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

See the live video session that I recorded on 4/25/2014 to discuss stenting in detail!

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:

(From: Drug-Eluting Coronary Stents — Promise and Uncertainty; Curfman, et al, N Engl J Med 2007; 356:1059-1060)

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

For what it's worth I wanted to update my recent article about the Stents I just had put in.  My doctor recommended a blood pressure monitor and I bought one Thursday.  Probably wasn't a good idea for someone who is a little paranoid and trying to adjust to a major health change in their life.  I say that because that night it was good, but when I woke up Friday I felt a little nausea and took an Alka-Seltzer which made me feel fine.  So I went to the kitchen to have my breakfast and take my meds and of course check my blood pressure.  The number were much higher than the day before and so I tried to be calm ate a little fruit and rechecked it again and it was even higher 168/80. I decided something wasn't right and went to the hospital to get checked. Making a long story short, they did and EKG, blood enzymes, blood pressure every 15 minutes and even an X-ray.

My heart doctor looked at the results and said I was fine and that blood pressure is going to fluctuate especially with A-fib and to only take my blood pressure five times a week and unless I'm having pain or other issues I should be fine.  So I hope that I can adjust to this huge change in my life very soon and take it all in stride.

I will be 68 in 12/2014 and about 10/25/14 I started having some chest discomfort and because I have a minor GERT issue I thought that was causing my problem. The discomfort two days later became very intense and on a scale of 1 to 10 I would say it was a 7. This happened while just shopping at Sam's club and I immediately grabbed some Tums off the shelf and ate a couple and drank some water.  That helped a little but I got the most relief from taking an Alka-Seltzer.  I took my blood pressure on the machine at Sam's and it was 175/95 which was very high for me. Typically my blood pressure is 129/78 but of course that will vary, but that isn't anywhere near the level I had at Sam's club then.

After waiting a while I did my shopping and drove 35 miles home, put the stuff away and still felt okay. Next morning when I got up I felt that nagging ache in the center of my chest that drove me to see a doctor 4 months earlier. The doctor then had me do a Barium test which showed some issues like a small Hiatal hernia.  Because back then I had this same nagging pain I thought it was the same thing again. But later in the day I went to the grocery store and hadn't been there 15 minutes before I got that discomfort again that was 7 on the pain scale.

So I decided to go to the hospital and get checked and they had me in a room to run tests within twenty minutes. The short version here is the nurse indicated my markers were high but didn't think I had a heart attack. They decided to admit me for 24 hours. My family doctor came by that evening and said he thinks my heart is strong with a great pulse and that he thinks it is my acid reflux problem.  Sounds good huh?

In the morning my heart doctor who I went to a year ago for a slight Atrial-fibrillation problem that he diagnosed and put me on mild dose of aspirin for which I might add, worked great with no further issues until now. So now my heart doctor comes by the next morning to tell me I did have a slight heart attack and that they want to do a coronary angiogram and that will decide one of three things. Either medicines, a stent or by-pass surgery to fix the problem.

Needless to say the two completely different doctor opinions was hard to take with the later being so much more serious. Just the idea of this test had me scared to death and the next morning they did the test and the one artery was 99% blocked. The other arteries were okay, but it was plain to see by the picture they showed me that I had the blockage which left me no doubt that my family doctor didn't know what he was talking about.

After the test I was taken to a different hospital where they do a lot of heart surgery and they put the Stent in me. The next morning I felt fine and they released me.  So now I'm on all this medicine you here all the possible side effects about and can only hope that I do okay on them. I will change my diet, lose 30 pounds and exercise at least three times a week and walk a lot.

I hope this comment wasn't too long and was helpful because I'm looking for information myself.

 

I am 48 years old now. In february 2014, i felt the burning in my stomach or a chest pain in central part of my chest for some good 3-4 days. One evening, when it get worsened, i rushed to hospital emergency. The medical officer gave me Angicid and i felt better. Later, the Doctor suggested me to go through blood tests which were fine, ETT which was fine, ECG which was fine but still they suggested me to go through an Angiography which showed artery blockage. An eventually as per my Heart Specailist reccommendation, I had2 Angioplasty + 2 stents. I neiter have Sugar nor blood pressure. Never had Heart Attack as well. 

I feel okay except some discomfort usually in the left side ofmy chest during initial months. Taking regular Medcines Since March 01,2014, Not taking meat, and completey/strictly following Doctors prescribed food only.

My questions are:

Can Angina lasts for 3-4 days ?

I did Right to put Stents ?

How long these medicated stents will last ?

What will be my life Expectancy ?

