Contraindications
Stent placement is a life-saving procedure, therefore it has no absolute contraindication. Some relative contraindications may compromise the outcome of the procedure or put the patient at potential risk of complications. General guidelines for any angiographic procedure are outlined including some limitations such as renal impairment, which may restrict the capacity of the kidney to metabolize iodinated contrast (injected dye) for the operation, or pregnancy, which would make the radiation exposure contraindicated. Recommendations for peripheral stenting include not to implant stents in the flexing regions such as the popliteal fossa (back of the knee) or easily compressible areas, which may result in stent crushing.
Since PCI is the most common form of stenting procedure, we will enumerate its contraindications into 1. Coagulopathy is a broad medical disorder in which the blood tends to bleed or clot excessively. Patients with uncontrolled coagulopathy will be at a life-threatening risk of internal hemorrhage or another vascular occlusion if they undergo a stenting procedure. Patients with stable angina are usually asked to perform a blood clotting profile to assess their eligibility for PCI.
- Critical left main coronary stenosis without collateral blood flow to the left anterior descending artery from a native artery or a patent bypass graft. Although CABG (coronary artery bypass grafting) is usually preferred in this condition, PCI is increasingly performed for selected patients after careful investigations.
- Stenosis of less than 50% of the artery is considered mild vascular blockage. Cardiologists usually prefer conservative management in treating this case because the risk of stenting or bypassing the occluded artery may outweigh their benefits. In such conditions, doctors prescribe blood thinners such as aspirin and ask their patients to modify their lifestyle by stopping smoking and following a healthier diet.
- An artery with a diameter of less than 1.5 mm is contraindicated to be implanted with a stent because its lumen would be too small and may rupture.
- patients with diffusely diseased arteries without focal stenotic areas wouldn’t get much better after stenting because the procedure depends on restoring the patency of a certain portion of an artery.
