It's no bigger than the little spring you find in a ballpoint pen, but it makes an enormous difference in the lives of heart attack and angina patients.
It's a stent, a tiny metal scaffold that keeps an artery open to allow blood flow. Although stents have been placed in arteries since 1986, they're much more technologically advanced these days. Want more good news? The procedure to place them in an artery is even more minimally invasive.
"Stents are important to two groups of patients — those having a heart attack and those who have angina, or chest pain, because of poor blood flow," said Mayurkumar Bhakta, MD an HonorHealth interventional cardiologist.
Stents are often the minimally invasive alternative to bypass surgery. That's when a surgeon opens the chest and bypasses the blocked part of the artery with a blood vessel from another part of the body.
A less invasive alternative
To perform the stent procedure, an interventional cardiologist inserts a catheter into a blood vessel in the groin or wrist. The specialist guides a stent over a wire into the heart artery to treat the blockage. Depending on its location — in front of the heart or the back, and how much calcium is in the artery — the procedure can take anywhere from 45 minutes to four hours. "You want to make sure it is placed perfectly," said Dr. Bhakta.
Stents are common now in hospitals; in fact, Dr. Bhakta places stents in patients every day.
Patients benefit in a number of ways from this less invasive procedure:
- The procedure is faster than open-heart surgery
- Discomfort is minimal
- Recovery is quicker
- Patient cost is lower
- Hospital cost is lower
Before stents became common, interventional cardiologists guided a balloon to the blockage in an artery. The balloon was placed through a catheter that the doctor maneuvered to the blocked coronary artery by way of a blood vessel in the groin. Once at the blockage, the doctor inflated the balloon to open the artery.
But two main problems arose with the use of balloons:
- The artery could close abruptly.
- The artery could narrow again due to scar tissue buildup.
Evolution of stent technology
Stents have come a long way since the mid-1980s. The first stents were strictly metal, and scar tissue was still a problem. In 1999, researchers developed drug-eluting stents coated with anti-cancer drugs that oncologists had been using for decades. Drug-eluting stents are commonly used today to prevent scar tissue formation.
The new frontier, Dr. Bhakta said, is a bioabsorbable stent that disappears over time so that no foreign object is left in the body.
In addition to the improvement in stents, surgeons can use the wrist to insert the catheter instead of the groin. That's important because not only is the procedure more patient friendly, the bleeding risk with a wrist procedure is close to zero. The entry point for a catheter placed in the groin area can bleed if improperly placed.
Aspirin and clopidogrel needed
Recovery still involves medication — aspirin or an aspirin-like drug to keep the stent from clotting. Historically, you took meds for a year; now, one to three months may be enough.
Stents shouldn't be used if you may be allergic to them or you can't take anti-platelet medications such as aspirin and clopidogrel.
Using the stent procedure, Dr. Bhakta has helped patients from the ages of 30 to 90, but most are in the 50 to 70 age range. As always, during a heart attack, time is the most important aspect when dealing with a blocked heart artery problem. "Time," he notes, "is muscle."
Care that's made with you in mind
If you need heart care, we've got you covered. Whether you live in the metro Phoenix area or you're looking to travel to HonorHealth from another part of the state or country, you'll receive in-depth care designed with your convenience in mind.