Stent

Arteries are blood vessels that carry blood away from your heart to other parts of your body.

Doctors also may place stents in weak arteries to improve blood flow and help prevent the arteries from bursting.

When a stent is placed into the body, the procedure is called stenting. There are different kinds of stents. Most are made of a metal or plastic mesh-like material. Fabric stents, also called stent grafts, are used in larger arteries.

Some stents are coated with medicine that is slowly and continuously released into the artery. These stents are called drug-eluting stents. The medicine helps prevent the artery from becoming blocked again.

Risk Factors

About 1–2 percent of people who have stented arteries develop a blood clot at the stent site. Blood clots can cause a heart attack, stroke, or other serious problems. The risk of blood clots is greatest during the first few months after the stent is placed in the artery.

Your doctor will likely recommend that you take aspirin and another anticlotting medicine for at least 1 month or up to a year or more after having a stent procedure. These medicines help prevent blood clots.

The length of time you need to take anticlotting medicines depends on the type of stent you have. Your doctor may recommend lifelong treatment with aspirin.

Stents coated with medicine may raise your risk of dangerous blood clots. (These stents often are used to keep clogged heart arteries open.)

Although rare, a few serious problems can occur when surgery or a fabric stent is used to repair an aneurysm in the abdominal aorta. These problems include:

• A burst artery (aneurysm rupture).
• Blocked blood flow to the stomach or lower body.
• Paralysis in the legs due to interruption of blood flow to the spinal cord. This problem is very rare.

Another possible problem is the fabric stent moving further down the aorta. This sometimes happens years after the stent is first placed. The stent movement may require a doctor to place another fabric stent in the area of the aneurysm.

Treatment

FOR THE CORONARY ARTERIES

Doctors may use stents to treat coronary heart disease (CHD). CHD is a disease in which a waxy substance called plaque builds up inside the coronary arteries that supply your heart muscle with oxygen-rich blood.

When plaque builds up in the arteries, the condition is called atherosclerosis.

Plaque narrows the coronary arteries, reducing the flow of oxygen-rich blood to your heart. This can lead to chest pain or discomfort called angina.

Doctors may use percutaneous coronary intervention (PCI), also known as coronary angioplasty, and stents to treat CHD.

Unless an artery is too small, a stent usually is placed in the treated portion of the artery during PCI. The stent supports the artery’s inner wall. It also reduces the chance that the artery will become narrow or blocked again. A stent also can support an artery that was torn or injured during PCI.

Even with a stent, there’s about a 10–20 percent chance that an artery will become narrow or blocked again in the first year after PCI. When a stent isn’t used, the risk can be as much as 10 times as high.

FOR THE CAROTID ARTERIES

Doctors also may use stents to treat carotid artery disease. This is a disease in which plaque builds up in the arteries that run along each side of your neck. These arteries, called carotid arteries, supply oxygen-rich blood to your brain.

The buildup of plaque in the carotid arteries limits blood flow to your brain and puts you at risk for a stroke.

Doctors use stents to help support the carotid arteries after they’re widened with PCI.

FOR OTHER ARTERIES

Plaque also can narrow other arteries, such as those in the kidneys and limbs. Narrow kidney arteries can affect kidney function and lead to severe high blood pressure.

Narrow arteries in the limbs, a condition called peripheral artery disease (P.A.D.), can cause pain and cramping in the affected arm or leg. Severe narrowing can completely cut off blood flow to a limb, which could require surgery.

To relieve these problems, doctors may do PCI on a narrow kidney, arm, or leg artery. They often will place a stent in the affected artery during the procedure. The stent helps support the artery and keep it open.

FOR THE AORTA IN THE ABDOMEN OR CHEST

The aorta is a major artery that carries oxygen-rich blood from the left side of the heart to the body. Over time, some areas of the aorta’s walls can weaken. These weak areas can cause a bulge in the artery called an aneurysm. An aneurysm in the aorta can burst, leading to serious internal bleeding.

To help avoid a burst, doctors may place a fabric stent in the weak area of the abdominal aorta. The stent creates a stronger inner lining for the artery.

Recovery

RECOVERY

After either type of stent procedure, your doctor will remove the catheter from your artery. The site where the catheter was inserted will be bandaged.

Eventually, a small bruise and sometimes a small, hard “knot” will appear at the insertion site. This area may feel sore or tender for about a week.

You should let your doctor know if:

• You have a constant or large amount of bleeding at the insertion site that can’t be stopped with a small bandage
• You have any unusual pain, swelling, redness, or other signs of infection at or near the insertion site

COMMON PRECAUTIONS AFTER A STENT PROCEDURE

After a stent procedure, your doctor will likely recommend that you take aspirin and another anticlotting medicine. These medicines help prevent blood clots from forming in the stent. A blood clot can lead to a heart attack, stroke, or other serious problems.

If you have a metal stent, your doctor may recommend aspirin and another anticlotting medicine for at least 1 month. If your stent is coated with medicine, your doctor may recommend aspirin and another anticlotting medicine for 12 months or more.

Your risk of blood clots significantly increases if you stop taking the anticlotting medicine too early.

Also, anticlotting medicines can cause side effects, such as an allergic rash. Talk to your doctor about how to reduce the risk of these side effects.

You should avoid vigorous exercise and heavy lifting for a short time after the stent procedure. Your doctor will let you know when you can go back to your normal activities.

Lifestyle Changes

Stents help prevent arteries from becoming narrow or blocked again in the months or years after percutaneous coronary intervention (PCI), also known as coronary angioplasty. However, stents aren’t a cure for atherosclerosis or its risk factors.

Making lifestyle changes can help prevent plaque from building up in your arteries again. Talk with your doctor about your risk factors for atherosclerosis and the lifestyle changes you’ll need to make.

Lifestyle changes may include changing your diet, quitting smoking, being physically active, losing weight, and reducing stress. You also should take all medicines as your doctor prescribes. Your doctor may suggest taking statins, which are medicines that lower blood cholesterol levels.