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Stenting is not just placement of a stent

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Dr KK Aggarwal    10 February 2018

A coronary angiogram is an invasive procedure and is done in a specifically designed catheterization laboratory, commonly known as Cath Lab. It must be equipped with ECG monitor, defibrillator, endotracheal tubes, temporary pacemakers and leads, oxygen and other equipments for cardiopulmonary resuscitation (CPR), including surgical (CABG) back up and arrangement with a link hospital. A diagnostic catheter, guide wire, needle for artery puncture, artery sheath is needed for an angiography.

Coronary angioplasty opens up the blocked artery and restores blood flow to the heart. It involves the use of guide wires, balloon catheter, stents, dye, special x-ray screen. For optimal results, knowledge of the lesion is important. This assessment is done by imaging (IVUS). It is also important to choose a stent that is most appropriate to the lesion.

Instead of direct stenting, pre-dilating the lesion with a balloon catheter to gain adequate caliber before the stent is placed is a part of lesion preparation, especially in complex lesions. Unless the stent has good apposition to the wall of the artery, there is the risk of complications like thrombosis, re-stenosis. Once the stent has been placed, high pressure balloon post-dilatation further optimizes stent deployment further lowering the chances of stent thrombosis. Complications not only add to the morbidity and mortality risk, they also add to the cost of treatment.

Angiography and angioplasty require lot of disposables. As per a recent govt. circular, “re-use of disposable items particularly in cardiology and other specialties, is not permitted”. So, the cost of stenting is not synonymous with just the cost of the stent.

This also underlines the fact that stenting is not just placement of a stent and being able to place the stent does not always mean a good patient outcome. Operator experience and proficiency also influence angioplasty outcomes.

Quality always comes at a price. Quality treatment is costlier but in the long-term, it is economical as it is associated with fewer hospital-acquired infections, complications, adverse drug reactions, re-hospitalization, as well as fewer system failures.

The general public should be aware of these nuances of stenting.

 

Dr KK Aggarwal

 

 Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

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