Stent Placement

A stent is a small metal tube or coil. Stent placement is a non-invasive procedure (no incisions required) in which the stent is placed inside a narrowed or blocked artery to keep it open and restore or maintain blood flow.

Stenting is most often combined with angioplasty. Angioplasty is a procedure to open blocked or narrowed arteries that supply blood to the heart. After your blocked arteries are treated with angioplasty, there is a possibility of them becoming blocked again (restenosis). Stenting helps keep the arteries open and decreases the chance of narrowing or blockage again.

You may need angioplasty and stenting when:

• Arterial blockage is severe and your heart condition is considered serious
• Medications or lifestyle changes have not improved your condition
• You have experienced a heart attack or stroke

Indications

Stent placement is usually indicated for the treatment of narrowed or blocked arteries.

Arteries are the blood vessels that carry oxygen-rich blood from the heart to all parts of the body. Healthy arteries are normally flexible and smooth on the inside. However, plaque (deposits of cholesterol, calcium, and fibrous tissue) can build up on the inner walls of the arteries, a condition called atherosclerosis. The plaque can cause the arteries to harden, stiffen and narrow, reducing or completely blocking the flow of blood through them. This can cause a stroke, heart attack, necrosis (tissue death), and other grave and life-threatening conditions. Stent placement helps to prevent such fatal conditions.

Preparation

Prior to the procedure, your doctor will evaluate your medical history and perform a detailed physical examination. A chest X-ray, an electrocardiogram (to record heart rate and electrical activity) and necessary blood tests may be carried out. Subsequently, an imaging test (coronary angiogram) to locate the blockages is also performed. Your doctor will instruct you to stop taking certain medications that may be contraindicated with the procedure. You need to inform your doctor of any allergies to medications, anesthesia, or contrast dye. Refrain from solids or liquids at least 8 hours prior to the procedure.

Surgical procedure

Before a stent is placed in the artery, a minimally invasive procedure called an angioplasty is performed under local anesthesia.

A dye is injected into the body to view the blood flow through the arteries, and X-rays are taken. Using these X-ray images, your surgeon inserts a thin guide wire through a blood vessel in the groin area and extends it up to the blocked artery with a small needle. A balloon catheter (thin tube) is then threaded through the guide wire to the narrowed artery. The balloon catheter has a deflated balloon at its tip, which is inflated at the site of the blockage. The balloon widens the artery by compressing the plaque against its inner wall. Your surgeon then inserts a wire mesh tube called a stent along with the balloon catheter to help keep the artery open and prevent it from narrowing again. The balloon and the catheters are removed, while the stent is left in place to keep the artery wide open and allow free flow of blood.

Postoperative care

Following the procedure, you may be released the same day, or may have to remain in the hospital for a day or two. You will be able to start walking 6 to 8 hours after the procedure.  You may develop swelling, pain or bruising at the catheter insertion site. Medications are provided as needed to address these. Blood thinning medications, such as Plavix and aspirin are also provided to prevent the formation of blood clots inside the stent. You can return to your normal activities in a week, but you should refrain from lifting heavy weights or engaging in certain strenuous activities for a defined period.  A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

The risks and complications associated with a stent placement procedure may include:

• Infection
• Bleeding
• Blood clots
• Re-narrowing of the artery
• Allergic reactions to dyes or medications used
• Damage to the blood vessel
• Kidney damage from the use of dye

Summary

Stent placement is most often employed to widen arteries and avert complications arising out of coronary heart disease and other disorders. The stent reinforces the inner walls of the affected arteries, minimizes the risk of the artery becoming blocked or narrowed again, and provides support to the artery.