Stent: myths and mysteries

Stent: myths and mysteries
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Do you need a stent? How long should it be in your heart? What are the risk factors? Dr Saurin Patel busts...

Do you need a stent? How long should it be in your heart? What are the risk factors? Dr Saurin Patel busts myths surrounding stents Health correspondent StentStents are commonly used to treat conditions that result from narrowed or blocked arteries such as coronary heart disease, peripheral artery disease, renal artery stenosis etc. Controlling diabetes, blood pressure, cholesterol, exercising, dieting and abstinence from tobacco are important for any heart patient. Stents help to open blockages. The "risks" are very small and rare, but can occur in an angioplasty procedure. Excerpts from an e-mail interview with Dr Saurin Patel, M.D. (USA), Consultant Cardiologist in Cardiac and Peripheral Vascular Interventions, Seven Hills Hospital, Mumbai
What is stenting and what are the risks and benefits of stenting?
A stent is a slotted metal tube (similar to the spring inside a pen) which is put inside the heart during an angioplasty procedure to open a blockage and to keep it open. They are typically made of stainless steel or cobalt chromium. The "risks" are minimal and rare but can occur in an angioplasty procedure
What are the different kinds of stents?
Medicated and non-medicated stents. Given that cardiac disease is complicated, how do you decide which stent to use on a patient? All stents carry the risk of a re-blockage occurring within the first year. With medicated stents that risk is lower than non-medicated. The decision of which one is to use is based on several factors including how long the blockage is and whether or not the patient has diabetes.
How have stents evolved and what are the latest developments?
Stents have evolved mostly in terms of their technical design, making it easier for the cardiologists to place the stents. The medicated stents which came out in 2003 and now the absorbable stent are advancements of technology. The absorbable stent has just entered the Indian market.
Are stents used on children? What are the stents used in paediatric cardiology? Are stents used more in women?
Stents are not used more in men or women. In general, women have been under diagnosed with heart disease but the rate of heart diseases between men and women is the same. Stents are not used in children except in rare and exceptional cases. In pediatric cardiology, different devices are used, mostly to close holes in the heart (as a result of a birth defect), but these are not stents.
How long is a stent functional post-implant?
There is no specific lifetime of the stent. As mentioned earlier, there is a chance of re blockage occurring within the stent that can happen in the first year. The chance of this re blockage occurring can range from 2-20% depending on many factors including whether or not the patient has diabetes and whether or not a medicated stent was used.
Is there any specific kind of care and medication required post-stent placement?
There is no specific post-care of a stent patient that is different than any patient with heart disease. Controlling diabetes, cholesterol, blood pressure, exercising, dieting and abstinence from tobacco are all basic tenants of any heart patient. Stent patients are put on blood thinning medications which have to be continued for at least one month in patients with a non-medicated stent and at least one year in patients with a medicated stent and in some cases lifelong.
Are there any controversies, myths or inhibitions around stents?
Stents are one of the most widely studied in the medical community, so there are not a lot of controversies or myths. One of the ongoing debates is the benefits of stents versus bypass surgery. There is still no final verdict and the decision is taken on a case to case basis. A lot of criticism is on the cost of stents...?
Hospitals should not be criticised for the cost of the stents. Hospitals don't set the costs, manufacturers do it. These are sophisticated medical devices which are life saving so there should not be criticism as to the cost. What is the importance of stent coatings? The importance of stent coatings is under debate. There is some suggestion that the substance which binds the medication to the stent in medicated stents can lead to an increase in chance of formation of a blood clot within the stent (although this happens at a frequency of approximately 1 in 1000 patients). Stent1
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