Heart stent surgery is an interventional procedure performed to reopen blocked or narrowed heart vessels. In this procedure, a thin metal mesh (stent) is placed inside the vessel and provides support to the vessel wall. Thus, blood flow to the heart muscle is restored to normal.
Stent application is generally performed using the angiography method and does not require open surgery. This procedure, which is performed under local anesthesia, is both a safe and quick-acting method.
✓What is a Stent?
Stent; is a tubular scaffold used in the treatment of heart vessel blockages. It is made from metals such as chromium, cobalt and platinum. After Angiography (coronary Angiography), your doctor may recommend stent placement. The most common reason for this recommendation is that narrowing or blockage has been detected in your heart vessels as a result of the Angiography. The stent procedure ensures that the vessel remains open. In most cases, the reason for performing Angiography is that patients are suffering from chest pain. When the narrowing is opened, chest pain also disappears. Chest pain may have been present for a relatively long time or may have started suddenly. For this reason, stent is placed in a planned manner, that is, in non-emergency conditions in some people, while in others it is placed in emergency situations such as a heart attack.
✓What tests are performed before the stent procedure?
An EKG is taken before the procedure. A blood test is also performed to check for bleeding risk, kidney function and infection.
✓How long does the stent procedure take?
Generally, 40-60 minutes. However, this time may vary depending on the characteristics of the vessel and how many vessels will receive stents. A procedure applied to a straightforward vessel can be completed in 30 minutes, while a complex case may take 3-4 hours.
✓Is the patient put to sleep during stent placement?
Only the vessel entry site will be numbed so you do not feel pain. You will be awake throughout the procedure. However, relaxing medications may be given to relieve your tension. These may put you in a slightly drowsy state; this is normal.
✓What are the risks of the stent procedure?
Like all interventional procedures, there are certain risks in stent procedures. Each of the serious complications occurs in 2 out of every 1000 people. Risk actually varies from person to person. For example, emergency procedures performed during a heart attack or procedures performed on patients with additional serious illnesses are more risky even if performed by the most experienced doctors.
✓Possible complications
Leg or wrist vessel damage: Serious bleeding or blockage may develop in the leg (groin) or wrist vessel. Therefore, blood transfusion or emergency vessel surgery may rarely be needed.
✓Heart rhythm disorder: Brief rhythm disturbances that resolve on their own are frequently seen in the procedure, but are not serious. Rarely, emergency situations that cause loss of consciousness and require medication or electric shock may develop.
✓Kidney failure: A contrast agent (dye) that allows us to obtain images in the procedure damages kidneys in 5 out of every 100 patients. The risk is even higher in those who already have kidney problems. For example, in advanced stage kidney failure, the risk is five times higher. Even if kidney damage develops, it usually completely resolves with fluid replacement from the vessel. Sometimes temporary dialysis may be required. The need for permanent dialysis is extremely rare.
✓Allergy: Allergy may rarely develop due to contrast agent. Itchy redness may appear on the skin; this is a temporary condition. Very rarely, allergic reactions may be serious enough to obstruct breathing. All necessary equipment for such emergency situations is available in the Angiography room.
✓Heart attack: If the patient's heart vessels are very narrow, the catheter may damage these vessels. This can lead to blockage of the heart vessels, that is, cause a heart attack. In this case, a stent must be placed immediately to open the vessel. Very rarely, emergency heart surgery (bypass) may be needed.
✓Heart vessel rupture (dissection) or perforation (rupture): These problems develop rarely. In most cases, the problem is solved by emergency interventions performed during the procedure. Very rarely, emergency heart surgery (bypass) may be needed.
✓Stroke: Small fats or clots that break off due to catheter contact with delicate areas of the vessels that allow us to reach the heart may rarely escape to brain vessels. This can cause temporary or permanent stroke.
✓When is discharge after the stent procedure?
After the stent procedure is completed, you will be admitted either to the coronary intensive care unit or directly to the ward depending on the difficulty of the procedure performed. Frequently, you are asked to stay in the hospital for one night. Sometimes we may consider discharge in the evening of the procedure day, sometimes a few days later. We adjust this based on the complexity of the procedure and your clinical condition.
