INOVA HEALTH SYSTEM : TREATMENT OPTIONS : Coronary Stent Implant

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Coronary Stent Implant

What is a coronary stent implant (also called a stent)?

A coronary stent implant is a therapeutic cardiac procedure that involves placing a stent, which is a small mesh-like wire tube in a narrowed artery. This procedure is similar to angioplasty in many ways. However, the stent is left permanently in place in the artery to act as a scaffold to help keep the artery open. Usually, an angioplasty procedure is performed first. The balloon inflations help open the artery to allow the stent to be placed easily. The angioplasty catheter is removed. A different angioplasty catheter with a stent crimped on the balloon is advanced into the artery and carefully positioned at the blockage. The angioplasty balloon is inflated which opens the stent and presses it into the artery wall. The stent holds the artery open and helps reduce the rate of restenosis (a recurrence of the narrowing within the artery).

Stent

What are the risks?

The risks of stents are low. The risks include all of the complications noted for cardiac catheterization, but some of the risks, specifically heart attack and emergency bypass surgery, are higher because angioplasty and stent are more complex procedures. The risks include injury or tearing of an artery which can cause the artery to close. This is often successfully treated with continued angioplasty or stent. Rarely, this is difficult to treat and three percent of patients may have a heart attack and one percent may need emergency bypass surgery. A cardiac surgery team is available at the Inova Heart Center if needed. In three to five percent of patients the procedure is unsuccessful because the catheter cannot be advanced to the blockage or the artery cannot be fully opened. This can occur when the artery is small, has calcium deposits, or has severe bends. Click here to read more about the Inova Heart Center's outcome indicators regarding stents.

What are the benefits?

The stent procedure will open blocked arteries and improve blood flow to your heart. It relieves symptoms, improves exercise duration, and in some cases stops or prevents heart attacks. It is more effective than medications in relieving symptoms in patients with a blockage in one artery. Following a stent, many patients can stop or reduce their number of heart medications. Coronary stents have been one of the most significant advances in cardiology in recent years. Compared to angioplasty, stents reduce the incidence of sub-optimal results and complications such as artery injury and emergency bypass surgery. Most importantly, stents significantly reduce the chance of recurrence of the blockage or restenosis. This means fewer patients will need a repeat procedure.

How effective is a stent?

Stents are initially successful in about 95% of patients. However, about 20% to 25% of patients will develop a recurrence of the blockage or restenosis (which is less than with angioplasty alone). This occurs because stents, like angioplasty, crush the blockage against the artery wall. The healing process within the artery can cause an overgrowth of cells and substances inside the stent, which cause a recurrence of the blockage. This usually occurs during the first six months. Your doctor will follow you closely for a return of symptoms and may even perform an exercise stress test. If a blockage returns, you can be treated with medications, repeat angioplasty or other interventional procedures, or possibly bypass surgery. Only about 10 to 15% of patients will need a repeat angioplasty. (Click here to review the successful outcomes at the Inova Heart Center).

Is a stent right for you?

A stent is the right procedure for most patients because it lowers the chance of restenosis. It is performed in about 70% of patients who need an invasive interventional procedure. Stents are not often used for blockages located in small arteries, with calcium deposits, that involve a branch point, or are long.

For more specific information regarding before, during and after the procedure, click here

Click here to see illustrations of the x-ray pictures your cardiologist reviews before, during and after an interventional procedure.

Drug-Eluting Stents

A drug-eluting stent is a normal metal stent that is coated with a pharmacological agent (drug) known to interfere with the process of restenosis (reblocking). The current medication available on the stent is known as sirolimus. Sirolimus had been used previously to prevent rejection following organ transplantation. These stents had been studied extensively and had been shown to dramatically decrease the chance of restenosis. This new technology is expected to significantly reduce the rate of restenosis and the subsequent need for additional interventional procedures.

Drug-eluting stents may have a substantial impact on the occurrence of re-blockages for patients with heart disease.