Any discussion on small vessel stents requires background information on coronary artery disease. Coronary artery disease is a condition in which fatty deposits accumulate in the cells lining the wall of the artery and obstruct blood flow. The inadequate supply of blood to the heart muscle damages the heart. Untreated, patients may experience angina – chest pain that occurs when the heart isn't receiving enough oxygen. Blocked arteries can also lead to a heart attack.

Coronary artery disease is treated by opening up these blocked blood vessels. In the past, open heart surgery was the only way to accomplish this. Today, though, there are innovative medical strategies and technologies that don’t require surgery. If symptoms of heart disease do not respond to drugs, diet and lifestyle changes, a cardiologist may recommend an angioplasty and stent. The combination of these two nonsurgical procedures have been highly successful in opening up blocked blood vessels and diminishing the chance a blockage will recur.

Percutaneous Coronary Intervention (or PCI) is the medical term for treating a heart blockage with both an angioplasty and stent.

What is a stent?
Balloon angioplasties have been the most common non-surgical technique for opening clogged arteries in patients since the 1980s. More recently, though, studies have shown that patients who also receive an implanted device called a stent were less likely to require additional angioplasties or bypass surgery in the future.

A coronary stent is a mesh tube the size of a spring in a ballpoint pen. The stent is placed in the artery to hold it open after the angioplasty balloon has cleared the blockage. About 70 percent of patients receiving balloon angioplasties today are now treated with stents as well to improve their odds of a successful outcome.

How does a stent help?
A stent can be used alone, but is typically inserted following an angioplasty procedure. Placing a stent in a cleared vessel has been shown to cut the risk of subsequent blockages in half by keeping the arteries wide and reducing the incidence of reclosure. The device usually relieves the chest pain of angina, and the benefits are longer lasting than an angioplasty on its own.

Another significant advantage is that only a small incision is required for a stent as opposed to invasive bypass surgery. The far less expensive non-surgical stenting procedure entails less pain and a shorter recovery time. While helping to restore normal blood flow, stents also keep the artery open if any damage occurs from the catheter during the angioplasty. Overall, the complication rate of angioplasty goes down, too, when a stent is used.

What is the advantage of the new small vessel stent?
What is new about stents, first introduced in the early 1990s, is that their design has steadily improved to offer greater effectiveness, more variety in size and minimal trauma.

One of the latest milestones in cardiac technology is a small vessel stent for tiny and hard-to-reach heart vessels. The new compact stents being used by top cardiologists today have the ability to reach lesions in small blood vessels which were previously difficult to access. The ultra smooth surface of the small vessel stents also promotes proper blood flow, thus reducing the possibility of thrombosis (blood clots), a particular risk when stenting small vessels.

Over the last year, the small vessel stent has been demonstrating the same positive rate of effectiveness as the larger models.

How is a stent inserted?
A physician trained as an interventional cardiologist performs the procedure which usually starts with the angioplasty. An incision, the size of a pencil tip, is made. Guided by X-ray images, the doctor threads a balloon-tipped catheter through the arterial system and into the obstructed coronary artery. At the end of the catheter is the stent, a small flexible tube made of plastic or mesh.

Next, the physician inflates the angioplastic balloon to force the plaque against the arterial wall; in the large majority of cases, this opens up the obstructed artery. This balloon inflation also causes the stent to expand and press against the vessel wall.

Once the angioplasty balloon is deflated and removed, the stent stays in place permanently to hold the blood vessel open. New cells and tissue slowly grow over the stent and eventually cover the surface.

Are there any risks or possible complications associated with stents?
Stenting is a safe procedure with no known long-term problems. Complications, if any, generally occur within the first day of the procedure. In all, the medical risks of the angioplasty and stent are much lower than for heart bypass surgery.

Are stents beneficial for anyone with coronary artery disease?
Stents are used to treat a wide variety of patients with narrowing or clogged arteries. The indications for using a stent can be angina (chest pain) or a heart attack. Or sometimes, stents are inserted as a temporary measure for cardiac patients who are not fit for surgery.

The size of the obstructed artery and location of the blockage will determine whether a stent is a suitable treatment and what size is required. Most, but not all, patients with blocked arteries are candidates for stents.

What should I expect after the procedure?
Most people need to stay in the hospital for only one night following an angioplasty and stent. Full recuperation takes about a week. Patients may feel mild chest pain initially from the stretched artery. After stenting, patients also must take blood-thinning agents to help prevent reclosure of the artery. Aspirin may be recommended indefinitely and an anti-platelet agent – ticlopidine or clopidogrel – is prescribed for the following four weeks and up to nine months. Other patients may also be given glycoprotein IIb/IIIa to block clotting factors in the blood.

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