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why do they put stents in your heart

Heart treatments have improved vastly in recent years, but heart disease remains a leading killer of Americans. While researchers are constantly looking for ways to make current treatments better, a new study found that people with chest pain who receive stents devices that open narrowed heart arteries aren t necessarily better off than people who don t get them. In Lancet, 200 people with chest pain were randomly assigned to either receive a stent, which requires a surgical procedure, or undergo a sham procedure in which the doctors only threaded a catheter through without inserting a stent. Six weeks later, they evaluated all of the people on a treadmill test. There were no significant differences in how much exercise the two groups could do, or in how much chest pain they reported. While the study raises a lot of questions, heart experts say the results don t mean stents aren t safe. Here s what you should keep in mind if you re worried about getting a stent or already have one. What is a heart stent? Stents are tiny mesh devices made of wire that doctors insert in narrowed heart arteries to prop them open. Stents can restore strong blood flow to the heart. For stent makers, it s become a big business. Each year, half a million people get stents inserted to relieve chest pain or angina. What is angina? Angina is the medical term for chest pains that can occur when blood flow to the heart is compromised.


Chest pains are usually caused by blood vessels in the heart that become narrowed and reduce the flow of blood to the heart. Are heart stents dangerous? Stents are relatively safe, especially if doctors carefully select the right people to get them. The American Heart Association and the American College of Cardiology do not recommend stents for all people who report chest pains. The groups advise doctors to evaluate how risky the chest pains are, and in most cases they suggest starting with
and blood pressure and blood vessel flexibility. If the symptoms continue, or people can not tolerate the medications, then they discuss the possibility of having stents put in. In recent years, however, better medication and stricter guidelines on when stents are appropriate have reduced the number of people getting the devices. There was an era in medicine when stenting was used far too commonly and without consideration for their value as a medical therapy, says Dr. Steven Nissen, chairman of the department of cardiovascular medicine at Cleveland Clinic. But that era is gradually disappearing. Prudent physicians counsel their patients about all of their options and give the best medication therapy possible. When you do that, the number of people who actually need to have a stent is fairly modest. While the Lancet study found no significant differences between those with stents and those with them, Nissen points out that the treadmill test the researchers used to analyze the effect of the stents is subjective.


People may stop on the treadmill for a variety of reasons, not all of which have to do with whether they are experiencing chest pain, Nissen says. While researchers also looked at other quality of life measures, 200 people is a relatively small number for such a study, and it s hard to determine if the results are generalizable to bigger populations. So if you already have a stent, the results do not mean you should consider taking it out. How do they put a stent in the heart? Doctors make a small incision into the blood vessel in the groin and thread a thin flexible catheter from there to the heart. The catheter is equipped with a flat balloon at its tip. Once the tip reaches the vessel that s narrowed, the balloon is inflated through the catheter, and the wire mesh stent pops open to keep the vessel open. Most people leave the hospital 12 to 24 hours after the procedure, and can return to work a few days later. How long do stents last? Theoretically, stents are made to last for as long as the person who has them, but some do get blocked up again. If that happens, doctors can remove the stent and insert another, or do bypass surgery to bypass the artery altogether. 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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