Stents

Stents used in airways include:

• Metal stents. These stents may be made of bare metal or covered with another material such as silicone. Metal stents that are covered with another material are also called hybrid stents, meaning they contain a mixture of materials.
• Silicone stents. These stents are made of a material that can be molded to a certain shape. They are used more often if the stent is temporary.

Stent grafts are used to treat aortic aneurysms. The stent graft is typically a tube made of leak-proof polyester with a metal mesh backbone. Stent grafts are used in larger arteries, such as the aorta, and provide a stable channel to support blood flow.

The stents used in coronary or carotid arteries include:

• Bare metal stents. These simple tubes are made of metal mesh and can be used in both the coronary and carotid arteries.
• Drug-eluting stents. These are the most common type of stents used in the coronary arteries. They are coated with medicine, which is released into the artery over time to prevent the artery from narrowing again. Different types of drug-eluting stents are coated with different medicines.

Learn about new types of stents being developed, including a biodegradable stent.

• Who Needs It? will discuss the conditions that these devices treat.
• Getting a Stent will explain the procedure for placing a stent in a patient.

Your doctor may use a stent graft to treat an aneurysm or dissection, or tear, of the aorta. The stent graft supports the weak area of the aorta and helps to prevent the aneurysm or dissection from bursting. Stent grafts can also help to treat injuries that have weakened the aorta. Blood flows through the stent graft and prevents blood from leaking into the body.

The carotid arteries are found in the neck and supply oxygen-rich blood to the brain. Plaque can build up in the carotid arteries, causing carotid artery disease and an increased risk of stroke and other complications.

Stents are often used to treat coronary arteries, which supply oxygen-rich blood to the heart, when they become narrow. A stent may be recommended to treat the symptoms that come with this narrowing, such as chest pain from angina that occur from lack of blood flow to the heart. A stent can also reduce damage to the heart muscle immediately after a heart attack, which is a complication of ischemic heart disease.

A stent may be used to treat narrowed airways in the lungs. Conditions that may lead to this include:

• A congenital problem. A problem at birth can cause the airways to be too narrow.
• Infections or diseases. Infections, inflammatory diseases such as sarcoidosis, or any problem in the body that presses on the lungs can narrow the airways.
• Injury. An airway may become narrowed or blocked from injury. Injuries can include side effects from intubation, which involves having a tube guided down into the lungs, or tracheostomy.
• Lung transplant complications. Sometimes after a lung transplant, problems occur within the airways of the new lungs. An airway may collapse, or a hole may form where the transplanted lungs were stitched together.
• Tumors. A tumor may block the airways within the lungs. Cancer treatment, such as radiation or chemotherapy, can sometimes damage the connection between an airway and an organ like the trachea. This connection prevents the airway from working correctly. A stent may be used to help open the airway.

Learn more in our How the Lungs Work topic.

A stent may be used as treatment for narrowed arteries caused by peripheral artery disease (PAD), a condition that happens when plaque builds up in the arteries that carry blood to your legs, arms, or abdomen.

Stents may be used to treat PAD symptoms and help prevent future complications caused by reduced blood flow.

An artery stent may not be recommended in the following circumstances:

• Your condition is mild. Your doctor may monitor your condition, start you on medicine, and recommend heart-healthy lifestyle changes.
• You have multiple narrowed coronary arteries, chronic kidney disease, or diabetes. Your doctor may recommend coronary artery bypass graft surgery (CABG) instead of the coronary stent procedure.
• You are older or have certain risk factors for complications. Your doctor may recommend another procedure instead of a carotid stent if you are over age 70, as the risk of complications, including stroke, may be higher. Stent grafts may be riskier for older patients or those with conditions such as renal failure or heart failure. For all procedures, your doctor will consider your health, talk to you about the risks, and make a decision with you and your family.

An airway stent may not be recommended in the following circumstances:

• You cannot have anesthesia or sedation.
• You need future procedures. Some lung procedures, such as laser therapy, can break or burn the stent. The stent can also get in the way if your lung requires surgery for other reasons.

• Before Getting a Stent will discuss the conditions that these devices treat.
• Getting a Stent will explain the procedure for placing a stent in a patient.

To diagnose narrowed arteries or an aortic aneurysm, your doctor may have you undergo some of the following tests and procedures:

• Chest magnetic resonance imaging (MRI) to look for aneurysms in the aorta. This test works well for detecting aneurysms and pinpointing their size and exact location.
• Computer tomography angiography (CTA) and magnetic resonance angiography (MRA) to take pictures of your blood vessels. These tests may give your doctor more information about the flow of blood and whether arteries are narrowed or have aneurysms.
• Coronary angiography to see how blood flows through your coronary arteries. This type of test involves injecting dye into your blood so that your blood vessels can be seen by X-ray.
• Fractional flow reserve can help determine how narrow the artery is. This is an added test done during CTA or coronary angiography to check the blood pressure in a specific artery.
• Ultrasound to see whether plaque has narrowed or blocked your carotid or peripheral arteries or to see if you have an aneurysm and where it may be located. This painless test uses high-energy sound waves to create pictures of the insides of your blood vessels.
• Echocardiography (echo) to evaluate the structure and function of your heart. Echocardiography uses sound waves to create moving pictures of your heart.
• Nuclear imaging to see whether the blood is flowing normally to the heart. Your doctor will inject a tracer substance that will show whether the heart is receiving enough blood flow.

