What to avoid after stent
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Post-Stent Care: What to Avoid
Introduction to Stent Complications
Stent placement, whether in coronary arteries or ureters, is a common medical procedure aimed at maintaining vessel patency. However, post-stent complications can arise, necessitating careful management and avoidance of certain practices to ensure patient safety and optimal outcomes.
Avoiding Premature Discontinuation of Antiplatelet Therapy
Importance of Dual Antiplatelet Therapy
One of the most critical aspects of post-stent care, especially for drug-eluting stents (DES), is the continuation of dual antiplatelet therapy (DAPT). Premature discontinuation of antiplatelet drugs, such as aspirin and thienopyridines, significantly increases the risk of stent thrombosis, a potentially fatal complication . Maintaining DAPT is crucial, even in the perioperative setting, to prevent thrombotic events.
Managing Bleeding Risks
While the continuation of antiplatelet therapy is essential, it also poses a risk of excessive bleeding during surgical procedures. Strategies to balance these risks include using aspirin alone or employing "bridging therapy" with glycoprotein IIb/IIIa inhibitors and/or heparin if DAPT must be temporarily halted. Novel antiplatelet therapies are also being explored to mitigate these risks.
Avoiding Inadequate Stent Deployment Techniques
Ensuring Proper Stent Placement
Proper stent deployment is vital to minimize the risk of complications such as stent thrombosis. Factors such as high-pressure balloon inflations and avoiding stent malapposition, overlapping stents, and excessive stent length are crucial for reducing the risk of late thrombosis . Ensuring complete reendothelialization and avoiding penetration of necrotic core are also important to prevent delayed healing and subsequent thrombosis.
Avoiding Emergency Stent Placement
Emergency stent placements are associated with higher rates of subacute thrombosis compared to elective procedures. Proper case selection and contemporary techniques can help mitigate these risks.
Avoiding Routine Ureteral Stenting Post-Ureteroscopy
Evaluating the Necessity of Stenting
Routine ureteral stenting after ureteroscopy is often unnecessary and can be avoided in many cases. Studies have shown that patients who do not require ureteral dilation during ureteroscopy can safely forgo stent placement, which reduces operative time, surgical costs, and patient morbidity. Avoiding routine stenting can also decrease postoperative pain and urinary symptoms.
Identifying High-Risk Patients
However, stenting may still be necessary for patients at increased risk of complications, such as those with residual fragments, bleeding, perforation, or urinary tract infections. In such cases, stenting acts as a preventive measure to avoid emergency interventions.
Conclusion
Post-stent care requires careful consideration of various factors to avoid complications. Maintaining dual antiplatelet therapy, ensuring proper stent deployment, and evaluating the necessity of ureteral stenting are critical steps in managing patients with stents. By adhering to these guidelines, healthcare providers can significantly reduce the risk of adverse events and improve patient outcomes.
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