Small mesh tubes to open blocked or narrowed arteries of the heart.

DESPITE the fact that coronary (heart) stents have been increasingly widely used for the better part of three decades, there is still much about this technology that is not well understood by both the layman and sometimes, even medical professionals.

Stents are broadly defined as small mesh tubes that are used to hold open narrowed or diseased passages in the body.

They come in an array of sizes and materials to accommodate the varying uses in the human body.

Stents are made from a variety of different non-corrosive materials like metals, metal alloys as well as plastic polymers, and modern devices can be bonded with therapeutic drugs tailored for specific healing purposes.

Although stents are used in various locations in the body – for example, the biliary and urinary system – they are most commonly used to treat blocked or narrowed arteries of the heart, aorta and peripheral (limb) circulation, according to Dr Goh Khiam Yan, consultant cardiologist at CVSKL.

Stent only the first step

Dr Goh shares that while stents help to treat coronary heart disease, they are only part of the treatment.

“Stents do not cure heart disease per se, although they are frequently but not always, the first step in the treatment process.

“This is because while a stent restores blood flow and therefore functionality at the site where it is delivered, the disease process causing the problem is an ongoing one.

“It is probably more appropriate to regard coronary stents as a symptom alleviator than a cure.

“Once you put a coronary stent in, your symptoms disappear almost immediately because blood flow is restored. Chest pains, shortness of breath, and lethargy – stents can rapidly alleviate these symptoms very effectively if used appropriately, which is why it can be a bit deceptive.

“The patient can literally go running the next day and feel fine, but technically they are not ‘cured of heart disease.’ The vessel has just been reshaped to function better. You still have to prevent the other areas in the circulation from narrowing again over time.

“One of the frustrating things about coronary stents is that although the rationale of restoring flow in abnormal arteries is easy to understand, there remains the longstanding paradox that stents, despite relieving symptoms effectively, do not always prolong lives in patients with stable heart disease when compared with optimal drug treatment. This apparent conceptual paradox is another long discussion in itself.

“Having said that, in acute emergencies like heart attacks which are caused by acute abrupt occlusions of coronary arteries, and in situations where a patient’s symptoms are escalating typically from imminent closure of a diseased vessel, stents are a crucial and often lifesaving treatment.”

Healthy lifestyle first

A stent (right image) restores blood flow and therefore functionality at the site where it is delivered.

Patients have to look at their well-being holistically after implanting a stent, as treatment of the disease requires addressing issues on a panvascular level, or pertaining to the entire circulation system of the heart and body.

Crucial to this is adherence to medications prescribed, especially blood thinners, and drugs to control cholesterol and blood pressure levels.

“Stents are only a part of the treatment process. Patients will still have to change their lifestyles – as mundane as this sounds.

“The repeated but necessary calls for dietary changes, regular exercise and stopping smoking are so easy to ignore because these issues are repeated so often it feels almost like background noise in every health talk.

“Sometimes I feel mildly embarrassed to talk about changing lifestyles to my patients because it feels a lot like nagging about things they already know (but don’t always do!).

“I appreciate that a person’s diet and exercise activities are deeply personal and, in many ways, cultural – which are hard things to change.

“For example, our meals with our families are almost unique to each household. The choice of dishes, the amount of food served, what is regarded as healthy or otherwise – these are things and beliefs that are not easy to change overnight.

“Diets that are overly restrictive (such as the zero carbohydrate fad) or culturally alien (how do you even pronounce quinoa?) are difficult to sustain in the long term for most people.

“Likewise, overambitious exercise regimes and weight loss targets will be discarded after the initial scare is over.”

Dr Goh usually advises his patients to shift their diet to more plant-based food and to abstain from any form of meat (and yes, chicken is meat, he says) for at least two days a week, as cholesterol originates from animal products like meat, milk and eggs plus downstream products from milk and eggs, pastries and baked goods, sauces, cheese etc.

