Terry had a stent placed in her blocked artery after she had a cardiac event. She didn't have a heart attack, just a big scare. The doctor told her that her type 2 diabetes had caused the blockage in her artery. After Terry came out of the hospital, she followed a strict diet, exercised daily, and took her prescribed medication. She lost weight and had much more energy than before. She started to reduce her medication and then stopped taking it all together. Then she had a heart attack. A blood clot had formed at the site of the stent, blocking arterial blood flow to the heart.
Opening a blocked artery
For partially blocked arteries, medication and lifestyle changes may be sufficient to reduce blockages, while severely blocked arteries require bypass surgery. In many other cases, blocked arteries are opened by angioplasty, the insertion of a balloon, or stenting, the insertion of a metal stent. In the past, stenting didn't work as well for women as men, because the stents were too large for women's smaller arteries. Now, stents used for women are smaller and cause less scarring and are as effective as in men.
Type of stents
A stent is a meshed tube that is inserted into the clogged artery to keep it open. The two types of stents are the bare metal stent and the drug-eluting stent.
- · Bare metal stent
Bare metal stents have no coating and are delivered by angioplasty (balloon method) to the site of the blockage. Stenting is more effective than angioplasty alone in keeping arteries open. But there are two problems with stents: they can cause blood clotting at the site of the stent and tissue can grow around the stent and narrow the artery. The risk of blood clots is usually greatest shortly after the stenting procedure.
- · Drug-eluting stent
Drug-eluting stents are stents coated with medication to prevent scar tissue from growing around the stent and narrowing the artery. Drug-eluting stents are safe and insurance against closing up of arteries. However, drug-eluting stents, just like bare metal stents, may cause blood clots. Blood clots with drug-eluting stents may not occur until many months after the procedure.
One reason Terry started to reduce her blood thinning medication was that she was bleeding too easily. Just blowing her nose caused a nose bleed that lasted for more than an hour. Women are often more sensitive to blood thinning medication and may need to take lower doses.
Common blood thinners prescribed after stenting are clopidogrel (Plavix) and aspirin. Terry was told to take clopidogrel daily for 12 months together with 81 mg of aspirin and to stay on aspirin for the rest of her life. Terry survived her heart attack and a new stent was placed in her artery. She agreed to stay on her blood thinning medication with some minor adjustments.