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Coronary artery stenting is also called cardiac stenting and is a process where a tube-like wire structure is placed inside a narrowed coronary artery that has been opened by means of coronary angioplasty. Most stents appear like a cage that pops open to keep the vessel open on a permanent basis.
The process starts with an incision and insertion of a catheter in usually the right femoral artery in the groin. The catheter is passed up into the heart arteries using x-ray technology and contrast dye, and is placed into a narrowed or blocked coronary artery. A balloon is blown up to open the narrowed artery. A stent is placed in the narrowed artery to keep the artery open.
There are two kinds of stents: those that have a medication to keep the artery open longer and those that have no drugs. The ones with the drugs are called drug-eluting coronary artery stents and those without drugs are called bare metal coronary artery stents. The bare metal stents have a 20 percent failure rate and the drug-eluting drugs have a 10 percent failure rate.
The resultant intracoronary stent is deployed as a self-expanding spring while others are expanded via the angioplasty balloon. Most stents are the latter type. The balloon is removed after the stent is expanded and the stent remains in place to keep the vessel open.
There are complications of percutaneous angioplasty and stent placement. They tend to work well in 90-95 percent of cases. In a small percentage of cases, the angioplasty itself cannot be done because the doctor could not technically perform the angioplasty. The guide wire or the balloon couldn’t fit into the narrowed artery.
The most serious complication of percutaneous angioplasty and stent placement is having an abrupt closure of the artery that was dilated within a few hours of having the procedure. This happens in 5 percent of cases where a stent wasn’t placed and can lead to a heart attack. Abrupt closure can happen because of a dissection of the inner lining of the artery or a blood clot that happens at the site of the angioplasty. This is called having a thrombosis in the artery. The artery can go into spasm, also called elastic recoil, resulting in closure of the artery.
In order to help in the prevention of a thrombosis at the stent site, patients are given aspirin. Aspirin prevents platelets from sticking to the wall of the artery or to the stent so that blood clots are prevented from happening. Intravenous heparin is a natural blood thinner that keeps blood thin around the time of the intervention to open the artery. Calcium channel blockers are given to prevent blood vessel spasm.
Those at highest risk for abrupt blood vessel closure include the following:
Stents that are placed in the vessel have diminished the number of cases of spasm and abrupt vessel closure and stents that include “super aspirin-like properties” imbedded in the stent have reduced the incidence of thrombus formation at the angioplasty location dramatically.
In some cases, even the use of the stent does not keep the blood vessel open and an emergency open heart surgery is indicated. In most cases, the patient receives a coronary artery bypass graft surgery that takes a vein from another part of the body and bypasses the area of blockage. This happens at a rate of about 1 percent since stents have been used. Prior to stenting, the CABG procedure was necessary in 5 percent of cases.
It’s important to choose a cardiovascular surgeon who has done a lot of stenting procedures. Check with the doctor or hospital to find out how many procedures the doctor has done and what the failure rate has been.
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