Understanding Stents and Treatment of Coronary Artery Blockages

Steven Raible, MD

Louisville Heart Specialists, Jewish Physician Group

What is a Stent?

When a coronary artery narrows due to a buildup of plaque, it reduces blood flow through the heart resulting in angina, or chest pain that occurs when your heart muscle does not get enough blood flow. Angina may feel like pressure or squeezing in your chest. Pain also can occur in your shoulders, arms, neck, jaw or back.

A heart attack occurs when blood flow is completely blocked to part of the heart muscle. Angina can be the symptom of a heart attack or of a milder blockage in a coronary artery.

A stent is a small wire mesh tube commonly used to prop open a blocked heart artery in a patient having  a heart attack.  Stents can also be placed in diseased arteries that are partially blocked for improved blood flow.

Stents are delivered to the heart arteries during a procedure called percutaneous coronary intervention sometimes referred to as angioplasty which is performed in a cardiac catheterization lab (cath lab). During angioplasty, a balloon is used to open the blocked artery and a stent is permanently placed to keep it open for adequate blood flow.

Angioplasty and stents are commonly used and offer an alternative treatment to coronary artery bypass surgery, often called open-heart surgery. Patients who undergo angioplasty recover much faster than those who have bypass surgery and have less discomfort.

When is a Stent the Right Choice?

While stents are a wonderful medical tool, they are not appropriate for all patients.

We use a diagnostic procedure called an angiogram, which is done in the cath lab, to get a clear picture of a patient’s arteries and determine the seriousness and location of the artery blockage.

Stents are used depending on certain features of the artery blockage such as the size of the artery and where the blockage is located. For example, if the angiogram reveals a blockage, but the patient’s angina is mild, the problem may be managed with medication and lifestyle changes such as diet and exercise.  Techniques are available for accessing the severity of a blockage by making certain pressure measurements that may assist in decision making about the patient’s blockage (fractional flow reserve or FFR). If a patient has multiple, serious blockages, coronary bypass surgery may be required.

Most often, we make these determinations as part of the angiogram procedure. If the patient is a candidate for a stent, we begin angioplasty at that time while the patient is still in the cath lab.

While a stent is permanently placed, some patients with a stent may later require coronary bypass surgery if their condition worsens and more aggressive treatment is required to keep blood flow to the heart and prevent heart attack.

Today, we use drug-eluting stents, which are covered with drugs that help keep the blood vessel from reclosing. Clinical trials have shown that drug-eluting stents are superior to bare-metal stents as a treatment of coronary artery narrowing reduce the rate of patient’s who require repeat intervention, such a coronary bypass surgery.

Once a patient has a stent, they remain on one or more blood-thinning medications, such as aspirin and/or Thienopyridine type antiplatelet agents.  These medications are used to help reduce the risk of a blood clot developing and blocking the artery.

Alleviating Blockages Quickly is Essential

When possible, patients should discuss options with their cardiologist prior to a cath lab procedure to understand treatment option. However, if a patient is experiencing a heart attack, clearing the blockage quickly will lessen damage to the heart.  A heart attack damages the heart muscle permanently; therefore limiting the damage caused is essential.

 

Hospitals and emergency medical services continually look for ways to improve care and reduce the time between the on-set of angina or a heart attack and treatment.  Jewish Hospital, part of KentuckyOne Health, recently launched the region’s first STEMI Network for patients with acute coronary syndrome, or a complete blockage of the coronary artery.  The program ensures the fastest access to life saving care for patients suffering a heart attack.

 

The STEMI Network allows emergency medical services to transmit EKG results directly to the Jewish Hospital emergency department. Once the emergency department receives a patient’s EKG, they can determine if the heart attack is one with elevated ST levels—a pattern on an EKG reading that indicates a total blockage.  If a total blockage is present, the emergency physician can alert the cath lab team and the patient is taken directly to the cath lab, bypassing the emergency department so physicians can clear the blockage more quickly.

Kentucky has some of the nation’s highest rates of death due to heart disease and stroke. The most important thing patients can do is recognize and seek medical attention quickly when they experience chest pain or other symptoms of angina.  Those symptoms include:

  • Discomfort, pressure, heaviness, or pain in the chest, arm or below the breastbone
  • Discomfort in the back, jaw, throat, or arm
  • Fullness, indigestion or choking feeling
  • Sweating, nausea, vomiting or dizziness
  • Extreme weakness, anxiety or shortness of breath
  • Fast or irregular heartbeats

Image from: healthvigil.blogspot.com/2011/01/latest-in-types-of-stents-to-treat.html

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