Do I Need a Coronary Artery Stent?

If you're one of the 11 million Americans affected by coronary artery disease, you may have wondered if a stent - a wire mesh tube that props open your artery to improve blood flow - is the right option for you.

What is Coronary Artery Disease?

Coronary artery disease is a hardening or narrowing of the arteries, typically caused by a buildup of cholesterol, inflammation or the growth of unhealthy tissue on the wall of the artery. You may have heard the medical term for this obstruction - atherosclerosis - but often we refer to it simply as "plaque" or a "blockage."

When the plaque is small, it doesn't typically cause symptoms or damage to your heart. But it becomes a problem when the plaque gets big enough to block your blood flow, causing chest pain and, for some, a heart attack.

Is a Stent the Right Option for Me?

So, how do you know if you would benefit from a stent? Stents are usually only needed if a blockage is causing symptoms, like chest pain, shortness of breath and fatigue. For some, medication alone may be sufficient to treat the problem. For others, a stress test may be required to examine the lack of blood flow to the heart.

If you and your doctor discuss a stent as an option, they'll need to confirm the artery blockage through a procedure called an angiogram. This involves using a needle and wires to insert a hollow tube into an artery, usually at the wrist. This tube is small and the procedure can be performed without anesthesia. The tube is then advanced to the arteries of the heart. A solution called contrast, which shows up on X-ray, is injected into the arteries and X-rays are taken to find the blockage.

Once the blockage has been found, a cardiologist with special training - known as an interventional cardiologist - confirms whether it should be treated with a stent.

What Can I Expect During the Procedure?

During a stent procedure, a thin wire is passed through the tube and into the artery. Next, a balloon is advanced over the wire and positioned across the blockage. It's inflated from the outside to open the artery. This may improve the flow initially, but usually the artery quickly narrows again - stents were invented to solve this problem. The stent wraps around the outside of another balloon, similar to the one used to open the artery, and is placed across the blockage. When the balloon is inflated, the stent expands and pushes into the wall of the artery, forming a kind of a scaffold to keep the unhealthy artery open.

Of course, making any decision about your heart health requires a strong partnership between you and your doctor. As an interventional cardiologist, I want to know that if I put a stent in someone's artery, we both feel confident we made the right decision.