Stenting involves the permanent placement of stents in vessels to limit the chance of re-closing after blockages or narrowing has been repaired. Stents are very small tubes made from mesh-like materials, generally using metal, plastic or fabric. These tiny tubes are used to brace open arteries, blood vessels, bile ducts, uterers or airways through a procedure called stenting. While stenting can be used outside of the vascular system to repair the flow of air, bile of urine, it is most commonly used in conjunction with angioplasty to hold open arteries or other blood vessels for enhanced blood flow.
How is the procedure performed?
Stenting can be performed alone or immediately after angioplasty and is a minimally invasive procedure that can usually be performed without general anesthesia. This procedure should only be conducted by a trained specialist and is normally completed on an outpatient basis; although, in some cases admission to the hospital may be required. Stenting is performed in a surgical setting, with the patient most often sedated, but awake, on an examination table.
Intravenous sedation is used to enhance patient comfort during the procedure, and a local anesthetic will be used at the site where the catheter will be introduced into the vascular system. The entrance site is most often an artery in the groin, but can sometimes be through the arm as well. Once the entrance location is cleaned and numbed, a small incision is made and a sheath is inserted into the artery.
The stent is placed over a balloon-tipped catheter, which is then inserted into the artery and guided to the damaged section of the vessel with the assistance of imaging technology. Once in position, the balloon is inflated to expand the stent and embed it into the vessel walls, where it will remain permanently. The balloon is then deflated and the catheter is withdrawn. Stents that are designed to open on their own without inflation of a balloon are sometimes used; however, it is not uncommon for these stents to require additional assistance from balloon inflation to fully open. Stents that are coated with drugs to inhibit scar tissue growth and decrease the chances of re-narrowing of the vessel are also used in some stenting procedures.
After the stenting is complete, the catheter and sheath are removed and the entrance site is bandaged. No sutures are needed, although the specialist may opt for using a closure device to seal the hole in the artery. The intravenous line will also be removed and the patient will go to a recovery room or area for a minimum of several hours.
What are the risks and side effects of Stenting?
Stenting is considered a safe, minimally invasive procedure with serious complications only happening on rare occasions. Serious complications can include arterial clots, weakened or torn blood vessels, hematomas, damaged artery lining and new blockages forming from plaque that has broken free from the treatment site. Other risks include allergic reactions to the stent material or the drugs coating drug-eluting stents, blood clots, in-stent restenosis, which is clogging inside the stent, and bruising or bleeding at the access site.
What is the recovery like?
Immediately after the procedure, the patient must remain in bed from several hours to one day, during which time you will be monitored for complications. Depending on the location of the access site, you will need to keep your arm or leg straight with minimal movement for several hours to limit bleeding. You will be advised to watch for certain symptoms, such as shortness of breath, fever, unusual bleeding, pain, numbness or swelling at the access site, or the leg or arm turning blue or feeling cold. If any of these symptoms arise, your vascular specialist needs to be informed right away.
Baths should be avoided, but showering is usually okay the next day. You should not perform any heavy lifting or strenuous activities for several days. You may be prescribed aspirin or blood-thinning medications to prevent the formation of clots, and you will likely be asked to participate in light physical activity, such as walking. Follow-up appointments will be necessary to assess blood flow through the stent and to check for complications during the recovery process.
Who is a candidate for Stenting?
Stenting is sometimes a viable option for patients who would otherwise need to undergo surgical plaque removal or bypass surgery. Good candidates for stenting include those who have fewer blockages and narrowing vessels, which can be opened using stenting or a combination of stenting and angioplasty, in the absence of additional disease or damage in the heart, heart valves or arteries.
What conditions does Stenting treat?
Stenting can be used in the treatment of a number of conditions, both in and outside of the vascular system. The most common vascular conditions that can be treated with stenting include artherosclerosis, peripheral artery disease, carotid artery disease, coronary heart disease, pulmonary vein stenosis, chronic venous insufficiency and related conditions and diseases.