There are several compelling rationales for the post-placement monitoring of a stent, all of which are fundamentally centered on ensuring patient safety. The recommended follow-up of patient care, as described in the National Medical Journal, includes a series of ambulatory tests that take place within one week as the post-interventional follow-up procedure. These tests include:
- Physical examination (particularly of the heart, lungs, and puncture site)
- 12-lead electrocardiogram (ECG) at rest
- Blood pressure measurement
- Routine laboratory tests (electrolytes, complete blood count, liver, and renal function)
Foremost, among these considerations is imperative to verify if the stent is functioning in its intended use, to keep the coronary artery open. Given the invasive nature of this procedure, it is essential to keep the artery from becoming blocked again. Any issue with the proper functioning of the stent carries risks to the patient’s health and thus regular monitoring of the patient’s condition is needed to ensure its safety. Detecting complications is the main reason to monitor a stent after its placement, especially since symptoms of stent failure use to appear late, making it difficult to diagnose correctly.
In this article addressing the monitoring of stent placements, we will explore both patient responsibilities in self-monitoring their stent and various techniques for stent surveillance. Additionally, we will move into topics such as the recommended frequency monitoring post-stent placement and recognizing indicators of stent malfunction.
Why monitor a stent?
The main reason to monitor a stent is for the prevention of restenosis. Monitoring a coronary stent helps detect signs of restenosis, the development of a stent obstruction, in a timely manner to protect the patient’s safety. The earlier a clinician can detect restenosis the higher the chance of fixing the problem to protect the patient.
By closely monitoring a stent, the doctor can identify signs of complications. These complications can be issues in the stent such as migration, dislodgement, or even collapsing. All of these can happen shortly after its placement and may lead to serious complications if not monitored and treated quickly.
The frequency and duration of stent monitoring are very dependent on the patient and the clinician; however, it can be expected that patients will need to be monitored for an extensive period for a coronary artery stent. On average, the patient should be seen by a cardiologist around two to four weeks right after the stent placement. After the first follow-up, the patient will need to do check-ups every three to six months, for at least a year. The doctor determines the duration of stent monitoring based on the patient’s clinical history.
How often should a patient monitor a stent?
We have seen that being monitored by a cardiologist or a healthcare provider, is essential to keep the disease under control and the frequency of the patient monitoring has a variety of factors. Paying attention to symptoms of stent failure is the first line of protection for a patient to monitor their condition, even though the symptoms of stent failure can often pass unnoticed or not appear at all. The most common symptom is chest pain, shortness of breath, palpitation, and fatigue.
As suggested in the National Disease Management Guidelines, patients who have undergone stent implantation should be followed up regularly, by their healthcare provider every three to six months. Within the first year after percutaneous coronary intervention, the patient should be in close care by their primary care physician and their cardiologist, and even more, if the patient notices any symptoms of stent failure. However, after that year the clinical guidelines recommend monitoring their stents at least once a year.
Different methods to monitor stents
Monitoring stents is crucial to ensure the stent’s effectiveness as well as the well-being of the patient. There are numerous methods and techniques that are used in modern medicine to conduct those tests. However, only a few of these techniques are used in coronary arteries and all these techniques are invasive procedures.
The angiography is the most common method for monitoring stents. This method uses a contrast dye that is injected into the coronary arteries, and then X-ray images are taken. The images can either reveal the presence of a stent blockage or restenosis.
- Intravascular Ultrasound (IVUS)
The IVUS is an imaging technique that utilizes a laparoscopic catheter using ultrasound, creating detailed images of inside the blood vessels. This technique is so precise that is able to provide information about the stent bonding to the arterial wall and can help show any potential irregularities of the stent placement.
These two techniques are used to monitor the stent after its placement. The angiography is the most common method to determine if the stent has been placed right, and it is a very costly and invasive procedure that the patient is put through.
Introducing the NIMBLE System: The future of non-invasive stent monitoring
The first of its kind, the NIMBLE system will be able to monitor a stent without an invasive procedure. Antoni Bayés Genís MD, a Global cardiovascular key opinion leader states,
“The NIMBLE System will be the first Point-of-care (POC) non-invasive device to accurately measure and quantify stent malfunction, allowing patients to be monitored over time independently of the stent’s location. The NIMBLE System will introduce a new standard of care for patients with implanted stent/s, supporting us, clinicians, at three specific points of the patient journey expecting a decrease of mortality, heart attack incidence, and hospitalization rates in these patients”.
The NIMBLE system will allow patients to live confidently knowing that their stent is working as intended. With this confidence, patients will no longer have to be referred to those invasive procedures to be assured their condition is under control and the stent is functioning as intended. The NIMBLE system will be able to show the cardiologists if there are any stent complications with a non-invasive test and in an outpatient setting.
Potential Stent Complications
Since the placement of a coronary artery stent is an invasive procedure there are a lot of complications and risks healthcare providers and cardiologists should be on the lookout for. The most common are:
- Bleeding or hematoma
- Allergic Reactions
- Stent Migration
- Stent fracture
- Stent Thrombosis (very rare)
- Stent erosion
It is important to understand that while these complications can occur the placement of a stent has far greater positive effects compared to negative ones. The specific risks and potential complications should be discussed individually between the patient and the healthcare provider, so the patient is aware of their specific risks.
Monitoring a stent is a process that as of today is a very costly and invasive process. Since there is no clear way to determine if a stent has failed besides conducting an invasive procedure. Since stent failure symptoms are hard to detect, it is important to watch out for the symptoms as well as attend checkups with the clinician. These check-ups should be conducted several times for at least a year and after that, it is important for the patient to continue monitoring themselves for any issues they may incur at least once a year. According to the AHA guidelines on follow-up care for stable patients, to maximize the benefits, patients are advised to consider utilizing telehealth centers, community centers, or a combination of both for implementing optimal lifestyle changes.
In the upcoming years, the NIMBLE system will be able to add a security layer detecting stent problems early and remove some of the uncertainty that patients and cardiologists may have after a stent placement.
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Rassaf, Tienush, et al. “Postoperative Care and Follow-up after Coronary Stenting.” Deutsches Arzteblatt International, U.S. National Library of Medicine, Feb. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3576602/#R6.