A stent can save your life during a heart attack, but can it help prevent one?
An estimated two million people get coronary artery stents every year, and if you have coronary artery disease, there is a good chance your doctor will suggest you get one.
But do you really need it? In 2013, the American Medical Association issued a report that said stents were one of the most highly overused medical interventions.
“When people learn that they may have a coronary artery blockage, they often automatically think they will need a stent,” says Dr. Douglas Drachman, who is an interventional cardiologist with Harvard-affiliated Massachusetts General Hospital. “It’s not a straightforward decision, as stent treatment may be helpful for some, but may have limitations or pose risk for others. A stent can be lifesaving for people who are having a heart attack, but may not be the best way to prevent a heart attack.”
The story on stents
A stent is a tiny wire mesh tube that is inserted into a narrowed or blocked coronary artery. The coronary arteries feed blood and oxygen to heart muscle cells. If a coronary artery narrows, you may develop symptoms of angina, such as chest pain, shortness of breath, a cold sweat, and lightheadedness. (It’s possible to have a narrowing and no symptoms.)
A heart attack strikes when plaque breaks open and causes the formation of a blood clot in a partially clogged artery and completely blocks blood flow. That’s when a stent can be lifesaving.
The stent is inserted into the clogged artery with a balloon catheter. The balloon is inflated, reopening the vessel, and the stent expands and locks in place. This holds the artery open to allow blood to flow freely.
“By opening up the blocked artery and restoring blood flow, the stent can stop damage to your heart muscle and reduce your chance of suffering heart failure or even death,” says Dr. Drachman.
Stent technology has evolved a lot in the past 20 years. Today stents are easier to insert and cause fewer complications and side effects. The mesh is now more flexible and lined with medication to discourage growth of scar tissue and prevent renarrowing of the artery, thus reducing the chance of needing a repeat procedure. About 75% of stents are now inserted through the wrist instead of the groin, which lowers the risk of bleeding and speeds recovery.
Signs of blockage
Some everyday signs can identify possible blockage, says Dr. Drachman. For example, do you feel weak or have any chest discomfort or shortness of breath after mild physical exertion, like carrying groceries or raking leaves?
Also, be mindful about subtle changes in your endurance. You might first have trouble only when you walk uphill, but a month later you feel a bit short of breath or lightheaded after walking on a flat surface.
“Don’t ignore these signs, no matter how insignificant they may appear,” says Dr. Drachman. “They could be red flags of poor blood flow in one of your coronary arteries, and you should see your doctor as soon as possible.”
To check for blockage, your doctor will review your symptoms, perform a physical exam, and likely order an electrocardiogram. Further testing may be required, such as a standard treadmill test, a stress echocardiogram, or a more advanced heart imaging test.
People may believe it’s the degree of coronary artery blockage that determines heart attack risk. But there’s more to it than that.
Again, heart attacks happen when a blood clot completely blocks an artery. “When people have chronic symptoms from stable narrowing of a coronary artery — even if it’s 90% blocked — inserting a stent may help improve the symptoms, but will not necessarily reduce the risk of a heart attack,” says Dr. Drachman.
Overused and overhyped?
The recent debate about stents comes from a groundbreaking study in the Nov. 5, 2017, issue of The Lancet. It concluded that people who took heart medicines to relieve symptoms of stable angina had similar relief of symptoms and quality of life compared to people who received stents. There were no deaths in either group.
Other research supports these findings and has also shown that stents don’t prevent heart attacks any better than optimal medical treatment.
Before considering a stent procedure, people with a diagnosed blockage should focus on lifestyle changes — such as not smoking, eating a heart-healthy diet, and engaging in exercise as prescribed.
It can also mean taking any necessary medications, like aspirin to prevent clots, beta blockers to slow heart rate and control blood pressure, and statins to lower cholesterol levels.
“Although some people may have a heart condition that requires a stent, for the vast majority, lifestyle changes and medications that focus on prevention is often the best approach,” says Dr. Drachman.