To diagnose narrowed airways, your doctor may have you undergo some of the following tests and procedures:

• Bronchoscopy to figure out the location and severity of the narrowed airway
• Chest CT scan to see whether one of your airways is being affected by a tumor, pneumonia, mucus, or other problem
• Pulmonary function tests to measure how well your lungs are working

You may need additional tests, such as blood tests, EKG, chest X-ray, or chest CT scan, to prepare you for the procedure. Tell your doctor about any medicines you take, other surgical procedures you have had, and any medical conditions you have, such as diabetes, kidney disease, or sleep apnea.

You will be asleep for most stent procedures, so plan to have someone to take you home. You may go home the same day or after a few days, depending on the stent and any other medical conditions you have.

Before your procedure, you will be given detailed information, including:

• When you should stop eating or drinking
• If and when you should start or stop taking medicines
• When to arrive at the hospital and where to go
• How long you should expect to stay
• What happens during the procedure
• What to expect after the procedure, including potential complications, such as bleeding or soreness
• What to do after the procedure, such as what medicines to take
• How to live with your stent

• Getting a Stent will explain the procedure for placing a stent in a patient.
• Living With a Stent will discuss the importance of following your treatment plan.

The procedures to place a stent to treat coronary and carotid arteries are similar. In both procedures, a thin tube with a deflated balloon on the end is threaded through a blood vessel to the narrowed or blocked artery. Once in place, the balloon is inflated and the stent is opened and placed in the artery.

• The procedure to place a coronary stent is called percutaneous coronary intervention (PCI), commonly known as coronary angioplasty. Sometimes the procedure is done in an emergency, such as during a heart attack. The stent provides support to the artery after the artery is re-opened.
• The procedure to place a stent in the carotid artery is called carotid artery stenting. This is a minimally invasive treatment for severe carotid artery disease.

After an incision is made in your upper thigh, your doctor will insert a stent graft through a large blood vessel using a catheter. Your doctor will guide the catheter and stent graft through the arteries to the aorta, where the aneurysm is located. The stent graft is opened up and placed in the aorta once it is in the right place.

Dye may be injected into the blood after the stent graft is placed to make sure the stent graft is working correctly and blood is not leaking into the aneurysm. The dye can be seen by X-ray.

An airway stent is placed using a bronchoscope, a small camera on the end of a long tube. The doctor will slide the bronchoscope through your nose or mouth and then down through your throat into the trachea and the airways.

The stent will be placed by sliding a guide wire along the side of the bronchoscope, then sliding a thin tube along the guide wire that carries the stent. Using the bronchoscope to watch, the doctors will open the stent in the narrowed airway. Fluoroscopy, a type of X-ray imaging, or ultrasound may also be used to help guide the stent placement. Afterward, the doctors may check your lungs by chest X-ray.

• Return to Who Needs It? to learn about the conditions that these devices treat.
• Return to Before Getting a Stent to learn how to prepare for surgery.

Before you leave the hospital, you will be given instructions that include:

• Which medicines to take. You will need to take medicine to prevent a blood clots from forming in the stent. You may need to take other medicines for different reasons. Follow your doctor’s instructions carefully.
• When to resume normal physical activity. Most people are able to return to work within a few days to a week.
• When to make a follow-up appointment. Your doctor will need to check on your progress and make sure there are no complications.

Sometimes there are complications from a stenting procedure in an artery. These complications may include:

• Allergic reaction to the dye used to show the blood vessels by X-ray
• Arrhythmia, or an irregular heartbeat
• Bleeding or discomfort where the catheter was inserted
• Damage to blood vessels from the catheter
• Infection
• Rarely, damage to the kidney from the contrast dye

More serious or life-threatening complications may occur during a stenting procedure, but these are rare. People who have had other procedures to treat blocked arteries or who have congestive heart failure, chronic kidney disease, or diabetes, are usually at higher risk for complications, which may include:

• Blood flow being cut off from the gut or the lower part of the body during an aortic aneurysm repair
• Heart attack
• Rupture of the aortic aneurysm
• Stroke
• Tear in the artery

Possible complications from a stenting procedure in an airway may include:

• Coughing up blood
• Sore mouth, sore throat, or hoarse voice

Less common but serious complications may include:

• Arrhythmia
• Needing a tracheostomy
• Pneumothorax
• Respiratory failure
• Sudden cardiac arrest

• Living With a Stent will discuss possible complications of living with a stent or stent graft.

