Since 1986, when the procedure was first performed, angioplasty with stenting has become the most common remedy for arteries narrowed by heart disease. Each year, about half a million Americans have stents — which are essentially little mesh tubes — implanted in their coronary arteries.
For the procedure, the patient is mildly sedated, and stent tube with a balloon inside of it is inserted into the groin through a catheter. It is then threaded to the coronary arteries.
Once it reaches the blockage, the balloon is expanded to widen the artery, improving blood flow. Then the stent, which was wrapped around the deflated balloon, is deployed to keep the artery propped open.
The procedure usually takes about an hour, although it could be longer if multiple stents are required. With no need for an incision, general anesthesia, or the heart-lung machine, stenting is vastly safer than bypass surgery.
However, it is not completely without risk.
Sometimes, a clot can form causing a stroke or heart attack. If a serious problem does occur, emergency bypass surgery may be required.
A clot can also form at the site of the stent after the procedure. For that reason, patients are directed to take an anticlotting medication such as Plavix or Effient for up to a year after the procedure.
Some patients also experience mild chest pain when the stent expands. Though this may be worrisome, it doesn’t always indicate a problem.
Over the years, the number of stenting procedures has grown astronomically. But according to the American Medical Association, one out of every 11 such elective procedures is unnecessary.
Personally, I suspect that number is low, as doctors are performing way too many procedures on borderline cases to compensate for revenue lost due to healthcare reform.
For many, following a heart-healthy diet and getting daily exercise, along with taking cholesterol-lowering statin drugs, can help dissolve arterial blockages without having to resort to stenting or coronary bypass surgery.
If you do undergo a stenting procedure, call your doctor if any of the following symptoms occur:
• Bleeding or redness from the site where the catheter was inserted
• Irregular heartbeat
• Infection
Posts by Chauncey Crandall, M.D.
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