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Cardiac Stents Overview

Stents are small expandable tubes used to treat narrowed or weakened arteries in the body. In patients with coronary heart disease, caused by the buildup of plaque, stents are used to open narrowed arteries and help reduce symptoms such as chest pain (angina) or to help treat a heart attack.

These types of stents are commonly called heart stents, but they're also referred to as cardiac stents or coronary stents. Usually made of metal mesh, heart stents are implanted in narrowed coronary arteries during a procedure called a percutaneous coronary intervention (PCI) or angioplasty.

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Unlike coronary artery bypass surgery, stenting is considered minimally invasive because it involves no major incisions. Performed with local anesthesia and mild sedation, the procedure usually takes about an hour, but it can take longer if multiple stents are required. Patients who undergo stenting experience significantly less discomfort and a shorter recovery time than those who undergo coronary artery bypass surgery.

But stenting isn't risk-free. Sometimes, a blood clot can form in the stent and cause a sudden renarrowing or even a complete blockage. To prevent this process, which is known as in-stent thrombosis, patients who undergo stenting must take one or more blood-thinning drugs after the procedure. These include aspirin, which usually must be taken indefinitely, and Brilinta or clopidogrel (Plavix), which is usually prescribed for at least one and up to 12 months.

Any manipulation of an artery (whether with a balloon or stent) can result in some injury to the blood vessel wall, especially the endothelium (the innermost layer of a coronary artery). So scar tissue can also form within the stented area, resulting in renarrowing over a period of months. This process is called restenosis. If restenosis develops, another stent procedure can often be used to solve the problem. In some patients whose stented arteries reclose, coronary artery bypass surgery may be necessary.

Types of Heart Stents

In the late 1970s, doctors began using balloon angioplasty to treat narrowed coronary arteries. During this procedure, a very thin, long, balloon-tipped tube, called a catheter, is inserted into an artery in either the groin or arm and is moved to the site of the blockage with help from an X-ray. The balloon at the tip of the catheter is then inflated to compress the blockage and restore blood flow, and then it’s deflated to allow the catheter and balloon to be removed.

Because no new support is left at the site of the blockage during balloon angioplasty, in a small percentage of cases, the artery will resume its previous shape or even collapse after the balloon is deflated. In addition, about 30% of all coronary arteries treated with balloon angioplasty are affected by restenosis.

To help solve these problems, doctors developed small stents which could be mounted on the balloon section of the catheter and inserted into a blood vessel. During a stenting procedure, the stent expands when the balloon is inflated, locks into place, and forms a permanent scaffold to hold the coronary artery open even after the balloon is deflated and removed.

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