“Get out of the habit of needing meat with every meal. Learn to cook a little – it is the best way to understand what goes into a meal and will enable you to make better food choices when you dine out.

“As for exercise, find something that you can enjoy whether it is a particular sport, running, dancing or swimming so that you will return to it on a regular basis.

“Aim for modest weight reduction over a few months rather than an intimidating target weight.

“Many people are unnecessarily self-conscious about starting on exercising especially if they do not feel they are physically fit, but the truth is no one else is really looking at you when you exercise and if they do, it’s none of their business anyway.”

He says that taking the prescribed blood thinners after implanting a stent is crucial to avoid early complications, as the body will treat the stent as a foreign object in the initial phase.

“When you put a stent within a blood vessel, the body will cover it with a layer of cells called the endothelium over a period of weeks and months.

“Once that happens, it becomes incorporated into the vessel wall and the blood flowing through the stent will no longer be in contact with the metal.”

Low maintenance, not maintenance-free

Although there is a little bit of “maintenance” required to prevent clots and/or new blockages, Dr Goh shares that stents do not require to be removed at any point after implantation, and they can remain in the body indefinitely.

But taking the prescribed medication is a must to prevent early complications.

“The stents are not replaced. If there is a new disease forming around the stent, we can conduct procedures such as balloon angioplasty or use small blades on special cutting balloons to cut open and reshape the narrowed areas.

“But the stents that are implanted, stay inside. Our primary interest is to allow adequate blood flow to allow the heart muscle to function properly.”

He says although there is no set limit to the number of stents that can be implanted in a person, it is not encouraged to have too many stents in the body, as it is still a foreign metal object in the body.

He adds that the decision of “when not to stent” is as important as “when to stent,” as it should not be considered a universal solution to all “heart narrowings”.

An open discussion between patients and cardiologists on the risks and benefits of the treatment should take place before the procedure.

Outside of an emergency, you do not always have to make an immediate decision and if in doubt, a second opinion is often beneficial in protecting the interests of both the patient and physician.

In conclusion

Dr Goh says living a healthy active life should still be the foundation strategy to keeping a healthy heart.

“Things like hypertension and hypercholesterolaemia have a long latent phase before it declares itself as a problem.

“So, the best time to start looking after yourselves is in your 20s or early 30s.

“By the time that patients come into our clinics in their 40s and 50s, the condition has already been brewing for a very long time.”

He advises men and women over the age of 40 to get routine health checks every year.

Find a doctor that you trust and stay on their follow-up, this is often preferable to changing doctors frequently as a timeline of test results and symptoms is often more informative than a “snapshot” assessment by different doctors.

“Above all, take the same commitment that you give your job or business and apply it to your own well-being – in the end your mind and body are your only true assets in this life.

“And one last thing, Google is not The Lancet!” stresses Dr Goh.

Dr Goh is a KL native. He has recently located to Kuala Lumpur and works at CVSKL.

For more information on Dr Goh, go to www.cvskl.com/doctors/dr-goh-khiam-yan.

KKLIU: 3630/2022

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Tan Sri Rashpal Singh Randhay, chairman of CVSKL Foundation shared that “One of the missions of CVSKL Foundation is to provide support for low-income group patients suffering from cardiothoracic and vascular diseases.

“On behalf of the trustees, we’d like to thank CVSKL for extending a helping hand to these patients.”

Dr Yahya also commented on the philanthropic effort, “I am proud that we can make this an annual occasion to highlight our core belief as a private heart centre in giving back to the society as much as we can.

“I am proud that this continuous effort has made an impact on our underprivileged patients and thankful that we were given such a meaningful chance to aspire others to do the same to improve the quality of healthcare to ensure the B40 patients are not being neglected.” Being the first private cardiac hospital in the region, CVSKL is looking forward to many more future charitable contributions via CVSKL Foundation, non-profit body to strengthen their CSR presence in Malaysia.

The foundation is currently open for donations where no amount of contribution is too small or too big.

For more information, call 03 2276 7002 or email info@cvskl.com.

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