Ask the Doctor: ‘I need to have an angioplasty and a stent inserted and I’m terrified. Is it dangerous and does the recovery take long?’

”My doctor has told me that I need to have an angioplasty and a stent inserted. I’m terrified of having this done, is it dangerous and if so, how dangerous? I have a young family to consider. Does the recovery take long? I do not want to be away from my family for a long period of time.”

Answer from Professor David Burke, Director of Cardiology, Consultant Cardiologist, Beacon Hospital

‘Getting a stent’ has become a much more common occurrence and most of us will know somebody who has had one. Over the last 40 years, angioplasty and stenting has evolved dramatically to what has become a straightforward and safe procedure.

A coronary angiogram is the test done in order to figure out whether or not there is a narrowing or blockage in one of our coronary arteries. The coronary arteries run on the surface of the heart and give a blood supply to the heart muscle. A narrowing in one or more of these arteries can put the heart under pressure or strain, and if a narrowing becomes a blockage, then this will cause a heart attack, or essentially damage to the heart muscle. A narrowing is caused by cholesterol (‘plaque’) build up within the walls of the vessels.

To do an angiogram, we numb up at the right wrist over the pulse with a local anaesthetic and advance a small tube or catheter up the arm, as far as the heart. Although this sounds very uncomfortable, there is usually very little to feel. Through this catheter, we inject a dye and take an X-ray, which gives us an instant picture on screen of an outline of the coronary arteries.

If there is a significant narrowing, this can be treated with a stent. This consists of a metal coil, that looks somewhat like the spring in a biro. We advance a very fine wire through the catheter and across the narrowing in the blood vessel. Then the stent is pushed along this wire into the correct position and expanded into place with a small balloon.

The beauty of stenting is that it has become an ‘instant fix’ and in general is a quick procedure. People often have experience of angiograms and stenting when parents or even grandparents had it done, and it was previously a more cumbersome and risky process.

If your doctor has recommended stenting, then you must have some degree of significant coronary narrowing, and then the best treatment for this would be a stent. Of course, there is a risk with any procedure, and in patients having these procedures done routinely, we would say there is a 1 in 10,000 risk of a heart attack or stroke. Although this always raises concern, this balances out with the risk of not undergoing the procedure if there is a problem to be fixed. Any risk involved has dropped considerably over the last 20 years as our techniques have become more finessed.

There is very little time needed in terms of recovery. We monitor patients overnight after stenting, and let them home the following morning. It is straight back to ‘business as usual’. Stents can’t shift or break or move, and so there is no restriction in terms of building up exercise and fitness.

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