Stent in heart
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Summary
10 papers analyzed
These studies suggest that stents are effective in treating various heart conditions, including subacute ischaemic heart disease, congenital heart disease, and obstructive coronary disease, with advancements in materials and technology improving outcomes and reducing complications.
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The Role of Stents in Heart Disease Treatment
Introduction to Coronary Artery Stents
Coronary artery stents are small, mesh-like tubes inserted into coronary arteries to keep them open and ensure adequate blood flow to the heart muscle. They are primarily used to treat ischemic heart disease (IHD), which is a leading cause of morbidity and mortality worldwide. IHD manifests in various forms, including stable and unstable angina and acute myocardial infarction (MI).
Effectiveness of Stents in Ischemic Heart Disease
Comparison with Percutaneous Transluminal Coronary Angioplasty (PTCA)
Stents have been shown to be more effective than PTCA alone in preventing adverse events and the need for repeat revascularizations. Studies indicate that stents reduce the combined event rate and improve event-free survival compared to PTCA . This is particularly significant in patients with stable and unstable angina, where stents have demonstrated superior outcomes in terms of reducing the incidence of MI and the need for further interventions .
Comparison with Coronary Artery Bypass Graft (CABG)
In cases of multiple-vessel disease, stents and CABG have shown no significant difference in mortality rates at one year. However, patients undergoing CABG tend to require fewer revascularizations over time. This suggests that while stents are effective, CABG may offer better long-term outcomes in complex cases.
Cost-Effectiveness of Stents
Economic evaluations reveal that while stents are initially more cost-effective than CABG, the long-term costs may balance out due to the higher rate of repeat procedures associated with stents. Drug-eluting stents (DES) have been found to reduce the need for revascularization compared to bare-metal stents, but their higher costs may not always justify their use in single-vessel disease.
Stents in Congenital Heart Disease
Application and Outcomes
Stents are also used in the treatment of congenital heart disease (CHD), particularly in cases where surgical intervention is challenging. Studies have shown that stents effectively reduce pressure gradients and increase vessel diameters in patients with pulmonary artery stenosis, systemic venous stenosis, and other congenital defects . The use of stents in CHD has been associated with significant improvements in hemodynamic parameters and patient outcomes, both in the short and intermediate term .
Challenges and Innovations
Despite their success, the use of stents in pediatric cardiology faces challenges due to the lack of dedicated devices optimized for the specific anatomical and functional needs of children. Most stents used in CHD are adapted from adult devices, which may not always provide the best outcomes. Recent advances in stent materials, such as bioresorbable metals like magnesium and zinc, offer promising alternatives that could reduce complications like late restenosis and thrombosis .
Conclusion
Stents play a crucial role in the management of both ischemic and congenital heart diseases. They offer significant benefits over traditional PTCA and, in some cases, CABG, particularly in reducing adverse events and the need for repeat procedures. However, the choice between stents and other interventions should consider long-term outcomes and cost-effectiveness. Ongoing research and innovation in stent materials and designs hold the potential to further improve patient outcomes and address current limitations.
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