Is there any other procedure that can remove my stents and make me healthier again ?

  

Re: your questions:

1. Yes

2. I don't think so. You were never tretaed before (had not fialed  therapy). Read the original article and my comments to questions. 

3. Read the article.

4. You have coronary artery disease. How that affects your future depends on whether you live a heart healthy lifestyle.

5. NO. 

Hope this helps,

Dr T

I am a male 64 yr old with 5 arteries block 90% including the LAD and circumflex almost 100%. No heart damage/ no diabetes / no kidney or liver damage/ no smoking/ heart disease in both sides of the family death of father 83yr mother 87 yr and brother 36yr from heart disease. Mt Sinai NYC and NY Presbyterian both recommended 2 stenting procedures 6 weeks apart. Blood pressure now 110 /80 after being 175/130 for over a decade with daily benazepril hctz 20/12.5 mg. If I have no negative reactions to the stents after 2 years is it likely that the stents will have as long lasting benefits as open heart surgery?

thank you

This is a no brainer: you need a coronary artery bypass procedure!. Patients with multi-vessel disease do much better. Read this:

http://www.cardiachealth.org/percutaneous-coronary-intervention-versus-c...

Hope this helps,

Dr T

I'm a 66YO with a stent put in my main artery in 2008 in southern cal, Now I live in Sydney since 2011  and my health was going south so I drop my 6 figure salary (very stressfuly job)  and start taken care of my health since this lucky country have free medical and with a little money on private insurance realy helps to get good service. Now I have compound my health issues with stent, a 3.3cm  pulmonary hamartoma and a 4.5 polyp inside of my bowel.running out parts in body!  SO the polyps are gone with 2 colonoscopies and one more schedule this october. but the stetnt and the hamartoma still there. In a way I am like Joe the english pommie fellow I eat well very nutricios diet and go to the gym now 3-times/week . A quick insert! my pulmonary doctor told me that " you dont have to do it but is better to do it" then I went on a research and start getting second opinions. What I would  like to do now is; 1.- can I maintain my stent (I take lipitor 10mg and aspirin 100mg)monitoring my MHR and target heart to optimum performence and how can I do it or where can I go. 2.- can breathing exercises witl helph maintain the size at least grow  slowly (2004 was 2cm 2014 is 3.3cm)the way of my lession? 8 more months here in Sydney  then I am moving to Barcelona my dream city for retirement! and when the wheter is to cold then back to Anaheim hills. 

Dr T, tank you very much in advance.

  • Re: Your coronary artery disease, if you live a heart healthy life style, you have done all you can do to protect against a recurrence. 
  • Re: Pulmonary hamartoma. In general, I'd recommend removal of any lung tumor even if thought benign, because Xrays and even CT scans are not always enough to make a definitive diagnosis of hamatoma vs. lung cancer.

Hope this helps,

Dr T

Hi

When I was 49, pear shaped , overweight , and hardly any exercise, bad diet etc. I had a extreme shortage of breathe while I was riding a bicyle. Turned out to be angina , main artery 95% blocked and 2 x 45% blockages. I thought this was the end of my life. I had 2 stents fitted.

Went to California for a vacation , as I am english living in UK.

The good life in california made me realise life can be better.

2 years later I kayak 12 hrs per week, cycle 50 -60 miles per week, and use the gym frequently. My diet is as good as I can get it, little fat, lots of carbs and protein. My body is a totally different shape and people approach me and comment on how fit I look.

My life is better than it has ever been. I am actually pleased I had heart disease that was diagnosed and treated other wise I could be one of the poor people that dont know and just drop dead one day.

The answer, and anybody can do it if they want to, is CHANGE your life style.

Joe - United Kingdom

 

I have been diabetic for 22 years.  Just after I was diagnosed, I began running. I had seen many patients with diabetes lose the battle.

On Nov. 1st, 2004, I had a heart attack.  My total cholestrol was 107. Two medicated stents were placed and nine months later, two more were placed. The cath dye apparently damaged my kidneys.  I have stage three kidney failure.

A fall on ice in 1995 caused a herinated disc and another in 2000. I had to quit running and I kept walking and exercising. My opthomologist tells me that she still can find no damage in my eyes. Biopsy of my kidneys five years ago showed little diabetic damage.

I am a 71 y/o male and exercise five days a week and do light weights. I have no chest pain and am considered by all doctors to be stable. I was blessed with another ten years and don't think that I am near the end.

I am concerned about the stents, but thankful for them. I tell my friends that I come to the gym to burn sugar and flush stents.

 

 

 

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