Coronary Stents: What you need to know!!

welcome back it's peter ballas here cardiologist now today's topic is all about stents and these little devices that we use to open up blockages in the arteries around the heart so we're going to talk about what they are what does it mean if we do have one and how do we look after them [Music] [Music] now there are many of you out in the community that have had stints and i have a lot of questions being asked about what are these stints what are they made of and how does it affect my body once the stent is inside so today we're going to focus on these devices and why they are used and what are some of the things you should know about so stents are put in through a procedure that we call angioplasty and this is a procedure that we undertake when we perform an invasive test called an angiogram and we've had a separate topic on what an angiogram is so please do go back and have a look through the videos on what angiograms are but these tests are picture tests using x-rays to visualize the arteries around the heart to look for any blockages or narrowings that may happen as a result of the build up of cholesterol or this fatty material called plaque now that can develop inside the arteries of the heart and obviously the arteries around the heart serve a very very important role what they do is they help support supply nutrients to the heart muscle to allow the heart muscle to beat as it does 70 times per minute delivering nutrients and blood and oxygen to all our body but of course if there is a buildup of this cholesterol plaque then you get less blood flowing to the muscle and that can cause symptoms and you might have heard of a term called angina and that's typically a condition whereby you might have some tightness in the chest going down the arm up in the jaw which can happen as a result of exertion or pushing yourself climbing up stairs going up in clients the blockages can also build up rather abruptly very suddenly in the form of what we know as a heart attack so placing these devices in called stents can be life-saving in that situation the coronis tends to placed through a procedure called an angiogram where we place a little catheter a little tube often through the the wrist artery from there advance some catheters up to the heart and inject dye visualizing the arteries looking for any narrowings if there is a significant narrowing and potentially if this is you know typically more than 70 percent or so narrowed there is a consideration for using these stents to open up the artery to prop open the artery and then restore blood flow now it's not the first thing we do when we diagnose somebody who might have these blockages depending on the clinical scenario there might be tablets and medications and just lifestyle factors that your doctor might recommend but in some patients it can be very useful to improve symptoms that they might be experiencing in their quality of life by placing one or multiple of these devices called stents to open up the blood flow and restore blood and oxygen getting to the heart muscle so it can do its own thing placing a stent is used to treat buildup of plaque around the arteries of the heart and thereby improving blood flow and reducing symptoms now placing a stent is not for everybody and discussions with your doctor are paramount here in your cardiologist to look at whether the stents are the best thing for you do you need to have a stint firstly or is there an alternative therapy of course medications and lifestyle changes addressing your risk factors but also whether coronary artery bypass surgery may be more appropriate for you and we're going to have a separate episode on exactly that in terms of what is bypass surgery how is it performed and why might it be useful for you traditionally stents were not the first thing we started implanting in the arteries and when we started developing what we call intervention and that's what i am an interventional cardiologist which essentially means i have had formal training in how to tackle the arteries and how to unblock the arteries using these stent devices but we traditionally used to put a balloon in simply popping a balloon through the catheter that we do an angiogram with opening up the arch we're squeezing the cholesterol open but unfortunately just placing a balloon itself means that the artery in the plaque buildup develops rather quickly so it wasn't a long lasting procedure and that's when stents arose stents came around because we used to find that when we placed a balloon to open up the artery the results were not long lasting and we thought well something needs to be there long term to actually restore blood flow and actually keep the artery open traditionally stints have been made of metal and you might hear of various alloys such as stainless steel cobalt chromium and these metals are very very thin devices sometimes even 60 to 70 microns thin and these act like a spring like a scaffold that goes into the archery at the site of where the blockage is and opens the artery up and you can imagine by opening the artery where we store proper blood flow and symptoms improve or if there is a clot forming in the artery as a result of a heart attack the stent can treat that area open the artery and restore blood flow thereby minimizing any long-term damage to the heart now stents are traditionally made of metal and there are two types of stents that you may have heard one being a bare metal stint and another being a drug eluting stent or a des now what does that all mean and why do we need these various stents well again the bare metal stents were the first generation stints that were developed essentially they were made of a metal like a spring that was used to prop open the artery but what we found with bare metal stents is that over time the body was often unhappy having this device inside it i guess a foreign material and sometimes there would be a reaction or a type of healing response where the body actually even tries to reject the implant or the stent and that can cause a process known as re-stenosis or re-narrowing inside the stent thereby developing more symptoms because of a repeat blockage more worryingly is also a complication called thrombosis or stent thrombosis whereby the cells in our blood that are traveling through the artery can clump on the stent and develop an acute clot causing a blockage inside the stent so of course there have been many changes in design of stents in the materials of stents in how they behave and perform inside an artery to look at reducing all these risks of stents long term in about 2002 and 2003 we started implanting these newer generation stints at the time called drug eluting stints now the difference between a drug alerting stent and a bare metal stint essentially means that we had the same material same stint same metallic scaffold however the stent was coated with a immune modulating drug and that drug is released over a period of a few months into the bloodstream and into the artery wall to reduce the body's reaction against the stent so you can imagine it's like an anti-inflammatory drug that is coated around the stent which reduces that reaction and reduces the likelihood that your body will reject the stint or there will be re-stenosis or re-narrowing inside the stent so that was a very very major advance back in 2003 and the stents since then have continued to evolve and to develop into what we have now the latest generation stints which are made of various metallic alloys they are very thin they go nicely into the artery and they give