Asked by Shirley Hoegberg, Stuart, Florida
I had a stent placed in my heart on December 9, 2002. What is the longevity for this stent? It was the newer kind that was safer at the time.
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
The coronary arteries provide blood to the heart muscle. They are, in essence, pipes conveying oxygenated blood to the heart muscle. These arteries can have partial blockage from cholesterol plaques obstructing blood flow. When the muscle doesn't get enough oxygen, it can cause chest pain. In extreme cases it can cause a myocardial infarction or heart attack, which means some of the heart muscle dies.
Percutaneous coronary intervention refers to attempts to open the artery so that blood can flow normally. In the 1970s, percutaneous transluminal coronary angioplasty, known more simply as PTCA or angioplasty, became common. This involves a catheter being passed through an artery from the groin or the bend of the arm to the heart and a balloon at the tip being inflated at the site of the partial obstruction. Many of these lesions recur and the artery has another obstruction within a short period. This occurs in 40 percent of angioplasties within six months after PTCA.
A stent is a short hollow tube. It is placed in the artery at the site of the former blockage. It holds the artery open. Initially, bare metal stents were used. Compared with no stents, re-obstruction rates at six months after angioplasty were cut in half, to 20 percent, and few re-obstructions were seen more than a year after treatment.
Drug eluting stents, or DES, were developed to try to further reduce the rate of re-obstruction. These stents are metal with a polymer coating and a drug, either sirolimus or paclitaxel, mixed into the polymer. The drug is delivered to the area of the opened artery over a period of up to a year.
The rate of recurrence of blockage in the first year is less than with bare metal stents. More than a year after therapy, it may be a bit higher than with bare metal stents. Even though drug eluting stents have a higher re-obstruction rate, most studies go only four to five years after stenting and indicate that the risk of re-obstruction is generally about 1 to 2 percent for either type of stent.
There was a time when everyone stopped using the bare metal stents in favor of the drug eluting stents. Today we know that some patients are better candidates for the older bare metal stent technology and some are better candidates for the newer drug eluding stents.
Patients have to take oral medications to decrease the tendency of their blood platelets to clot. Generally lifestyle changes are imperative for someone with coronary artery disease. You may have done this, but for the benefit of others, I recommend you talk to your doctor about preventive measures.
You can decrease your chances of a stent problem or more coronary artery disease elsewhere in the heart by maintaining an ideal body weight and a good diet low in fat and high in vegetables. Control your cholesterol and triglycerides and take the antiplatelet medications as prescribed. Your doctor may also encourage some exercise.
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