What is a stent?

A stent is a tiny tube placed surgically in arteries, veins, and other body parts to allow a seamless flow of bodily fluids. It is most commonly used when arteries or veins narrow due to plaque buildup when organically weakened and can no longer be kept open. Plaque is caused by cholesterol and other fatty substances present in the blood. These tend to stick to the walls of the arteries and block the blood flow or reduce the blood flow rate.

Stents are also used to maintain the uninterrupted flow of urine and bile. They generally are hollow metallic tubes placed to keep the blocked area of the artery open. However, with the evolution of modern medicine, stents today are made of organic-dissolvable material. These stents are coated with medicine, and with time, they tend to dissolve in the body, eliminating the need for a patient to undergo an invasive procedure to remove them. Non-metallic stents have witnessed widespread adoption as they avoid complications involved with invasive surgeries.

When is a stent used?

A stent is used in major and minor procedures depending on the nature of the disease and the patient's condition. Over the years, stent insertion surgery has become less invasive with minimal after-effects. Stents are majorly used for:

Coronary Angioplasty:

A coronary Angioplasty or Percutaneous intervention is a procedure done to remove the blockage in the Aorta artery and the arteries near the heart due to plaque buildup. In this procedure, a heart stent is placed in the blocked region to resume the flow of oxygen-rich blood to the rest of the body. Usually, the catheter is inserted into the body through the groin or an incision in the arm. The doctor uses a dye to reach the blocked area and place the stent in the affected region.

Intracranial stenosis:

Intracranial Stenosis refers to the narrowing of an artery inside the brain, reducing the blood flow to the organ. When plaque-causing agents like cholesterol block the carotid artery, the amount of oxygen-rich blood reaching the brain reduces. Early symptoms of this condition include giddiness, nausea, and blurry vision. This condition, when left untreated, can lead to strokes. To treat intracranial stenosis, a stent is placed in the carotid artery near the neck or the arteries inside the brain, depending on the location of plaque buildup. The procedures involved in treating intracranial stenosis are complicated and time-consuming as the arteries in the brain are small and placed in several loops throughout the brain.

Brain aneurysms:

Aneurysms are spots where the blood vessel has weakened and is on the verge of bloating or breaking out. An Aneurysm in the brain is called a Brain Aneurysm. It can occur due to genetic conditions, plaque buildup or injuries caused to the head. Aneurysms are not always harmful, but in a few scenarios, they can pose a serious threat in the form of a stroke, intracranial bleeding, and subarachnoid haemorrhage, among other conditions. In brain aneurysms, a stent is placed in the affected region to prevent the artery from rupturing.

Tracheobronchial stenosis:

Tracheobronchial stenosis occurs when the trachea or windpipe narrows the air supply into the lungs. It is caused due to the excessive development of scar tissue in the trachea. Excessive scar tissue growth is generally caused as a side-effect of prolonged intubation, a process that keeps a steady inflow of oxygen into the lungs. There are many ways of treating tracheobronchial stenosis; one major method is inserting a stent in the affected trachea region to keep it open. It can be used as a short-term or long-term medication treatment, depending on the severity of the condition.

Bronchial Stents:

Bronchial stents, also known as airway stents, are used to keep the bronchial openings of the lungs open. They are used when a tumour obstructs the blood flow in the bronchi or when the bronchi are weakened due to natural reasons, lymphoma, or other metastasising diseases. Bronchial stents, also known as Airway stents, are either placed through an incision in the neck or inserted orally. The stent helps seamless airflow in and out of the lungs.

Ureteral stent treatment for kidney stones:

Ureteral stenting is done when the urethra clots due to blood clots, kidney stones, infection, or other reasons. The urethra is a pair of long, thin tubes that connect the kidneys to the bladder. Its primary function is to allow seamless discharge of toxic substances processed by the kidney through the bladder.

A ureteral stent is the preferred treatment option as it does not involve an incision through the skin. In this process, a stent is placed in the urethral tubes in the affected region after the clotting agents are removed. When a ureteral stent can't be placed due to various factors, the patient undergoes nephrostomy.

Biliary stent treatment:

Biliary stent treatment is the preferred treatment for obstructive jaundice. In this condition, a tumour in the liver causes a buildup of bile in the liver. Bilirubin is a substance in bile, and its excessive formation causes jaundice. It can be very dangerous if left untreated. In a biliary stent treatment procedure, the cancerous or benign tumour is removed, and a stent is placed in the area of the affected blood vessel to keep the flow consistent and stop the excessive buildup of bile within the liver.

