Stents in the heart

Stents in the heart are small medical devices (small mesh tubes) used to treat narrowed arteries (arteries are blood vessels that carry blood from heart to the tissues). The procedure of placing stents in the heart is called angioplasty. Angioplasty alone, without stent placement is associated with a high risk of recurrence of the arterial blockage, in months or years after the procedure. That is why placing stents in the heart solved this disadvantage of the angioplasty, maintaining blood vessels opened and avoiding heart surgery. The risk that the arteries will renarrow is 10-20%  in the first year after angioplasty, while in the absence of a stent the risk is twice as much.

Stents in the heart are usually made of metal mesh or fabric (these ones are used in larger arteries). Some of these stents contain a special substance that prevent blood from coagulating and are called drug-eluting stents.

How are stents in the heart placed? 

Doctors use a balloon inside the artery to compress the plaque (deposits of fats in the arteries wall, also called atherosclerosis) and widen the passage (the arterial lumen through which will flow blood). After this, they place the stent in order to maintain the passage (the artery lumen) opened.

How do we prepare patients before placing stents in the heart?

Patients should be well informed about the stents in the heart procedure, about the risks and the special precautions. These are a few questions u must always ask your doctor about:

•  Why is it performed?
•  How is it performed?
•  What are the risks and precautions of this procedure?
•  Is there any other alternative?
•  What happens if I refuse this procedure?
•  Always sign a consent paper.

Why are stents in the heart placed for?

The purpose for stents in the heart placement is to keep the arterial lumen opened and allow blood to flow, in this way tissues will receive enough blood and the symptoms of ischemia (oxygen deprivation) will be relieved.

• For carotid arteries blockage: fat deposits in carotid arteries wall (also called plaques, they are a manifestation of the disease named atherosclerosis) can determine neurologic symptoms like dizziness, fainting, headache, memory and concentration problems and in severe cases even stroke.
• For coronary vessels (blood vessels that supply blood for heart tissues): a special tube called catheter is introduced in the femoral artery (the main artery of the lower limb) and it is conducted in the arterial system until it reaches the coronary arteries. In that moment, a special substance is pumped into the catheter in order to view the arteries and the blockage. This catheter has a tiny balloon on its tip, which is inflated in the narrowed area, compressing the atheroma (the plaque of fats from the artery wall that blocks blood flow) and enlarging the lumen. After this a stent may be placed to keep the lumen opened.
• For kidney or leg arteries, aneurysm of the aorta.
  

What are the common precautions after placing stents in the heart?

•  blood clotting precautions: in order to prevent blood clotting, patients with stents in the heart have to take antiplatelet medication (aspirin, clopidogrel)
•  if the stent is made of metal, than the patient can’t have MRI (magnetic resonance imaging)
•  avoid vigorous effort early after the stent placement procedure.
  

What risks are related to stents in the heart?

•  restenosis- blood vessel becomes blocked and narrow again, despite the angioplasty procedure
•  about 1 or 2 percent of the patients with a stented artery are at risk of developing a cloth at the stent site; the consequence of this complication can be a heart attack. This complication is more frequent in the first year after stent placement and can be prevented by antiplatelet medication (like aspirin, clopidogrel).
•  bleeding at the site of the catheter insertion into the skin
•  damage of the blood vessel produced by the catheter
•  irregular heart beats
•  infection or allergic reaction (due to the substance used to view the arterial lumen)

Stents in the heart brought a significant contribution in cardiology, saving and improving life in patients with heart attack and coronary disease.