Stent Procedures in Modern Medical Practice
Yes, stent procedures are extremely commonplace in modern medical practice, with over 1 million procedures performed annually in the United States alone and approximately 2 million worldwide. 1
Overview of Stent Utilization
Stenting has become the dominant form of percutaneous coronary intervention (PCI), with most catheterization laboratories in the United States employing stents in 80-85% of their PCI procedures 1. This widespread adoption reflects the evolution of interventional techniques from simple balloon angioplasty to more sophisticated endoprostheses.
Types of Stents in Clinical Practice
- Bare-Metal Stents (BMS): The first generation of stents, which provide scaffolding to maintain vessel patency
- Drug-Eluting Stents (DES): Advanced stents that release medications to prevent restenosis
- Bioresorbable Stents: Newer technology that dissolves over time after serving its purpose
Applications of Stent Procedures
Stents are widely used in various vascular territories:
Coronary Artery Disease
- Primary therapy for common iliac artery stenosis and occlusions (Level of Evidence: B) 1
- Treatment for external iliac artery stenoses and occlusions (Level of Evidence: C) 1
- Salvage therapy for suboptimal results from balloon dilation in iliac arteries 1
Peripheral Arterial Disease
- Treatment of choice for TASC type A lesions in peripheral arteries 1
- Used in selected TASC type B and C lesions, though more evidence is needed 1
- The ACC/AHA guidelines recommend endovascular intervention with primary stenting for TASC B lesions (Class I, Level A recommendation) 2
Renal Artery Disease
- Primary therapy for atherosclerotic renal artery stenosis 1
- Studies show stent placement is significantly more effective than balloon angioplasty alone in atherosclerotic renal artery lesions 1
Efficacy and Success Rates
Stent procedures demonstrate high success rates across various applications:
- Renal stenting: Procedural success rates ≥96% with procedure-related mortality <1% 1
- Iliac stenting: Primary stenting has 98% technical success rates and 92.1% 12-month primary patency rates 2
- Subclavian artery stenting: Initial success rates of 93%, with 89% maintaining patency at 5 years 1
Evolution of Stent Technology
The field has evolved dramatically since the introduction of percutaneous techniques:
- Stenting has contributed greatly to catheter-based revascularization by reducing risks of both acute vessel closure and late restenosis 1
- Drug-eluting stents have markedly reduced restenosis risk compared to bare-metal stents 1
- Newer technologies include biodegradable/bioresorbable polymers, polymer-free platforms, and fully biodegradable scaffolds 3
Clinical Decision-Making
When considering stent placement, physicians evaluate:
- Anticipated life expectancy
- Ventricular function
- Comorbidities
- Functional capacity
- Severity of symptoms
- Quantity of viable myocardium at risk 1
Potential Complications
Despite their widespread use, stent procedures carry some risks:
- In-stent restenosis (occurring in approximately 10-18% of cases within the first year) 2
- Late stent thrombosis (particularly with drug-eluting stents if antiplatelet therapy is discontinued prematurely) 4
- Access site complications and distal embolization 2
Patient-Centered Approach
Modern stent selection incorporates patient preferences and values:
- Shared decision-making tools help patients understand trade-offs between options 1
- For example, bare-metal stents require shorter duration of dual antiplatelet therapy but have higher restenosis rates than drug-eluting stents 1
Conclusion
Stent procedures have revolutionized the treatment of vascular disease across multiple territories. Their widespread adoption, high success rates, and continuous technological improvements have made them a cornerstone of modern interventional practice for improving morbidity, mortality, and quality of life outcomes in patients with vascular disease.