Use of Stents
Written by:The stent is a structure that is implanted in patients who have one or more obstructed coronaries: Dr. Sollazzo, an expert in Surgery in Foggia, explains its uses
What is a stent?
The coronary stent is a very small, cylindrical metal mesh structure that is implanted in the coronary arteries to reopen them when they are obstructed by atherosclerotic plaques.
How are the stents used?
At the time of surgery in the hemodynamics room a puncture is usually performed at the femoral artery, but in our laboratory, more frequently, in the artery of the left (radial) wrist with minimal local anesthesia, and then catheters are introduced that reach the obstructed coronary. The patient may experience a mild but well-tolerated pain. The movement of the catheters through the arteries does not cause pain.
Once arrived at the site to be treated, the obstruction is crossed with a metal guide wire and then the stent is run over it with the aid of a balloon carrying the precise point inside the vessel: this technique must be performed under close radiological monitoring. and with the contrast medium, which allows to see the lumen of the artery.
Is it a risky procedure?
There may be potential problems related to the use of coronary stents: the most common is the thrombosis of the same, which leads to an acute occlusion of the vessel and ischemia of the heart muscle, but they are generally rare events and occur in the immediate or within 24 hours after implantation. For this reason the patient is transferred to UTIC under clinical monitoring and anti-aging and / or anticoagulant therapy. Even late intimal proliferation, if excessive, can lead to complication, called restenosis. The focus of current research is the reduction of neointima growth following placement of the stents. Considerable steps have been taken to improve the methodology, including the use of more biocompatible materials, the use of drug-eluting stents to release antiproliferative drugs or resorbable stents and bioactive stents. Despite these precautions, it is possible that a late thrombosis may occur, with a careful compliment of the patient with the double anti-aggregation therapy, which nowadays must be performed for at least a year. In some cases of obstructive restenosis, re-operation is indicated with the use of medicated flasks (DEB).
How to choose the best procedure?
The rapid development of percutaneous revascularization methods with the stents has changed the strategy of choice of therapy to be performed, especially in complex cases in which patients present a severe obstruction of three coronary vessels or a severe obstruction of the common trunk of the left coronary artery. Currently, despite the medical literature indicates the surgical approach as a procedure to be performed in patients at high cardiovascular risk, the "drug eluting stents" are widely used, which significantly reduce the number of patients operated by bypass (CABG) .