How heart stents (and their relatives) have gone from strength to strength

Heart stents have come a long way since doctors first started using balloon angioplasty to treat narrowed coronary arteries. During this procedure, a very thin, long, balloon-tipped tube (catheter), is inserted into an artery in either the groin or arm and is moved to the site of the blockage with help from an X-ray. The balloon at the tip of the catheter is then inflated to compress the blockage and restore blood flow, and is then deflated to allow the catheter and balloon to be removed. In some cases, these heart stents aren’t enough to prevent collapse of the coronary arteries after the balloon is deflated and restenosis can also be a side-effect. This led to the development of small stents which could be mounted on the balloon section of the catheter. These stents then expand when the balloon is inflated, lock into place, and form a permanent scaffold to hold the coronary artery open after the balloon is deflated and removed.

Carotid artery stenting (CAS) has increasingly assumed an important role in the management of significant carotid artery stenosis, and recent recommendations (by the UK National Institute for Health and Clinical Excellence (NICE) and the American Heart Association (AHA) suggest that it is a viable alternative to carotid endarterectomy (CEA) for standard-risk populations. There is a consensus among experts suggesting that embolic protection devices (EPDs) can reduce the risk of stroke during CAS. These recommendations are supported by an early meta-analysis. Embolic protectiondevices can be divided into three distinct types based on their mechanism of operation: distal occlusion aspiration devices, distal filters and proximal occlusion aspiration devices.

Devices aside, cardiology training in carotid artery stenting is imperative in terms of technical success rates, as it is in any new or technically challenging procedure. In a report which examined four groups of 50 patients, the authors observed a significant increase in technical success rate after 50 procedures and a concomitant reduction in total procedural time and contrast volume used, demonstrating a clear benefit of cardiology training.