Stents are small, expandable tubes. They are inserted during angioplasty into a narrowed or blocked section of the coronary artery to open the artery and improve blood flow.
Bare metal stents are first generation stents. Bare-metal stents are tiny wire mesh tubes that help widen a clogged artery, but are not coated with a polymer or drugs to help prevent re-blockage of the artery. This type of stent may be used in patients who are allergic to either the polymer or drugs used in drug-eluting stents.
Choosing a stent?
Two main factors are considered when choosing between a bare-metal or a drug-eluting stent. First, the presence of clinical or technical factors associated with an increased risk of restenosis is considered; such patients benefit most from a drug-eluting stent.Second, the patient's ability to comply with the necessary dual antiplatelet therapy is carefully considered. Patients with a history of poor compliance, an increased risk of bleeding, or those who are known to need surgery or invasive procedures that would necessitate the premature withdrawal of antiplatelet therapy are often better served by placement of a bare-metal stent because the duration of dual antiplatelet therapy is shorter. However, depending on the individual circumstances, surgical revascularization or further increasing the intensity of medical therapy may be appropriate.
BMS are still often used in elderly patients, patients with peptic/gastric ulcers, patients with planned surgery and in those who need long-term anticoagulant therapy.
BMS stents are choosen accordingly to the patients condition, need and requirement by the doctor.
. In patients preparing for percutaneous coronary intervention who are likely to require invasive or surgical procedures within the next 12 months, consideration should be given to use of a bare-metal stent or balloon angioplasty with provisional stent implantation instead of the routine use of a drug-eluting stent
How stents are placed in an artery?
A stent is placed in a coronary artery during an angioplasty procedure.
Your doctor inserts a thin, flexible tube called a catheter into an artery in your groin or arm. The doctor moves the catheter through that artery to the coronary arteries. The doctor then uses dye to see any arteries that are blocked or narrowed. If you have a blocked or narrowed artery, a tiny balloon is moved through the catheter. It is used to widen the artery.
The doctor uses the balloon to place a stent in the artery. The balloon is placed inside the stent and inflated. This opens the stent and pushes it into place against the artery wall. Because the stent is like woven mesh, the cells lining the blood vessel grow through and around the stent to help secure it.. Bare-metal stents reduced the occurrence of restenosis to roughly 30 percent, compared with 40 percent for balloon angioplasty alone.3 In addition, stents nearly eliminated the likelihood of severe coronary artery dissections, markedly reducing the need for emergency bypass surgery.
Living with a stent?
You don't have to live differently if you have a stent. But you'll want to take care of your heart by eating healthy, being active, staying at a healthy weight, taking your medicines, and not smoking. There are a few precautions to follow.
The stent is positioned across the stenosis and the balloon is then inflated, expanding the stent into the vessel wall. After deflation and removal of the balloon, the stent remains in the artery, minimizing the progressive constriction (restenosis) of the treated lesion.
Taking anti platelets and aspirin after stent placement:
Take your blood-thinning medicines to prevent a heart attack or stroke. After angioplasty, you will probably take aspirin plus another antiplatelet.Following placement of a stent, strict adherence to dual antiplatelet therapy with aspirin, 162 to 325 mg daily, and a thienopyridine derivative is imperative.14,19,30,31 Clopidogrel, 75 mg daily, is preferred because of fewer side effects, but ticlopidine, 250 mg twice daily, may be substituted if clopidogrel is not tolerated. Prasugrel, 10 mg daily, is now being substituted for clopidogrel in patients with a higher risk of stent thrombosis, but it also imparts a higher risk of bleeding.Although one year of dual anti-platelet therapy following stent placement is optimal, the minimum recommended duration after placement is one month for bare-metal stents.Patients must be strictly instructed to not discontinue their antiplatelet medications without first consulting their cardiologist.After the recommended duration of treatment with dual antiplatelet therapy, aspirin (75 to 162 mg daily) should be continued indefinitely. Family physicians have an important role in emphasizing the need for dual antiplatelet therapy and monitoring the use of other medications as they help coordinate future care.
Elective or Emergency Surgery After Stent Placement
Patients or their family physicians may know of the need for future invasive procedures or surgery when the patient presents with a clinical situation requiring stent placement. This information must be disclosed to the cardiologist before the procedure, because it will affect the choice of stent used. Based on expert opinion, elective surgery should not be performed within one month following bare-metal stent placement, but may be considered after two weeks in special circumstances. Elective surgery should be delayed and dual antiplate-let therapy continued for at least one year after drug-eluting stent placement. Once these periods have elapsed, elective surgery may be performed with the patient receiving aspirin alone, but this does not provide a guarantee that stent thrombosis will be avoided.