It is important to get routine medical care if you have a stent. Talk with your doctor about how often you should schedule office visits and blood tests.

• Discuss when you should follow up with specialists, such as a cardiologist or pulmonologist.
• Take medicines to prevent complications. If you have a stent in your artery, take all medicines regularly, as your doctor prescribes. Do not change the amount of your medicine or skip a dose unless your doctor tells you to. You will need to take antiplatelet medicines, or blood thinners, to prevent blood clots from forming in the stents in your arteries. Your doctor may prescribe these medicines for one year or more after getting a coronary stent, while it may be one month or more for carotid or peripheral artery stents. Antiplatelet medicines include aspirin, clopidogrel, dipyridamole, and ticlopidine. Bleeding is a possible side effect, which can make it much riskier to have surgery.
• Talk with your doctor about when you can resume normal physical activity. It will depend on the stent and your condition before the stent procedure.

Return to After Getting a Stent to review instructions from your healthcare team after your stenting procedure.

Stents serve as treatment but cannot cure an underlying condition. Some types of stents need to be checked by your doctor to make sure they have not moved and are functioning properly. This may include:

• Bronchoscopy to check an airway stent about four to six weeks after placement.
• Chest X-ray or CT scan to look for signs of any complications from an airway stent.
• CT angiograph (CTA) or ultrasound to make sure a stent graft placed to treat an aortic aneurysm is not leaking or has moved. You will likely need imaging about one month after your procedure. If a leak or other problem is detected, you may need imaging tests again after six months or one year to check it. If there is a bad leak, more surgery may be needed. Your stent graft will need to be monitored by imaging throughout your life.
• Referring you to a specialist if you have signs or symptoms related to your condition.
• Regular general exams to check overall physical and mental health.

Your doctor may recommend the following healthy lifestyle changes to reduce the chance of needing more procedures in the future or experiencing a heart attack or stroke.

• Aiming for a healthy weight
• Being physically active
• Heart-healthy eating
• Managing stress
• Quitting smoking. Visit Smoking and Your Heart and the National Heart, Lung, and Blood Institute’s Your Guide to a Healthy Heart. For free help quitting smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).

Watch for signs or symptoms of complications from a coronary stent, carotid stent, or stent graft, including:

• Blood clotting. A blood clot is an uncommon but serious complication that can occur within the stent. Your risk of getting a blood clot is much higher if you stop taking your blood thinners before your doctor says to do so. Blood clots can lead to life-threatening conditions, such as heart attack, stroke, and venous thromboembolism.
• Chest pain. This can be a symptom of restenosis, in which the artery where a stent is located closes up again. Restenosis is a common complication because of too much tissue growth within the portion of the artery where the stent is placed. It can lead to a heart attack if your stent is in a coronary artery. In this case, a symptom of restenosis may be chest pain. If it happens in other arteries, restenosis may or may not cause symptoms. If restenosis occurs, you will need another procedure, such as one that involves both angioplasty and possibly placing another drug-eluting stent.
• Stent or stent graft failure. Occasionally stents may break within a peripheral artery. Rarely, a stent graft used to repair an aortic aneurysm or dissection may move from where it was placed. Blood may also leak out of the graft. Symptoms may be similar to those you experienced before getting a stent, or you may have no symptoms. Your doctor will use imaging to monitor the stent graft.

If you have a stent because of ischemic heart disease or carotid artery disease, you are still at risk for complications related to those diseases, such as heart attack or stroke. If you think you are or someone else is having the following symptoms, call 9–1–1 immediately.

Heart attack signs and symptoms include:

• Mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion.
• Nausea, vomiting, light-headedness or fainting, or breaking out in a cold sweat. These symptoms of a heart attack are more common in women.
• Shortness of breath, which may occur with or before chest discomfort.
• Upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach.

If you think someone may be having a stroke, act F.A.S.T. and perform the following simple test.

• F—Face: Ask the person to smile. Does one side of the face droop?
• A—Arms: Ask the person to raise both arms. Does one arm drift downward?
• S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
• T—Time: If you observe any of these signs, call for help immediately. Early treatment is essential.

Read more about the signs and symptoms of a stroke.

Complications of an airway stent procedure may happen soon after the procedure or later. You should call your doctor right away if you experience any of the following signs or symptoms:

• Changes in your cough
• Coughing up blood
• High fever
• Persistent bad breath
• Problems breathing

These signs and symptoms may be caused by one of the following complications of your airway stenting procedure:

• Changes in stent placement, which can happen if the stent moves out of place. You may need another procedure to fix or remove the stent. This occurs more often with silicone stents. In rare cases, stents can become fractured or distorted.
• Lung infection
• Mucus caught in the stent
• Tissue growing into the stent, which can happen if the condition that caused a narrowed airway also causes it to become blocked again, such as in the case of a tumor growing through the stent. This occurs most often in the spaces in metal stents.