Colleagues Stephen Lownie and David Pelz investigated the use of stents to prevent stroke (Lownie & Pelz, 2013). The authors’ research revealed that stroke is considered the third leading cost of death both domestically, and worldwide (Lownie & Pelz, 2013). Stroke has many symptoms but the quickly limited blood flow to the brain cause immediate loss of body functions such as the ability to speak and see, along with often causing partial paralysis, as well as death (Lownie & Pelz, 2013). Strokes occur for various reasons including the narrowing of the large blood vessels that supply the brain, also called the carotid arteries, that are located in the neck, despite the existence of other arteries that supply the brain (Lownie & Pelz, 2013). The paper reviews the use of stents to prevent strokes and provides information on various types of stent procedures.
Plaque is a major concern of blood vessel issues and strokes. Plaque builds up in the body, but nobody is sure why this occurs, but what is known is that because it is thick like oatmeal, it can build up inside the blood vessels linings (Lownie & Pelz, 2013). The buildup creates a condition known as stenosis, or inside narrowing of an artery, which impacts blood supply to the heart or other parts of the body, as well as has the potential to rupture (Lownie & Pelz, 2013). Broken pieces of plaque can block arteries partially or completely, along with causing a condition defined as an embolus, where the plaque pieces flow downstream in the body blocking other small arteries (Lownie & Pelz, 2013). Debates about what causes strokes is centered around the issues of embolus and stenosis. Various types of stents and surgeries are used to manage these conditions, including stent scaffolding, tubular wire mesh stents, and balloon expandable stents (Lownie & Pelz, 2013).
Using an existing practice patient, Lownie and Pelz explored the use of self-expanding stents, or balloon stents in carotid surgery performance (Lownie & Pelz, 2013). The patient was a 72-year-old male that had already experienced carotid surgery 18 years before becoming the authors’ patient; the patient’s arteries were narrowing again, as well as he had experienced a very small warning stroke, and based upon research using stents in cancer patients by Suleyman Men, the authors installed an expanding stent into the patient (Lownie & Pelz, 2013). After surgery the stent expansion was monitored and immediately after the surgery the stent expanding from 0.8 millimeters to 1.2 millimeters, and again a few days later to 3.5 millimeters; a review after three months revealed it had expanded to 4.5 millimeters; future follow-up at very intervals disclosed that the stent remained open and the patient was stroke free; the patient later died of non-related stroke and stent issues (Lownie & Pelz, 2013).
Due to the success of the patients, Lownie and Pelz continued to perform primary carotid stenting on patients without the use of an angioplasty balloon. The future study was done on twenty-one clients between March 2000 and September 2002 that had experienced stroke warning symptoms, along with severe carotid artery narrowing; Lownie and Pelz performed twenty successful stent surgeries from the group of twenty-one; one patient required the use of balloon (Lownie & Pelz, 2013). The surgeries resulted in a 49 percent reduction of narrowing versus the 83 percent later; reductions in narrowing continue to occur; one week after the surgeries, results were 30 percent and approximately eleven months after the surgeries, results were 21 percent, justifying the authors’ belief that “the majority of carotid plaques opened up by simply placing a self-expanding stent without a balloon” (Lownie & Pelz, 2013).
The authors concluded that self-expanding stents were highly effective in the prevention of strokes; they cautioned that more research is required in using these types of stents with patients with high calcified plaque levels, as well as more research is needed to track better the stent expansion levels (Lownie & Pelz, 2013). I agree with the authors’ conclusion regarding self-expanding stents; however the article left me with questions about how successful these types of stents are with various numbers and types of strokes a patient might have.
- Lownie, S., & Pelz, D. (2013). Stents to Prevent Stroke. American Scientist, (101.4), 292 – 299.