Stent — Procedure Guide, Recovery & Risks | MyMedicPlus

A stent is a small expandable mesh tube made of metal (stainless steel or nitinol) or polymer, deployed inside a narrowed or blocked vessel, duct, or lumen to restore flow. Types include coronary drug-eluting stents (DES), biliary self-expanding metal stents (SEMS), ureteral stents (DJ stents), esophageal stents, and carotid stents. Coronary DES are the most commonly placed, with over 1 million procedures performed annually in the United States alone. Modern stents are designed with biodegradable polymer coatings or thin-strut platforms to minimise long-term inflammatory response and reduce risk of late stent thrombosis.

Modern drug-eluting stents (DES) are coated with antiproliferative drugs (sirolimus, zotarolimus, or everolimus) released from a bioabsorbable or durable polymer coating to inhibit smooth muscle cell proliferation and dramatically reduce in-stent restenosis rates compared to bare-metal stents. Biodegradable polymer DES (Synergy, BioMatrix) allow earlier cessation of dual antiplatelet therapy. Stents are also used outside the heart: self-expanding metallic stents (SEMS) relieve malignant biliary and oesophageal obstruction; carotid, renal, and peripheral arterial stents treat vascular disease; ureteric stents drain obstructed kidneys; and tracheobronchial stents maintain airway patency. TAVR (transcatheter aortic valve replacement) uses a specialised self-expanding or balloon-expandable stent-mounted valve to replace the native aortic valve via a catheter-based approach.

Coronary DES treats atherosclerotic coronary artery disease (acute MI and stable angina) when lesions are suitable for percutaneous coronary intervention. Biliary SEMS relieves malignant or benign biliary obstruction causing jaundice and cholangitis. Ureteral DJ stents bypass ureteral obstruction from stones, stricture, or tumour. Esophageal stents palliate malignant dysphagia in inoperable oesophageal cancer. Carotid stents treat symptomatic carotid stenosis (greater than 50-70%) in patients at high surgical risk for carotid endarterectomy. Patient selection for each stent type is guided by multidisciplinary team review and anatomical suitability assessment.

Specific patient selection criteria for coronary DES include: angiographically confirmed coronary artery stenosis greater than 70% in a vessel causing ischaemia on functional testing, or greater than 50% stenosis in the left main coronary artery. Acute STEMI (ST-elevation myocardial infarction) represents the most urgent indication — primary PCI (pPCI) with stenting within 90 minutes of first medical contact is the standard of care, superior to thrombolysis for door-to-balloon times under 120 minutes. Non-ST elevation ACS (NSTEMI, unstable angina) is managed with early invasive angiography and stenting. Stable coronary artery disease is treated with PCI when the fractional flow reserve (FFR) is 0.80 or below, confirming functional lesion significance.

Coronary: radial or femoral arterial access is obtained; a guidewire is crossed across the lesion under fluoroscopy; balloon pre-dilatation prepares the lesion; the DES is deployed at 8-16 atm; post-dilatation optimises apposition confirmed by IVUS or OCT imaging. Biliary or esophageal: an endoscope is advanced under conscious sedation; a guidewire is passed through the obstruction; the SEMS is advanced over the wire and self-expands to full diameter. Ureteral DJ stent: performed via cystoscopy with the patient awake under local or sedation; a guidewire is placed to the kidney under fluoroscopy and the stent positioned over the wire with one curl in the renal pelvis and one in the bladder.

Radial access (transradial PCI) is now preferred over femoral access in most centres, reducing access site bleeding and vascular complications by 40–50% compared to transfemoral access. After crossing the lesion with a 0.014-inch guidewire, intravascular imaging (IVUS or OCT) is increasingly used to optimise stent sizing, ensure complete lesion coverage, and confirm full stent expansion and apposition. Stent sizing is critical: undersized stents cause stent thrombosis from incomplete expansion; oversized stents cause dissection or perforation. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) provides precise stent sizing and post-deployment assessment of expansion and apposition to reduce restenosis and stent thrombosis risk.

Coronary DES reduces target-vessel revascularisation to below 5% at 1 year versus 20-30% with bare-metal stents, significantly reducing the need for repeat procedures. Biliary SEMS achieves jaundice relief in over 90% of cases with median patency of 6-12 months, improving quality of life in patients with malignant obstruction. Ureteral stents relieve obstruction in over 95% of cases, protecting kidney function until definitive stone treatment or surgery can be planned. TAVR-associated coronary stenting is routinely performed safely at experienced centres with excellent acute outcomes.

For acute STEMI, primary PCI with DES reduces 30-day mortality compared to thrombolysis (mortality 5–7% vs 10–14%) and achieves TIMI-3 flow (complete reperfusion) in over 90% of cases. For stable coronary artery disease, the COURAGE and ORBITA trials demonstrated that PCI with DES effectively relieves angina symptoms, improving quality of life and exercise capacity, though it does not reduce myocardial infarction or all-cause mortality compared to medical therapy alone. Biliary SEMS provides effective palliation for malignant obstruction, enabling discharge and avoiding the morbidity of surgical bypass in patients with unresectable pancreatic cancer.

Coronary DES: in-stent restenosis occurs in 5-10% at 1 year; stent thrombosis (acute under 24h, subacute 1-30 days, late) in under 1% if dual antiplatelet therapy (DAPT) is maintained; access site haematoma occurs in 1-3%. Biliary SEMS: stent migration in 5%, tumour ingrowth causing re-obstruction at 6-12 months. Ureteral DJ: urinary frequency and haematuria are common side effects; encrustation, infection, and migration occur if the stent is left beyond the recommended duration. All stenting procedures carry small risks of contrast nephropathy, perforation, and bleeding.

Dual antiplatelet therapy (DAPT) is mandatory after DES implantation: premature discontinuation is the most common cause of late stent thrombosis, which carries a mortality of 20–40%. Duration of DAPT (6–12 months standard; potentially 1 month with modern biodegradable polymer DES for stable disease without high bleeding risk) must be individualised balancing thrombosis risk versus bleeding risk. Coronary perforation — a rare but potentially fatal complication — requires emergency pericardiocentesis or covered stent deployment. Contrast nephropathy is a risk in patients with chronic kidney disease.

Coronary stenting requires 24-hour observation; dual antiplatelet therapy (DAPT) with aspirin plus ticagrelor or clopidogrel is prescribed for 6-12 months for DES (12 months for ACS patients, as short as 1-3 months for selected stable CAD patients). Biliary SEMS patients are discharged same-day or next-day with liver function test monitoring. Ureteral DJ stents are removed at 4-6 weeks via cystoscopy; retained beyond this duration risks encrustation and infection. Follow-up echocardiography, imaging, or renal function tests are scheduled based on stent type and indication. Patients are advised on symptom recognition for stent complications.

After coronary PCI, aspirin 75–100 mg is continued indefinitely and the P2Y12 inhibitor (ticagrelor, prasugrel, or clopidogrel) for 6–12 months. Patients are reviewed at 4–6 weeks post-procedure with a functional assessment; cardiac rehabilitation is recommended to reduce future cardiovascular risk, improving exercise capacity and long-term cardiovascular outcomes. Work return depends on the underlying indication: desk work within 1 week after elective stenting; 4–6 weeks after STEMI with recovery from myocardial damage.