Post Coronary Stent Care: Understanding the Do’s and Don’ts

Navigating the path to recovery after a cardiac procedure can be overwhelming. With the introduction of coronary stents, many patients have found relief from blocked arteries, but the journey doesn’t end there. Proper post-operative care is crucial to ensure the longevity of the stent and to maintain optimal health. This article delves into the complexity of coronary stents, offering insights into their function and the essentials for post-coronary stent care.

What are the Coronary Stents?

The arteries that feed the heart are called coronary arteries. Human beings have three main arteries that feed the heart with oxygenated blood full of nutrients to maintain it healthy and functional. When one of these arteries is blocked, the heart will not receive as much blood as it needs to function properly. Coronary stents are mesh-like cylinder devices that are used to open up the narrowed or blocked arteries that feed the heart. A cardiac stent is placed into the coronary artery during a percutaneous coronary intervention (PCI) to expand and support the vessel. After a stent is placed, the artery is back open, and the blood flow is restored immediately. A coronary stent also may prevent recurrent blockages. The stent acts as a barrier and keeps the artery open, reducing the risk of the artery re-blocking with plaque.

Post-coronary stent care is an important aspect of recovery for patients who have undergone a PCI.  Patients should avoid strenuous physical activity such as heavy lifting, as well as follow a heart-healthy diet after the stent placement, the most preferred would be the Mediterranean diet. Antiplatelet therapy, a group of medicines that prevent the generation of blood thrombus, is typically prescribed after the procedure to prevent blood clot formation. Coronary stent recovery also includes regular follow-up appointments with a healthcare provider to monitor stent patency and overall heart health. These appointments may include imaging tests such as an angiography.

angioplasty-stent

Taking Care After Stent Placement: What You Need to Know?

After getting a stent, it’s essential to understand the steps for a smooth recovery and long-term heart health. While the stent does its job inside, there’s plenty a patient can do outside to ensure its success. This guide will walk you through the post-stent journey, from the medications you might need to the lifestyle changes that can make all the difference.

Overview of antiplatelet therapy: Why it's crucial after stent placement?

Antiplatelet therapy is typically prescribed to patients who have undergone a coronary stent procedure. After the stent placement, antiplatelet therapy is necessary for the patient’s well-being after the procedure. This treatment is important because it helps prevent blood clots from forming to increase the blood flow to the heart. Blood clots can cause heart attacks and strokes, and antiplatelet drugs are used to avoid those conditions. Dual antiplatelet therapy (DAPT) involves taking two types of antiplatelet, aspirins and a P2Y12 inhibitor. The antiplatelet therapy creates protection from stent thrombosis, which occurs due to the inflammation during the healing process.

Duration of the Medication Treatment

The duration of post-cardiac care depends on the patient’s condition and the type of antiplatelet drug prescribed. There are many different types of antiplatelet medication, which include:
  • Aspirin: Aspirin Therapy should almost always be continued indefinitely in patients with coronary arterial disease.1
  • Clopidogrel: Clopidogrel Therapy depends on the patient’s condition. On average, the patient can expect this therapy to be combined with aspirin or another type of Antiplatelet therapy for at least a year after percutaneous coronary intervention.2
  • Prasugrel: Prasugrel Therapy depends on the patient’s condition. In general, this therapy combined with aspirin is favored for patients with high risk of bleeding or a low risk of ischemia.3
  •  Ticagrelor: Ticagrelor therapy depends on the patient’s condition. In general, this therapy combined with aspirin or another type of antiplatelet therapy is recommended for less than one year for patients with a high risk of bleeding or a low risk of ischemia.3
Medications to take after a stent placement

The duration of antiplatelet therapy should be personalized to the patient’s condition and the benefit/risk ratio should be explained to the patient thoroughly. Decisions regarding treatment and duration of antiplatelet therapy require thoughtful assessments as well as patient preferences.

