Choosing the right type of stent for your clogged coronary artery

When they were introduced in 2003, drug-coated stents were hailed as a revolutionary new step in angioplasty, a surgical procedure to open a blocked coronary artery. But reports of heart attacks and deaths in a small number of patients soon forced a more careful examination of the risks of these devices. The June 2008 issue of the Harvard Heart Letter provides an update on drug-coated stents and outlines how to choose the right stent for your needs.

Stents are tiny wire cages that can fit inside an artery. They were invented to prop open heart arteries after angioplasty cleared them of clogs. The first stents were made of bare metal. The drug-coated versions release medication to stop restenosis, a regrowth of cells that can create a new blockage. Soon after drug-coated stents hit the market, doctors began seeing heart attacks and sudden deaths caused by clots forming inside the devices. Researchers found that clotting problems were twice as likely to happen with drug-coated stents as with bare-metal ones. However, a longer-term analysis showed no significant difference three years after surgery.

Which stent is right for you? The Harvard Heart Letter suggests that a drug-coated stent might be a good choice if the anatomy of the affected artery makes it prone to restenosis; if you aren't planning any surgery in the next year; and if you're good about taking medications. (People with drug-coated stents need to take medicine to prevent clotting for a year or more.) A bare-metal stent might be better if you might need surgery soon or if you can't afford the medications.

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