From the Guidelines
Contraindications for endovascular stent placement include complex coronary anatomy, severely compromised left ventricular function, extensive peripheral vascular disease, contraindication to antiplatelet therapy, and patient refusal of stenting. These conditions should be carefully considered before proceeding with the procedure to minimize risks and ensure the best possible outcome for the patient. Some of the key contraindications include:
- Complex coronary anatomy unsuitable for stenting, such as severe calcification, severe tortuosity, total occlusions at other major epicardial coronary arteries (≥2), multiple and diffuse long coronary lesions, and complex in-stent restenosis unsuitable for repeat stenting procedure 1.
- Severely compromised left ventricular function, which may increase the risk of complications during and after the procedure 1.
- Extensive peripheral vascular disease unsuitable for placement of a guiding catheter or intraaortic balloon pump, which may limit access to the affected area and increase the risk of complications 1.
- Contraindication to antiplatelet therapy, including aspirin, heparin, or thienopyridine, which is essential for preventing stent thrombosis and ensuring the success of the procedure 1.
- Patient refusal of stenting, which is a critical consideration in the decision-making process, as patients must be fully informed and willing to undergo the procedure 1. It is essential to weigh the benefits and risks of endovascular stent placement against other treatment options, such as coronary artery bypass surgery, and consider patient preferences and individual circumstances when making a decision 1.
From the Research
Contraindications for Endovascular Stent Placement
- Severe cardiopathy or coagulopathy are contraindications for endovascular stent placement, as noted in a study on stenting for malignant superior vena cava syndrome 2
- The presence of aortic neck thrombus was initially thought to be a contraindication, but a study on endovascular stent grafting found that it may not necessarily be a contraindication in select patients 3
- Discontinuation of antiplatelet therapy, particularly clopidogrel, is a significant risk factor for stent thrombosis, and bleeding complications, such as gastrointestinal bleeding, can be a limiting factor for antiplatelet therapy 4
- Placement of a foreign body in a contaminated field, such as in the case of carotid "blowout", may be a concern, but endovascular stent placement can be a temporizing measure in such cases 5
Relative Contraindications
- Lesions difficult to treat with balloon angioplasty, such as renal aorto-ostial lesions and restenotic lesions, may require careful consideration before endovascular stent placement 6
- Patients with significant medical comorbidities, such as those with abdominal aortic aneurysms, may require individualized assessment before endovascular stent placement 3