Types of stents

With the evolution of modern medicine, there are now five different types of stents to choose from when considering a heart stent surgery. They are:

Dual Therapy Stent
Bioresorbable Vascular Scaffold:
Bio-engineered stent:
Drug-Eluting Stent
Bare Metal Stent

Dual Therapy Stent:

Dual therapy stenting is a form of heart stent surgery that has shown tremendous results in clinical trials worldwide. In Dual therapy stents, the polymer around the stent is coated with medication to ensure that the walls of the arteries do not close down, and the affected region is provided with the medication required to boost cell generation. The insides of the stent are coated with EPC technology that promotes the growth of healthy tissue and offers speedy recovery in the coverage of the stent structure.

Bioresorbable Vascular Scaffold:

Bioresorbable Vascular Scaffolds are the latest technological advancements made by modern medicine in heart stent surgery. Unlike bare-metal stents, Bioresorbable Vascular Scaffolds (BVS) are made up of naturally occurring elements in the body, making them dissolvable over time. Using bare-metal stents is a widely adopted practice, but BVS is now replacing it as it does not pose the risk of long-term stent thrombosis.

Bio-engineered stent:

A bio-engineered stent is a new alternative used in heart stent surgery. It first received approval in Europe and has been experiencing widespread adoption ever since. It consists of a thinner and more flexible cobalt and chromium mesh and comes with endothelial progenitor cell (EPC) technology that enables the infarcted area to heal and develop its cell walls over time. These Bio-engineered stents feature a Dual-helix stent design, making them optimal for a longer duration. EPCs also protect against thrombosis and modular restenosis.

Drug-Eluting Stent:

Drug-eluting stents are stents coated with medication. They are just one of the options for treating heart artery narrowing. Drug-eluting stents contain medicinal substances coated around them that keep blood clots from occurring again. They release a series of blood thinners into the bloodstream; hence, they are not a preferred heart stent for patients likely to receive invasive procedures. They are also not recommended for people who suffer from bleeding and clotting problems.

Bare Metal Stent:

Bare-metal stents are made up of aluminium, stainless steel and nickel. These stents present no outer coating and are used to keep the cell walls of the arteries from collapsing after removing the clots from an artery. Bare metal stents are generally used when the patient has a heart-related or non-heart-related invasive surgery scheduled in the immediate future. After a bare-metal heart stent surgery, the cell wall tends to grow around the bare-metal stent and keep the stent in place. It, however, has led to the overgrowth of scar tissue around the stent.

Are you the right candidiate for a stent?

The examining team of medical professionals conducts a series of tests to understand your body's current condition and determine whether you are a good candidate for heart stent surgery. These include blood tests, electrocardiograms, and imaging tests to determine whether this process could treat the blocked arteries.

How do i prepare for stent placement surgery?

A heart stent surgery is advised for patients who have been diagnosed with single or multiple blockages in the arteries.

Patients with acute chest pains and those who have suffered mild strokes in the recent past should get imaging tests to diagnose the presence of a blockage or its formation for early diagnosis.
It is imperative to keep your surgeon informed about your medication. It is advised not to take any drugs/medication that could affect the clotting capabilities of your blood. Ex: Aspirin, Ibuprofen, and Naproxen.
Quit consumption of cigarettes or any tobacco-based products and alcohol.
Consume the medication prescribed by the doctor before the surgery. Reach the hospital in such a manner that there is plenty of time to go through the last-minute details.
Prepare yourself to be at the hospital overnight after the surgery. Take all your medications and arrange for someone to drive you back after the surgery. You might be sedated using a local anaesthetic or general anaesthesia, depending on your body type and condition. Hence, leaving the hospital immediately after that is not recommended.
Medical experts recommend not driving or signing any legal documents until the anaesthetic's effect wears off.

How is stent placement performed?

Heart stent surgery is a minimally invasive form of surgery in which a surgeon makes an incision on the side of an arm or sends a catheter to the affected region through the groin. The catheter is then sent to the affected area, guided by fluoroscopy, a dye-based imaging system that lights up the arteries in the body and helps the surgeon find the way to the affected region.

The catheter is followed by another catheter with a balloon attached. After the balloon-attached catheter is in the narrowed artery, it is made to expand, thereby compressing the plaque buildup and pushing it against the artery's walls.

The balloon further expands, leaving the stent in place to resume the flow of oxygen-rich blood to the heart.

Complications and Risks that may arise

Like any other surgical process, heart stent surgery comes with its own set of risks. It is imperative for the patient undergoing a heart stent operation to discuss the possibility of side effects and devise a plan to overcome them before or after the surgery.

