Pharmacist answers, ‘Why do I need another stent?"

Hello again everyone! It’s Beth, one of your Pharmacy Chicks. Last week, a patient asked me to write an article about stents. The patient wants to understand why their doctor says they need another stent. What a great subject to talk about!

First let’s talk generally about a stent. A stent is a small tube that is placed into some type of hollow structure in the body. It can be inserted into an artery, a vein, the ureter (urinary tube), bile duct, or some other structure. The purpose of the stent is to keep the structure open. There are also different kinds of stents. Stents can be made of metal mesh, fabric, silicone, or combinations of materials. Some stents are drug-eluting, meaning they are coated with medicine that releases into a blood vessel to prevent it from narrowing again. Other stents may be biodegradable so that they dissolve after a few months when the need for them is temporary.

The type of stenting we are going to discuss is related to blood vessels. When plaque builds up in blood vessels, the blood vessels harden and narrow, causing atherosclerosis. Plaque is made of cholesterol, fat, calcium, and fibrous tissue. This buildup can occur in any blood vessel. The flow of oxygen-rich blood to your body’s organs is restricted with the plaque buildup and blood vessels can become completely blocked. Plaque buildup in the carotid (neck) arteries can lead to stroke or transient ischemic attack (TIA or mini-stroke). Narrowed blood vessels that supply blood to the legs or arms contribute to peripheral artery disease (PAD) which can lead to mild discomfort in the extremities, debilitating pain, inability to walk, and gangrene. Plaque buildup in the coronary arteries (heart) can lead to chest pain (angina), shortness of breath, and heart attack.

 When blood vessel blockage exists, an angioplasty and stent placement can be performed. Angioplasty uses a medical balloon to widen the blocked blood vessel and place the stent. The surgeon places a catheter (flexible tube) into a blood vessel. X-rays will be used to guide the catheter to the blocked area. A guide wire is inserted through this catheter to the blockage. Another catheter with a very small balloon and the stent is pushed over the guide wire to the blocked area. The balloon is then inflated to push the plaque against the wall of the blood vessel. The stent expands at the same time and is left in place to keep the blood vessel open. The balloon, guide wires, and catheter are then removed. After the procedure, you will usually be prescribed medications to prevent blood clots from developing. These are usually aspirin and/or clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta).

Now that we have discussed the background about a stent and why it is needed (blood vessel blockage), let’s answer the question my patient asked. Why do I need another stent? A stent is needed to open a blocked blood vessel. If you have had enough plaque buildup to require a stent, there is a good chance this will occur again in another blood vessel or a different location in the same blood vessel. The stent placement only helps the blockage in that specific location. If changes are not made to your diet and lifestyle, the blood vessels can narrow and become blocked again. Diabetes also increases the risk of carotid, coronary, and peripheral artery disease. There are some healthy living changes that can reduce the chances of developing another blocked blood vessel.

Quit smoking. Smoking is a major risk factor for developing artery disease, heart attack, stroke, and limits blood flow throughout the body.

Increase physical activity. Regular physical activity encourages blood flow.

Eat a healthy diet. Reducing cholesterol, which causes fatty deposits in the blood vessels, reduces the risk of plaque buildup.

Manage chronic conditions. Type 2 diabetes increases the risk of artery disease. Control blood sugar with a healthy diet and medications.

Symptoms that may indicate plaque buildup in blood vessels include the following:

Carotid artery: Stroke or TIA including sudden numbness or weakness in face or limbs, sudden trouble speaking and understanding, sudden trouble seeing in one or both eyes, sudden dizziness or loss of balance, sudden severe headache with no known cause

Coronary artery: Angina (chest pain or discomfort), shortness of breath during light physical activity, and heart attack

Peripheral artery (legs or arms): Claudication (pain caused by restricted blood flow), muscle pain or cramping, weakness or numbness, coldness in extremities, sores on extremities, weak or no pulse in extremities

Any of these symptoms of artery disease should be discussed promptly with your healthcare provider.

Your pharmacist is a resource, along with your healthcare provider, for helping you understand the importance of your medications, your health conditions, and physical disease symptoms. You can always stop by and see one of the Pharmacy Chicks at Sparta Drug Center or Payless Family Pharmacy with questions. Pharmacy Chicks out!