Coronary Artery Disease: How Stents Prevent Heart Attacks

Dr Lim Yean Teng, cardiologist at Mount Elizabeth Hospital, explains the 5 things you need to know about blocked arteries and heart disease – and how a heart stenting procedure (Percutaneous Transluminal Coronary Angioplasty or PTCA) can save your life.

What is heart stenting and who needs it?

Your arteries are the blood vessels that carry blood around the body. Sometimes fatty tissues called plaques can build up on the walls of your arteries, blocking them. Clogged arteries prevent the flow of blood around the body, which can cause heart disease – including heart attacks and strokes.

PTCA is a minimally invasive procedure that is performed if your coronary arteries are blocked. It allows blood to circulate unobstructed along the arteries to the heart.

If you have been diagnosed with coronary artery disease, which has not improved with medication or lifestyle changes, or you have had a heart attack, you may be advised to go for a heart stenting procedure.

What does the procedure involve today?

A coronary angiogram, in which a catheter is introduced to the heart through a small cut in the groin or arm, is used to detect coronary heart disease and show where the artery-clogging plaques (fatty tissues) are located.

Once the plaques are detected, the catheter is then reintroduced with a little balloon-like device at the tip, which is inflated and deflated several times to prise open the blocked artery. It is now common for stents (little pieces of expandable metal made from stainless steel mesh) to be inserted and flattened against the wall of the artery to keep it open and allow the blood to flow smoothly. Drugs that help prevent clogging may be inserted into the artery at the same time as the stent.

Today, most balloon procedures use stents. When a heart stenting procedure (PTCA) is performed without stenting there are often high recurrence rates – where the coronary artery becomes blocked again – within 6 months of the procedure.

How long will the operation take?

Inserting stents usually takes from about 30 minutes to 2 hours. After the procedure, you will need to rest in hospital for between 2 – 6 hours, after which you should be able to walk around. You may be able to go home the same day or might need to stay overnight. For the next week you are likely to experience some soreness and should refrain from lifting heavy items and driving, but should then be able to continue your life as normal. If you feel any pain during or after heart stenting do, of course, discuss it with your doctor.

According to Dr Lim, the stenting procedure is considered a minimally invasive procedure – which can be carried out through a tiny incision in the wrist (radial approach) or groin region (femoral approach). The duration of the procedure ranges from only minutes – for a simple lesion – to hours for a totally blocked artery.

How soon will I be up and about again?

Recovery time is generally short, especially for procedures carried out by the radial approach, and the patient can be discharged following overnight observation. Procedures carried out via the femoral approach typically require an extra day of hospitalisation.

Patients who have undergone the radial procedure generally move about normally a day after surgery, while those who have undergone the femoral procedure will only be up and about 3 or more days later.

How long will the stents last?

The success rate for this procedure is very high – about 90% – with few complications. Occasionally the artery can become blocked again, which means the process needs to be repeated, but modern stent technology is decreasing this risk.

Dr Lim says that the durability of the stents should be considered from 2 aspects. Firstly, look at the stent's physical durability. Metal stents are permanent implants and form part of the artery wall months after they are implanted. Bioabsorbable vascular stents, or BVS, gradually dissolve into the body before completely disappearing after 2 years. As the healing process is already complete within a year of heart stenting, the body no longer needs it.

Secondly, look at the long-term result of stenting. Restenosis, where there is a recurrence of the narrowing of the blood vessel, can happen in the first 6 – 8 months following heart stenting. If the narrowing of the vessel wall does not recur, it is considered a successful procedure.

What can I expect after the treatment?

Today's advanced technology means that stents can now be used in many cases where open heart bypass surgery would have previously been the only option. Stenting is not an automatic alternative to heart bypass surgery, but if it's suitable for you, heart stenting is quicker, with less trauma. It eliminates angina chest pains and can have long-term success.

What happens when you go for heart stenting (coronary artery bypass grafting or CABG) or a coronary angiogram? Learn more with our step-by-step guide to heart treatments.

Find out some of the medical procedures available should you need to undergo heart treatment. With the correct insurance coverage, your bill size can be better gauged and managed, while Mount Elizabeth Hospitals can assist with all Medisave, MediShield Life and Integrated Shield Plan claims.

For your peace of mind, talk to one of our heart specialists today.