How long can a person live with stents?

Coronary artery disease is a common condition that affects millions of people worldwide. One of the main treatments for coronary artery disease is the placement of stents – tiny mesh tubes that are inserted into blocked arteries to help keep them open. Stents help restore blood flow to the heart muscle and relieve symptoms like chest pain. But how long can a person expect to live after having stents implanted? Here is an overview of stent lifespan and prognosis.

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What are stents?

Stents are tiny, expandable mesh tubes made of materials like stainless steel or cobalt-chromium alloy. During a stent procedure, the stent is mounted on a balloon catheter. It is threaded through the blood vessels to the site of the blockage using X-ray guidance. Once in position, the balloon is inflated which expands the stent. This pushes the plaque outwards and opens up the artery. The stent stays in place after the balloon is deflated and removed.

There are two main types of stents:

Bare metal stents – made of stainless steel or cobalt-chromium. These stents provide scaffolding to keep the artery open but do not have any coating.
Drug-eluting stents – these stents are coated with medications that help prevent the artery from becoming blocked again due to renarrowing or restenosis. The coating slowly releases the medication over time.

Stents provide mechanical support to the arterial wall and help improve blood flow. However, they do not cure the underlying disease process of atherosclerosis or plaque buildup.

Average lifespan of stents

In general, most stents will continue to function for many years after implantation if the patient follows medical advice. Here is an overview of the average lifespan of stents:

Bare metal stents – These typically last about 8-10 years before narrowing may occur again requiring repeat procedures.
Drug-eluting stents – These have a lower restenosis rate and studies show they remain open between 5-7 years on average.

However, stents may not last this long in some individuals, especially if guidelines are not followed. Factors like diabetes, smoking, poor stent deployment, small vessel size, and early discontinuation of anti-platelet medications can all impact stent patency and longevity.

Prognosis after stent placement

The long-term outlook after stent placement is generally good, especially if steps are taken to optimize longevity. Some key points about prognosis include:

Anti-platelet therapy – Taking medications like aspirin and clopidogrel as prescribed after stent placement is crucial to prevent blood clots. Premature discontinuation is linked to early stent failure.

Making lifestyle changes – Quitting smoking, losing weight, eating healthy, and exercising regularly can all help stents remain open longer.
Seeing a cardiologist – Getting regular follow-up and screening tests for restenosis allows any issues to be caught early before blockages reoccur.
Repeat procedures – Some people may need additional stenting or bypass surgery over time if multiple vessels are affected or new blockages develop.

Adhering to lifestyle and medication guidelines provides the best prognosis. But even with optimal care, some stent failure and return of symptoms is possible over time as the underlying coronary artery disease progresses.

Survival rates after stenting

Large clinical studies allow us to estimate typical survival rates after coronary stent placement:

1 year – Approximately 95% of patients are alive 1 year after stenting.

5 years – After 5 years, around 88% of patients are still alive.
10 years – At 10 year follow-up, about 75% of those who received a stent are still living.

Survival is slightly higher for elective stenting procedures compared to stenting done urgently for heart attack. Underlying health, age, diabetes, kidney disease and extent of heart disease also affect individual prognosis.

In general, studies show stents prolong life in many people with coronary artery disease compared to medical therapy alone. But lifestyle modifications, medications adherence, and follow-up care are key to optimizing longevity.

Factors that impact stent lifespan

There are several key factors that can influence how long a coronary stent will remain open and functional:

Medication adherence – Prematurely discontinuing the prescribed anti-platelet therapy aspirin, P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) or anticoagulants raises clotting risk which can block stents.

Stent thrombosis – This blood clot inside the stent is a dangerous complication that can block the artery and lead to heart attack. Certain stents may have a slightly higher risk.
Type of stent – Drug-eluting stents tend to have better long-term patency than bare metal stents.
Technique – Proper stent sizing and optimal deployment helps prevent complications like stent thrombosis or restenosis.

Vessel size – Smaller diameter vessels or bifucartion lesions are associated with lower stent longevity.
Location – Stents in certain arterial segments like the left main coronary artery may be more prone to dysfunction.
Comorbidities – Diabetes, smoking, obesity, and metabolic syndrome increase risk of repeat narrowing.

Dual anti-platelet therapy – How long aspirin and a P2Y12 inhibitor are continued affects stent patency.

Talking with a cardiologist about these factors can help optimize stent lifespan on an individual basis.

Signs of stent failure

Some signs that may indicate a stent is failing or becoming dysfunctional include:

Recurring chest pain or angina, especially with exertion
Shortness of breath or problems breathing
Fatigue, tiredness, lack of energy

Irregular heart beat or palpitations
Fainting or dizziness
Swelling in the legs, ankles or feet

Routine follow-up and screening tests are recommended after stent placement to detect any issues early. Tests like an EKG, stress test, CT angiogram or cardiac catheterization can diagnose in-stent restenosis before complete blockage or heart attack occurs.

Can a stent come loose or fall out?

It is extremely rare for a stent to come loose or fall out of place once implanted. Here are some reassurances:

Stents are designed to be permanent implants. The metal mesh integrates into the lining of the arterial wall over 4-6 weeks.

Expanded stents have a rigid, cylindrical structure that resists external compression or deformation forces.
Stents are further held in place by neointimal tissue growth over and through the mesh that occurs during healing.
Even small stents are over 10 mm long – too large to easily move around or dislodge.

