How long does a heart stent last? Do they need to be replaced?

It all depends:  Stents will last forever if they are made of some sort of metal as most are. There is a new product on the market, a new heart stent that dissolves in the artery three years after being implanted. It is yet to be used in clinically, and it will be a while (years) before its risks & benefits will be known.

(From: Scrutiny of Stent Problems Turns to Doctors, WSJ, May 29, 2007)

So, your question is not about stent durability, but about keeping the coronary artery opened up in the location where it was deployed. Because a stent destroys the artery locally, there will be scar tissue that rapidly grows over the stent. In addition, there is a strong tendency for clots to form at the site where the stent damages the arterial wall. Since platelets are involved in the clotting process, patients must take anti-platelet therapy afterwards, usually clopidogrel (Plavix) for six months and aspirin indefinitely.

Neither stents nor coronary artery bypass surgery treat atherosclerosis, the disease process that causes coronary artery disease with obstructive blockages. That means you may be developing new obstructions elsewhere, even after a successful intervention.

That said, there is about a 10-15% failure rate of stents to stay open and more than 40% of patients with a stent will need another procedure within a year, despite the use of expensive medications. This is in sharp contrast with a bypass operation that has a >95% success rate.  While stents are more or less successful as treatment of anginal symptoms, they do not protect against future heart attacks or prolong life, again as opposed to bypass surgery:

If you have coronary artery disease, it is important to choose the right treatment that should in all cases include life style modifications (diet & exercise) and medications that include cholesterol meds (the only way presently to stop progression of atherosclerosis – a process that will take years). It has been shown that in most patients with stable symptoms, this last option, called “Optimal Medical Therapy”, is actually a better treatment option than Stenting.

Patients with extensive (“3 vessel”) disease that may include a “Left main stenosis”, diminished heart function and/or Diabetes do much better with a bypass operation. In situations where time is of the essence, such as an acute heart attack, a stent is may the best option if treatment is quickly enough. The same is probably also true for patients with only “one or two” vessel disease, although there are mini bypass operations that offer an equal if not superior treatment because it promises a much better long term protection.

The following includes an article from HealthDay News in 2012:

Many people with stable heart disease undergo an expensive artery-opening procedure when medication would work just as well, a new study suggests. The procedure involves placing a tiny mesh stent, or tube, in a clogged artery. As many as three-quarters of these operations are unnecessary, said lead researcher Dr. David L. Brown, a professor of medicine at Stony Brook University Medical Center in New York.

Money is the driving force, Brown said. "Everybody gets paid to put in stents, the hospital gets paid, the doctor gets paid, the stenting company gets paid," he said. "It's how our fee-for-service environment has taken over the decision making of this branch of cardiology." Stenting costs an average of $9,500 more to the patient over a lifetime compared with medication, Brown said. Although the procedure, called percutaneous coronary intervention, reduces death and future heart attacks for someone actually having a heart attack, its use in stable heart disease patients is questionable, he noted.

For the study, published Feb. 27 in the Archives of Internal Medicine, Brown and Dr. Kathleen Stergiopoulos, an associate professor of clinical medicine at Stony Brook, analyzed eight trials involving more than 7,000 patients randomly assigned to medical therapy or stenting plus medication. The trials were begun between 1997 and 2005. In this type of study, called a meta-analysis, researchers look for patterns that might not have been the main intent of the individual trials. 

During an average follow-up of more than four years, no significant differences were seen in longevity or quality of life.

Overall, 649 patients died, 322 who received stents and 327 who received medication alone, the study found. Nonfatal heart attacks were suffered by 323 patients with stents and 291 taking only medication.

Among those with stents, 774 needed new procedures to open blocked heart arteries. Among those on medical therapy, 1,049 also needed a procedure to open blocked arteries.

Of more than 4,000 patients for whom data on chest pain — called angina — was available, 29 percent of those with stents had persistent chest pain compared with 33 percent of those on medical therapy alone, Brown found.

There is no data that stenting patients with stable heart disease reduces the risk of dying or having a heart attack, Brown said.