Potential side effects

Antiplatelet therapy is generally safe, but like all medications, it can have side effects. Here are some of the common side effects of antiplatelet therapy:
  • Upset Stomach
  • Heartburn
  • Nausea
  • Diarrhea
  • Rash
  • Itching
  • Bruising
  • Hemorrhage
  • Nosebleeds
  • Headache
  • Dizziness
  • Tinnitus
  • Fatigue
 The most serious side effect of antiplatelet therapy is excessive bleeding. The medications prevent the potential of clotting, including the necessary scar formation process that the patient’s body may need. This can lead to undesired bleeding all over the patient’s body. If a patient has any of the following symptoms, contact a healthcare provider immediately. 4
  • Blood in urine, which may look red, pink, or brown.
  • Blood in stools, which may look red or black.
  • Coughing up/ vomiting blood, which may look like blood or black.
  • Chest Pain
  • Hematoma
  • Ringing in ears

Monitoring the Stent: Traditional Methods vs Innovative Solutions

After the stent placement, the patient will be monitored for a few hours and cardiologists will need to monitor the patient’s vitals and check for bleeding around the insertion site. Depending on the severity of the procedure, a patient can expect to be in the hospital for one to two days after the procedure and will need time off from work or daily activities. The patient will also need to make diet and lifestyle changes to prevent another blockage.  Follow-up appointments are essential to ensure that the stent is working as intended with no complications.

There are several tests that can be used to monitor stent patency and detect potential issues. These include:

  • Computed Tomography angiography (CTA)
  • Dual- Source CT coronary angiography
  • Stress echocardiography
  • Single-photon emission computed tomography

It is important to discuss with a healthcare provider which test is best for the patient based on the patient’s individual situation and medical history.

NIMBLE Diagnostics: Revolutionizing Stent Monitoring

The first-in-class NIMBLE System is a non-invasive, non-ionizing stent monitoring device. The NIMBLE System is a microwave-based medical device that allows continuous, non-invasive, non-ionizing monitoring for patients with implanted stents. The NIMBLE System will be the first point-of-care device that will accurately measure and quantify a stent malfunction. This system will allow patients to be monitored over a period as well as introduce a new standard of care for patients with implanted stents.

The NIMBLE system will be able to provide comfort to the patient during a post-op recovery. Learn more about the post-operational recovery of a heart attack in this article HERE. Instead of having the patient travel all the way to the hospital for every check-up to ensure that the stent is working as intended, the NIMBLE System will be able to provide accurate and quick information about the stent. This technology will be able to scan the stent to make sure the coronary artery is not blocked. This immediate feedback provides the patient and healthcare provider with accurate information about the stent status.

 As of now, in today’s modern technology, there is no way to ensure a stent is working properly without an invasive procedure. This procedure is not only costly but it could also put the patient at risk. That is why the NIMBLE System will be one of the most important cardiac technologies in stent placement procedures.

 The landscape of cardiac care is always evolving and changing for the better. New research and technologies are always present and NIMBLE Diagnostics is certain that we will be a front-runner in the cardiac space. The NIMBLE System allows simple and accurate clinical follow-ups since it is portable and cost-effective. The NIMBLE System helps clinicians in diagnosing on time typical stent complications such as blockages or fractures before symptoms even appear.

Healthy Heart Diet After Stent Placement

The Mediterranean diet, often recommended as the ideal diet after an angioplasty, is considered one of the best diets for a patient to be on after a stent placement. This diet is rich in fruits and vegetables, whole grains, lean proteins, healthy fats, limited sugar and sodium, which all promote cardiovascular health and help reduce the risk of heart disease. Other foods include fatty fish, nuts and seeds, olive oil, avocado, berries, and green tea. All of these foods and hydration help prevent complications after a stent is placed. Hydration is important for several reasons after a stent is placed but the biggest one is to prevent blood clots. Drinking enough fluids can help prevent dehydration, which can make your blood thicker and increase the risk of blood clots. 5

Exercise After a Stent Placement

Regular exercise is highly encouraged to help prevent heart disease if it is exercises that won’t start the stent. This means exercising 3-5 days a week for at least 30 minutes. Exercising can include cardiovascular exercise, strength training, and flexibility/ stretching exercises. During physical activity with a stent it’s important to look out for these symptoms that may indicate a problem with a stent:
  • Chest discomfort or pressure
  • Cold sweats or clamminess
  • Dizziness or lightheaded
  • Fatigue
  • Nausea
  • Shortness of breath
  • Heart palpitations
Exercise is important after a stent placement however it’s important not to overdo it, and have the patient listen to their body and learn about symptoms of a stent failure, especially while exercising.

