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Heart Stents: A guide to understanding how they work
A stent is a tiny tube placed surgically in arteries, veins, and other parts of the body to allow a seamless flow of bodily fluids. A stent is majorly used when arteries or veins become narrow due to building up of plaque, when they are organically weakened and can no longer keep 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 blood’s rate of flow.
Stents are also used to maintain the uninterrupted flow of urine and bile.Stents generally are hollow metallic tubes that are placed to keep the blocked area of the artery open. However, with evolution in 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, thereby eliminating the need for a patient to undergo an invasive procedure to get them removed. Non-metallic stents have witnessed widespread adoption as they avoid complications involved with invasive surgeries.
A stent is used in major and minor procedures depending on the nature of the disease and the condition of the patient. Over the years, stent insertion surgery has become less invasive with minimal after-effects. Stents are majorly used for:
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 build-up. In this procedure, a heart stent is placed in the blocked region to resume the continued flow of oxygen-rich blood to the rest of the body. Usually, the catheter is inserted into the body either 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 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. For the treatment of intracranial stenosis, a stent is placed in the carotid artery near the neck or in the arteries inside the brain depending on the location of plaque build-up. The procedures involved in the treatment of intracranial stenosis are complicated and time-consuming as the arteries in the brain are small and placed in a number of loops through the brain.
Aneurysms are spots where the blood vessel has weakened and is on the verge of bloating up or breaking out. An Aneurysm in the brain is called a Brain Aneurysm. It can occur due to genetic conditions, plaque build-up or due to injuries caused to the head. Aneurysms are not always harmful, but in a few scenarios 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 occurs when the trachea or the windpipe becomes narrow and blocks the supply of air into the lungs. This 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, and one majorly used method is by inserting a stent in the affected region of the trachea to keep it open. This can be used as a short term or long term medication treatment depending on the severity of the condition.
Bronchial stents are used to keep bronchial openings of the lungs open. Bronchial stents are used when there is a tumour obstructing the blood flow in the bronchi or when the bronchi are weakened due to natural reasons or lymphoma or other metastasizing diseases. Bronchial stents or Airway stents are either placed through an incision in the neck or are inserted orally. The stent helps the seamless flow of air in and out of the lungs.
Ureteral stenting is done when the urethra clots due to the presence of 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 used as the preferred treatment option as it does not involve the need for an incision through the skin. In this process, a stent is placed in the urethral tubes in the affected region after removing the clotting agents. When a ureteral stent can’t be placed due to various factors, the patient undergoes nephrostomy.
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 that’s present in bile, and its excessive formation causes jaundice. This 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.
With the evolution in modern medicine, there are now 5 different types of stents to choose from when considering a heart stent surgery. They are:
Dual therapy stenting is a form of heart stent surgery that has shown tremendous results in clinical trials around the world. 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 the process of cell generation. The insides of the stent are coated with EPC technology that boosts the growth of healthy tissue and provides speedy recovery in the coverage of the stent structure.
Bioresorbable Vascular Scaffolds are the latest technological advancements made by modern medicine in the field of heart stent surgery. Unlike bare-metal stents, the Bioresorbable Vascular Scaffolds (BVS) are made up of naturally occurring elements in the body, thereby making it dissolvable over time. Using bare-metal stents is a widely adopted practice, but is now being replaced by BVS as it does not pose the risk of long term stent thrombosis.
A Bio-engineered stent is a new form of alternative used in heart stent surgery. Bio-engineered stents first received approvals in Europe and have been experiencing wide-spread adoption ever since. They consist of cobalt and chromium mesh that is thinner and more flexible and comes with endothelial progenitor cell (EPC) technology that enables the infarcted area to heal and develop its cell walls in due course of time. These Bio-engineered stents feature a Dual-helix stent design, making them optimum for a longer duration. EPCs also protect against thrombosis and modular restenosis.
Drug-eluting stents are stents coated with medication. These stents are just one of the options to treat the narrowing of heart arteries. Drug-eluting stents contain medicinal substances coated around them that keep the blood clot from occurring again. It releases a series of blood thinners into the bloodstream, and hence, is not a preferred heart stent for those patients who are likely to receive invasive procedures in the future. This is also not recommended for people who suffer from bleeding and clotting problems.
Bare-metal stents are made up of aluminium, stainless steel and nickel. These are stents that 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 years to come. After a bare metal heart stent surgery, the cell wall tends to grow around the bare-metal stent and keep the stent in place. This, however, has lead to the overgrowth of scar tissue around the stent.
The examining team of medical professionals conduct a series of tests to understand the current condition of your body to see if you are the right candidate for heart stent surgery. These include blood tests, electrocardiograms, and imaging tests to see if this process could treat the blocked arteries.
A heart stent surgery is advised to patients who have been diagnosed with single or multiple blockages in the arteries.
A heart stent surgery is a minimally invasive form of surgery where 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. Fluoroscopy is 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 then followed by another catheter which has a balloon attached to it. After the catheter with the balloon is at the narrowed artery, it is made to expand, thereby compressing the plaque build-up and pushing it against the walls of the artery.
The balloon further expands and leaves the stent in place, to resume the flow of oxygen-rich blood to the heart.
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 possibilities of occurrence of side-effects and chalk a plan to overcome them before or after the surgery.
The most common complications of a heart stent operation include:
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 upon insertion tend to stimulate the growth of scar tissue around them. This mostly happens when a bare-metal stent is used. In other forms of Bio-engineered stents, there is a medicinal layer wrapped around the stent to prevent excessive growth of scar tissue.
The road to recovery after a heart stent operation is divided into 2 types:
After the heart stent operation, your cardiologist will have you stay over at the hospital so that he could examine your body for post-surgery complications. Your rate of blood flow, blood sugar, breathing, and blood clotting functions will be examined.
You might be continuously tired in the first few weeks after a heart stent surgery. This duration only becomes longer if the heart stent operation was conducted in an emergency. While recovering from a heart stent surgery, it is advised not to indulge in any kinds of 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.
An angioplasty or heart stent surgery is only a treatment option for narrowed blood vessels. It is not a cure. The cure lies in the proper post-op treatment, and this can be done 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 if you see any signs of bleeding at the area of catheter insertion, alert the medical authorities immediately.
A patient who undergoes a heart stent operation should:
After coronary angioplasty, it is advised that the patient shouldn’t drive for weeks. If you are a professional driver whose livelihood depends on it, 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, then, you should be able to get back 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 get back 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. These medications in combinations are blood thinners.
It is important 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:
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