What are heart stents?
Heart stents are placed inside the artery at the area of blockage or weakness to decrease the blockage or strengthen the artery wall. Stents can be placed primarily or after balloon angioplasty. Most often, they are made of metal mesh. There are two types
of stents: bare-metal stent and drug-eluting stent. The latter are used more frequently and are coated with medication that helps keep a blocked artery open longer. The stent eventually becomes a part of the artery that it’s placed in.
Why are heart stents used?
Heart stents are often placed in a blocked artery during a percutaneous coronary intervention (PCI). They hold the artery open so blood can pass through freely. The goal of the stent is to reduce the chance of a heart attack (or another heart attack), to improve blood flow and possibly heart function.
When are heart stents used?
There’s no exact science about when a stent should be used and when it might be best to treat a narrowed artery with medication and lifestyle changes
instead. When a patient is having a heart attack and needs an interventional heart procedure like a percutaneous coronary intervention (PCI) or if the narrowing is so severe blood cannot pump through the artery, stent placement is often the only choice.
But if the narrowing is less severe, cardiologists and heart surgeons may recommend trying other treatments, such as diet changes, an exercise plan and
medicine before placing a heart stent.
PCI with heart stent implantation can help some people avoid more invasive procedures like coronary artery bypass graft (CABG) which is an open-heart surgery. Stents are more often used when people have one or two blockages that need attention, whereas
CABG is often the treatment of choice when there is severe blockage in multiple areas.
The American Heart Association reports that heart stent placement is as safe and effective for people over 70 years old as it is for younger people with coronary artery disease.
How are heart stents inserted?
The interventional cardiologist makes an arterial stick much like an IV, only larger. A sheath is placed. Through the sheath, catheters can safely be directed to the coronary artery. Once the artery is engaged by the catheter, balloons and stents can
be directed to the area that is blocked. Once placed, a stent does not move. During this procedure, one or more stents may be placed.
Benefits of stents
Stents can truly save your life. A stent helps keep your artery open, which improves blood flow through the heart. Improved blood flow helps prevent additional heart damage and can also prevent future heart attacks. A stent can also improve heart disease
symptoms, like chest pain and shortness of breath.
Stents were originally made of bare metal. They were good at keeping arteries open for a short time, but they weren’t great at keeping arteries from re-narrowing. About 25 percent of people treated with a bare-metal stent needed another procedure
in about six months.
Today, stents are coated with medication that helps interrupt the process of coronary artery re-narrowing. These are the drug-eluting stents mentioned earlier. Drug-eluting stents are about 90 percent effective at keeping arteries open, and they tend
to reduce the need for additional procedures, especially in people who have diabetes.
Drug eluting stents (DES) are made of a polymer drug coating that surrounds the stent struts and releases a drug that limits scar tissue growth that can re-block the artery, leading to in-stent restenosis. A new generation of DES is being developed with
bioabsorbable polymers with degrade over time and leave behind a bare metal stent.
Expected lifespan of the stent
Metal stents themselves will last for a lifetime; however, the usefulness of the stent may not continue, as re-blockage can occur despite the stent placement. The best way to improve the length of time a stent will work is to take steps to improve heart disease.
Recovery from angioplasty and stent placement is much faster than recovery from coronary artery bypass grafting (CABG). You will likely be discharged from the hospital within one to two days after your procedure, and is not uncommon to go home the same day depending on individual circumstances. Additionally, you may be able to return to work within a couple days after you return home.
Once you’re home, you may have some bruising near the incision site where the catheter was inserted. You may also have a small lump and mild pain or soreness at the site. You may also be quite tired for several days.
You should take it easy for the first three to five days. Don’t do any strenuous activities, including lifting, pushing, or pulling heavy objects. Talk to your doctor about what your activity level should be and when it’s safe to return to your normal activities. Whatever you do, don’t continue any activity that causes chest pain, fatigue, or shortness of breath.
If at any time you have chest pain that lasts more than 15 minutes, call 911 or seek immediate care at an emergency room.
Make sure you take all your medications as your doctor prescribed them, and follow all of your discharge instructions and doctor’s recommendations. It’s also important to work toward a healthier lifestyle. Making positive lifestyle changes will help your recovery and reduce your chances of having a heart attack or stroke. Your doctor may also recommend a cardiac rehabilitation program to help you get stronger and healthier.
If you had a heart attack that prompted the angioplasty and stent placement, your recovery will be slower.
Angioplasty and stent placement are now relatively safe procedures that tend to have good outcomes. Complications are rare, but may include:
- re-narrowing or re-stenosis
- formation of blood clots
- bleeding at the sound site
- an allergic reaction to the dye used to help visualize the arteries
- heart attack or stroke
- temporary kidney dysfunction
- the need for emergency bypass surgery if severe blockages are found
Types of doctors that perform these procedures
The doctors who perform angioplasty and heart stent placement are interventional cardiologists