Coronary angioplasty is a medical procedure used to restore blood flow in a narrowed or blocked artery in the heart. The arteries of the heart (the coronary arteries) can become narrowed and blocked due to buildup of a material called plaque on their inner walls. This narrowing reduces the flow of blood through the arteries, causing coronary artery disease, and can lead to heart attack.
In angioplasty, a thin tube with a balloon on the end is first threaded through the femoral artery (upper thigh) or radial artery (near the wrist) up to the site of a narrowing or blockage in a coronary artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery, widening the artery and restoring the flow of blood through it.
Coronary stents are metal mesh tubes inserted into an artery after an angioplasty to help prevent the artery from becoming narrowed or blocked again (restenosis). The first stents, approved in 1994, were bare metal, but today there also are stents coated with a thin layer of medication, called drug-eluting stents. Medication from these stents is slowly released (eluted) to inhibit the growth of scar tissue in the artery lining.
Drug-eluting stents were developed because in 20 percent of individuals who received bare metal stents, tissue grew over the stent, eventually leading to reblockage of the artery. Drug-eluting stents reduce this risk to less than 10 percent, and less than five percent of people need repeat procedures. Millions of people with heart problems have been treated successfully with drug-eluting stents, preventing the need for more invasive procedures such as coronary artery bypass surgery.
Although the FDA considers bare-metal and drug-eluting stents to be safe and effective in most people, both types have a risk of clotting after implantation. It now appears that in some people who get drug-eluting stents, there is a small risk of blood clots forming in the stent – sometimes a year or more after implantation. This risk is quite low, ranging from 0.5 percent to 1.5 percent.
It is very important that individuals with a drug-eluting stent take anti-clotting medications exactly as directed by their physician. Experts say if you have a stent of any kind, you should take aspirin indefinitely to reduce the risk of clotting. In addition, people with stents are given a prescription anti-clotting medication. The American Heart Association recommends people who have had drug-eluting stents should continue to take this medication for one year if possible, to reduce the risk of blood clots after the stent is inserted.
An FDA advisory panel said the benefits of drug-eluting stents still outweigh concerns about blood clot formation when stents are used according to the manufacturer’s directions. It is important to remember that in all circumstances studied so far, drug-eluting stents have been shown to be more effective than bare-metal stents, with less risk of restenosis and the associated risk of more procedures. An alternative for some people would be bypass surgery, which has its own risks and benefits.
Talk with your cardiologist about how long you should take these medications, because the answer will vary depending on the nature of the blockage you had and your risk of bleeding. The most important thing to remember is to take all your medications in the manner your physician prescribes. Compared to bare-metal stents, drug-eluting stents dramatically reduce the chances that arteries will again become clogged. FBN
Dr. Eric Cohen, interventional cardiologist, specializes in vascular care and the treatment of peripheral arterial disease and limb salvage. Dr. Cohen is part of the Heart & Vascular Center of Northern Arizona physician practice. The Heart & Vascular Center of Northern Arizona (HVCNA) is a partnership between Flagstaff Medical Center and Verde Valley Medical Center. It combines physician office practices with extensive hospital-based services including diagnostic and interventional cardiology procedures and open heart surgery. HVCNA offices are located in Flagstaff, Cottonwood, Camp Verde, Sedona and Winslow.
For more information on the Heart & Vascular Center of Northern Arizona, visit NAHeartCare.com. To schedule an appointment with Dr. Cohen or one of the world-class physicians at the Heart & Vascular Center, call 877-928-WELL.