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What is a coronary Stent Procedure and how is one used?

coronary Stent Procedure uses a wire mesh tube (a stent) to prop open an artery that has recently been cleared using angioplasty. The stent is collapsed to a small diameter, placed over an angioplasty balloon catheter and moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a rigid support to hold the artery open. The stent remains in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain).

What's a stent ?

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Stents are metal mesh tubes inserted after an angioplasty into an artery that has become partially or completely blocked. Stents help prevent restenosis — when the artery becomes blocked again. Without the use of stents, about 30 percent of arteries become blocked again.

There are two basic kinds of stents: bare-metal stents and drug-eluting stents : -

Bare-metal stents :-

as the name implies, are metal stents with no special   coating. Bare-metal stents act as simple scaffolding to prop open blood vessels   after they are widened with angioplasty. As the artery heals, tissue grows   around the stent holding it in place. However, sometimes an overgrowth of this   scar tissue in the arterial lining increases the risk that the artery will become   blocked again, hence the invention of the drug-eluting stent.

Drug-eluting stents :-

are coated with medication that is slowly released (eluted)   to help prevent the growth of scar tissue in the artery lining. This helps the   artery remain smooth and open, assuring good blood flow through it.   Drug- eluting stents were developed because in about 20 percent of those   who get bare-metal stents, tissue growth over the stent eventually leads to   re- blockage. Drug-eluting stents reduce this risk to less than 10 percent, and   less than 5 percent of people need repeat procedures.

Millions of people with heart problems have been successfully treated with drug-eluting stents, preventing the need for more-invasive procedures such as coronary artery bypass surgery. The reduced risk of re-narrowing from drug-eluting stents minimizes the need for repeat hospitalization and repeat angioplasty procedures — each of which carry some risk of complications including heart attack and stroke.

When are coronary Stent Procedure used ?

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The stent procedure is fairly common, sometimes used as an alternative to coronary artery bypass surgery. A stent may be used as an alternative or in combination with angioplasty. Certain features of the artery blockage make it suitable for using a stent, such as the size of the artery and location of the blockage.

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What are the advantages of using a coronary Stent Procedure ?

In certain selected patients, coronary Stent Procedure have been shown to reduce the renarrowing that occurs in 30-40 percent of patients following balloon angioplasty or other procedures using catheters. Stents are also useful to restore normal blood flow and keep an artery open if it has been torn or injured by the balloon catheter.

Can stented arteries reclose ?

Reclosure (restenosis) is also a problem with the coronary Stent procedure, but at a rate lower than baloon angioplasty alone. In recent years doctors have used stents covered with drugs that interfere with changes in the blood vessel that encourage reclosure. These new stents have shown some promise for improving the long-term success of this procedure, and may become available soon.

What precautions should be taken after a coronary Stent Procedure ?

After a stent procedure has been done, a patient must take one or more blood thinning agents such as aspirin, Ticlopidine and/or Coumadin. Aspirin is used indefinitely; the other two drugs are used for four to six weeks. Ticlopidine and Coumadin can cause side effects, so blood tests will be performed often. For four to six weeks after a coronary Stent Procedure it is necessary to take antibiotics for any minor surgical procedure (such as a dental cleaning). Also, for the next six to eight weeks a magnetic resonance imaging (MRI) scan should not be done without a cardiologist’s approval. However, metal detectors do not affect the stent.

Can having a stent cause problems later?

To date there is no evidence of long-term complications from having a permanent stent.

Do drug-eluting stents increase risk of heart attacks ?

An FDA advisory panel found that when drug-eluting stents are used "on-label" — meaning for specific situations approved by the FDA — there was no increased risk of heart attack or death with drug-eluting stents compared with bare-metal stents. However, about 60 percent of the time stents are used for "off-label" indications — meaning for reasons that, while appropriate, are not specifically spelled out in the FDA guidelines. When stents are used off-label, it's generally for more-complex cases, such as in someone who has multiple blockages and other complications.

The FDA panel said when drug-eluting stents are used off-label, there's a small but increased risk of blood clotting that can lead to heart attack and death. But, it's unknown if drug-eluting stents cause this increased risk or whether people in this group tend to be at higher risk in the first place.

There are a variety of potential explanations for blood clots developing later after implantation. Much of it may have to do with how long a person takes anti-platelet medications — aspirin, clopidogrel (Plavix) — which help prevent blood clots from forming in the stents. If these medications are stopped earlier than recommended or an individual doesn't have an effective response to the anti-clotting medications, there can be problems. People also have varying healing times.

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It's worth remembering that you basically have four options if your arteries become narrowed, each with risks : -

Bare-metal stents : -

These stents can work well, but have a much higher rate of restenosis than drug-eluting stents. If you will need some type of noncardiac surgery soon (for example, a stomach or hernia operation), you may do better with a bare-metal stent.

Drug-eluting stents : -

As we've been discussing, these stents work well and have a lower rate of restenosis than bare-metal stents. The issue we're trying to sort out is whether the use of drug-eluting stents in some people causes a higher risk of dangerous blood clots. As of right now, we can't give a definitive answer.

Coronary bypass surgery : -

Bypass surgery is used to divert blood around blocked arteries in the heart. This surgery uses a healthy blood vessel harvested from your leg, arm, chest or abdomen and connects it to the other arteries in your heart so that blood is bypassed around the diseased or blocked area. While bypass surgery does work well, it's also more invasive than using stents, which means a longer recovery time. In addition, the risk of complications for bypass surgery can be higher than with stents.

Medications and lifestyle changes : -

This is a good option for many people. If you have symptoms from your narrowed arteries, such as angina, and your condition isn't severe or immediately life-threatening, it may be worth first trying medications such as statins and lifestyle changes such as eating a more balanced diet. This option can be as effective as receiving a stent, especially for those who don't have unstable and "acute" chest pain (angina). Keep in mind that even if you receive a stent, your doctor will likely also prescribe medications such as statins.

What should you do if you have a drug-eluting stent ?

Here's what to do if you have a stent of any kind : -

Take aspirin : -

If you have a stent, you'll have to take aspirin daily and indefinitely to reduce the risk of clotting.

Take anti-clotting medication : -

People with stents are given prescription anti-clotting medications such as clopidogrel (Plavix). The American Heart Association and FDA recommend that people who have had drug-eluting stents inserted should continue to take medications such as Plavix to reduce the risk of blood clots for at least one year after the stent is inserted.

Listen to your cardiologist : -

Always talk with your cardiologist about how long you should take anti-clotting and other medications because the answer will vary depending on the nature of the blockage you had and your risk of bleeding. The most important thing to remember is to take all your medications exactly as your doctor prescribes.

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