Overview
What Is A Stent And How Is One Used ?
A stent is a wire metal mesh tube used to prop open an artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It's then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain). Within a few weeks of the time the stent was placed, the inside lining of the artery (the endothelium) grows over the metal surface of the stent.
What Are The Advantages Of Using A Stent ?
In certain patients, stents reduce the renarrowing that occurs after balloon angioplasty or other procedures that use catheters. Stents also help restore normal blood flow and keep an artery open if it's been torn or injured by the balloon catheter.
Risks
Risks of angioplasty may include:
- Bleeding or bruising at the site where the catheter is inserted.
- Sudden closure of the repaired artery.
- Heart attack.
- A need for additional procedures. Angioplasty may increase the risk of needing urgent bypass surgery. In addition, if the repaired artery narrows again (restenosis), a repeat angioplasty may be needed.
- Death. The risk of death is higher when more than one artery is involved.
Can Stented Arteries Reclose ?
Yes. Reclosure (restenosis) is also a problem with the stent procedure. In recent years doctors have used new types of stents called drug-eluting stents. These are coated with drugs that are slowly released and help keep the blood vessel from reclosing. Stents that are not coated with drugs are called bare metal stents. As detailed below, it is very important that patients with either type of stent take their anti-clotting medicines as directed.
Treatment Overview
Angioplasty, also know as percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA), is a procedure in which a catheter-guided balloon is used to open a narrowed coronary artery. A stent (a wire-mesh tube that expands to hold the artery open) is usually placed at the narrowed section during angioplasty.
Angioplasty with stent placement has become the first choice of treatment for a heart attack if it can be performed in a timely manner. It is a common procedure in large medical centers in the United States.
The goal of this revascularization procedure is to increase blood flow to the heart muscle tissue by clearing out both the blood clot and cholesterol from a ruptured plaque that is blocking the blood vessel. Clot-dissolving drugs (thrombolytics) only remove the blood clot. Angioplasty/stenting is less invasive and has a shorter recovery time than bypass surgery, which requires open-heart surgery.
After you are given a sedative, a thin flexible tube (catheter) is inserted through an artery in the groin or arm and carefully guided up the aorta into the blocked coronary artery. Usually, cardiac catheterization and coronary angiography are performed first to identify any blockages by injecting a dye that contains iodine. The dye makes the coronary arteries visible on a digital X-ray screen.
If there is a blockage, the catheter is advanced to the narrowed portion, and a small balloon at the end of the tube is inflated. The balloon may remain inflated from 20 seconds to 3 minutes, then it is deflated and removed. The pressure from the inflated balloon presses the plaque against the wall of the artery, creating more room for blood to flow. See a picture of a balloon angioplasty.
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