Complications with coronary artery stent implantation

Dear Ask The Doctor: My wife has always been in good health we walk for miles very often out of the blue she started having chest pains she had a 100% blocking in the LAD. She had a stent put in my question is "what are the chances of this happening again? I read a lot of negative about stents and now I really don't know if she is safe (or safer)

Dear Nancy: A stent is implanted in a narrowing of a coronary artery. At the time of implantation the stent is deployed using a small balloon which stretches the artery and therefore reduces the narrowing. The stent which is comprised of metal subsequently prevents recoil of the vessel at this point. There are certain risks associated with having a stent in the coronary artery. These include narrowing within the stent itself (in-stent restenosis) or clot formation within the stent (in-stent thrombosis). In-stent restenosis is generally a gradual process which tends to occur within the first 12 months and is associated with worsening symptoms of angina and/ shortness of breath. In-stent thrombosis is an acute process resulting in a heart attack, and is generally considered higher risk. The actual risk of either of these complications depends on the individual type of stent used. If a standard “bare metal stent” was used then the risk of in-stent restenosis is slightly higher. If a “drug-coated stent” was used then the risk of in-stent restenosis is lower. However there may be a slightly increased risk of late in-stent thrombosis associated with a drug coated stent. The overall risk of both of these events is significantly reduced with drug therapy such as aspirin and clopidogrel (Plavix). Aspirin is generally recommended for long term usage while clopidogrel is recommended for a variable time period depending on which stent was implanted. Your cardiologist will have provided you with this specific information at the time of implantation. It is also important to control risk factors for coronary artery disease including; smoking cessation, high blood pressure, high cholesterol, diabetes, and improve general lifestyle measures such as increased exercise and light alcohol consumption. If your wife experiences any new onset of symptoms, it is important to seek medical advice urgently.