Dr. Sylvain Plante, MD, FRCPC, FACC, Interventional Cardiologist, discusses commonly asked questions in regards to cardiac stents. Southlake Regional Health Centre

BIO:

Dr. Sylvain Plante received his medical degree at the University of Sherbrooke (QC) in 1983. He completed his postgraduate internal medicine and cardiology training at the University of Sherbrooke and at the University of Montreal. After completing a clinical fellowship in interventional cardiology and an experimental research fellowship at the Thoraxcenter, Erasmus University in Rotterdam (Netherlands), he worked as an interventional cardiologist at the CHU in Sherbrooke from 1990 to 1993, and at the Heart and Lung Institute in Quebec City from 1993 to 2003. From 2003 to 2007, he was the Medical Director of the Percutaneous Coronary Intervention (PCI) Program at Southlake Regional Health Centre, where he performed the first procedure.

Dr. Plante has more than 25 years of experience in the field of coronary intervention. He has performed thousands of procedures and he has been a pioneer in radial artery access (artery of the wrist) for angioplasty. He has published several articles in medical journals.

( Dr. Sylvain Plante, Cardiologist, Newmarket, ON ) is in good standing with the College of Physicians and Surgeons. Now Health Network

Fortunately, complications after stent placement are rare. There are basically two types of complications, there’s what we call stent thrombosis and stent restenosis. Now, just to be clear, when we implant a stent people have to be on blood thinners. Maybe aspirin, and some medication like Plavix, Brilinta.

Despite the fact that patients take their medication appropriately, sometimes there is some stent thrombosis, which means a blockage of the stent by a clot. It might occur in the first hours, first days after the stent placement, because there was some technical or mechanical complications.

It might happen a bit later because there were multiple stents inserted, stents were placed in small vessels with a lot of disease, or sometimes it happens because the patient decided to stop his medication, or the blood thinners are stopped because there’s a surgery. So this is a complication, stent thrombosis and it occurs abruptly, all of a sudden.

The other type of complication that we call restenosis is more of a progressive process. It’s kind of a scar tissue formation inside the stent that’s going to go over months and patients will develop symptoms. There’s not much we can do about it, most of it has been done with the new stent generation. The former ones were bare metal. The new ones have a polymer which releases drugs to control the healing process. And nowadays, this restenosis process is pretty rare, probably less than 5 percent.

Stents don’t move, or migrate or collapse. So when we implant them we choose them according to the vessel size, so when we expand them we tug them against the walls. And on top of this, over months the stent will be covered by the patient’s own cells. So they don’t move or migrate.

If you have to have an MRI, just tell the MRI technician that you have a stent, but you know, all the commercial stents nowadays are MRI safe. Stents are made of alloys, they have like platinum, cobalt, chromium. The amount of iron in them is minimal, so you will not trigger alarms in airports. And they’re not sensitive to cabin pressure changes, so you know, it’s safe to travel with stents.

Unfortunately, in 2018 there’s no cure for coronary heart disease. Stents are very useful to help patients with stable disease to improve their symptoms. They can save lives in patients with acute heart attacks, but it’s not a cure. It’s just a tool in our toolbox. Stents will never replace changes in lifestyle and taking your medication.

Presenter: Dr. Sylvain Plante, Cardiologist, Newmarket, ON

Local Practitioners: Cardiologist