narrow tube (a catheter) into the blocked artery. Here, a metal mesh, also known as a stent, is passed along the tube with a deflated balloon to the blocked or narrowed area of the artery. The balloon is then inflated, pushing open the metal coil into the inner walls of the blocked artery. This pushes out the plaque causing the blockage against the inner walls and opens up the artery. In time, arterial tissue grows around the stent, keeping it in place.

Stenting technology is advancing continually, and now medicated stents are employed that release medication into the arteries that prevent the stent from narrowing and clogging from scar tissue at the site of the stent application.

When is stenting used?

A number of factors decide when stenting is to be used for a patient with coronary artery disease. They include:

• To improve blood flow immediately following a heart attack.
• Unlike coronary artery bypass surgery, stenting is ideal when there are just 1 or 2 blockages and they are minor.
• If the blockage is in one or more of the 3 major coronary arteries, stenting is not an option and a bypass surgery must be performed.
• For the elderly, stenting is recommended if medication is ineffective. Coronary artery bypass is generally not advised for elderly patients as they cannot bear the strain of the surgery.
• Stenting is not recommended for patients suffering from comorbidities such as diabetes, heart valve disease, kidney disease, peripheral arterial disease, a prior incident of heart attack, or stroke. For them, a coronary artery bypass is the best option.
• Patients with a weak heart or those in a frail condition cannot bear the strain of open-heart surgery. For them, a coronary artery bypass is not an option, and stenting is recommended.

Post-procedural care

To mitigate the increased risk of clotting in the operated artery after stenting, treatment with anti-platelet/ anti-clotting drugs and blood thinners is needed for a prescribed period. It is important that the patient understands the dosage and duration of the medication and that medication is not altered or stopped without consulting the cardiologist.

Do stents cure coronary artery disease?

Stents are not a cure for coronary artery disease and do not reduce its risks. The stent will simply prevent the blocked or narrowed artery from restricting blood flow to the heart for a certain period after the procedure.

To control coronary artery disease, risks such as smoking, hypertension, and high bad cholesterol (LDL) must be controlled. Lifestyle changes that include being physically active, maintaining a healthy diet and body weight, and not smoking can prevent plaque from building up in your arteries.

Recovery from an angioplasty with stents is usually quick and most patients can resume normal activities within days. Some patients may experience bruising, but that is temporary. Sagar Heart and Vascular Institute has the best cardiologists in Bangalore. Consult our cardiologists to have a clear understanding of the benefits and risks of stent implementation.