Who needs a stent in the arteries to the heart, and when?

Like any other organ in the body, the heart too requires a steady supply of oxygen-rich blood to function properly.

The heart muscle gets its blood supply from the right and left coronary arteries. The left divides into two main branches, so you will hear about three major blood vessels, Right Coronary Artery (RDA), Left Anterior Descending (LAD) and Left Circumflex(LCX).

Atherosclerosis is a condition of hardening of the arteries, which is mostly due to fat deposits on the inner walls of the coronary arteries, and calcium. Together they harden over time and eventually clog or narrow down the arteries, thereby restricting blood flow to the heart muscles. Smoking and a diet rich in cholesterol are high risk factors for developing atherosclerosis. So are Diabetes and high blood pressure. The hard material is called plaque and the area of constricted blood flow is called a blockage.

To quote Thomas Sydenham, an English physician (1624-1689), “A man is only as old as his arteries.” His belief was certainly ahead of his time since we now know that arterial aging is one of the mechanisms for chronic illnesses, such as heart attacks, strokes, dementia, erectile dysfunction and more.

Till the 1960s, medication and changes to lifestyle were the only methods to overcome atherosclerosis. In the 1960s, a new procedure called Coronary Artery Bypass Grafting or just ‘bypass’ emerged. In this open-heart procedure, a piece of blood vessel taken from another part of the body is stitched above and below the blocked artery, at the site of blockage, in order to bypass the blood flow around the blockage. This procedure is the only option for many categories of patients with Atherosclerosis. However, for the frail, and elderly with other health conditions, who cannot bear the strain of surgery, other options are desirable.

In the 1980s, a new procedure called Percutaneous Coronary Intervention (PCI), also called Angioplasty, or Balloon Angioplasty with stenting, or just ‘stenting’, emerged. In this minimally-invasive procedure, a metal coil called a stent is inserted at the blockage, and inflated using a tiny balloon. This pushes the plaque back against the walls of the artery, thereby opening up the artery, Soon, wall tissue starts growing around the stent holding it back in place.

Stenting is ideal when there are just 1 or 2 blockages and they are not major. Patients are discharged quickly and can resume a normal life within a week. A cardiologist will conduct tests to note the extent of blockages and evaluate various parameters to decide whether you are a candidate for bypass or stenting. But when does one get these tests done or how does a doctor decide you need a stent?

When is stenting required?

Symptoms

The doctor may suspect atherosclerosis when the patient shows or has shown signs of angina or heart-attack, once or more than once. This includes:

• Dizziness
• Fatigue
• Nausea and discomfort
• Shortness of breath
• Sweating
• Aching or burning feeling in the heart
• Feeling of fullness, heaviness or squeezing in the chest for men
• Feeling of pressing, crushing or pressure in the chest for women
• Upset stomach or vomiting
• Radiating pain in the chest, neck and shoulders for men
• Radiating pain in belly, neck, jaw, throat or back for women

Some of these symptoms are similar to that of heartburn or gastritis; so many people ignore these symptoms till they have had a mild or severe heart attack.

Tests

• ECG
• Treadmill stress test
• Pharmacological stress test
• Angiogram

These tests will determine if there is constricted blood flow, if the person has had a mild heart attack, if there are one or more blockages, the extent of the blockages and their precise location.

Deciding factors

• The number and extent of blockages: If there are 1 or 2 blockages and they are minor in nature, stenting is ideal
• The location of blockages: Among the various coronary arteries, three of them are major and one of them is the left anterior descending artery. If there are one or more blockages in these arteries, stenting is not an option and bypass is inevitable.
• Age: Generally, elderly patients are not advised bypass as they cannot bear the strain of an open-heart surgery. For them, stenting is advisable if medication is not effective.

• Weight or BMI: Frail people and those with a weak heart, irrespective of their age, are not advised bypass and stenting is the best option.
• Co-morbidities: If the person suffers from any of these: diabetes, kidney disease, peripheral arterial disease, heart valve disease, a prior incident of heart attack or stroke, stenting is not recommended and bypass is the best option.
  

  Post stenting precautions

Your cardiologist will explain to you what drugs you should be taking after stenting.

Besides your usual medication for other conditions like Diabetes, high blood pressure or high cholesterol, your doctor would be placing you on what are called anti platelet drugs to prevent the stents getting blocked again. Invariably you will be on two of these drugs for at least a year; often these drugs are combined into one formulation, for your convenience.

To get the best benefit from angioplasty and stenting, it is important that you control conditions like Diabetes, high blood pressure and high cholesterol. It is equally important to adopt a healthy life style with achievement of ideal body weight and waist: hip circumference ratio by making healthy choices in food and regular aerobic exercise. It is more important to stop smoking and consume alcohol, if at all ,  only in moderation.

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Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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