Stent implantation for coronary heart disease
A stent can be implanted in a diseased coronary artery. The aim is to use the stent to open up the narrowed vessel to allow for unimpeded blood flow.
What is a stent?
In the case of coronary heart disease, deposits build up in the coronary arteries, causing them to become narrower and narrower. A stent is a tube-shaped wire mesh that can be inserted into these vessels to reopen them or keep them open. To place the stent in the diseased vessel, specialised doctors perform a so-called percutaneous coronary intervention, or PCI for short.
Stent – Risk of the Procedure
The risk of stent implantation depends on how many stents need to be implanted and how narrow the coronary arteries are. Undesirable effects may include bleeding in the area where the blood vessels are accessed. Therefore, every patient must remain lying still with a pressure bandage applied to the puncture site for the first few hours after their procedure.
Overall, the procedure is generally less arduous than bypass surgery. During any stent implantation, there may be a short period of insufficient blood supply to the heart muscle. This can lead to further damage to the heart muscle tissue as well as too little blood being pumped to the rest of the body. Therefore, some high-risk patients cannot be treated with cardiac catheterisation. For these patients, the use of a stabilising heart pump can be beneficial.
Following the procedure, most patients only need a short stay in hospital. Rehabilitative measures help patients to lead a heart-healthy life.
Anticoagulants during and after stent implantation
Blood-thinning medication is generally used throughout the procedure to prevent a blood clot from forming. A blood clot of this type could be swept away by the bloodstream and block coronary vessels, resulting in a heart attack. To prevent this, you must continue to take the blood-thinning medication following the procedure.
If you are unclear about the dosage of your new medication, your doctor will be happy to help you. On the Aftercare page, you will find practical advice to help you remember to take your medication every day.
What is the advantage of a stent?
Stents are a minimally-invasive way of keeping diseased coronary vessels open. Normally, patients can stay awake throughout the entire procedure. This avoids the need for general anaesthetic, which subjects the body to stress, meaning that stent insertion is even less invasive. Stent technology is constantly developing. For example, in addition to conventional stents, some stents deliver small amounts of medication over a long period of time. This type of stent is called a drug-eluting stent. In some cases, it may be beneficial to use this type of stent.
Restenosis – Recurrence of narrowing in a vessel
In rare cases, it is possible for narrowing to recur inside a stent. This is called restenosis. The drug-eluting stents described above, for example, deliver drugs to prevent a new blockage forming. However, even these cannot always prevent the recurrence of narrowing in the vessel. In this case, another PCI or bypass surgery is necessary.
What can be done if the risks of surgery are high?
Whether a stent can be inserted depends on which vessel is blocked and how much the blood flow is reduced. Together with your doctor, you must decide whether a stent or bypass surgery can offer better results. Comparative studies have shown that no method is superior to the other across all cases.
There are high-risk patients for whom neither PCI nor bypass surgery can be performed. One of the reasons for this is that both methods involve the heart muscle being briefly subjected to insufficient oxygen supply. In particularly critical cases, the odds of high-risk patients suffering a heart attack as a result are too high.
Patients with multi-vessel disease, diabetes or kidney failure are often at high risk.
However, there are now support systems which can assist the heart during a high-risk procedure. These systems can also make it possible to use stents in high-risk patients. Talk to your doctor about whether an assisted procedure is an option for you. You can find a helpful checklist here.