Definition & Overview
One of the primary causes of coronary disease is the build-up of plaque in arteries to the heart. This can cause a partial or complete blockage, which hinders the heart from getting enough supply of oxygen-rich blood it needs to function properly. This results in a variety of symptoms including shortness of breath and chest pain. If not corrected, the patient can suffer from a stroke or heart attack.
Due to the various advances in the field of heart care, the condition can now be treated using a non-surgical, minimally invasive method that eliminates the need for an open-heart surgery stent placement. Called angioplasty, this involves guiding a wire through the artery until it reaches the blockage. The plaque buildup is then removed and in some cases, a heart stent is used for support to keep the treated artery from collapsing in the future.
Angioplasty with stent placement in heart is safe and highly effective offering more than half of the patients with immediate symptom relief. Once the stent is placed, it quickly becomes a part of the coronary artery walls as surrounding tissue envelops it. Thus, patients do not require an additional procedure to have it removed.
Who Should Undergo & Expected Results
Patients diagnosed with a blocked artery to the heart will greatly benefit from the procedure. The removal of plaque will immediately reduce the pressure on the heart and significantly lower the patient's risk of developing serious, potentially life-threatening complications. Adding a heart stent will ensure that the artery remains stable, thus reducing the risk of it collapsing in the future.
The procedure is also performed following a heart attack with the goal to restore blood flow in the affected area as soon as possible to save oxygen-deprived heart tissue. This is often done in conjunction with cardiac catheterisation (a procedure used to locate blockages) and stent placement after heart attack.
Recovery after heart attack stent placement can be hastened with cardiac rehabilitation. Many hospitals and dedicated heart care centres offer programs that focus on lifestyle changes, medications, and helping patients manage emotional issues. Depending on the severity of the heart attack and how soon the patient received treatment, the program can last between a couple of weeks and a couple of months.
Before angioplasty with stent placement heart is performed, the patient undergoes various diagnostic procedures including those that involve taking blood samples and x-ray images. Other imaging tests, which include magnetic resonance imaging (MRI) and computed tomography (CT) scan are also performed along with the review of the patient’s medical history and a thorough physical examination. If tests confirm the presence of a blocked artery, another procedure called coronary angiogram is performed. In this procedure, a catheter is inserted either into the femoral (groin) or brachial (elbow) vein and guided to the blocked coronary artery. An iodine dye is then injected into the blood stream with its flow monitored using an imaging technology. If the dye’s flow is interrupted at a certain location in an artery, the doctors would have then identified the location of the blockage.
In cases wherein the plaque blocks more than 50% of blood flow, doctors may perform an angioplasty to remove the blockage right after an angiogram. This is done to avoid life-threatening complications, such as heart attack. If doctors believe that the treated area is compromised or could weaken, they may opt to insert a heart stent during the same procedure.
How Does the Procedure Work?
Inserting a heart stent usually occurs right after angioplasty, a relatively simple procedure that requires only a small amount of anaesthetic or pain medication. It involves creating a small incision either in the arm or leg to access an artery or vein that leads to the affected coronary artery. A small balloon catheter is then inserted through the incision and guided to the blocked artery. The entire process is closely monitored using a live x-ray feed. Once the catheter reaches the blocked portion of the artery, the balloon is inflated several times until it is wide enough to restore normal blood flow. The wire mesh is then inserted using the same catheter.
The main reason why arteries become blocked is because of a small damage to the artery. The body repairs such damage by applying a small layer of cholesterol. However, if the damage continues to grow, the body will continue to apply more layers until such time that plaque builds up and blocks the artery. By removing the blockage, the original damage to the artery could possibly cause the artery to collapse. The heart stent will prevent this from happening.
After the procedure, patients are transferred to a recovery room where they are monitored for possible complications including infection and bleeding of the site where the catheter was inserted. In many cases, angioplasty with heart stent placement requires hospitalisation with patients spending at least one day in the hospital. However, they are able to return to work or normal routine a week after the procedure.
Possible Risks & Complications
Stent placement for heart blockage is a relatively safe procedure performed in more than one million patients in the United States every year. The majority of patients are able to make a full recovery with minimal to zero complications.
Unfortunately, a small percentage of patients report minor complications including suffering from an allergic reaction to the material used for the stent or any drugs administered during the procedure. Some also developed blood clots and experienced abnormal bleeding as well as heart pain after stent placement.
Patients who undergo this procedure also have a small risk of suffering from additional damage to the artery caused by the catheter or stent. If the blood clot travels to the brain, the patient would be in danger of developing a stroke. If the blood clot becomes stuck in the heart, the patient faces the risk of suffering from a heart attack after stent placement.
However, the benefits of a heart stent placement almost always outweigh the risks. In fact, most patients who undergo the procedure experience symptoms relief right away and lower their risk of heart attack after stent placement.
While in recovery after stent placement in heart, patients are advised to take medications, including aspirin and blood-thinning drugs. They are also advised to change their lifestyle, diet, and perform exercises regularly to reduce the risk of plaque building up in their coronary arteries again.
US National Library of Medicine:”Angioplasty and Stent Placement – Heart”; https://medlineplus.gov/ency/article/007473.htm
National Heart, Lung, and Blood Institute:”How are Stents Placed?”; https://www.nhlbi.nih.gov/health/health-topics/topics/stents/placed
Health Library, Johns Hopkins Medicine;”Angioplasty and Stent Placement for Heart”; http://www.hopkinsmedicine.org/healthlibrary/testprocedures/cardiovascular/percutaneoustransluminalcoronaryangioplastyptcaandstentplacement_92,P07981/