Stent- Cardiology, Gastroenterology, Neurology

A stent is a medical device used by doctors to hold narrow vessels or other body passages open. Stents are tiny cylindrical tubes that are either plastic or metallic, and they come in many forms, shapes, and sizes.

When a blood vessel is blocked or is too narrow, your doctor might insert a stent to widen the lumen and restore its continuity. These vessels can be in any part of your body, such as your heart (coronary stent), brain, neck, abdomen, or somewhere else.

 Stents can also be used to open other passageways that can be blocked in the body, such as parts of the gastrointestinal tract or urinary tract. This article will focus on vascular stents procedures and will provide a short overview of stents used in non-vascular conditions.

Uses

Vascular conditions

Blood vessels can become narrow from plaque buildup, a condition known as atherosclerosis. Stents are frequently used to hold weak or blocked blood vessels open, restoring blood flow to the affected organ.

A typical example of this is coronary stenting. The coronaries are the vessels that supply the heart muscles. In people who have coronary artery disease, when plaque builds up in the coronaries, they become narrow, and blood flow to your heart muscle is reduced. If the coronaries become completely blocked, part of the heart muscle will die, causing a heart attack. Stenting is widely used to treat coronary artery disease. It might be done as an emergency procedure, like if someone has a heart attack, or as an elective procedure in diagnosed individuals.

Other vessels that are frequently opened with stents include the carotid (neck) arteries, the abdominal aorta, and brain vessels.

Stents are not only used for narrow vessels, and they can be used to manage aneurysms (weak dilated bulging parts of a blood vessel). Aneurysms in your brain or abdomen might be at risk of rupturing, and putting a stent would help prevent that from happening.

Non-vascular conditions

Doctors also use stents to open closed passages in other parts of the body. These passageways might have become closed due to external compression (by a tumor for example), or internal blockage (like inflammation or strictures). Inserting a stent can open these passageways and restore a patent lumen:

• Airways: Your bronchi or trachea might become compressed by tumors
• Bile ducts: The bile ducts run in your liver, and stenting can be done if they become blocked
• Ureters: The ureters are the muscle tubes that transport urine from your kidneys to your bladder. They might become blocked due to external compression by a tumor, or due to inner narrowing
• Gastrointestinal tract: Stents can be placed in parts of your gastrointestinal tract, like the esophagus, if it becomes too narrow to pass food properly.

Preparation

Depending on the type of stent you’re getting, you might be asked to do one of the following things:

• Stop smoking for at least a couple of weeks before the procedure
• Stop taking certain medications, like anticoagulants for example
• Stay without food and water the night before the procedure
• Inform your doctor about any allergies or medical conditions

Procedure

Vascular stents can be installed using several techniques, however, they all share some common features. You will usually be awake during the procedure but might receive a minor sedative.

The doctor will access your circulation from your radial artery (near your wrist) or femoral artery (near your groin). They will apply some numbing medication first so that you won’t feel any pain. They will enter your circulation with a catheter, and advance it through your vessels to reach the diseased vessel. An X-ray machine will be active during this time so that your doctor knows where the catheter is, and they might inject some contrast material to better see your blood vessels (this is called angiography). Once the narrow part is identified, a stent will be advanced and placed there to hold it open.

The catheter will be withdrawn, and the stent will stay in its place. Your doctor will apply dressing at the access site, and you can usually leave the same day if the procedure had been planned electively.

Complications

Possible complications of vascular stenting include:

• Allergy to contrast material
• Bleeding from the access site
• Blockage of the stent by a clot
• Infection at the access site or stent site
• A reclosure of the stent
• Blood clotting
• Heart attack
• Abnormal heart rhythm

Non-vascular stents can cause complications specific to the organ they are placed in.

After the procedure

The access site in your wrist or groin will feel sore for a few days and might require a change of dressing.

If you had received the stent as an elective procedure, you will be discharged the same day or might stay over for the night, depending on the type of stent you’ve received and your general condition.  If you’ve received the stent in an emergency setting, like during a heart attack, your doctor will keep you at the hospital for a few days to manage your condition.

Upon discharge, you will probably be prescribed drugs that prevent blood clotting, like aspirin or ticagrelor. These drugs are usually continued for life to prevent the stent from closing.

 Sources:

• https://www.nhlbi.nih.gov/print/4884
• https://www.radiologyinfo.org/en/info.cfm?pg=angioplasty
• https://www.ctsnet.org/article/airway-stenting
• https://www.mayoclinic.org/tests-procedures/coronary-angioplasty/about/pac-20384761

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