In this second part of a two-part series on heart stents, one of the most frequently used treatment options for coronary artery disease (CAD), we examine the technology with interventional cardiologist Colin Barker, M.D.
Dr. Barker is CAD patient Shawna Dukes’ doctor. He determined that getting a stent that promotes faster healing was the right treatment option for her, and one that gave her back control of her health again. Most stents are tiny wire mesh tubes placed within an artery to help keep it open and blood flowing as needed. A medicine coating on the stents is slowly released to prevent re-blockage of the artery.
Read part one of the series about Shawna’s experience and her advice for learning from her story.
Lisa Nelson, RD: Dr. Barker, how has stent technology changed over the years? What does it mean for patients?
Dr. Barker: Stent technology has come a long way, where it’s a very safe and effective therapy. Years ago, before stents were around, blocked coronary arteries were treated with balloons. You inflated and deflated them. There was a 50/50 chance that it would re-narrow.
Twenty years ago, we started using metal tubes. A stent is a metal tube that goes inside an artery and props it open. It stays there to provide a scaffolding to keep the artery open. But 25% of the time, these stents developed scar tissue and re-narrowed. So, we started putting medications on the stents to try to prevent that re-narrowing. It worked, but it came with a little bit of risk of heart attacks due to inflammation from the medication.
Current technology, including the SYNERGY stent made by Boston Scientific who we’re partnering with today, includes all of the good things. It has a very thin metal tube that goes in and stays there. It provides a scaffolding for the artery to stay open. There’s a medication on it that prevents scar tissue. Then there’s a coating on it that dissolves slowly over time that allows the stent to heal in nice, smooth ways so that the artery essentially returns back to its normal functioning tube without any blockage.
The coating is used to get the medication to stay on the stent. It also controls the time frame of the medication. It’s the combination of the medication and the coating that allows the medication to slowly dissolve over time and prevent any scar tissue or heart attacks to develop from the stent.
Lisa Nelson, RD: What percentage of stents re-block? How quickly can blockage occur after stent placement?
Dr. Barker: Current stents, like the SYNERGY stent, have a risk of re-blocking or building up scar tissue anywhere from 4 percent to 5 percent over years. The timing of the re-blockage is generally delayed. It used to be very early on with the older technology. Now, if we see a re-narrowing, it is usually after six to twelve months. Still, it’s a very rare event. It happens in one out of twenty-five cases. Most people have a very good, durable result these days.
Lisa Nelson, RD: If the stent does not re-block, what is the lifespan of the stent? Do they usually need to be replaced at some point?
Dr. Barker: It’s usually good for the rest of a patient’s life. In the rare circumstance that it re-blocks, you can get another stent. That has become less and less frequent these days with different technologies.
Lisa Nelson, RD: Do patients also receive diet and lifestyle education to prevent future blockage when receiving stent treatment?
Dr. Barker: Absolutely. There are well-established cardiac rehab programs that are offered with every cardiologist in every hospital. Once someone has gone through a stent procedure, they would qualify for this intervention and counseling. It includes diet and lifestyle improvements. There are very subtle changes that go a long way, as well as an exercise prescription. This can allow people to understand how much they can do and how far they should push their exercise so that they remain heart healthy.
Lisa Nelson, RD: Dr. Barker, would you share where we can learn more?
Dr. Barker: In addition to the website that Shawna pointed out [in part 1, BostonScientific.com/synergypatient], the important place to go first would be to your primary care physician and/or your cardiologist. Make sure you’re getting heard and explaining your symptoms. Be sure that you’re getting the appropriate attention and respect. Once a diagnosis is made, make an informed decision with all of your options laid out before you.
Lisa Nelson is a dietitian/nutritionist with a genetic predisposition for high cholesterol and heart disease. She guides clients to lower cholesterol and blood pressure levels through practical diet and lifestyle changes. Learn more and sign up to receive How to Make Heart Healthy Changes into Lifelong Habits at http://lisanelsonrd.com.