As you recover, your artery will begin to heal around the stent. This will give it added strength. Drug-eluting coronary stents can help prevent plaque buildup, promote good blood flow to your heart, and relieve chest pain. They may also lower your chances of having a heart attack. The procedure to insert a stent is much less invasive than coronary bypass surgery, which is usually recommended for people who have more than two narrowed arteries.
Most people recover within a few days of having a stent inserted. In contrast, it may take you six weeks or more to recover from coronary bypass surgery. A stent can help you can get back to your regular schedule faster. Most people can safely tolerate drug-eluting stents. But like any medical procedure, coronary angioplasty and stenting do involve some risks, including:. In the event that scar tissue forms after stenting, your doctor may need to repeat the procedure.
Report any chest pain to your doctor immediately. It could be a sign of a serious complication. Common risk factors for heart disease include high cholesterol, high blood pressure, and being overweight.
You can significantly lower your risk of developing blocked arteries or having a heart attack by practicing healthy habits. For example, a nutritious diet and regular exercise can go a long way toward keeping your heart strong and healthy.
If you smoke, now would be a good time to quit. You may also need to take statins, aspirin, or other medications. Anti-platelet therapy for coronary stents. Mayo Clinic; Omar WA, et al.
The current literature on bioabsorbable stents: A review. Current Atherosclerosis Reports. Piccolo R, et al. Drug-eluting or bare-metal stents for percutaneous coronary intervention: A systematic review and individual patient data meta-analysis of randomised clinical trials.
The Lancet. Mankad R expert opinion. Mayo Clinic. May 12, See also Angina Angina treatment: Stents, drugs, lifestyle changes — What's best? Cardiac catheterization Chest pain Coronary angiogram Coronary angioplasty and stents Coronary artery disease Coronary artery disease: Angioplasty or bypass surgery? Coronary artery spasm: Cause for concern?
Pseudoaneurysm: What causes it? Shortness of breath Silent heart attack Stress test Symptom Checker Coronary angioplasty What is meant by the term "heart age"?
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There are still many issues that lead the interventional cardiologist to be cautious about BRS. Thus, mechanical considerations are more challenging, especially when calcification or tortuosity are present. Post-dilatation is also mandatory to ensure correct expansion and apposition. Defective healing and late adverse reactions may therefore not be completely avoided with the use of BRS. These technical particularities mean that the total cost and duration of percutaneous coronary intervention with BRS may be higher than with conventional DES.
There are other drawbacks to BRS. The most challenging issue is the process of resorption and scaffold disintegration in human coronary arteries with atherosclerosis. There is an increased scaffold fracture risk with over-dilatation of BRS; thus, significant upsizing is impossible.
Recently, scaffold collapse has been described in subacute and late coronary thrombosis. Observational findings from cases with very late thrombosis show the presence of largely dismantled scaffold remnants 2—3 years after implantation.
These concerns have been confirmed clinically in trials. For example, there is a significantly higher risk of subacute and very late thrombosis with BRS compared to metallic everolimus-eluting stents. Having highlighted these issues, we think this technology is worth pursuing and hope that research will overcome most, if not all, of its limitations. Although considerable advances have been made, the ideal DES system has yet to be developed.
The occurrence of stent thrombosis has accelerated technological evolution in interventional cardiology and the eradication of this fatal outcome should be the focus of n ew DES.
Since the advent of DES, restenosis figures have dropped to a single digit, even for the most complex lesions. The most recent generation of DES are associated with a greater reduction in the risk of early and late thrombosis than BMS. However, target lesion-related events are still observed years after implantation due to neoatherosclerosis. Future DES designs will have to address this issue. The ideal DES should incorporate a number of newer and improved materials and delivery systems to enhance safety, efficacy and cost-efficiency.
The ideal system should include: The duration of DAPT for new DES could safely be shortened by up to 3 months in stable patients and 6 months in acute coronary syndrome patients who have a higher bleeding risk. The safety and efficacy of contemporary stents are supported by evidence from clinical trials and registries; however, larger trials and longer follow-up are necessary to assess the effectiveness of novel devices. The risk of late thrombosis with first-generation metallic DES and the risk of early and very late thrombosis with BRS were not properly identified in the preclinical stages of research.
The more complex the interplay between a device and arterial wall-plaque, the harder it is to predict the long-term effects in humans. Computational models based on finite element analysis could complement the animal data but new advances in animal models will be crucial.
In summary, a validated and standardised set of preclinical studies is warranted before clinical studies of new stent models are conducted. Once a device is approved for use in humans, a well-designed programme of clinical studies is warranted before it is widely introduced on the market. Dae-Hyun Lee ,. Abstract There has been a great evolution in the development of coronary stents in order to avoid both restenosis and thrombosis. Keywords Drug-eluting stent , -limus drugs , biodegradable polymers , bioresorbable stent , stent thrombosis , double antiplatelet therapy ,.
