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If your doctor has recommended an angioplasty, ask these five questions that could make a big difference to your heart and life.
A stent is a tiny, metallic, expandable mesh like tube that supports the artery and helps to keep it open. In an un-deployed state stents are mounted on a balloon catheter which is the delivery system to track the stent to the blocked area of the coronary artery. The balloon is inflated to expand the stent. As the stent expands, it helps flatten the plaque against the artery wall, increasing blood flow. Once the stent is properly expanded, the balloon is deflated and the catheter is removed from your body. The stent stays in your artery permanently to help keep it open to maintain blood flow.
In people with coronary artery disease (CAD) caused by the buildup of plaque, stents can:
These types are called heart stents, but they're also referred to as cardiac stents or coronary stents. Usually made of metal mesh, they’re put into arteries in a procedure called a percutaneous coronary intervention or, its more common name, angioplasty.
First-generation stents were made of bare metal (Non Medicated). Although they almost eliminated the risk of the artery collapsing, they only modestly reduced the risk of re-narrowing also termed as Restenosis. Restenosis is the re-narrowing of the artery due to the overgrowth of tissue within the stent during the healing process. About a quarter of all coronary arteries treated with bare-metal stents would close up again, usually in about 6 months.
To help prevent restenosis from occurring, scientists developed drug-eluting stents (DES). Drug-eluting stents reduce the risk of restenosis and reduce the potential need for future treatment. They provide the same support to the artery wall as uncoated stents, except they have a coating on the stent that includes a drug that is released over time. The drug helps limit the overgrowth of tissue within the stent as the artery heals, preventing re-narrowing
In clinical trials, these reduced re-narrowing cases to less than 10%. They also lowered the need for repeat procedures for people with diabetes, who have a bigger chance of their arteries getting narrow again. For more details you may contact your physician.
Globally one of the most recognized and stringent regulatory bodies for medical devices is United States Food and Drugs Administration (USFDA). Conformité Européene (CE) is another globally recognized regulatory body. These regulatory bodies certify a device or medicine after its efficacy and safety is proven through stringent tests and clinical studies. There is local body named Drug Controller General of India (DCGI) which provides an approval for these devices in India. All these bodies have their own protocol and standards for approval. Please contact your physician for more information.
Stent therapy is an established life-saving therapy; however there is no sure way to prevent a recurrence of symptoms and to keep the arteries open without any adverse reactions like re-clotting or blockade. This is because human anatomy is complex and several other factors (like discipline in following post therapy medication, choice of heart healthy lifestyle, etc) can modify the risk of re-narrowing and lead to future complications and repeat procedures.
Clinical trials have confirmed a reduction of as much as 50% to 70% in need for a repeat procedure by drug eluting stent (DES) over bare metal stent (BMS)1
Therefore one should check for drug eluting stents (DES) that are well studied and have shown excellent safety and efficacy results in large patient populations (at least more than 5,000 patients) with different complexities and tested under a variety of clinical situations. Seek your interventional cardiologist’s guidance on the choice of your DES.
Studies2 have shown that patients with diabetes mellitus have a less favorable clinical outcome at one year after successful stent placement as compared to the nondiabetic patients. The clinical follow-up was characterized by a higher incidence of death, myocardial infarction (heart attack) and re-interventions. Diabetic patients also demonstrated an increased risk for restenosis. People with diabetes are more likely to have high blood pressure, heart disease or suffer a stroke. In fact, CAD is the leading cause of death in patients with diabetes.
Few DES have been evaluated in people with diabetes and have been approved by the USFDA as safe and effective treatment options for this patient population. For more details you may contact your physician.
Once the stent is implanted and pressed against the artery wall, it will remain there permanently. Tissue will grow over the stent and hold it in place so it will not move.
Yes, it is possible that you may experience symptoms again, either due to a re-blockage in the artery with the stent or a new blockage in a different heart artery. Notify your doctor if you have recurring symptoms.
While there is no sure way to prevent a recurrence of symptoms, you can reduce your risk through exercise, not smoking and adopting a healthy diet. Your doctor can advise you about lifestyle changes.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician.