Download Stenting: Function, Problems, and Procedure

Stenting: Function, Problems, and
Procedure
Uses for Stents
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Peripheral artery disease (PAD)
Renal vascular hypertension
Hemodialysis access maintenance
Coronary artery disease (CAD)
Carotid artery disease
Aneurysms
History
 Percutaneous Interventional cardiology
introduced in 1977.
 Stenting first performed in the mid 1980’s.
FDA approved it in 1994.
 70-90% of balloon angioplasty procedures
now use a stent.
 Currently 1,500,000 stenting procedures
performed annually.
Stent Types
 Components- stainless steel with different
designs.
 Designs
 Drug-eluting
stents
 Sizes
Drug-eluting Stents
 Sirolimus
– Immunosuppressive
agent used for solid
organ transplant.
– Coated with
140mcg/cm^2.
– Releases over 14-28
days.
 Paclitaxel
– Chemotherapeutic drug
used to treat patients
with ovarian or breast
cancer.
– Coated with
3mcg/cm^2.
– Released over at least
a ten day period.
Procedure
 Sterile Table.
 Clean entry site- femoral
or brachial artery.
 Cut into skin.
 Catheterization, with use
of a guide wire.
 Inject contrast to visualize
vessels.
 Balloon angioplasty.
 Stent attached to deflated
balloon and takent to site.
Restenosis
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Reclosure of the artery
Bare metal stents rate is around 20-30%
Drug-eluting stents rate is around 9%
Usually recurrence time
Most vulnerable- those with diabetes, long
stents (35mm+), or in small arteries
 Why it occurs
Post Procedure
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Pressure and dress Femoral artery
Take proscribed medications
Limit activities- lift no more than 10 pounds
Other restrictions depending on extent of
heart disease.
 Get exercise- 3-4 days a week for around 30
mins. Walking is best.
 No MRI’s for at least six months.
Contraindicators and Complications
 Contraindicators
– Size of the artery
– Where the blockage is
located
– Other Blockages
– Condition of the heart
– Allergies
 Complications
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Blood clots
Tearing the artery
Abrupt vessel closure
Excessive bleeding
through femoral artery
– Heart attack or sudden
cardiac death
– Stroke
Plaque Classifications
 Homogeneous
– Usually white
– Smooth outer surface
– Consistent texture
throughout
 Heterogeneous
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Yellowish color
Rough edges
Inconsistent texture
More likely to rupture
and have blood clots
 Stenting
– After six months will
grow thin layer of cells
– Now classified as
homogeneous