Coronary artery disease, CAD, is a global health threat. It requires advanced treatments, like stent procedures, also known as PCIs. Stents have greatly improved the outcome of patients with CAD by keeping the coronary arteries open. But, though advantages, these operations do not come without risks.
One of the most significant is the risk of death, although it is low, which still needs to be carefully assessed. This article thoroughly examines the mortality risk related to stent procedures. Clinical trials have reported mortality rates as high as 50% in patients with early (within 1 month of the procedure) stent thrombosis.
What is Stent Placement? Types of Stents
Stent insertion is an interventional procedure. It aims to re-establish blood circulation in tight or obstructed coronary arteries. It entails inserting a deflated balloon and a stent within the catheter down the vascular system. They go to the artery containing a case. The balloon is inflated, enlarging the stent. The stent remains open within the artery after the balloon is deflated and withdrawn.
There are two main types of stents: bare-metal stents and drug-eluting stents. Bare-metal stents are common metal scaffolds. Drug-eluting stents are coated with medication, which decreases the possibility of artery narrowing. The difference between these stents depends on such factors as the patient’s history and the current state of the specific artery.
Causes of Mortality Risk in Stent Procedures
✔ Procedural Complications
- Coronary Artery Damage
This procedure can injure the coronary arteries, causing dissection or perforation. These injuries are potentially fatal.
- Stent Thrombosis
This is considered a major complication. It is the development of a thrombosis within the stent, possibly causing a myocardial infarction.
After a stent placement, restenosis of the artery may significantly increase the risk of cardiac events.
✔ Patient-Related Factors
- Advanced Age And Comorbidities
The risk of death during a stent procedure varies depending on patient-specific factors. Older patients and those with multiple conditions, such as diabetes, kidney disease, or a previous stroke, are at higher risk.
- Cardiogenic Shock
Patients who undergo the procedure after suffering cardiogenic shock due to a heart attack face a higher risk of death.
✔ Technological and Technique-Related Factors
- Inadequate Stent Placement
Improperly placed stents can cause complications. For example, stents can move or release particles into the bloodstream. This can block the blood flow and cause pain resulting in a heart attack.
- Choice of Stent
The kind of stent used can affect the risk. Some people may be allergic to certain materials or drugs in drug-eluting stents.
✔ Medication-Related Complications
- Bleeding Due To Anticoagulants
Drug administration may further enhance the risk of bleeding complications. This is required in stent procedures. This is because anticoagulants and antiplatelet drugs are necessary during the procedures.
✔ Allergic Reactions
Patients may rarely have a risk of allergic reactions to the stent material or the contrast dye used during the procedure.
✔ Systemic Factors
Infections can develop at the insertion point for catheters. They can also develop more severely at the level of the bloodstream, though this is rare.
- Renal Failure
The procedure involves a contrast dye. Patients who have to undergo it might have kidney issues. As a result, nephropathy can occur due to the contrast dye.
▶ Pre-procedural assessment and Planning
Conduct detailed pre-procedural assessments. Consider the patient’s general condition, cardiac function, and coronary lesions anatomy. This stage helps select the best type of stent and make the procedure as safe as possible.
Advances in Technology and TechniqueStent design, imaging methods, and procedural approach continue to improve, greatly improving safety.
▶ Post-Procedure Care
importance of Medication AdherenceAdherence to recommended medications after the procedure is essential for minimizing complications.
▶ Regular Monitoring and Lifestyle Changes
The follow-up visits need to be regular. They will closely monitor the patient’s progress and ensure any complications are resolved. Stent procedures are only successful for the long term when combined with lifestyle changes. These include a healthy diet and regular exercise. Also, quitting smoking and managing other health issues like diabetes or hypertension.
Safety Aspects of Stent Procedures Around the World
▶ Variation in Mortality Rates
The risk of death in stent procedures may vary by country. This depends on healthcare infrastructure, advanced technology accessibility, and skilled practitioners. Countries with the latest technology and top cardiologists tend to have lower mortality rates.
▶ International Collaborations and Standards
Standardizing stent procedures and training internationally can help reduce outcome disparities. Collaborations among countries and international cardiology societies are crucial. They share knowledge, techniques, and advancements in stent technology.
The Future of Stent Procedures
A bright future lies ahead of stent procedures. Emerging technologies include bioresorbable stents that gradually dissolve. They also include tailored medicine approaches to dosing based on stent type and medication. These innovations can potentially minimize the related risks, including mortality. This would make stent procedures even safer and more helpful for more types of patients.
Stent procedures have completely changed how we manage coronary artery disease. They have provided a second life to millions of people around the world. One cannot eliminate the risk of death due to these operations. However, the risk is quite small compared to the possible advantages. Technological development, procedural innovation, and cutting-edge patient care continually prevent this risk.
The value of pre-procedural, post-procedural care, or patient adherence cannot be overemphasized. Second, the changing environment surrounding interventional cardiology holds further promises.
Down the road, treatments may become safer and more effective. Healthcare providers must stay informed about these developments. They should also make sure patients are involved in their treatment regimens.
Finally, the ultimate goal is to ensure that stent procedures save lives. They should also improve the quality of life for people with coronary artery disease.
- MedlinePlus(n.d) Angioplasty and stent placement – heart Available Online at: https://medlineplus.gov/ency/article/007473.htm
- National Institutes of Health(2022) Coronary Stent Thrombosis and Mortality: Does the Relationship Stand the Test of Time? Available Online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9075428/