When you need to stent your heart arteries


An unexpanded cardiac stent is seen here next to an enlarged illustration of it in its actual form. — Filepic

A friend of mine suddenly had chest pain. He lived alone, so we rushed him to the hospital. He had to have two heart stents put in. What is a heart stent?

A heart or cardiac stent is a small tube that can be put into the blood vessels supplying your heart (called coronary arteries).

When you have a heart attack, or the beginnings of a heart attack, or significantly narrowed coronary arteries, you may be advised to get a heart stent.

Your coronary arteries deliver oxygen-rich blood to your heart muscles.

Due to age, bad habits or genetics, arteriosclerotic plaques can gradually build up in your coronary arteries and clog them, thus limiting the blood flow through them.

This is coronary heart disease.

When blood flow is thus reduced, it can damage your heart muscles due to decreased oxygen and nutrient supply, and put you at risk of having a heart attack.

A cardiac stent is a tool used to reopen your narrowed or blocked coronary arteries.

Even after you have had a heart attack, stents can be used to improve blood flow to the heart afterwards (assuming you survive the heart attack, of course!).

Oh. What do heart stents look like?

Cardiac stents are tiny, expandable coils made of fine metal mesh.

Most stents are coated with polymer, as well as a drug to help keep your artery open and to stop scar tissue from growing between the mesh of the stent, as this can cause re-narrowing of the artery.

This type of stent is known as a drug-eluting stent.

The metal is usually stainless steel, platinum-chromium or cobalt-chromium.

Some of them are made out of synthetic fabric, however.

These are meant for larger arteries and are called stent grafts.

Stents are cylindrical in shape, following the shape of your artery.

Most of them are around 1.5 to 2cm in length, but can be as long as 4.8cm. Their diameter is around 0.2-0.5 cm.

When stents are inserted, they support the walls of your narrowed artery and help prevent it from becoming narrow after an angioplasty.

They are meant to be permanently placed in your body, giving you a new lease on life.

Previously, there was one type of stent designed to dissolve in your body and disappear over time.

Similar to permanent drug-eluting stents, it would also slowly release a drug as long as it was in the artery so that your arterial walls would be less likely to get clogged up again.

However, due to safety concerns, this dissolving stent was withdrawn from the market and is no longer available.

Your cardiologist will decide which stents are the best for your particular condition.

What is an angioplasty?

A coronary angioplasty is also called percutaneous coronary intervention.

It is the treatment or procedure that is used to open your clogged or narrowed heart arteries.

In this procedure, a tiny balloon catheter is inserted into your blocked blood vessel.

Once inside, the balloon is inflated to widen the blood vessel lumen, thereby improving blood flow to your heart.

All this is done by the cardiologist or cardiac surgeon, who can see where your blockage is through a live feed using X-rays.

Angioplasty is often combined with placement of cardiac stents.

The stent is collapsed around the balloon at the tip of the catheter, and is guided through the artery to the area of blockage where it is expanded and set into place.

An angioplasty can improve the symptoms of blocked arteries, such as chest pain and shortness of breath.

It is also often performed during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart muscles.

That is why it is always important to go to the emergency department of a hospital as soon as you can when you experience chest pain.

Wait. So how is the stent inserted into the artery? It is not open heart surgery, is it?

Not at all. The catheter that carries the balloon and the stent is inserted through the radial artery in your wrist or the femoral artery in your groin.

Thereafter, it is guided via X-ray imaging through your body’s arteries until it reaches the site of the narrowing in the coronary artery.

Some people have to have more than one stent placed.

The whole procedure usually takes 30 to 60 minutes.

Does it require anaesthesia? Will it hurt?

Most patients are completely awake during this procedure.

The doctor will give you local anaesthesia at the site of catheter insertion, which is usually at your wrist.

The prick of the needle for local anaesthesia is the only minor pain you are likely to feel throughout this procedure.

Your arteries do not have pain nerve endings, so you will not feel pain while the catheter is travelling upwards.

Some patients do experience slight chest pain when the balloon is inflated.

After having a stent placed, will my coronary arteries narrow again?

There is only a 2% to 3% risk of this happening.

If it does happen, it will happen within the first nine months after the angioplasty.

It is best that you take the doctor’s complete advice, such as taking your medications regularly and changing your lifestyle to be more healthy.

Don’t forget that you have other coronary arteries where narrowing can occur and blockages can form – you don’t want to have to keep going for multiple angioplasties and stents.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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