When can physical activities be started after stent placement?
You should avoid heavy lifting in the first week. The timing for driving, flying, returning to work, and resuming sexual activity varies depending on each patient's condition; you can ask your doctor when you can start these activities. For most people, this period is 1 week.
What is the difference between a stent and a balloon?
Both balloon and stent are materials used to open vessels. After the balloon, there is a high likelihood of the vessel closing again. To prevent this, a stent that acts as a scaffold is usually placed inside the vessel. In most cases, the balloon is used before placing the stent to widen the narrowed area of the vessel enough for the stent to pass through and to understand the vessel's opening capacity. Additionally, after stent placement, the balloon is often inflated inside the stent in the final stage to ensure the stent sits properly on the vessel wall and opens smoothly.
What is the difference between a stent and angiography?
Angiography does not provide any improvement to the patient. Because no intervention is performed on the vessel; the vessel is only visualized. A stent is a device used to open the vessel if a narrowing is detected in the vessel during angiography. In other words, angiography is a diagnostic method, while stent placement is a treatment method.
What is the probability of stent procedure being successful?
In general, the success rate is over 90%. The probability of successful procedure decreases in these situations: The patient being very elderly, the blockage existing for a very long time (CTO), calcified or tortuous vessel structure, chronic kidney insufficiency, and inadequate interventional technique (lack of physician experience)... In summary, the success rate differs for each patient.
If stent placement fails, will the patient worsen?
In case of failure, your vessel condition generally continues as it is. Therefore, your symptoms will not be worse than they were initially.
How many stents can be placed in the heart at most?
Many people think that only a certain number of stents can be placed in the heart. For example, "No more than 5 stents are placed in the heart." This thinking is incorrect. Yes, placing a large number of stents means an increase in the risks that each stent can cause. A cardiologist following current scientific data should try to solve the problems with the minimum number of stents that need to be placed in treating the disease.
What is a drug-eluting stent?
A drug-eluting stent (DES) is a stent that contains medication in its metal components. These medications control the proliferation of vessel cells on the vessel wall in contact with the stent, preventing excessive tissue growth. Thus, the frequency of in-stent stenosis (ISR) decreases. However, the cause of in-stent narrowing development is not only whether the stent is drug-eluting or not. The patient's genetic predisposition and technical deficiencies in stent placement can also cause this.
Does a stent prevent heart attacks?
We now clearly know that stent procedures save lives when applied in emergency situations such as heart attacks. However, stent procedures are often applied as a result of examination of chronic complaints such as chest pain and shortness of breath that are non-emergency but bothersome to the patient. In these cases, the main purpose of the stent is to relieve the complaints. The stent's success in preventing heart attacks is actually similar to medication use alone in most cases. However, narrowing at the beginning of major main vessels is an exception (for example, narrowing in the vessel called LMCA). Placing a stent in these areas is more successful in preventing heart attacks compared to medication use alone.
What is the lifespan of a stent? Does a stent get clogged?
After a stent procedure that is technically successful, the patient's regular use of medications, control of risk factors such as high blood pressure and diabetes, and adoption of a healthy lifestyle significantly reduce the probability of stent narrowing or blockage. In complex cases, there are usually problems in more areas, which is why more stents are needed.
How many years does a patient with a stent live?
Stents do not have a specific lifespan. It cannot be determined exactly how many years a patient who will have a stent placed will live. Only estimated percentages can be given by looking at statistics of previous patients with the same characteristics. The most important factors negatively affecting this statistic are: Technical deficiency in the stent procedure, patient's advanced age, heart failure, heart valve disease, presence of serious diseases in other organs, hypertension, diabetes, high cholesterol, smoking, medication non-compliance, and lack of social support.
Stent or bypass?
Cardiac surgeons and interventional cardiologists are two different groups of doctors treating vessel problems. While cardiac surgeons solve vessel problems through surgery (bypass), interventional cardiologists solve the same problems through non-surgical methods (complex stent procedures).
