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Doctor, how safe is the stent in my heart?
Stents are tiny expandable tubes made of metal mesh. The angioplasty procedure opens the artery, and stents are placed and expanded to fit the size, shape and bend of the artery. The stent remains in the artery after the procedure to help keep the artery open. Over time, the artery heals around the stent.
There are two kinds of coronary artery stents, uncoated and coated, known as bare-metal stents and drug-eluting stents. A drug-eluting stent is a bare-metal stent coated with a special drug and polymer to help reduce the chance of the artery becoming blocked again. The drug is released from the stent over the period of time when re-blockage is most likely to occur.
After your coronary stent is implanted, your cardiologist prescribes a number of medications that you will need to take each day for a period of time. This combination of drugs, called anti-clotting therapy (blood thinners or antiplatelet therapy), reduces the risk of blood clots forming.
There has been a lot of bad publicity about drug-eluting stents recently. This has included reports of clotting of the stents, which has caused heart attacks and even death in some patients even years after the stent was implanted. So how safe are these stents?
Most reports of the clotting and closing up of the stents causing heart attacks occurred in patients who stopped taking the blood-thinning medications for one reason or another. In the first generation of stents (the bare-metal stents), blood-thinning drugs are needed for a few weeks. However, we are finding out now that in drug-eluting stents these blood thinners are sometimes needed for several years after implantation to prevent clotting. The new recommendation is to take the medications for at least one year. Please consult your cardiologist before you stop taking any of the blood-thinning medications.
The clotting of drug-eluting stents also occurred in patients who received multiple stents in Y or T formation at a branching point in the heart. These complications led to catastrophic consequences, possibly death, if the clot was in the left main artery in the heart. Usage in the left main artery is not an approved indication of drug-eluting stents.
The good news is that drug-eluting stents remain a safe and effective treatment when used in accordance with their approved indications. Drug-eluting stents have significantly improved upon the benefits of bare-metal stents. They have a lower restenosis (re-blocking) rate than bare-metal stents.
To avoid any complications, always take your medications as instructed and follow up frequently with your cardiologist. Also remember that having a stent put in your heart is the beginning - not the end - of your heart treatment. Exercising, losing weight, quitting smoking, and controlling your cholesterol, blood pressure and blood sugar decrease your chances of having a heart attack or a blocked artery again in your heart.
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| Contact Information |
Dr. Naji Kandalaft, M.D., F.A.C.C. is board-certified in internal medicine, cardiology, nuclear cardiology and interventional cardiology. His private practice is at 412 W. Carroll Ave., Suite 204 in Glendora and he can be reached by phone at 626/852-8873.
For more information about Dr. Kandalaft or other fine physicians who have medical staff privileges at Foothill Presbyterian Hospital, call The Doctor Connection at 888/456-CVHP or visit The Doctor Connection on the web.
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