heart attack


Undergoing a stent implant is daunting for most people, but having information at hand can demystify the process and make the situation a tiny bit less scary. While most of your questions can and should be answered by your cardiologist, here are a few things you should know about before getting a stent.

What is a stent made of?
After all, in some situations like metal stents, it is likely to be a permanent part of your body going forward. To understand what stents are made of, let us quickly go over what stents are and what they do. As the cardiologist may have already informed you, our hearts are supplied blood by a network of arteries known as coronary arteries. With age and improper lifestyle, these arteries narrow and become filled with plaque deposits which can lead to Coronary Artery Disease, heart attacks, or even death. A coronary artery stent is simply a small, self-expanding, metallic mesh tube meant to be inserted inside the artery post a procedure referred to as balloon angioplasty. The stent keeps the artery wide open and the blood flow, continuous. Now as to their make, stents were traditionally made of a metallic or plastic mesh-like substance; however, stent-grafts are manufactured from fabric. These metallic stents are classically composed of medical-grade metal alloys including stainless steel, nitinol (nickel-titanium alloy), cobalt-chromium alloys (L605). However, these stents are fast falling out of favor. The most common type of stents in use these days, in fact, the ones that are the standard of care presently, are DES or Drug-Eluting Stents. These stents are not only made of polymers that dissolve in one’s blood after a few years but are also coated with drugs that reduce the risk of blockages.

Why is DES the standard of care?
The biggest advantage of DES is that they have thinner struts which can be as thin as < 100 μm, with some ultrathin struts reaching approximately 60 μm. This is vital as the thinner the strut, the lesser chance there is of restenosis or the recurrence of abnormal narrowing of an artery. Thinner struts have also been found to cause a lower inflammatory response which could potentially lead to clotting.
The other benefits of these stents are that they allow the artery to return to its natural shape and curvature, promote early healing, and allows for flexibility and normal dilation and constriction.

Advantages of stents
1) First and foremost, stents literally save lives by alleviating the damage that happened to one’s heart muscles during the heart attack. It does so by replenishing blood flow to one’s heart.
2) Immediately relieve/decrease symptoms of heart disease.
3) Reduce the risk of heart attack or stroke in the future.
4) Getting a stent placement may diminish the need to undergo a CABG (Coronary Artery Bypass Grafting).
5) Stenting is not only comparatively much less invasive versus CABG it also boasts of a much shorter recovery period.

Disadvantages of stents
1) One can get an allergic reaction from one’s stent
2) Angioplasty can result in hemorrhage of a blood vessel or even heart damage, or arrhythmia.
3) In rare cases, complications such as heart attack, stroke or renal failure can also occur.
4) Post-stenting scarring may occur that may require another procedure to remove it.
5) There is a risk of further blood clot formation; however, the cardiologist will already have you on blood thinners for prevention.
6) Stenting is not a cure for coronary artery disease. One needs to be vigilant about one’s diet and exercise while managing the contributing risk factors for coronary artery disease such as hypertension, higher body weight, diabetes, or high cholesterol.

So there you have it, a short primer on stents, how they are made and what you should be aware of while getting them implanted. Hope it has been of help!

Angioplasties are increasingly recommended for uncomplicated cases with minimum blockages as they are less invasive and require shorter recovery time. However, as with any surgery, there are quite a few precautions that one must undertake to ensure a complication-free recovery. This handy primer is a supportive document to your cardiologist’s advice. In case of any doubts, consult your cardiologist. For your ease, let us break down the recovery period into what one can expect at the hospital after the procedure, the actual recovery, and general precautions.

What to expect at the hospital after the procedure:
1. In the case of groin catheterization, one will need to lie straight with unbent legs while the groin sheath is in place. In some situations, a sheet may be placed across your legs to help you keep them straight.

2. You are advised to stay lying in a flat position for at least 6 hours post sheath removal. This is to prevent hemorrhage. If you are uncomfortable, you can have your head elevated after 2 hours.

3. Moving out of bed will depend on the nature of your recovery and the nursing staff’s advice.

4. It is best to avoid consuming anything other than clear liquids while the sheath is in place. This will help prevent nausea. Remember to stick to a heart-healthy diet once the cardiologist gives the all-clear sign to resume solid food.

5. In case you experience chest pain, swelling, pain at the insertion site or bleeding; call your cardiologist immediately.

6. In case you have had a stent placed in your heart after your angioplasty, you will be required to take certain medicines to reduce the chances of blood clot formation.

7. In the case of arm catheterization, a specialized bandage will be placed to ensure proper healing.

During the recovery period:
1. In case your angioplasty was done without you undergoing a heart attack prior to it, you can be back in the driver’s seat just after 2 days. If you have had a heart attack though, you will need to wait till your cardiologist gives you the green signal.
2. Even though an angioplasty is less invasive, it is still a major procedure so take care and rest to avoid all strenuous activities. Avoid lifting heavy objects (more than 5 kg) preferably till 1 week after the procedure.
3. Getting enough rest does not mean that one can turn into a couch potato though. Regular exercises recommended by the doctor will not only speed up your recovery but also will help in preventing further cardiac incidences. Your diet will also play a major role in your recovery. Consuming a heart-healthy diet that is low in sodium and fats is crucial to your long-term wellbeing.

1. Don’t be in a hurry to resume your routine activities after your angioplasty and stent implantation. Resume them gradually to avoid strain.
2. One major point to remember is that angioplasty won’t cure your disease. It only serves to keep your arteries open. To truly prevent future incidence, you will need to change your lifestyle and diet.
3. Ensure that your diet mainly consists of fruits, vegetables, whole grains, nuts, etc. to decrease your heart disease risk.
4. Reduce and control your salt consumption as well as sugar intake.
5. Most importantly, do NOT skip or neglect your medication. Consume your prescribed medicines such as blood-thinners, lipid-lowering medicines, such as statins or anti-hypertensive as recommended by your cardiologist, depending on your condition.
6. Exercise regularly and maintain a healthy body weight.
7. Do follow-up regularly with your cardiologist.
8. Always carry a stent implantation card with you to avoid unforeseen problems.

1) Stop smoking immediately. Consume alcohol only if your cardiologist says it is ok to do so.
2) Avoid taking on too much stress.

Now that you are on the journey towards healing, here’s wishing you a happy and complication-free recovery period! Get well soon!