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Stents and Risks

A stent is a small metal mesh tube that is inserted into an artery that has become clogged, to prevent it from narrowing again. Stents can be placed in various parts of the body, including coronary arteries, carotid arteries and arteries in the kidneys and in the limbs. A procedure called angioplasty is performed to open the artery first, using a small balloon, and the stent is inserted following the angioplasty. A stent may be made of metal alone or, more recently, may be coated with a medication. These are called drug-eluting stents, which release medication slowly over time to keep the artery from becoming blocked again.

  1. Procedural Risks

    • The first risk encountered with a stent is during the angioplasty. A catheter is inserted into the blood vessel, which can cause bleeding or damage. If the angioplasty and stenting is performed on the carotid artery, there is a risk of stroke. A contrast material or dye is used during the procedure to guide placement of the stent. This dye can cause an allergic reaction in some people, while others have experienced renal failure, although usually that risk is limited to patients with compromised kidney function. Occasionally, an irregular heartbeat may develop in a patient during an angioplasty and there is always the risk of infection at the insertion site.

    Stent Risks

    • After a stent is inserted there is a small risk of a blood clot developing at the site of the stent, which can cause a heart attack or stroke. The risk of a blood clot decreases after the first few months following placement of the stent, and patients typically take an anticlotting medication for several months following the surgery. It is also possible for arteries to become reblocked, even after a stent has been inserted. Tissue can grow around and into the stent, closing the artery and requiring a second procedure to unblock it. Tissue growth that causes narrowing in an artery that was previously treated is called restenosis.

    Drug-Eluting Stent Risks

    • The development of drug-coated or drug-eluting stents has improved patients' prospects and reduced the need for more serious surgery for many people. There is, however, a significant risk for individuals who have other surgeries soon after having a drug-eluting stent implanted. Because the drugs that are released by the stent inhibit cells that prevent clotting, patients who have a drug-eluting stent must take an anti-platelet drug that prevents clotting for some period of time after their procedure. Patients who are having surgery are taken off of these anti-platelet drugs prior to surgery, which can increase clotting risks significantly. As a result, although use of drug-eluting stents has grown substantially, these stents have become somewhat controversial.

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