What Are the Risks of Having a Stent?
Why do you need to be cautious before a dental extraction??
There is an increased risk of bleeding when patients taking anticoagulant or antiplatelet drugs require surgery.This risk must be balanced against the risk of harm if treatment is stopped. For many minor procedures aspirin or warfarin can be continued. Patients having non-cardiac surgery may be able to continue aspirin, but clopidogrel should be stopped unless there is a high risk of thrombosis. Patients taking warfarin may require bridging anticoagulation around the time of major surgery.This involves replacing the warfarin with unfractionated or low molecular weight heparin. Consultation with a cardiologist is particularly recommended if a patient with a coronary stent requires surgery.
Figure A shows the coronary arteries located on the surface of the heart.
Figure B shows a stent-widened artery with normal blood flow. The inset image shows a cross-section of the stent-widened artery.
In figure C, tissue grows through and around the stent over time. This causes a partial blockage of the artery and abnormal blood flow. The inset image shows a cross-section of the tissue growth around the stent.
Risks Related to Percutaneous Coronary Intervention
Percutaneous coronary intervention (PCI), the procedure used to place stents, is a common medical procedure that is sometimes referred to as coronary angioplasty. PCI carries a small risk of serious complications, such as:
Bleeding from the site where the catheter was inserted into the skin
Damage to the blood vessel from the catheter
Arrhythmias (irregular heartbeats)
Damage to the kidneys caused by the dye used during the procedure
An allergic reaction to the dye used during the procedure
Infection
Another problem that can occur after PCI is too much tissue growth within the treated portion of the artery. This can cause the artery to become narrow or blocked again. When this happens, it's called restenosis (RE-sten-no-sis).
Using drug-eluting stents can help prevent this problem. These stents are coated with medicine to stop excess tissue growth.
Treating the tissue around the stent with radiation also can delay tissue growth. For this procedure, the doctor threads a wire through a catheter to the stent. The wire releases radiation and stops cells around the stent from growing and blocking the artery.
During any dental procedure which might involve bleeding, a consultaton with the cardiologist is mandatory and bridging treatment with Low molecular weight Heparin and close monitoring is mandatory.
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Dr.Sreenita Chowdhury
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