Open access: The copyright in this work belongs to Radcliffe Medical Media. Drug First-generation DES used paclitaxel and sirolimus. Coating and Polymers Great advances have been made in the field of coating and pol ymers.
Download Display full size. Biodegradable Polymers It was hypothesised that durable polymers used in the first generation DES would trigger the inflammatory process and induce stent thrombosis. Bioresorbable Stent Technology Bioresorbable stent BRS technology has been called the fourth revolution in interventional cardiology due to its potential advantages.
Looking to the Future Although considerable advances have been made, the ideal DES system has yet to be developed. Drug-elution for 60—90 days, followed by complete absence of drug release Stimulation of early re-endothelialisation A thrombus-resistant luminal surface A very thin surface of durable or biodegradable polymer coating A minimal duration of DAPT The duration of DAPT for new DES could safely be shortened by up to 3 months in stable patients and 6 months in acute coronary syndrome patients who have a higher bleeding risk.
State of the art: coronary artery stents — past, present and future. EuroIntervention ; 13 — Optimal stent design: past, present and future. Influence of topography on endothelization of stents: clues for new designs. Circulation ; — A survey of stent designs. Min Invas Ther Allied Technol ; 11 — Designing the ideal stent. Ninety-five percent of zotarolimus elutes within the first 2 weeks. In a recent trial assessing EES and ZES in complex clinical or lesion characteristics renal insufficiency, low ejection fraction, recent acute MI, multiple or long bifurcations, bypass grafts, in-stent restenosis, unprotected left main artery, thrombus, or total occlusion , there was no difference in the primary endpoint of target-vessel failure.
Coronary rethrombosis and coronary restenosis are sequelae of stent placement. Coronary rethrombosis is defined as reocclusion of coronary vessels by thrombin formation, and coronary restenosis is reocclusion of coronary vessels and smooth-muscle endothelial overgrowth. DES are associated with a reduced risk of restenosis but an increased risk of rethrombosis, specifically with early discontinuation of DAPT.
Predictors of later DES thrombosis have been identified, including patient and angiographic characteristics. Patient characteristics consist of older age, diabetes mellitus, low cardiac ejection fraction, renal failure, and ACS. In addition, early discontinuation of antiplatelet medications has been identified as a risk factor for stent thrombosis.
Angiographic characteristics such as long or overlapping stents, stent placement in small vessels, bifurcation lesions, and suboptimal stent results also increase the risk of DES thrombosis.
Antiplatelet Therapy Prior to PCI: Prior to undergoing PCI, patients currently receiving daily aspirin therapy should take 81 mg to mg; those not currently receiving aspirin therapy should be given nonenteric aspirin mg.
In addition, a second antiplatelet agent or DAPT is warranted. Duration of and agent choice for P2Y 12 inhibitor therapy after stent implantation vary according to the indication. Options include clopidogrel 75 mg daily, prasugrel 10 mg daily, and ticagrelor 90 mg twice daily. Patients receiving BMS for a non-ACS indication should receive clopidogrel for a minimum of 1 month, and ideally up to 12 months unless patient is at increased risk for bleeding, in which case it should be given for a minimum of 2 weeks.
The continuation of clopidogrel, prasugrel, or ticagrelor beyond 12 months may be considered in patients undergoing DES placement. The guideline states that the daily use of aspirin 81 mg is preferable to higher maintenance doses. Prasugrel should not be administered to patients with a prior history of stroke or transient ischemic attack. Clopidogrel Resistance: The effectiveness of clopidogrel is dependent upon its activation to an active metabolite by the cytochrome.
In patients who are CYP2C19 poor metabolizers, clopidogrel at recommended doses forms less of that metabolite and has a smaller effect on platelet function.
The FDA issued a warning concerning genetic differences in the metabolism of clopidogrel and its effectiveness. The warning addressed ways to test for these genetic differences and offered advice concerning alternative dosing strategies or the use of other medications in poor metabolizers CYP system, mainly CYP2C19 of clopidogrel. Genetic testing may be considered to determine whether a patient at high risk for poor clinical outcomes is predisposed to inadequate platelet inhibition with clopidogrel.
When a patient is identified by genetic testing, treatment with an alternative P2Y 12 inhibitor, such as prasugrel or ticagrelor, may be considered. Furthermore, platelet-function testing may be considered in patients at high risk for poor clinical outcomes. A number of factors for premature discontinuation of antiplatelet agents were highlighted, including older age, lower educational level, being unmarried, lack of discharge instructions for medication use, lack of referral to cardiac rehabilitation, preexisting CV disease, anemia, and lack of health care due to cost.
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