Patients are prescribed anti-platelet drugs after stenting to deter blood clots during the healing process.

In very rare cases, certain factors can lead to stent dislodgement:

Poor initial stent deployment or improper stent sizing.

Placement in challenging or high-movement arterial segments.
External trauma directly over the stented area, like a seat belt injury.
Brachytherapy used after stenting to prevent restenosis.

A large aneurysm adjacent to the stented artery segment.

But even with these factors, stent dislodgement occurs in far less than 1% of cases. Most stents remain fixed in their target position and integrate into the artery lining over time.

Restenosis after stenting

Restenosis refers to the renarrowing of a stented coronary artery that was previously successfully opened. There are two main types:

Acute stent thrombosis – An immediate blood clot within the stent occurring in the first 24 hours after placement.
Late restenosis – A more gradual renarrowing process that occurs months or years after stenting due to scar tissue growth.

Drug-eluting stents were specifically designed to reduce restenosis rates compared to bare metal stents. But restenosis can still occur in a small percentage of patients depending on various risk factors. Diagnostic tests like a stress test, CT angiogram or cardiac catheterization can detect problematic restenosis before complete artery occlusion and heart attack occur.

Risk factors for restenosis

Premature discontinuation of anti-platelet medication
Diabetes
Long or multiple stented segments

Smaller vessel diameter
Bifurcation stenting
Stent under-sizing

Kidney disease/failure

Discussing these risk factors with your cardiologist allows development of a personalized plan to help optimize stent patency and longevity.

Can a stent be replaced?

If severe restenosis does occur, a dysfunctional stent most often can be treated with another stent placed inside the first one. This is called stent-in-stent placement. There are a few considerations with stenting a previously stented lesion:

The old stent must be fully covered axially and radially by the new stent.
This avoids geographic miss which causes restenosis.
Too many stent layers may eventually cause occlusion. 3 layers is generally the maximum.

Underlying restenotic tissue must be adequately pre-dilated for stent access.
IVUS (intravascular ultrasound) helps guide optimal deployment.

In some cases, coronary artery bypass may be recommended instead of repeat stenting if there is high risk of recurrent failure. But in most cases, previous stents can be successfully replaced with good long-term results.

Are stents removed during bypass surgery?

Coronary artery bypass grafting (CABG) may become necessary if stenting proves insufficient to control symptoms over time. This procedure uses blood vessel grafts to route blood flow around severely blocked arteries.

Existing stents are usually just left in place and bypassed during CABG. There are several reasons for this:

Removing or manipulating stents risks complications like arterial damage or thrombosis.

Leaving them avoids additional surgical time and complexity.
Previous stents are incorporated into the vessel wall – removing could weaken the artery.
Studies show similar CABG effectiveness with stents left in place.

Less invasive endoscopic vein harvesting allows grafting around stents.

In rare cases, stents may be removed to allow for graft anastomoses or reuse of the internal mammary artery. But in most cases they are simply avoided and left intact during CABG.

Stent fracture

In a small percentage of cases, coronary stents may later be found to have fractured or cracked years after implantation. Fatigue from mechanical stresses is the most common cause. Stent fractures occur more often:

In areas exposed to high mechanical stress and movement – like the lower left anterior descending artery or right coronary artery.
With longer, overlapping or bifurcation stents.
In tortuous vessels or areas near heavy calcification.

With stents subject to external compression between the heart and chest wall.

One study using intracoronary imaging found an 8.4% prevalence of stent fracture in patients with prior stents presenting for repeat procedures. However, not all fractures are symptomatic or require reintervention. Close monitoring is warranted if a clear fracture is found.

Signs and symptoms

Many coronary stent fractures are incidentally found on routine imaging after stent placement. However, some signs a fracture may be present include:

Recurrence of cardiac symptoms like chest pain.
Evidence of restenosis within the stented segment.
New myocardial ischemia or EKG changes.

Stent deformation visible on X-ray, CT scan or intravascular ultrasound.

If concerning symptoms develop, imaging can confirm stent fracture. Repeat stenting, CABG or medical therapy may be warranted depending on the severity.

Risks associated with stents

While generally safe, stents do carry some potential risks and complications to consider:

Restenosis – Reblockage of the stented artery. More common with bare metal stents.
Thrombosis – A blood clot forming within the stent. Very dangerous complication.
Stent fracture – Cracks in the stent frame, more likely in areas under mechanical strain.

Stent malapposition – Improper stent-wall contact, risking thrombosis.
Neoatherosclerosis – Lipid or plaque buildup within the stent body.
Myocardial infarction – Heart attack due to acute stent thrombosis.

Arrhythmias – Abnormal heart rhythms during placement.

However, modern techniques and drug-eluting stents help minimize these risks. Discuss all potential complications with your cardiologist before stenting.

Conclusion

Most coronary artery stents will remain functional for 8-10 years on average. Some may last over 15 years if optimally deployed and with adherence to prescribed anti-platelet medications to prevent thrombosis. Regular follow-up and making heart-healthy lifestyle changes provides the best prognosis after stenting. With ongoing medical care and prudent lifestyle choices, many patients live a normal lifespan with stents in place. However, complications like restenosis, stent fracture or thrombosis remain possible long-term. Working closely with your cardiologist allows early detection and management of any future issues.