Coronary stents: Frequently-asked questions

Coronary stents may be required for patients that have developed a narrowing in the blood supply to the heart, leading to chest tightness or chest pain. They can also be inserted in an emergency situation when a patient has had a heart attack, and the obstruction in the heart needs to be cleared. 

Highly-esteemed consultant cardiologist Professor Michael Mahmoudi explains all about stents, including what they are made of, how they are inserted, how long they last for, and how they affect the patient. 

When is a coronary stent necessary?

Broadly speaking, we use coronary stents in two major settings. The first one, is in individuals who have developed narrowings in the blood supply to their heart, and start feeling tightness in the chest or chest pain when they exert themselves. Once a diagnosis of such narrowings has been made, patients often commence a combination of drugs that are aimed to;

• a: relieve their symptoms, and 
• b: alter the various pathways that alternately lead to the narrowing in the first instance. 

If, despite being on the right medication, patients continue to experience chest discomfort then coronary stents can be placed in the narrowed areas to restore blood flow and therefore takeaway their symptoms. 

Coronary stents can also be used in the case of an emergency, when an individual presents with a heart attack. A heart attack occurs when there is sudden obstruction of blood flow down one of more of the three blood tubes that take blood to the heart muscle. In this setting, it's extremely important to relieve the obstruction;

• a: to make the patient feel better, and 
• b: restore the blood supply to the heart, and minimise heart muscle damage.  

This is the second scenario where we use stents, and this is usually done in the context of an emergency. 

What is a coronary stent made of?

The two major components of a coronary stent are a metal scaffold. This is designed to provide a scaffold within the narrowed segment and prevent the collapse of the narrowed area. The metal component can be an alloy; a combination of cobalt and chromium, or stainless steel. These are the two major components that various companies have used to produce their stents.

The more modern stents, however, also contain a very sophisticated drug coating that's designed to reduce the risk of narrowing within the stent once it's been placed in the coronary arteries. Examples of these drugs include: sirolimus, or, zotarolimus, depending on the company that's produced the stent. 

How does a coronary stent work?

The coronary stent in its purest form is a metal scaffold. It stretches the narrowed segment of the blood vessel. It embeds into the artery and keeps the artery open. It's only one facet of treating narrowings within the circulation to the heart.

The other major facets are drugs. They are designed, in addition to relieving symptoms, to prevent or certainly minimise the risk of further cholesterol deposition in the artery walls. In essence it's the basic principle by which narrowings develop in the blood supply to the heart. 

The third facet, which is extremely important as well, is what the patient can do for themselves. We often recommend that patients should, for example, stop smoking if they are smoking; adopt a healthy Mediterranean-style diet; exercise regularly if they're overweight to optimise their weight. If they have high blood pressure, or diabetes, to ensure that their blood pressure and diabetic control is as good as it can be. 

Is coronary stent insertion a major surgery?

It's a major procedure; more commonly for the patient than the doctors who are doing it. For the patient, it's often the fear of the unknown. A patient goes into hospital, they're in an anxious state and this is often the first time they present with what they think it's a life-threatening problem. We counsel the patients extremely well before the procedure. During the procedure we have excellent nursing and support staff that ensure;

• a: the comfort of patients, and
• b: as a whole team, ensure the safety of the patient remains our number one priority.  

For the cardiologists that do the procedure, by the time you've become a consultant, you've carried out hundreds, if not thousands, of this procedure. It's a major procedure, yes, but all of us who do this kind of procedure are well-trained and well-versed with any potential issues that may arise during the course of the procedure. 

So, if I had to summarise, I would say it's a major surgery from the patient's perspective, but for the doctors, because we do it all the time we don't think of it as such. 

How long should a coronary stent last?

Once we put a stent in, it stays with you for the rest of your life. The more modern stents have a re-narrowing rate of probably about 3 per cent per year. It's for that reason it's extremely important our patients take the medication we prescribe them, and do everything else I've already mentioned in ensuring that:

• they exercise regularly;
• eat well, and;
• equally important, they essentially look after the stent. It's a friend for the rest of your life. 

What's life like after having a coronary stent inserted?

We expect patients to return to a full, active lifestyle. Once you've had coronary stents, there are very few things, if any, you cannot do. You should be able to do whatever you like. 

Is there an alternative to coronary stent?

Yes, there is. When we recommend a coronary stent, it should be for the right individual in the right setting. Patients may choose to seek alternative treatment and the major two treatments are medication that's designed to relieve symptoms. Medicines often don't relieve obstruction that has developed in the blood supply to your heart. They are designed to;

• a: relieve your symptoms, and;
• b: minimise the risk of further narrowings developing, and the pre-existing narrowings getting worse.

If the narrowings are extensive depending on their location and depending on the extent of the involvement of the three tubes that take blood to the heart muscle, then a bypass operation is also a very effective alternative.     

If you'd like to arrange an appointment with Professor Mahmoudi, you can do so via his Top Doctors profile.