Stenting: Function, Problems, and Procedure
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Transcript Stenting: Function, Problems, and Procedure
Stenting: Function, Problems, and
Procedure
Uses for Stents
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
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
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
–
–
–
–
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
–
–
–
–
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