Balloon but no stent

[firstlight40]

So a question:

A friend has just had an HA with primary PCI (so suffered a STEMI i guess) but has just had balloon angioplasty without a stent for treatment.

Reading up this seems uncommon with 80% of cardiac angioplasty procedures appatently resulting in a stent emplacement. I ended up with 6 stents from my NSTEMI so it seems quite odd to me.

Does anyone know from their own experience why a stent wasn't inserted? there doesn't seem to be much info on this that I could find. Thanks in advance

[Heythrop51]

I imagine MichaelJH will have some thoughts on this. Adding his name in the post triggers a notification.

[MichaelJH Heart Star in reply to Heythrop51]

😇

[MichaelJH Heart Star in reply to MichaelJH]

My understanding is that stents are used if after the ballon is deflated the artery reverts. I had balloon angioplasty to my left leg and things were normal for around five years. Part of the problem is restenosis which sometimes occurs within a year as the body rejects the stent. This then requires further intervention.

With your friend the aim would be to stabilise things with drugs and lifestyle changes. The most damaging issues are smoking and uncontrolled blood pressure.

[Jongemini]

In some cases, based upon where the blockage is, the insertion of a stent can compromise another artery and therefore they may suggest a ballon as a first option. For example, I have a 75% stenosis at the ostium of the first diagonal artery - just where it meets the LAD. During the angiogram the cardiologist said that inserting a stent might compromise blood flow in the LAD and therefore was reluctant to insert a stent.

Another reason might be that the narrowing of the artery might be caused by a coronary spasm, unrelated to the stenosis. So rather than putting in a stent which may not fix the problem and will need anti-rejection medication indefinitely, they may suggest a balloon initially to see if this removes the symptoms - even if only for a few months or years.

Hope that helps.

[Milkfairy Heart Star in reply to Jongemini]

Stents are not usually inserted to treat a transient narrowing of an artery due to a coronary artery vasospasm. The usual treatment of coronary vasospasms is by medication.

[Jongemini in reply to Milkfairy]

Agreed. I was just replying to MichaelJH and trying to explain why a stent was not necessarily applied.

From my experience cardiologists are dismissive of the concept of vasospastic angina. They have just left me to what other cardiologists have described as “maximum dose medication for heart failure” which I do not have.