The most common complications of a heart stent operation include:

An allergic reaction to the iodine-based dye used to map the arteries before inserting a catheter.
A problem in smooth breathing due to the insertion of a stent in the heart
Chest pains
Excessive bleeding
Heart attack
Excessive growth of scar tissue around the stent

If you are allergic to Iodine, the medical team assisting you with the Coronary stent transplant should be informed about your condition. They will then look for other options in the imaging tech field to identify the narrowed artery.

After the stent is inserted, you should be experiencing slight chest pains and shortness of breath, which is normal. However, if you are experiencing this for prolonged durations, immediately contact your doctor and inform them about the new development.

Seizures and heart attacks are rare situations when dealing with a heart stent surgery.

Stents tend to stimulate the growth of scar tissue around them upon insertion. This mostly happens when a bare-metal stent is used. In other Bio-engineered stents, a medicinal layer is wrapped around the stent to prevent excessive scar tissue growth.

How do i recover from a stent surgery?

The road to recovery after a heart stent operation is divided into two types:

Within the hospital and
At home

After the heart stent operation, your cardiologist will have you stay over at the hospital so that he can examine your body for post-surgery complications. He will examine your rate of blood flow, blood sugar, breathing, and blood clotting functions.

In the first few weeks after heart stent surgery, you might be continuously tired. This duration becomes longer if the heart stent operation is conducted in an emergency. While recovering from a heart stent surgery, it is advised not to indulge in any heavy lifting and stick to light physical activities in the first five days. Avoid any activity that could cause shortness of breath, exertion, chest pain, or tiredness.

Taking a stress test every few weeks after the heart stent surgery can help the doctor analyze the rate at which your body is accepting and adapting to the stent and how your body is progressing in terms of physical activities. There are therapeutic sessions that are specially designed for patients looking to receive post-op care after a stent insertion process. These are designed to build a stronger heart and reduce the risk of another blocked artery in the future.

Precautions to take after a stent surgery

An angioplasty or heart stent surgery is only a treatment option for narrowed blood vessels. It is not a cure. The cure lies in proper post-op treatment, which can be achieved by maintaining a good diet, regular exercise, and controlling certain habits.

After an Angioplasty, the patient might experience chest pains for a short period. However, if the chest pain intensifies or you see any signs of bleeding at the catheter insertion area, alert the medical authorities immediately.

A patient who undergoes a heart stent operation should:

Maintain a healthy diet
Quit smoking cigarettes or consuming any tobacco-based product
Eat a healthy, low-saturated fat diet
Exercise regularly,
Lower levels of cholesterol in the blood
Take all the medications and care prescribed by the cardiologist

After coronary angioplasty, it is advised that the patient shouldn't drive for weeks. Suppose you are a professional driver whose livelihood depends on it. In that case, the consulting doctor will suggest whether you are fit to drive or against it after conducting a series of tests.

If the heart stent surgery was a planned medical procedure, you should be able to return to work a week after the surgery. However, in the event of an unplanned coronary angioplasty (emergency procedure), it could take several weeks of recovery before the patient is fit to return to work.

Most people are asked to take medication for up to a year after heart stent surgery. This medication contains low doses of aspirin, clopidogrel, prasugrel, and ticagrelor, which are blood thinners in combination.

It is essential to know the risks that could present themselves after a heart stent placement operation. Call the ambulance or head to the nearest cardiologist (do not drive if you are alone) if you experience any of the following:

A high fever
A lump formed around the area where the incision was made to insert the catheter. This lump is hard, slightly larger than a pea and is around the wound
Increasing pain, redness, and swelling from the wound
Severe chest pain. If your doctor has prescribed something, take the medication; if the pain does not subside, go to a doctor.
If bleeding from the wound where the incision was made, apply pressure for 10 minutes. If the bleeding doesn't stop, then visit a doctor.
If the arm/ part of the body where the incision was made is witnessing any form of discolouration, numbness or feeling cold.

Heart stent FAQS: All Your concerns addressed

Q1. Why has my doctor recommended stenting?
A1. Stenting or heart stent surgery is recommended when an artery begins to become narrow/ or has already narrowed due to the formation of cholesterol-based plaque. With stenting or coronary angioplasty, the artery can be widened to resume the flow of nutrition and oxygen-rich blood to the heart.

Q2. What is an angiogram?
A2. An Angiogram is a process of using an X-ray to take a picture of your blood vessels. A contrast-based dye is injected into your blood vessels to make the arteries visible in the imaging scans of X-rays.

