Stent Procedure to Treat Coronary Artery Disease
Over the past 20 years, treatment options for coronary artery disease (CAD) has become much more effective and commonplace. This often leads patients to ask fewer questions about treatment options, advances, and benefits. Instead, questions focus on monetary cost and logistics of the planned procedure versus how quickly they will return to normal daily activities.
A stent procedure is one frequently used treatment option for CAD. When plaque builds up inside an artery, blood flow to the heart can be compromised. The blockage leads to coronary artery disease and can result in chest pain and a heart attack.
Most stents are tiny wire mesh tubes placed within an artery to help keep it open and blood flowing as needed. A medicine coating on the stents is slowly released to prevent re-blockage of the artery.
A conversation with a stent patient and cardiologist
Knowing the right questions to ask proved to be of special significance for CAD patient Shawna Dukes. A combination of active research and persistence with doctors enabled Shawna to ask the right questions, which ultimately saved her life. After consulting with a number of physicians who could not determine the cause of her extreme fatigue and overall discomfort, she finally found answers from her interventional cardiologist. He determined that getting a stent that promotes faster healing was the right treatment option for her, and one that gave her back control of her health again.
Shawna and her interventional cardiologist, Dr. Colin Barker, took the time to answer a few questions regarding her situation and results.
Lisa Nelson RD: Shawn, please tell us about your heart condition and how your personal research led to a diagnosis and treatment plath?
Shawna Dukes: I’m a very active person. I live a very active lifestyle. Several months ago, out of the blue while I was doing one of those activities of working out, I had troubling symptoms of throat and neck tightness. I had chest tightness on my left side. I had numbness that ran down my left arm.
They were symptoms that I had never experienced before. It definitely got my attention. Over the next several weeks, I had them again and again. It led me to my primary care doctor. Through him and a couple more doctors, and about ten diagnostic tests along the way, I was told I had coronary artery disease and angina. I was given medication for that.
But it limited my lifestyle. I couldn’t do the things I was doing before without those symptoms flaring up. I really didn’t think that was my best solution. It didn’t sit well with me, that this was going to be my new normal. With my symptoms that kept breaking through, even when I was on medication, on a particular day when they were very severe, I thought, “I really need to seek someone else. I need to get an answer from someone else.”
That led me to Dr. Barker. The day that I had the very severe symptoms, he saw me. Finally, I learned the cause of it. It was the 90% blockage of a major artery of my heart. That day, he had me in the cath lab. He performed a procedure to implant a stent. It’s the SYNERGY stent that I received. Within minutes, I felt better. A few weeks later, I was back to my very active lifestyle of working out every day and walking a couple of miles with my dog. It just restored my life and gave it back to me.
Lisa Nelson RD: Did your primary care doctor assist you in connecting with Dr. Barker or did you have to be proactive and research on your own?
Shawna Dukes: I was proactive and did searching on my own. My primary care doctor led me to other doctors. But I ended up having to be proactive and seek out some friends I knew that were familiar with his practice.
Lisa Nelson RD: Dr. Barker, how has stent technology changed over the years? What does it mean for patients?
Dr. Barker: Stent technology has come a long way, where it’s a very safe and effective therapy. Years ago, before stents were around, blocked coronary arteries were treated with balloons. You inflated and deflated them. There was a 50/50 chance that it would re-narrow.
Twenty years ago, we started using metal tubes. A stent is a metal tube that goes inside an artery and props it open. It stays there to provide a scaffolding to keep the artery open. But 25% of the time, these stents developed scar tissue and re-narrowed. So, we started putting medications on the stents to try to prevent that re-narrowing. It worked, but it came with a little bit of risk of heart attacks due to inflammation from the medication.
Current technology, including the SYNERGY stent made by Boston Scientific who we’re partnering with today, includes all of the good things. It has a very thin metal tube that goes in and stays there. It provides a scaffolding for the artery to stay open. There’s a medication on it that prevents scar tissue. Then there’s a coating on it that dissolves slowly over time that allows the stent to heal in nice, smooth ways so that the artery essentially returns back to its normal functioning tube without any blockage.
The coating is used to get the medication to stay on the stent. It also controls the time frame of the medication. It’s the combination of the medication and the coating that allows the medication to slowly dissolve over time and prevent any scar tissue or heart attacks to develop from the stent.
Lisa Nelson RD: What percentage of stents re-block? How quickly can blockage occur after stent placement?
Dr. Barker: Current stents, like the SYNERGY stent, have a risk of re-blocking or building up scar tissue anywhere from 4% to 5% over years. The timing of the re-blockage is generally delayed. It used to be very early on with the older technology. Now, if we see a re-narrowing, it is usually after six to twelve months. Still, it’s a very rare event. It happens in one out of twenty-five cases. Most people have a very good, durable result these days.
Lisa Nelson RD: If the stent does not re-block, what is the lifespan of the stent? Do they usually need to be replaced at some point?
Dr. Barker: It’s usually good for the rest of a patients life. In the rare circumstance that it re-blocks, you can get another stent. That has become less and less frequent these days with different technologies.
Lisa Nelson RD: Do patients also receive diet and lifestyle education to prevent future blockage when receiving stent treatment?
Dr. Barker: Absolutely. There are well-established cardiac rehab programs that are offered with every cardiologist in every hospital. Once someone has gone through a stent procedure, they would qualify for this intervention and counseling. It includes diet and lifestyle improvements. There are very subtle changes that go a long way, as well as an exercise prescription. This can allow people to understand how much they can do and how far they should push their exercise so that they remain heart healthy.
Lisa Nelson: Shawna, what do you want people to learn from your story?
Shawna: I want people to understand that this isn’t something that happens to a certain group of people, people who look a certain way or have high cholesterol. It happened to me. It can really happen to anyone. They should listen to their symptoms, know when things are out of the ordinary, seek treatment and go to their doctor.
If they’re not satisfied with the opinions, then they need to seek out another opinion. Be very persistent. They need to be their own advocate with their healthcare. After I had the stent placed, I went to BostonScientific.com/synergypatient. It was a great resource. It gave me a lot of information on the stent that was placed in me. It had a lot of good information on diagnosis and treatment options.
Lisa Nelson RD: Dr. Barker, would you share where we can learn more?
Dr. Barker: In addition to the website that Shawna pointed out, the important place to go first would be to your primary care physician and/or your cardiologist. Make sure you’re getting heard and explaining your symptoms. Be sure that you’re getting the appropriate attention and respect. Once a diagnosis is made, make an informed decision with all of your options laid out before you.
The stent placement procedure
The stent procedure is not considered major surgery and takes approximately one hour to complete. Your doctor makes a tiny incision in a groin, arm, or neck blood vessel. Then a catheter is threaded through the blood vessel to the blocked artery. A tiny balloon at the end of the catheter is inflated inside the blocked artery to widen the artery and allow blood flow. The stent is then placed within the artery and the catheter with balloon removed.
There are risks associated with stent placement, which include…
- Blood vessel damage from the catheter
- Irregular heartbeat
- Infection
- Heart attack
- Stroke
- Death
If you are at risk for coronary artery disease, be proactive and implement diet and lifestyle changes to reduce your risk. Unhealthy cholesterol levels is one risk factor that leads to plaque build-up and arterial blockage. You may access the free ecourse How to Lower Cholesterol in 8 Simple Steps at http://lowercholesterolwithlisa.com.
All the best,
Lisa Nelson RD
Health Pro for HealthCentral
Image courtesy of hywards / FreeDigitalPhotos.net