"This is not to say no one will need stenting, but only about a third of patients treated initially with medical therapy will need to cross over to stenting," he said. "People shouldn't blindly agree to have procedures unless the doctor can tell them that there is a documented benefit" in quality or length of life, he said.

Quality of life involves relief of chest pains, he said. If patients on the best medication still have chest pain that is unacceptable to them, stenting becomes appropriate, Brown said. Medical therapy included aspirin to prevent clotting, beta blockers and ACE inhibitors or angiotensin receptor blockers to control blood pressure, and statins to lower cholesterol, the researchers noted.

"If you go the medical therapy route, it means the patient has to be followed in an outpatient environment to see how they are responding to the medical therapy, and that takes time and effort that doesn't reimburse very well," he said. "That's part of the equation that drives putting in a stent rather than following the patient on medical therapy."

Dr. James Blankenship, a spokesman for the Society for Cardiovascular Angiography and Interventions, wasn't surprised by the study. "This is largely old news and many interventional cardiologists are avoiding the pitfalls that the authors are pointing out," he said. "In fact, the volume of interventions among Medicare patients has gone down 18 percent between 2005 and 2010."

"For many people, conservative medical therapy is the right thing, but for those who have a lot of symptoms, having a coronary intervention is a reasonable strategy," he said.

Dr. Gregg C. Fonarow, co-director of the University of California, Los Angeles Preventive Cardiology Program at the David Geffen School of Medicine, agreed that medical therapy is the first choice for patients with stable heart disease.

Coronary stenting should be reserved for those patients who have worsening symptoms despite optimal medical therapy, he said.

For patients with stable coronary artery disease, "the most effective and valuable therapy to prevent disease progression, heart attacks, stroke, heart failure and premature cardiovascular death is a combination of medications together with lifestyle modification," Fonarow added.

 

Hope this helps,

Dr T

 

Comments

I'm 38 years old and 2 stents were put on me cause 1 artery was blocked. I was told because my cholesterol was too high and I honestly was not taking care of my self on how eat. So now I'm in lots of meds and I'm just concerned how is this going to affect my life. I know it will change how I eat and whatever goes into my stomach.I'm trying to lower my cholesterol by eating right and I don't want to keep taking med because I was diagnosed with Ulcer Colitis 13 years ago and I have been in med since then.Thank you,

Hi Ish,

Please read my comment of 4/4/14. The same answer applies to your situation. Good luck,

Dr T

Hi,I'm 42 and had a cardiac infarction two months ago.  My LDA was 99% blocked with what seemed mostly like clots from ruptured plaque.  I was able to get to the ER within an hour of my attack and it looks like I didn't suffer any damage to the heart muscle itself.  VEF was 55 the next morning.  They did put a drug eluding stent in do to the size of the blockage and emergency conditions.  I will be on Effient for a year and aspirin and statins forever.  My question is regarding the stent and the healing process...will the endothelial cells eventually cover the stent leaving the artery in a new state?  or is it just scar tissue?  Also, after my year of effient and once the stent is covered, is there still that much clot risk at the stent sight?  And one more, does that section of the artery still have the ability to dialate and constrict as needed? I am in good shape with no other health issues besides I guess this newly found CADthanks,  

Hi. I also had a cardic infarction at a young age. I was 44 with a 100% blockage of the LAD.  This was in 1997. I had a bare metal stent put in during the attack which then stopped the heart attack. I took Plavix for about 6 weeks if I remember right, and have taken a 325mg Ecotrin, 200mg of metoprolol, 5 mgs of Amolodipine, 40 mgs of lisinopril, 20 mgs of Lipitor, 10 mgs of Zetia, and 20 mgs of omeprozole daily for almost 17 years now! I can tell you that I've had no problems since and feel pretty good for being almost 61 years old. My stent is still in there and last time I had it checked I only had about 20% residual restinosis. These are truly miracle drugs, and other than taking the meds everyday, I really don't know that I had a heart attack. So that stent of yours may last well into old age with no worries! Good luck. Exercise and stay in shape also.

