Coronary Stenting

Stents are metallic hollow devices that serve to scaffold an area of obstruction within the coronary artery. The stents made today are 2.0 to 4.5 mm in diameter and vary in length from 5 mm to 40 mm. Most stents are made of stainless steel.

The first stent was successfully implanted in a human in 1993 in Europe. Shortly thereafter in 1994, the first stent was successfully implanted in the U.S. Then followed two large randomized trials: STRESS and BENESTENT. These two trials the former in the US, the latter in Europe, showed that stents placed in coronary arteries were better than conventional balloon angioplasty (PTCA) in maintaining vessel patency. The restenosis rates were 17-25% for stents while PTCA restenosis rates were 35%.

 

 

In 1995, when stents were first available for clinical use, stent implantation was fraught with two major problems:

  1. Large doses of blood thinners were required leading to unacceptable high rates of bleeding. If the blood thinner was not used, stents quickly clot off resulting in large disastrous heart attacks!
  1. Long hospitalization rates two to three times that of conventional PTCA. 

Both these limitations were overcome when it was found that Ticlid was far superior that Coumadin in preventing acute stent occlusion from clot. Ticlid also had much lower rates of bleeding compared to Coumadin. Clopidogrel, a drug similar in molecular structure to Ticlid but with fewer side effects, is used instead of Ticlid. With the replacement of Ticlid or Clopidogrel instead of Coumadin, patients’ rates of excessive bleeding fell dramatically. As a direct consequence, the duration of hospital stays also fell dramatically. Now days, patients usual stay in the hospital for only one day after an uncomplicated stent deployment. With the use of Ticlid or Clopidogrel, acute stent occlusion is a now a rare phenomenon.

 

What about restenosis? Restenosis is the gradual process by which the stented or ballooned area gets plugged up by tissue ingrowth and plaque. The rates of restenosis for conventional angioplasty are 40% in four to six months after the PTCA. In BENESTENT and STRESS trials, the restenosis rates were 17 and 25% respectively. With the newer generation stents, restenosis rates have fallen to 10 to 15% in national registries. In order to get around this challenge of stent restenosis, newer Drug eluting stents were designed. In 2003, two drug eluting stents were introduced: Cypher which elutes the drug Sirulimus and Taxus which elutes the drug Paclitaxel. After placing these types of drug eluting stents (DES) the stent restenosis rates fell dramatically down to single figures. As of this update, in 2012, there are now three new drug eluting stents available eluting two different drugs: zotarulimus, and Evarilimus. Both these drugs are variants of the Sirulimus drug from the initial Cypher stent. Stent restenosis is reduced but not totally resolved by implantation of Drug Eluting Stents. There is also procedural differences in how the stents are implanted by the Cardiologist. Before getting your stent procedure, you should ask your cardiologist for his/her specific restenosis rates.

Stent deployment in a coronary artery has made it possible for most patients to avoid a disastrous heart attack. However neither stent deployment nor any other intervention can reverse the atherosclerosis process. Atherosclerosis is the abnormal accumulation of cholesterol and lipids in the walls of blood vessels.   Atherosclerosis, if left untreated, can culminate in a heart attack. 

Reversing the process requires changing your life style: increasing activity, lowering the fat intake in your diet and reducing your blood cholesterol. Read more about how you can prevent a heart attack here.

 

About Dr. Nanavati

Dr. Vimal Nanavati is an Interventional Invasive Cardiologist residing in San Diego, California.  He was recruited to Northern California from Ohio in 1997 to initiate a quality Cardiology Program for the people living on the Northern Coast of California.  Dr. Nanavati inaugurated the Arcata Heart Care Program and was the director of their first Cardiac Catheterization Lab at Mad River Hospital from June of 1998 to March 1999.  

In 1999, Dr Nanavati relocated to Redding in order to provide his patients with more comprehensive cardiology services.  Since 2005, Dr. Nanavati has been in San Diego providing Cardiology Services.

Dr. Nanavati performs cardiac catheterizations, angioplasty, coronary Stent deployment, intracoronary ultrasound, and Doppler Pressure measurements in the coronary artery.  He also provides the complete array of non-invasive diagnostic tests such as echocardiography, stress testing, pacemaker follow-up, and EKG testing.  Since March 2002, Dr. Nanavati has added EECP (Enhanced External Counterpulsation), the only noninvasive therapy for angina not amenable to intervention or bypass surgery.

Dr. Nanavati received his medical training in Chicago, Illinois, where he grew up.  After finishing his fellowship training at the University of Illinois in 1993, he traveled to Ohio where he was in practice until 1997.  Dr. Nanavati is Board Certified in Cardiovascular Diseases and Internal Medicine.  He is a member of American College of Cardiology, Society of Angiography, and Interventions, American College of Physicians, California Medical Association, and San Diego County Medical Society.

Dr. Nanavati's Philosophy of Patient Care in his own words: 

"Treat every patient as if they were your own family member."

"If I cannot provide the most advanced therapy, I will find someone eminently qualified who will."

"The smile on a patient's face is my greatest reward." 

"If you don't need the procedure, I'm not going to order it." 

"The best patient is the informed patient."

Dr. Nanavati feels it a singular honor and privilege to serve the heart care needs of all patients and family members who use this site. This website is dedicated to them.

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Critical Care Cardiology

Dr. Vimal Nanavati is an Interventional Invasive Cardiologist residing in San Diego, California.  He was recruited to Northern California from Ohio in 1997 to initiate a quality Cardiology Program for the people living on the Northern Coast of California.  Dr. Nanavati inaugurated the Arcata Heart Care Program and was the director of their first Cardiac Catheterization Lab at Mad River Hospital from June of 1998 to March 1999.  

In 1999, Dr Nanavati relocated to Redding in order to provide his patients with more comprehensive cardiology services.  Since 2005, Dr. Nanavati has been in San Diego providing Cardiology Services.

Dr. Nanavati performs cardiac catheterizations, angioplasty, coronary Stent deployment, intracoronary ultrasound, and Doppler Pressure measurements in the coronary artery.  He also provides the complete array of non-invasive diagnostic tests such as echocardiography, stress testing, pacemaker follow-up, and EKG testing.  Since March 2002, Dr. Nanavati has added EECP (Enhanced External Counterpulsation), the only noninvasive therapy for angina not amenable to intervention or bypass surgery.

Dr. Nanavati received his medical training in Chicago, Illinois, where he grew up.  After finishing his fellowship training at the University of Illinois in 1993, he traveled to Ohio where he was in practice until 1997.  Dr. Nanavati is Board Certified in Cardiovascular Diseases and Internal Medicine.  He is a member of American College of Cardiology, Society of Angiography, and Interventions, American College of Physicians, California Medical Association, and San Diego County Medical Society.

Dr. Nanavati's Philosophy of Patient Care in his own words: 

"Treat every patient as if they were your own family member."

"If I cannot provide the most advanced therapy, I will find someone eminently qualified who will."

"The smile on a patient's face is my greatest reward." 

"If you don't need the procedure, I'm not going to order it." 

"The best patient is the informed patient."

Dr. Nanavati feels it a singular honor and privilege to serve the heart care needs of all patients and family members who use this site. This website is dedicated to them.


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Heart Attack Symptoms and Information

If you are experiencing these symptoms, dial 911 immediately!

  • Chest discomfort

  • Shortness of breath

  • Arm pain

  • Dizziness

  • Jaw pain

Every year, tens of thousands of Americans survive heart attack, go back to work and enjoy a normal life. You have every reason to be confident of a full recovery. Your heart is healing and with each passing day you’ll get stronger and more active.

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