Angioplasty and stent placement can alleviate the blockage of an artery and angina, orpersistent chest pain, that medications can't control. They're also emergency procedures used if someone is having a heart attack.
If you are having a heart attack, a stent is absolutely needed, stresses Donald Lloyd-Jones, M.D., chair of the Department of Preventive Medicine at the Northwestern University Feinberg School of Medicine in Chicago. Since a clot has completely blocked an artery, your heart muscle is starved of oxygen.
A stent can cause blood clotting, which may increase the risk of heart attack or stroke. The National Heart, Lung, and Blood Institute state that about 1 to 2 percent of people who have stented arteries develop a blood clot at the site of the stent. Doctors will usually prescribe one or more drugs to prevent clotting.
Stenting is a minimally invasive procedure, meaning it is not considered major surgery. Stents can be made of metal mesh, fabric, silicone, or combinations of materials. Stents used for coronary arteries are made of metal mesh. Fabric stents, also called stent grafts, are used in larger arteries such as the aorta.
As with all types of surgery, coronary angioplasty carries a risk of complications. However, the risk of serious problems is small. Complications can occur during or after an angioplasty. It's common to have bleeding or bruising under the skin where the catheter was inserted.
What should you expect? The procedure may take place right after the arteriogram, which is used to find the blockage, or it may occur the next day. You may need to stay in the hospital two or three days.
Clinical trials have reported mortality rates as high as 50% in patients with early (within 1 month of the procedure) stent thrombosis.
Angioplasty and stent placement can alleviate the blockage of an artery and angina, orpersistent chest pain, that medications can't control. They're also emergency procedures used if someone is having a heart attack.
The meta-analysis showed that stents delivered no benefit over medical therapy for preventing heart attacks or death for patients with stable coronary artery disease. Still, many cardiologists argued, stents improved patients' pain. It improved their quality of life.
General anesthesia isn't needed. You'll receive a sedative to help you relax, but you may be awake during the procedure depending on how deeply you are sedated. You'll receive fluids, medications to relax you and blood-thinning medications (anticoagulants) through an IV catheter in your hand or arm.
By clinical guidelines, an artery should be clogged at least 70 percent before a stent should be placed, Resar said. "A 50 percent blockage doesn't need to be stented," he said.
Stent placement usually takes 30 minutes to two hours, but the preparation and recovery time may add several hours. This procedure is usually performed in the cardiac catheterization laboratory.
A stent may be used as treatment for narrowed arteries caused by peripheral artery disease (PAD), a condition when plaque builds up in the arteries that carry blood to your legs, arms, or abdomen. Stents may be used to treat PAD symptoms and help prevent future health problems caused by reduced blood flow.
After having a planned (non-emergency) coronary angioplasty, you'll usually be able to leave hospital the same day or following day. Arrange for someone to take you home. Before you leave hospital, you should be given advice on: any medication you need to take.
The most widely used surgical alternative to a coronary angioplasty is a coronary artery bypass graft (CABG).
It depends primarily on the underlying heart disease, age, and medical condition of the patient. A younger patient, for example, who has a strong heart and has never experienced a heart attack, will be expected to live a full and active lifespan.
And this question has an answer—bypass surgery—as long as the individual's surgery risk isn't too high. "For three-vessel coronary disease, bypass now has been shown to be superior to stenting, with the possible exception of some cases in which the narrowing in the artery is very short," Cutlip says.
Results show that managing the condition with beta blockers, calcium blockers, statins, aspirin therapy, and forms of nitroglycerin can allow more patients to avoid common and invasive bypass or stent procedures.
-Discomfort or pain
Stents can cause discomfort or pain, commonly in the bladder and kidney (loin) area, but sometimes in other areas such as the groin, urethra and genitals.
Usually, patients stay overnight and return home the day after the procedure. Some may even go home the same day. The amount of time that you stay in the hospital will depend on if there were any difficulties during the procedure and how well the catheter insertion site is healing.
Just after the procedure
Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) or a regular hospital room. If the sheath was left in the insertion site, it will be removed from the groin or arm at the appropriate time.
Walking, climbing stairs and taking care of routine activities are usually fine. After five days, your doctor will likely say you can resume moderate activities, but you should avoid over-exertion that leads to shortness of breath, tiredness or chest pain.
Chest pain (angina) that worsens when you engage in physical activities. Shortness of breath that accompanies physical activity. Chest pain that doesn't improve when you've taken medication or made lifestyle changes.
The largest research study of its kind has found that drugs can be just as effective as stents and surgery for treating blocked arteries. Results of the study, sponsored by the National Heart, Lung, and Blood Institute, were released on November 16.
Coronary arteries with severe blockages, up to 99%, can often be treated with traditional stenting procedure. Once an artery becomes 100% blocked, it is considered a coronary chronic total occlusion, or CTO. Specialized equipment, techniques and physician training are required to open the artery with a stent.