Author: Dr. David Thorpe, DC, DACBOH
I frequently get calls from providers, truckers and motor carriers relating to the specific regulations or guidelines associated with procedures and treatments such as this. To begin with, a stent can be placed in different parts of the body. In this case, the question relates to the heart.
In answering these questions, I often have to ask a few myself to actually come to the correct answer.
- Why did you have the procedure (the stent)?
- When did you have the procedure?
- Did you suffer any other event prior to the stent, such as a heart attack?
- Has your cardiologist done any testing before or after the stent?
These are just a few questions that a medical examiner might ask. There certainly can be more based on the answers.
Let’s start however, by providing the simple answer to “am I disqualified?”…..that answer is no.
You may however be delayed in certification based on some of the answers to the questions above.
WHAT IS A STENT?
A cardiac (heart) stent is a small, metal mesh tube that expands inside a coronary artery. They are often placed following a procedure called angioplasty which is used to expand the artery. During the procedure the doctor will typically use x-ray pictures to carefully guide the catheter (a flexible tube inserted into the artery) up into your heart. Dye is injected into your body to highlight blood flow through the arteries. This helps the doctor see any blockages in the blood vessels that are around your heart.
Angioplasty is often performed when you go to the hospital or emergency room for chest pain, or after a heart attack. Sometimes you are admitted simply for the procedure because you have been treated medically for chronic recurrent chest pain (angina) and the cardiologist has decided that the procedure is appropriate for treatment at that time.
After a wire is inserted, a balloon is actually inflated in the artery to widen the area. The stent is placed in the area to help the artery stay open. The average hospital stay is 2 days or less. Some people may not even have to stay overnight in the hospital.
Generally, the person is able to walk around within a few hours after the procedure depending on how the procedure went and where the catheter was placed. Complete recovery takes a week or less.
WHY ARE THEY PUT IN?
Angioplasty is performed and stents are put in because arteries can become narrowed or blocked by deposits in the artery called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This is often called hardening of the arteries or atherosclerosis.
When treating chest pain, angioplasty and stents are used after medication used to treat the condition is no longer effective, or if the severity of the blockage is enough to warrant performing the procedure. They are often used to treat blockages that have led to a heart attack, or as a result of poor heart function (called heart failure).
Not every blockage can be treated with angioplasty or stents. Some people who have several blockages or the blockages are in certain locations may need to have coronary artery bypass surgery (often simply called bypass surgery like a triple bypass or quad bypass meaning 3 or 4 arteries for example).
ARE THEY SAFE?
Angioplasty and putting in stents is typically a very safe procedure. There are a few risks that can occur however no matter how rare they might be. They include:
- Allergic reactions to the drugs used with certain types of stents (called drug-eluting stent), the stent material, or the x-ray dye.
- Bleeding or clotting in the area where the catheter was inserted. This can also lead to blood clots forming.
- The inside of the stent can become clogged.
- There can be damage caused to a heart valve or blood vessel.
- Heat attack or stroke can occur during the procedure.
- Irregular heartbeats can occur.
The outlook for most people is positive. It will improve blood flow around the heart and will significantly reduce symptoms, especially chest pain. It may help avoid more complicated surgeries like bypass surgery as we had discussed previously in this article. By following your doctor’s orders in improving your diet, taking certain medications if needed (like those to control cholesterol), getting some exercises, and stopping smoking if you do, you will significantly decrease the chances of forming another blocked artery, or even worse, have a heart attack or other heart related issues.
WHAT ARE THE REGULATIONS?
This procedure falls into a category of heart condition called “Ischemic Heart Disease”. This means that there is a lack or reduced blood supply to the heart. This will lead to symptoms of chest pain which typically be following exertion or exercise. This symptom is referred to as angina. Angina can typically be treated with medication, dietary change and exercise and does not always need a stent. If the symptoms become more severe, and/or include chest pain at rest, is called unstable angina.
In cases where the cardiologist feels they wish to continue to manage the angina medically, the driver must be stable (no symptoms at rest) for a period of 3 months (waiting period), and have an acceptable exercise tolerance test (ETT) along with clearance prior to returning to driving. The maximum certification will then be 1 year with annual clearance required from a cardiologist and an exercise tolerance test that meets the minimum requirements (6 METS) every two years thereafter.
If the cardiologist decides to perform angioplasty and put in a stent this changes the scenario. The driver will have to wait a week following the procedure, be provided medical clearance, and have no ischemic issues identified in an electrocardiogram (ECG). The driver can then be considered for certification and must have a new medical exam prior to returning to driving.
The initial certification interval following this procedure is 3 to 6 months (not 1 year), and then the driver will have to have another test called an exercise tolerance test (ETT). If the driver meets the minimum requirements, then the driver will be certified for 1 year thereafter. The driver must have annual clearance from a cardiologist for every recertification (not your family doctor), and have an acceptable exercise tolerance test every two years thereafter.
If another stent is needed to treat a different artery, or if it is done to repair a stent that had failed, then the time table resets every time. Remember the first certification period following angioplasty/stent is 3 to 6 months and there are testing requirements prior to the next certification exam.
If angioplasty and a stent is put in following a heart attack, all guidance changes and relates more to the heart attack. The driver will have a 2 month waiting period, be asymptomatic (no resting chest pain, meaning angina that is unstable), clearance annually from a cardiologist, and the same testing (ECG and ETT that meet the minimum requirements). As with a stent, an ETT will be required every 2 years, but the driver will only be certified for 1 year.
Finally, in the event that the cardiologist decides to perform a bypass surgery, regardless of what has been done before, the driver will then have a 3 month waiting period following the surgery, need clearance from a cardiologist, and have an acceptable ECG and ETT prior to certification. The certification period will be 1 year, and annual clearance will be required from a cardiologist. Lastly, the driver will not need any additional testing in addition to the medical clearance until they are 5 years following the surgery. At that point they will need an ETT every year thereafter.
As you can see, they answer to a simple question becomes more complicated when the question relates to the procedure (the stent). The more important reasoning that helps a driver determine what they need to do to ensure they can become medically qualified with the minimum delay relates to the reason why the procedure had to be performed (angina vs. heart attack). Once this becomes known, then what you need to do becomes more understandable.