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Expert Q&A

Can two stents be implanted in the same surgery?

Asked by John E. Gault, Whiting, New Jersey

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If, during a cardiac catheterization procedure, the doctor determines that more than one stent is required to open one or more partially closed coronary arteries, can multiple stents be inserted in the same procedure or are multiple procedures required to insert multiple stents? Also, are coated stents more effective and do they last longer at preventing the artery from closing than bare or otherwise untreated stents? There is a lot of confusion out there on these two important points. Thank you!

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Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer

Dear John:

Thanks for your questions.

Percutaneous coronary intervention (PCI) is commonly used to treat partial and complete blockages of the coronary arteries. When doable, it is the favored treatment versus coronary artery bypass grafting (CABG) as it is less invasive.

In PCI, a catheter is passed usually from the femoral artery in the groin up to the heart and into the small coronary arteries that pass through the heart muscle. X-rays are used to help guide the placement of the catheter. When angioplasty is done, a balloon is placed in the area of the narrowed coronary artery, and it is inflated to widen the narrowed opening. Just a couple of years ago, total occlusions always had to be treated with a bypass.

Today, even a completely blocked coronary artery can sometimes be opened with PCI.

Within one year of an angioplasty, as many as 20 to 30 percent of patients develop partial or complete obstruction at the site of angioplasty that requires a repeat procedure, or CABG. The introduction of bare metal stents (BMS) produced a significant improvement. This is a tube-like metal cylinder. The proportion requiring a second procedure after angioplasty and bare metal stent placement is 10 to 15 percent within the first year.

In recent years, some stents have medications embedded in them designed to further prevent blockage after placement.

These drug-eluting stents yield a marked reduction in early reblockage compared with bare metal stents. However, after one year, drug-eluting stints may have a slightly higher risk of occlusion compared with bare metal stints.

Today, a stent is left behind in perhaps 75 percent of all angioplasties done in the U.S. Most are drug-eluting stents.

In answer to your first question, in some cases doctors can place two or even three stents during one procedure. There are, however, cases in which the cardiologist will want to place one and then place a second or even a third stent in a later procedure.

Factors that go into this decision include the overall condition of the patient. More complex coronary disease and complex anatomy might require several procedures to achieve the best placement of the stents.

Optimal stent placement decreases risk for stent blockage.

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