November 24th, 2010
03:45 PM ET

Can two stents be implanted in the same surgery?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

Question asked by by John E. Gault, Whiting, New Jersey

If, during a cardiac catheterization procedure, the doctor determines that more than one stent is required to open one or more partially closed coronary arteries, can multiple stents be inserted in the same procedure or are multiple procedures required to insert multiple stents? Also, are coated stents more effective and do they last longer at preventing the artery from closing than bare or otherwise untreated stents? There is a lot of confusion out there on these two important points. Thank you!

Expert answer

Dear John:

Thanks for your questions.

Percutaneous coronary intervention (PCI) is commonly used to treat partial and complete blockages of the coronary arteries. When doable, it is the favored treatment versus coronary artery bypass grafting (CABG) as it is less invasive.

In PCI, a catheter is passed usually from the femoral artery in the groin up to the heart and into the small coronary arteries that pass through the heart muscle. X-rays are used to help guide the placement of the catheter. When angioplasty is done, a balloon is placed in the area of the narrowed coronary artery, and it is inflated to widen the narrowed opening. Just a couple of years ago, total occlusions always had to be treated with a bypass.

Today, even a completely blocked coronary artery can sometimes be opened with PCI.

Within one year of an angioplasty, as many as 20 to 30 percent of patients develop partial or complete obstruction at the site of angioplasty that requires a repeat procedure, or CABG. The introduction of bare metal stents (BMS) produced a significant improvement. This is a tube-like metal cylinder. The proportion requiring a second procedure after angioplasty and bare metal stent placement is 10 to 15 percent within the first year.

In recent years, some stents have medications embedded in them designed to further prevent blockage after placement.

These drug-eluting stents yield a marked reduction in early reblockage compared with bare metal stents. However, after one year, drug-eluting stints may have a slightly higher risk of occlusion compared with bare metal stints.

Today, a stent is left behind in perhaps 75 percent of all angioplasties done in the U.S. Most are drug-eluting stents.

In answer to your first question, in some cases doctors can place two or even three stents during one procedure. There are, however, cases in which the cardiologist will want to place one and then place a second or even a third stent in a later procedure.

Factors that go into this decision include the overall condition of the patient. More complex coronary disease and complex anatomy might require several procedures to achieve the best placement of the stents.

Optimal stent placement decreases risk for stent blockage.

soundoff (4 Responses)
  1. Harriet Garner

    I had two stent successfully implanted in 2002 without any subsequent blockage. I am extremely thankful to the medical team that chose the less invasive bypass alternative. A good lifestyle and support system, great diet, exercise and medical dream team allows successful management of heart disease. I am proof as a 62 year old female who was very fortunate to survive a massive heart attack.

    November 28, 2010 at 00:46 | Report abuse | Reply
  2. Harriet Garner

    Correction: I am extremely thankful to the medical team that chose not to use the more invasive bypass alternative.

    November 28, 2010 at 00:48 | Report abuse | Reply
  3. Burt Cohen

    Would like offer this correction to Dr. Brawley's text "However, after one year, drug-eluting stints may have a slightly higher risk of occlusion compared with bare metal stints." In fact, drug-eluting stents have shown in many trials to have a lower rate of restenosis than bare metal stents. This long has been known to be the fact for narrower coronary arteries, but the recent BASKET-PROVE trial of over 2,000 patients showed that drug-eluting stents had half the restenosis of bare metal stents even in patients with large coronary arteries. Restenosis is the gradual reblocking of the stent by tissue growth. In BASKET-PROVE, restenosis occurred in less than 1 in 9 patients with bare metal stents, less than 1 in 4 with drug-eluting stents. Dr. Brawley may be alluding to another type of "occlusion", where a sudden clotting of blood occurs after one year - called late stent thrombosis. It is a rare occurrence, especially with the newer drug-eluting stents - less than 1 or 2 in 1,000.

    Also, the word is "stent" not "stint" 😉

    Otherwise a helpful article. Thanks for the opportunity to comment.

    Burt Cohen - Angioplasty.Org

    November 28, 2010 at 15:47 | Report abuse | Reply
  4. Burt Cohen

    Sorry...my typo - the stats for BASKET-PROVE should read "restenosis occurred in less than 9 out of 100 patients with bare metal stents, less than 4 out of 100 with drug-eluting stents."

    November 28, 2010 at 15:50 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.

November 2010
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