Recognizing and Responding to Potential Stent Issues

There are a large variety of symptoms that can be related to a stent failure. The symptoms of stent failure can vary depending on the underlying cause and the location of the stent. As demonstrated in the Global Journal for Research Analysis the most common symptoms of stent failure include 6:
  • Chest pain and/or discomfort (usually similar pain that is experienced during a heart attack. Pain may be during physical activity or while resting)
  • Tightness in the chest (squeezing, or a pressure-like feeling in the chest)

Other common symptoms include:

  • Shortness of breath (difficulty breathing, especially during a hard/big breath)
  • Fatigue (unexplained weakness or tiredness)
  • Palpitations (irregular heartbeats)
  • Swelling in the legs, ankles, or feet
  • Dizziness/ Lightheadedness
  • Nausea and sweating
The-Causes-of-Chest-Pain, Chest-Pain, Stent-Failure, Stents, Heart-Attack

Even though these symptoms might go unnoticed or be confused with other symptoms, they are serious. Regular medical checkups are strongly recommended to help manage the effects of malfunctioning stents.

Lifetime of a stent

Stents are designed to remain permanently in a patient’s body without breaking over time.7 As this may be the case, a stent does not solve all the underlying issues because a stent can only treat one area where your artery is blocked. A patient may need another stent in a different coronary artery or if the stent malfunctioned in its original placement. 

Even though stents are built to be permanent, there are few factors that influence how long a stent can last:

  • An underlying condition: a condition that can cause a build-up in the artery.
  • Stent length and diameter
  • Medications
  • Lifestyle changes

Conclusion

After the successful placement of a coronary stent, it is crucial to take measures to minimize the chances of experiencing another cardiac issue. This could involve making lifestyle adjustments like adopting a healthy diet and engaging in regular exercise. It is also essential for patients to adhere to their prescribed medications to reduce the risk of complications and future heart-related incidents.

Regular follow-up examinations, including blood tests, echocardiograms, and chest X-rays, may be required during the initial year following the stent procedure. The NIMBLE System is aiming to change the standard follow-up care of post-stent placement in the goal of providing better patient care.

The information published in this Blog article, or in NIMBLE DIAGNOSTICS website, is provided for information purposes only and does not and cannot be considered as a consultation, treatment, therapy, or medical or clinical prescription, nor is it a substitute for treatment, diagnosis, therapy, or supervision by a healthcare professional. The information published is neither intended to be used as a guide and should not serve nor be used as an exclusive orientation for the healthcare professionals to make decisions about the treatment and therapy of their patients, nor does it replace the healthcare professionals’ criteria. NIMBLE DIAGNOSTICS makes no warranties as to the accuracy, suitability, or completeness of the information provided, and shall not be held responsible for any decisions made based on the information provided on this Blog article, NIMBLE DIAGNOSTICS website or any other websites linked or referenced in NIMBLE DIAGNOSTICS website.

References

1: Levine, GN, et al. “ACC/AHA Guideline Update on Duration of Dual Antiplatelet Therapy in CAD Patients.” American College of Cardiology, 29 Mar. 2016, https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2016/03/25/14/56/2016-acc-aha-guideline-focused-update-on-duration-of-dapt. 

2: Aslam Zahid, Muhammad Bin, et al. “Duration of dual antiplatelet therapy after stent implantation, still an enigma: A systematic review of randomized clinical trials.” Cureus, 13 Nov. 2021, https://doi.org/10.7759/cureus.19549. 

3: Howard, Travis M., and Umesh N. Khot. “Dual antiplatelet therapy after percutaneous coronary intervention: Personalize the duration.” Cleveland Clinic Journal of Medicine, vol. 88, no. 6, 2021, pp. 325–332, https://doi.org/10.3949/ccjm.88a.20113. 

4: Iqbal, Arshad  Muhammad, et al. “Antiplatelet medications.” National Library of Medicine, 7 Nov. 2022, https://www.ncbi.nlm.nih.gov/books/NBK537062/. 

5: “Coronary Angioplasty and Stents.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 8 Oct. 2021, www.mayoclinic.org/tests-procedures/coronary-angioplasty/about/pac-20384761. 

6:Simsek, Ziya, et al. “Late coronary stent thrombosis associated with exercise testing.” The Texas Heart Institute Journal, 2009, pp. 154–157, https://doi.org/10.1002/ccd.10783. 7:Srakocic, S. “Do Stents Ever Need to Be Replaced?” Healthline, Healthline Media, 15 Apr. 2021, www.healthline.com/health/heart-disease/how-long-do-stents-last.

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