Stening is the process of implanting a tube called a stent inside an artery.
Stents can be made of various materials. The most common material is a metal mesh, which may be either woven or laser-cut. The specific metal is often stainless steel, but alloys such as nickel-titanium or cobalt-chromium are also used.
Stent placement is an endovascular procedure, meaning it occurs entirely from within blood vessels. Unlike traditional surgery, it requires no large surgical incision.
Stents have a variety of purposes. Some of their most common uses are in the treatment of atherosclerosis, brain aneurysm, and ischemic stroke.
Atherosclerosis can lead to narrowing of the carotid arteries, a common cause of stroke. At Columbia’s Cerebrovascular Center, carotid artery disease is frequently treated with a stenting procedure called stent-angioplasty.
In the NIH-funded CREST trial, stent-angioplasty was shown to be equivalent in safety and outcomes to carotid endarterectomy, the traditional surgical treatment. For some patients whose other medical conditions make traditional surgery high risk, the stent procedure may actually be a superior option.
Another common use for stents is in the treatment of brain aneurysms. For many years, stents have been used as part of a procedure to create a safe alternative path for bloodflow–away from an aneurysm at risk of rupture. The first step in this procedure is to treat the aneurysm with coil embolization. Then a stent prevents fresh blood from entering the aneurysm, helping it heal, and also prevents the materials used in embolization from blocking blood flow in the normal arteries.
Recent innovations allow stents not only to reinforce embolization, but also sometimes to work on their own. A kind of brain stent called a flow diverter can effectively channel blood flow away from an aneurysm without any additional treatment, resulting in a very high rate of permanent cure. Flow-diverter stents were initially used for the types of brain aneurysms that were too large to be suitable for coil embolization. But because they are so effective, these flow-diverters are now used for a broad range of aneurysms.
Stents also play a pivotal role in the treatment of acute ischemic stroke. Up to 40% of all strokes are caused by blockage of the largest brain arteries, usually by a blood clot formed in the heart. These strokes can be treated on an emergency basis using a special stent called a stent-retriever. A stent-retriever can capture and retrieve the clot, removing it from the brain arteries and thereby restoring normal blood flow. This procedure is called an emergency thrombectomy. Emergency thrombectomy and a full range of other emergency stroke services are offered at Comprehensive Stroke Centers like Columbia University Medical Center. We are proud to be one of only two Comprehensive Stroke Centers in Manhattan.
Finally, stents may also be used to treat blood vessel injuries. They are effective in treating dissections, in which the layers of a blood vessel become separated and impair blood flow. Covered (non-mesh) stents can also be used when an injury or cancer causes a tear in a blood vessel, to stop blood from leaking out of the injured blood vessel.
Details of stent placement vary depending on the type of stent and its purpose.
All stenting is performed entirely from within blood vessels, using tiny, specialized tools. This makes it an endovascular procedure, performed by highly trained endovascular specialists.
To access the vessel system, a physician usually makes an incision in the femoral artery, near the hip. Guided by real-time imaging scans, the physician threads instruments through the vessels to the area requiring treatment.
Equipment varies depending on procedure. In an angioplasty, for example, the doctor will guide a tiny, deflated balloon inside a mesh stent to the target area. Inflating the balloon will open the stent and compress the atherosclerotic buildups, widening the artery. Or, to remove a blood clot from a blocked artery, the doctor will deploy the stent-retriever. The stent portion of this device props the blood vessel open, and the retriever portion captures the clot and is removed from the body.
If the procedure is performed on an emergency basis, as in treating an ischemic stroke, no preparation is necessary. Your medical team will work quickly to ensure you receive the best possible care.
If the procedure is scheduled, make sure you understand the goals, benefits, and risks. It may help to write your questions down as you think of them and bring the list to your appointment. Bring a written list of your medications, too.
At Columbia University Medical Center, we also participate in a number of “cutting edge” research trials and protocols using the most modern devices and techniques available.
How long will I stay in the hospital?
Hospital stay depends largely on the condition being treated and your medical situation.
Will I need to take any special medications?
Over the course of several weeks to months, the stent will heal in place, effectively becoming part of the blood vessel wall. Until this occurs, patients take medications designed to keep blood elements, especially platelets, from clinging to the stent and re-clogging the blood vessel with a blood clot.
Will I need rehabilitation or physical therapy?
There is no need for physical therapy due to the stent itself. There may be a need due to the underlying condition; check with your neurosurgeon to learn more.
Will I have any long-term limitations due to stenting?
There are no long-term limitations due to the stent itself. Your neurosurgeon will be able to discuss with you whether there will be any limitations due to the underlying condition.
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