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Heart of Healthy You
How Risky Are Stents?
Pros and cons of the bare-metal and drug-coated versions
Which is best at keeping arteries open, bare-metal or drug-coated stents? It’s been a controversial topic lately. Whether you had a stent inserted years ago or want to be informed should you ever need one, Lehigh Valley Hospital and Health Network cardiologist J. Patrick Kleaveland, M.D., answers your questions.
 What is a stent?
It’s a small wire-mesh tube used to perma-nently hold a blocked artery open after it’s stretched open with a balloon.
What’s the difference between bare-metal and drug-coated stents?
Bare-metal stents, the first to be developed, are made of metal only. After they’re placed, a thin layer of scar tissue grows over the metal and incorporates the stent into the body. In some people this tissue continues to build up and reblocks the artery (restenosis), which can cause angina or heart attack. Drug-coated stents were developed to resolve this problem. While they significantly reduce restenosis, new studies suggest they slightly increase the risk for blood clots in the stent several months after it is placed.
Is there a way to prevent this?
Yes. Medications like aspirin and clopidogrel (Plavix) help prevent these potentially deadly clots. Doctors used to prescribe such drugs for up to six months after stent placement, and they now recommend them for a year, if your risk for bleeding is low. Stent patients should be on aspirin lifelong; as for Plavix, talk to your cardiologist. Researchers are still studying the benefit of combined aspirin/Plavix therapy beyond one year.
Are stents still a safe treatment?
Yes. Stents have helped millions of people live longer lives, and when you need stenting, a drug-coated stent is the best way to keep your artery open. Though recent studies raise concern, blood clots in drug-coated stents are still very rare. The risk rises if aspirin and Plavix are stopped prematurely, so check with your cardiologist before stopping any anti-clotting drugs. Researchers are improving safety by developing a stent coated with a scar-preventing drug that dissolves 6-12 months after being placed.
I received a stent years ago but don’t know which kind. What should I do?
Talk to your doctor. He or she can determine which type of stent you have by reviewing your medical records, and can review your medications and further recommendations with your cardiologist.
When is a bare-metal stent the better choice?
Though they have a higher risk for re-narrowing, bare-metal stents are the better option if you have an intolerance to aspirin and Plavix or will be having surgery in the next six months. (These drugs can increase your risk for bleeding complications with surgery.)
Want to Know More about how stents are implanted? Call 610-402-CARE.
Published from Healthy You Magazine May-June 2007
This page last updated 3/30/08 04:08 PM
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