Talking with Your Doctor About Heart Stent
People with advanced coronary artery disease (CAD) who have symptoms like angina, or those who have had a heart attack, may benefit from receiving a heart stent. These devices enlarge the opening of arteries that have become clogged with cholesterol plaques.
Minimally invasive heart stent surgery is a beneficial alternative to open heart surgery for people who qualify for the procedure. Before you undergo a heart stent procedure, though, you should talk with your doctor about the various types of stents available and which one is the right choice for you.
Heart attacks occur when any of the arteries of the heart muscle—the coronary arteries—become narrowed or blocked due to the buildup of cholesterol plaques. When a coronary artery becomes clogged, the heart tissue does not receive enough oxygenated blood to function, and portions of the tissue die. This is what’s commonly called a heart attack.
Cardiologists can identify people at high risk of a heart attack and act in advance to potentially prevent one from happening by placing one or more stents in narrowed coronary arteries. Some people also can receive a post-heart attack stent, if they don’t need bypass surgery.
Stents are tiny metal coils inserted into clogged arteries to hold them open and allow more blood and oxygen to flow to the heart tissue. Stents come in two basic types: bare metal and drug-eluting. When you talk with your doctor about a stent procedure, you should ask a few questions about the benefits and risks of each type.
The original coronary artery stent consisted of a plain metal coil. This device has been in use for decades. However, bare metal stents can sometimes stimulate excessive tissue growth around the coil, leading to another arterial blockage at the same site, called restenosis. If this happens, an interventional cardiologist may need to perform another catheterization to deliver a small dose of radiation to the stent site to stunt tissue growth in that area. And if restenosis can’t be addressed through radiation, then open heart surgery may be required.
Because of the restenosis issue, a second type of stent was developed: drug-eluting stents. These devices contain medication that slowly releases (“elutes”) into the surrounding tissue to prevent or delay excessive growth around the stent. But research has shown drug-eluting stents carry a higher risk of blood clots at the stent site than bare metal stents do. If you receive an eluting stent, you may need to take an anticoagulant medication (blood thinner) over a long period of time to reduce your risk of a clot.
In addition to the specific risks of restenosis with bare metal stents and blood clots with drug-eluting stents, both types of heart stents carry a risk of other complications, including:
Blood clot, though the risk is higher with a drug-eluting stent
Internal bleeding related to the use of anticoagulant medications, even over the short term
Informed patients often experience better outcomes after any type of surgery or medical procedure, and you can become informed by asking your cardiologist plenty of questions before undergoing a heart stent catheterization.
Ask your doctor:
Why are you recommending this procedure to me? Why is this a better option for me than coronary bypass surgery?
What are the risks and benefits of receiving a heart stent?
Can you estimate how many stents you think I will need?
Which type of stent do you recommend for my situation? What are the specific benefits and risks of each type for me?
What does receiving a stent mean for my overall, long-term health? How does receiving a stent affect my risk of a future heart attack?
What medications will I need to take after the procedure and for how long?
What will my recovery look like? How long will it take?
What lifestyle changes can I make to improve my heart health and reduce my risk of developing additional clogged arteries?
Compared to coronary artery bypass surgery, a heart stent procedure is far less invasive, with a shorter recovery period and less pain. But because stents also have some risks, you should have a conversation with your doctor to find out how receiving a stent will affect your life—possibly for years to come.