Stent implantation and then?
The insertion of a stent into a coronary artery is a very common procedure in cardiology. The important thing in aftercare is, on the one hand, to ensure that the blood is thinned with medication so that the stent remains open. On the other hand, it is important to ensure that the underlying disease of atherosclerosis does not progress by treating the cardiovascular risk factors (e.g. LDL cholesterol).
Stent implantation for acute coronary syndrome versus elective stent implantation.
In coronary stent implantation, we distinguish between procedures that take place in the context of a so-called acute coronary syndrome, for example, in the event of a heart attack. In contrast, elective stent implantation is performed in stable, chronic coronary syndrome. In these elective procedures, double blood thinning therapy is necessary for 6 months after stent insertion. This is even necessary for 12 months in acute coronary syndrome. Another difference is that a different second substance is usually used in acute coronary syndrome as well (ticagrelor and prasugrel), compared to the usual clopidogrel in chronic coronary syndrome.
Blood-thinning therapy after elective coronary stent implantation
Thus, it is very important to perform dual antiplatelet therapy with acetylsalicylic acid 100 mg once daily as well as clopidogrel 75 mg once daily during the first 6 months. Nowadays, coated stents are implanted almost exclusively. This serves to prevent excessive wound healing during the first weeks when the inner vessel wall grows over the implant. Blood thinners must be consistently taken daily and there must be no gaps in therapy. Otherwise there is a risk of stent occlusion with subsequent heart attack.
After coronary stent implantation, dual blood thinning therapy is mandatory for chronic coronary syndrome. In order for the stent to heal well and remain open, there should be no gaps in therapy. Minor operations that cannot be postponed during the phase of intensive blood thinning can now even be performed under dual blood thinning therapy.