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Heart Stents:
1.
What is a Stent?
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.
2.
When is a Stent used?
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:
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 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:
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.
Brain aneurysms:
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:
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:
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 stent treatment for kidney stones:
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:
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.
3.
Types of Stents
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 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 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 Scaffold:
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.
Bio-engineered stent:
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 Stent:
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 Stent
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.
4.
Are you the right candidate for a 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.
5.
How do I prepare for Stent placement surgery?
A heart stent surgery is advised to 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 any sorts of medication that you consume. 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.
- It is recommended by medical experts not to drive or sign any legal documents until the effect of the anaesthetic wears off.
6.
How is Stent placement performed?
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.
7.
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 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:
- An allergic reaction to the iodine-based dye use 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 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.
8.
How do I recover from a Stent surgery?
The road to recovery after a heart stent operation is divided into 2 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 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.
9.
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 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:
- 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. 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:
- A high fever
- A lump forming 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 for that, take the medication, if the pain does not subside, then go to a doctor.
- If you are 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 is feeling cold.
10.
Heart Stent FAQs: All your concerns addressed.
Q. Why has my doctor recommended stenting?
- 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.
Q. What is an angiogram?
- 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.
Q. What is angioplasty?
- Angioplasty is a process in which a cardiologist inserts a stent in the blocked or narrowed region of the artery to resume the flow of blood. Angioplasty is generally used for removing blockages in the heart, lungs, trachea, brain, liver, and kidneys.
Q. What is the stent for?
- A stent is a structure built to keep the walls of the affected region of the artery open. Stents are generally made of an alloy of aluminium, nickel, and steel. There are a few stents that are made of bio-substances. These stents tend to dissolve in the body after their purpose is served.
Q. How do I prepare for stenting?
- The consulting cardiologist will give you a complete set of instructions before you arrive for your heart stent surgery.
Q. Will the stent be in forever?
- The bare-metal stents are designed to remain in your body forever. The Bio-absorbable polymers are designed to get absorbed into the body after a certain period.
Q. How are bio-absorbable polymers absorbed?
- The bio-absorbable polymers are made of polyacid, which is 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.
Q. Can I undergo an MRI with a stent?
- yes, you can undergo an MRI after undergoing 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.
Q. Will the stent set of metal detectors?
- Both bare-metal stents and bioabsorbable polymer stents do not activate a metal detector. Hence it is safe for you to walk through a metal detector safely after undergoing coronary angioplasty.
Q. How serious is the stenting procedure?
- Having a stent may result in blood clotting at the site, which may further increase the risk of getting a heart attack or stroke. According to the National Heart, Lung, and Blood Institute, a small percentage of people who have got 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 about any known reaction to metals to their doctor and talk about other alternatives.
Q. How is a stent performed?
- A stent can be inserted in several ways. Generally, the process followed to insert a stent is minimally invasive. Your doctor will first make a small incision on the skin, which is usually done in the groin or arm. A catheter and specialized tools are then advanced through it 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 imaging technique called angiogram may also be used during the procedure to 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.
Q. What happens after a stent insertion?
- After stent insertion, it is normal to feel a bit of soreness at the site of the incision. It can be easily treated with mild painkillers. Your doctor may also prescribe anticoagulant medications to prevent further clotting of blood.
Typically, after the procedure, the patient has to stay in the hospital overnight to make sure that no complications arise. However, they 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 have to drink plenty of fluids and stay away from physical activities for some time. It is recommended to follow every instruction from the doctor.
Q. What follow-up care is involved after the stenting procedure?
- After leaving the hospital, you have to 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 in the right way.
Your doctor may also order an exercise stress test for you three to six weeks after the procedure. Depending on that, the appropriate level of activity 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.
Q. Can you live a normal life with a stent?
- Yes, you can live a normal, healthy and active life with a coronary stent. Some of the general guidelines that you need to follow are mentioned below.
- 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: People can go back 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 can you do after the procedure or if you can resume any sports or exercises that you used to do.
- Carrying your stent implant card: Having your stent implant card with you at all times is important. The card contains your name, the doctor’s name and phone number, and other information about the implanted stents.
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