Stents - What You Need To Know

Stents have revolutionized the treatment of coronary artery disease over the past few decades.  Doctors can now treat coronary artery plaques with a minimally invasive procedure that has become routine and safe.

At the same time, the decision to receive a stent is anything but a slam-dunk.  If you have a blockage that is not producing any symptoms, or is producing only stable angina, then you are likely to do quite well with medication only.  Furthermore, stents can produce their own problems.  And they always introduce a difficult management question that has stirred up a lot of controversy among cardiologists. 

So before you get a stent, there's a lot you should know.  The following articles should help you understand the issues surrounding stents, and should help you formulate questions for your doctor.

Stents - What They Are and What They Do

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 Stents are metal wire-mesh struts that are positioned into an artery to “prop open” the artery after an angioplasty.  This article will give you a basic description of stents, and what they do.

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Restenosis After Angioplasty and Stenting

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 Restenosis is a gradual blockage of an artery after angioplasty and stenting, caused by the growth of new tissue inside the stent.  The problem of restenosis has been minimized in recent years by the use of drug-eluting stents (DES) - minimized, but not eliminated.

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The Ongoing Problem of Stent Thrombosis

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 Stent thrombosis is a sudden, often catastrophic occlusion of an artery, at the site of the stent, caused by the acute formation of a blood clot.  Stent thrombosis is greatly reduced by using anti-platelet drugs, but remains a major issue with the use of stents.

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Anti-Platelet Drug Therapy After A Stent


 The use of two anti-platelet drugs (also known as dual anti-platelet therapy, or DAPT), significantly reduces the risk of stent thrombosis.  However, DAPT itself can introduce new risks, some of which are quite serious.  Here is a discussion of DAPT, and of the ongoing controversy surrounding its prolonged use after a stent.

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Bare Metal Stents (BMS) vs. Drug Eluting Stents (DES)

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 When DES were first introduced, they were found to be so effective at reducing stent restenosis that most cardiologists believed that the days of BMS were numbered.  However, because of evidence (though not proof) that the problem of late stent thrombosis is more severe with DES, some doctors are still opting for BMS in some patients.  This article discusses the use of BMS vs. DES.

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The Problem With Stents

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 If you have read this far, you may be getting confused about stents - are they helpful or not?  This article attempts to summarize the ongoing problems and controversies surrounding the use of stents.

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Do You Really Need A Stent?

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 Now that we've laid out the pros and cons of stents for the treatment of coronary artery disease, let's talk about when the use of stents really makes sense - and when it may not.

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New Stent Technologies

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 Where there are problems there is opportunity. An amazing engineering effort is underway, by several companies, to develop new kinds of stents that greatly diminish the risk of stent thrombosis and stent restenosis. Read about these efforts here.

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Treatment Options for Coronary Artery Disease

Anyone who is being asked to consider a stent (and also their doctors) ought to keep in mind that stent placement is only one of the several treatment options for coronary artery disease. This link (above) describes all your options.

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