Are stents used differently in diabetic patients? 

Coronary artery disease is a significant health consideration for individuals living with diabetes. When arteries become narrowed or blocked by fatty deposits, a procedure known as an angioplasty is often performed to insert a small mesh tube called a stent. This helps to keep the artery open and restores blood flow to the heart muscle. 

While the physical procedure of stent insertion is similar for most patients, the clinical approach for those with diabetes requires specific considerations. This is because diabetes can affect the way blood vessels heal and increases the risk of further blockages. This article explains how medical teams adapt stent use for diabetic patients to ensure the best possible long-term outcomes. 

What We’ll Discuss in This Article 

• How diabetes affects the health of coronary arteries 

• The specific types of stents preferred for diabetic patients 

• Why clinical outcomes may differ between diabetic and non-diabetic individuals 

• The role of drug eluting stents in reducing re-narrowing risks 

• Comparison between stenting and bypass surgery for complex cases 

• Essential aftercare and medication management following the procedure 
   

Are stents used differently in diabetic patients? 

For patients with diabetes, clinicians typically use the same physical procedure to implant a stent, but the choice of the stent itself and the overall management strategy are tailored to address higher risks of re-narrowing. Clinical guidelines from NICE and the NHS generally prioritise the latest generation of drug eluting stents for diabetic patients to improve long term vessel health. 

Diabetes can lead to more diffuse and complex patterns of arterial narrowing compared to those without the condition. Because high blood sugar levels can interfere with the healing process of the blood vessel wall, there is a higher chance of scar tissue forming inside the stent. To combat this, cardiologists focus on: 

• Stent Selection: Using stents coated with specific medications that slowly release into the artery wall to prevent excessive tissue growth. 

• Aggressive Risk Management: Ensuring blood pressure, cholesterol, and blood glucose levels are strictly managed before and after the procedure. 

• Enhanced Imaging: Using advanced internal imaging during the procedure to ensure the stent is perfectly positioned and fully expanded. 

Risks and outcomes for diabetic patients receiving stents 

Research indicates that diabetic patients have a higher risk of restenosis, which is the re-narrowing of the artery after a stent has been placed. Additionally, there is a slightly increased risk of stent thrombosis, where a blood clot forms within the device. However, modern medical advancements have significantly narrowed the gap in outcomes between diabetic and non-diabetic patients. 

The presence of diabetes often means that heart disease is more widespread throughout the coronary arteries. This can make the stenting process more technically challenging. Clinical teams monitor diabetic patients more closely for: 

• In-stent Restenosis: The growth of scar tissue that can block the artery again. 

• Delayed Healing: The vessel wall may take longer to recover after the intervention. 

• Kidney Health: Since the procedure involves using a contrast dye, doctors must ensure the patient’s kidneys, which can be affected by diabetes, are protected. 

Stenting vs Bypass Surgery for Diabetes 

In cases where a diabetic patient has multiple blocked arteries or complex disease, UK clinical guidelines often suggest Coronary Artery Bypass Grafting (CABG) as an alternative to stenting. Large scale studies have shown that for some diabetic patients, surgery may provide better long term survival and a lower risk of future heart attacks compared to multiple stents. 

The decision is usually made by a ‘Heart Team’, which includes cardiologists and surgeons. They weigh the benefits of a less invasive stent procedure against the long term durability of a bypass. Factors influencing this choice include: 

• The number of arteries involved. 

• The location of the blockages. 

• The patient’s overall health and ability to undergo surgery. 

Conclusion 

Managing heart disease in diabetic patients requires a specialised approach to stenting. While the procedure remains a vital tool for restoring blood flow, the use of drug eluting stents and careful management of blood sugar levels are essential to reduce the risk of complications. Most patients find that with correct medical oversight, stenting significantly improves their quality of life and heart function. 

If you experience severe, sudden, or worsening symptoms, such as intense chest pain or difficulty breathing, call 999 immediately. 

Authority Snapshot  

This article was written by Dr. Stefan Petrov, a UK-trained physician with extensive experience in general medicine and emergency care. Dr. Petrov holds an MBBS and is certified in Advanced Cardiac Life Support, ensuring the information provided aligns with current clinical standards. This content is designed to offer clear, evidence-based guidance on cardiac interventions for diabetic patients, prioritising patient safety and NHS best practices.