Do You Need a Stent? How They Work and How Long They Stay Effective

Introduction

In the fight against heart disease, coronary stents have become a cornerstone of modern cardiology. For millions of people worldwide, this small, seemingly simple device has provided a second chance at a healthier life, often in the face of a life-threatening emergency. However, for a patient, the rapid-fire diagnosis and procedure can leave a host of unanswered questions: What exactly is a stent? When is it truly needed? And perhaps most importantly, how long will this tiny piece of metal last?

This article aims to demystify the world of coronary stents. We will explain what they are, detail the scenarios where they are a critical intervention, and provide a clear, scientifically-backed overview of their longevity, from the immediate post-procedure period to a lifetime of cardiac health.

Imagine a coronary artery, one of the main blood vessels that supplies oxygen-rich blood to the heart muscle, that has become clogged with fatty plaque. This plaque narrows the artery, restricting blood flow. A coronary stent is a small, expandable mesh tube, typically made of a metal alloy like stainless steel or cobalt-chromium. Its sole purpose is to act as an internal scaffold to prop open a narrowed or blocked artery and keep it that way.

The vast majority of stents used today are drug-eluting stents (DES). These are coated with a medication that is slowly released into the artery wall over several weeks. This medication is crucial because it prevents the overgrowth of scar tissue inside the stent, which was a common problem with earlier generations of bare-metal stents (BMS). ^[2]

A stent is not a preventive measure; it is a critical intervention to treat existing and often advanced coronary artery disease (CAD). Its use is almost always part of a procedure called angioplasty, where a balloon-tipped catheter is used to clear a blockage before the stent is placed.

Stents are primarily used in three key clinical scenarios:

• During a Heart Attack: In the midst of a heart attack, a coronary artery has become completely blocked, cutting off blood supply to a part of the heart muscle. In this life-threatening emergency, a procedure known as primary angioplasty with stenting is the gold standard of care. The goal is to open the blocked artery as quickly as possible, a process often referred to as “door-to-balloon time”, to restore blood flow and minimize heart muscle damage. For this reason, a stent is a life-saving intervention. [3]
• For Unstable Angina: Unstable angina is a severe form of chest pain that occurs suddenly, often at rest, and indicates that a patient is at very high risk of having a heart attack. If a traditional angiogram reveals a high-grade blockage, a stent is often placed to stabilize the artery and prevent a future cardiac event.
• For Stable Angina: Stable angina is chronic, recurring chest pain that occurs with exertion. For patients whose symptoms are not well-controlled with medication and lifestyle changes, a stent can be used to open a significant blockage, improving blood flow to the heart muscle. The goal in this scenario is to relieve symptoms and improve the patient’s quality of life. ^[4]

The stent placement procedure is a rapid extension of a traditional angiogram (cardiac catheterization). Once a significant blockage is identified, the cardiologist can proceed with the treatment. A catheter with a deflated balloon and a collapsed stent on its tip is guided to the site of the blockage. The balloon is then inflated, which compresses the plaque against the artery walls and simultaneously expands the stent. The balloon is then deflated and removed, leaving the expanded stent permanently in place to hold the artery open and maintain blood flow. ^[5]

This is one of the most common questions patients have, and the answer is reassuring: a properly placed stent is designed to be a permanent solution. In most cases, it is meant to last for the rest of a patient’s life. However, its long-term success depends on two primary factors:

• The Problem of Restenosis: Historically, the biggest threat to a stent’s longevity was restenosis, the re-narrowing of the artery. This occurred when the artery’s inner lining grew too much tissue over the stent, eventually blocking it again. Restenosis rates for bare-metal stents (BMS) were as high as 20-30%. The development of drug-eluting stents (DES) was a revolutionary step that solved this problem. The medication on a DES slowly inhibits this tissue growth, reducing the restenosis rate to less than 5% in most cases. ^[6]
• The Risk of Stent Thrombosis: Another, albeit much rarer, risk to a stent is stent thrombosis, which is the formation of a blood clot inside the stent. This is a life-threatening event that can cause a heart attack. This risk is highest in the first year after the procedure. To prevent this, patients are prescribed dual antiplatelet therapy (DAPT), typically a combination of aspirin and a second antiplatelet drug like clopidogrel, ticagrelor, or prasugrel. Adherence to this medication regimen is critical to ensuring the stent remains open and free of clots.

In essence, a stent itself does not “expire.” Its long-term prognosis is a function of the patient’s underlying disease process and their adherence to a heart-healthy lifestyle. While the stent itself is a permanent fixture, new blockages can form in other arteries or even at the edges of the stented area if the underlying disease is not managed.

A stent is a powerful tool, but it is not a cure for heart disease. It is the first step on a new path toward a healthier future. The long-term success of the procedure depends entirely on the patient’s commitment to post-procedure care.

• Medication Adherence: It is non-negotiable to take all prescribed medications as directed, especially the antiplatelet therapy, to prevent blood clots. A cardiologist will advise on the duration of this therapy.
• Lifestyle Changes: This is where the patient takes control. A heart-healthy lifestyle is essential to prevent new plaque from forming. This includes:
  • A heart-healthy diet low in saturated fats, cholesterol, and sodium.
  • Regular physical activity as advised by a doctor.
  • Smoking cessation, as smoking is a major risk factor for restenosis and future heart problems.
• Regular Follow-ups: Consistent appointments with a cardiologist are necessary to monitor blood pressure, cholesterol levels, and overall heart health.