Q3. What is angioplasty?
A3. Angioplasty is when a cardiologist inserts a stent in the blocked or narrowed region of the artery to resume blood flow. It is generally used to remove blockages in the heart, lungs, trachea, brain, liver, and kidneys.

Q4. What is the stent for?
A4. A stent is a structure built to keep the walls of the affected artery region open. Stents are generally made of aluminium, nickel, and steel alloys. There are a few stents that are made of bio-substances. These stents tend to dissolve in the body after their purpose is served.

Q5. How do I prepare for stenting?
A5. The consulting cardiologist will give you complete instructions before you arrive for your heart stent surgery.

Q6. Will the stent be in forever?
A6. Bare-metal stents are designed to remain in your body forever, while bio-absorbable polymers are designed to be absorbed into the body after a certain period.

Q7. How are bio-absorbable polymers absorbed?
A7. The bio-absorbable polymers are made of polyacid, a dissolvable medicinal substance used for medicinal sutures. These bio-absorbable polymer stents tend to disintegrate into water and carbon dioxide through naturally occurring processes.

Q8. Can I undergo an MRI with a stent?
A8. Yes, you can undergo an MRI after heart stent surgery. However, it is advised that you inform your consulting doctor and imaging technician about your stent implant, or you can show them your implant card.

Q9. Will the stent set of metal detectors?
A9. Both bare-metal and bioabsorbable polymer stents do not activate a metal detector. Hence, it is safe to walk through one after undergoing coronary angioplasty.

Q10. How serious is the stenting procedure?
A10. A stent may result in blood clotting at the site, which may further increase the risk of a heart attack or stroke. According to the National Heart, Lung, and Blood Institute, a small percentage of people who have stented arteries may develop a blood clot near the stent. Therefore, doctors usually prescribe one or more drugs to prevent the formation of blood clots. Anti-clotting medications, again, don't come without any risks and may lead to side effects like irritations or rashes.

In certain rare cases, an individual's body might reject the stent or develop an allergic reaction to the material in the stent. So, before proceeding with the stenting procedure, the person needs to mention any known reaction to metals to their doctor and talk about other alternatives.

Q11. How is a stent performed?
A11. A stent can be inserted in several ways. Generally, the process is minimally invasive. Your doctor will first make a small incision on the skin, usually done in the groin or arm. A catheter and specialized tools are then advanced into the blood vessels to reach the site that needs a stent. A camera may be attached to the end of the catheter or the tools to guide the stent.

An angiogram imaging technique may also guide the stent through the vessel. With the specialized tools, the doctor can identify the area of the broken or blocked vessel and install the stent. Once the stent is installed, the instruments are removed from the body, and the incision is closed.

Q12. What happens after a stent insertion?
A12. After stent insertion, it is normal to feel a bit of soreness at the incision site. This can be easily treated with mild painkillers. Your doctor may also prescribe anticoagulant medications to prevent further blood clotting.

Typically, after the procedure, the patient has to stay in the hospital overnight to ensure no complications arise. However, their stay may be longer if the stent was placed due to a coronary event, such as a stroke or heart attack.

After the patient is home, they must drink plenty of fluids and stay away from physical activities for some time. It is recommended that you follow every instruction from the doctor.

Q13. What follow-up care is involved after the stenting procedure?
A13. After leaving the hospital, you must take the medications as prescribed and make a few lifestyle changes, such as exercising, eating a healthy diet, quitting smoking, etc. Follow-up visits with your doctor, interventional cardiologist, or another qualified specialist are essential. These visits allow your interventional cardiologist to examine the site where the catheter was inserted and make sure that it is healing properly.

Your doctor may also order an exercise stress test for you three to six weeks after the procedure. Depending on that, the appropriate activity level will be recommended for you. You may be enrolled in a supervised cardiac rehabilitation program to help you reduce the chances and risk factors for more blocked arteries in the future.

Q14. Can you live a normal life with a stent?
A14. Yes, you can live a normal, healthy, and active life with a coronary stent. Below are some general guidelines.

Lifestyle changes: Although the coronary stent does restore proper blood flow to the heart, it is still necessary to switch to healthy diet choices, increase physical activity levels and quit smoking.
Work life: Most people can return to their normal work lives within a few days of the procedure. However, it is better to talk to the doctor and decide what is right for you.
Physical activity: The doctor can suggest what physical activities you can do after the procedure or whether you can resume any sports or exercises you used to do.
Carrying your stent implant card: It is important to always have your stent implant card with you. The card contains your name, the doctor's name and phone number, and other information about the implanted stents.