us long lasting results but you might hear that after you've had a stent in you are asked to stay on blood thinning medication for a lengthy period of time we traditionally use aspirin and that's one that we often use for life and aspirin is a blood thinner that reduces the risks of clots forming inside the arteries but also inside the stents but we often find that aspirin is insufficient to help reduce the risk of clots forming inside the stents and we often combine it with a different type of blood thinner which is a little bit stronger than what aspirin is but used in combination and one of those medications you might have heard is called clopidogrel that is a blood thinner that we use another one is ticagra law and these are newer generation types of blood thinners that we use to reduce the risks of complications developing inside the stents particularly in the first six to twelve months as the body is getting acclimatised to having the stint inside but over time what happens is our body forms a nice amount of tissue to cover the stint and that means that the blood traveling throughout and inside the stent is not visualizing any bits of metal in the artery wall and it's less likely to cause a clot formation as a result of trying to reject the metal stent now stents are continuing to evolve and that's one of my key areas of interest in my research i work across medicine and also biomedical engineering and we are looking at what are the best types of stents for our patients into the future which stents are going to be better for patients which dents might have less complications for patients and which might be more compatible with the body we've been looking at various materials not only metal stents but the newer generation stents potentially made of magnesium see that the magnesium over a period of 18 months to two years actually breaks down and dissolves potentially leaving nothing behind so that's where i believe the future is going at a slow pace with our research there are other devices we are working on that are made of polymers or plastic type materials rather than metal stents now we know that the metal stents are typically there for life with polymer stents these stents open the artery up but over a period of a few years potentially there's a role that these stents will dissolve and break away leaving the artery open and that's really what we're looking at in terms of future research there have been a few generations of these scaffolds or stints that have had some promising trial clinical data however the first generation perhaps we're still learning a bit about were associated with some slight increased complications so now we're looking at second third and fourth generation scaffolds that potentially into the future well we'll form the mainstay treatment for patients now when we place stents we size them depending on your artery some of our arteries are large and typical size being about three and a half millimeters in diameter to four millimeters in diameter but the arteries have curves have bends a larger in one section than another so at the moment our stents are pretty much on the shelf with fixed measurements so they come in 2.5 millimeter diameter 3 3.54 4.55 millimeters in diameter and the lengths can vary depending on the size that you need to treat for a particular blockage but they are typically standard lengths 12 millimeter 16 millimeter 20 millimeter up to you know 40 odd millimeters of stencil four centimeters long and sometimes we do need to use long stents to treat quite long parts of an arch that have got a lot of cholesterol but i guess what what excites me in terms of my research is well how do we actually tailor the stent or customized tents to fit individual patients all our arteries are unique no two arteries are the same so we're looking at some very exciting applications of 3d printers and potentially taking very clear images of of an archery and these laser type scans that we use potentially could then provide us with an exact custom design that we could then print prior to implanting into patients so that's again that's not been done at the moment that's purely a research avenue but certainly holds a lot of promise and something that my team is working very very strongly with across both in australia but also with international partners so when you have a stand in the treatment isn't done we have to maintain the stint and that's really the paramount importance here of trying to control the underlying risk factors now these risk factors and as we've covered in previous videos include high blood pressure including high cholesterol smoking weight or being overweight inactive diabetes these are key cardiac risk factors that we know if we don't control problems will again develop both in other parts of the artery but also inside the stint and there is a rate or a risk of complications developing inside stents that they can re-narrow clog off and that's why it is important that we do control risk factors we do remain on a key number of medications now again i'm an advocate for minimizing medications but we know that once a stent is in place we need to be on a few medications long term to maintain blood flow within the arteries and stop the process and build up of cholesterol developing again but there might be blood thinners as i mentioned aspirin but there's a different type of aspirin that we often use in combination typically for 12 months but then there are cholesterol medications that we know have a dedicated impact on reducing the amount of cholesterol building up in other parts of the artery but also we've seen new research emerging that cholesterol can also develop inside stents a process known as neo-atherosclerosis so it's a process that we're learning a lot more by using these 3d images or scans inside the heart and the arteries to see that over time cholesterol can actually build up inside stents so it's paramount importance that we do work on those risk factors nicotine smoking cholesterol diabetes blood pressure keeping them all in check now after the procedure depending on how you've presented and if it's not been an emergency then often you can go home the next day there is also some data to say that in certain situations depending on where the narrowing is or where the blockage is and depending on the level of support that you might have at home there might be an opportunity for you to go home that evening but typically we usually stay the night if you're presented in an emergency situation whereby there might be a diagnosis of a heart attack where the arteries been abruptly closed and we've got to get in there a any time of the day or night to open up the artery then you're often in hospital for a few days being monitored and having your medication changed and monitored just to get you fit and strong recovering and probably go home after a few days so again hopefully i've given you some insight into what these stents are why they are used and obviously the key factors are trying to minimize the risks of stents failing or complications building up or new blockages developing so thanks for joining me and i look forward to seeing you on the next video bye for now

Channel: Heart Matters

Views: 1,770,639

Keywords: aspirin, blockages, bypass surgery, cardiologist, cardiovascular disease, choleterol, clopidogrel, coronary artery disease, coronary stents, diabetes, drug eluting stent, heart attack, heart stents, high blood pressure, peter barlis, technology, ticagrelor, heart, cardiology

Id: wF2I8yrfCVE

Length: 17min 58sec (1078 seconds)

Published: Mon Sep 13 2021