It sounds you were appropriately and successfully treated for an Acute Coronary Artery Syndrome. However, this also means you have coronary artey disease to a greater or lesser extent elsewhere that may need further treatment in the future. These medications don't address that issue, and there certainly is a chance of stent failure and/or progression of disease locally or elsewhere (about a 10-15% failure rate of stents to stay open and more than 40% of patients with a stent will need another procedure within a year):

Therefore, you should review your cardiac risks and evaluate what you can do to live a heart healthy life style.

Re: "the ability to dilate and constrict as needed" the artey is locally destroyed by the stent and completely looses its ability to change size.

Hope this helps,

Dr T

My friend had a stent put in yesterday morning.  Went to recovery and was doing good.  I found out this morning that she passed away at 12:31 this morning from complications.  My question to you is: How does a stent fall out of place? At least that is what we were told.                                   RMS                                                                                                                                                                                                               

Hi Rosemary,

Any procedure has potential complications, some of them lethal. I guess that's what happened:

The most likely cause: a local tear (called dissection) causing acute closure of the involved coronary artery, followed by an

Avoidable? Probably, if either the stent procedure had not been performed: 

That said, it may well have been the best treatment for yopur friend and this a very sad complication.

Hope this helps,

Dr T

Helo Dr. T

I am a 53 years old male with no family history of cardiac problems. have an active life style and smoke a pack/day.Last august I had 2 episodes of near collapse associated with shortness of breath and lightheadedness ( never had angina pectoris) .was admitted to hospital and acute MI was excluded.  for next 2 months I had to restrict physical activity. After a light excersie I was getting dizzy and short of breath. Since october of last year I feel much better, can endure more excersise and walking. Strees test showed no ECG signs of cardiac ischemia. I insisted on angiography which was performed yesterday. The procedure revealed that RCA is 99% blocked at the proximal level and 40% blocked at mid level. Main left artery is normal. LAD has a 50% stenosis at proximal level and 40% at mid level.

 my cardiologist put me on antiplatelet medication and plans angioplasty in 2 weeks.

what is the best strategy? how many stents are optimal and in which locations?

what type of stents would you recommend if any?

Sohuld i continue anti-cholesterol pills while my cholesterol levels are normal?

You are at a high risk for a host of diseases that include not only CAD but a variety of other illnesses that include emphysema and cancer.

  1. I am going out on a limb and suggest these episodes had nothing to do with your heart. 
  2. A negative stress test suggests optimal medical therapy in your case, not stenting. You can check this here yourself.
  3. The expected benefits of stenting in stable coronary artery disease (a reduction in the risk of death or heart attack), is not supported by medical evidence. I believe this fits your situation at this point
  4. You can read the technical part about indications for stenting here.
  5. And here.
  6. You are at a high risk for progression of your coronary artery disease, if you don't change your lifestyle. If you develop significant blockages in ALL your coronary arteries, a coronary artery bypass operation will be the treatment of choice (and you still need to optimize your lifestyle)
  7. In patients with known coronary artery disease, statins are usally indicated.

Hope this helps,

Dr T

I need help in order to make a descion. I have been diagnosed with cardiac artery spasms. I had ct angiography performed and was told i had minium plaque build up in the left circum flex artery. And mild plaque build up in part of one of the right arterys. They also found what they called a small calified lesion in the top right part of the heart. I was placed on medacation and told to change my lifestyle which i did. Quit smoking , started eating healthy etc. I am still having shooting pains of a small nature inbthe heart area they shoot up threw what feels like the main pumping chamber. I went and saw a different cardiologist he wants to do a heart cath threw the wrist and my whole thing is that i have been told that theres nothing that can be done as far as stenting goes because the arterys havent reached 70% blocked in order to be stented safely. I am tired of being scared and losing sleep. I would give anything for some one to help me. Should I go ahead and let this cardiologist do the heart cath or should i listen to cardiologist one and keep taking my meds, which i will do anyway but wanted to know if there was any way to stop these spasmswithout being cut on badly.

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