What is a stent and what are the benefits?
Stents are small, expandable, metallic mesh tubes. A stent is placed in the narrowed portion of an artery to keep the artery open after balloon angioplasty. The stent, therefore, acts as scaffolding to keep the blood flowing freely in the artery.
In some patients, stents have prevented the renarrowing that may occur after a balloon angioplasty is performed.
Who needs stents?
If your doctor determines that you have a build-up of plaque in a localized area of an artery you may be a candidate to undergo balloon/stent angioplasty.
A common place to feel the cramping is in the calf muscle, although cramping may also appear in the thigh or buttock.
Before the procedure
Your doctor may order blood tests and an EKG test before your procedure. You may be asked not to eat or drink after midnight or 6-8 hours prior to the procedure. At the hospital an intravenous line will be inserted to provide fluids and medications.
How can I tell if I have arterial blockage?
Tell your doctor about your symptoms. After your doctor has spoken to you and has done a physical exam, you may need to have some testing done.
How and where is a stent inserted?
The stent is placed over a balloon catheter. The stent and balloon catheter are passed through a plastic tube called a sheath, which is inserted in the groin. The balloon and stent catheter are positioned at the narrowed area in the artery. When the balloon is inflated, the stent expands to the size of the artery and compresses the plaque against the artery wall.
The stent remains in the vessel permanently, giving the artery structural support. Stents are usually inserted through the femoral (groin) artery and can be placed in the superficial femoral (leg), iliac (abdomen), renal (kidney), subclavian (shoulder), or coronary (heart) arteries and dialysis grafts as well as other sites. Research is being done on the role of stents in the carotid (neck) artery.
Patients are given a local anesthetic to numb the groin area where the sheath will be inserted. Sometimes, IV or epidural anesthesia will be given for longer cases. Your vascular specialist will tell you which type of anesthesia is best for you.
How the procedure is done:
- A sheath is inserted into the groin or arm artery.
- A guide wire is passed across the narrowed portion of the artery.
- The balloon catheter is passed over the guide wire to the area of arterial renarrowing.
- The balloon is expanded which compresses plaque against the artery wall.
- The balloon is then withdrawn and a dye test done to observe the result.
- If the narrowing is still tight, a balloon with a stent is passed to the narrowed area and the balloon is expanded to put the stent in place and restore blood flow.
After the procedure
The nurse will check your blood pressure and insertion site frequently. You may have a heart monitor and an IV line to provide fluids and medications. The doctor may prescribe a blood thinner type of medication after the procedure to prevent blood clots from forming in the stented artery.
What are the risks?
With any procedure there is a risk of blood clots. Discuss this with your doctor before the procedure.
Types of stents
Stents have dramatically improved over the years. Currently used materials include stainless steel stents, which are either expanded by the balloon catheter and/or Nitinol (nickel and titanium), which are frequently self-expanding stents. Medicated stents are being developed that will allow the slow release of medicines to prevent the renarrowing (restenosis) of arteries after balloon/stent angioplasty. There are also covered stents that prevent the plaque in the narrowed artery from breaking loose when the stents are expanded. Your doctor will select a stent that is appropriate for you.
It is important to be your own best health advocate. A good way to do that is by committing to routine exams and diagnostic tests as often as is recommended by your doctor. Early detection of vascular disease is important for effective treatment.
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