Internal pudendal artery stent

Content Written By: Irwin Goldstein, MD

An internal pudendal artery stent is a tiny wire tube or metal scaffold placed within the internal pudendal artery to treat cholesterol blockages that reduce arterial blood flow to the penis during sexual stimulation that cause erectile dysfunction and decreased erection hardness. Similar stents and procedures are used in the arteries of the heart and in arteries in the legs. The goal is to unblock the artery blockage, so that during sexual stimulation, there will be increased blood flow to the erection arteries and increased penile hardness. The patient with erectile dysfunction who is a candidate for internal pudendal artery stenting will have already undergone testing so show that the blood trapping mechanism (corporal veno-occlusion) is functioning normally. Thus, the patient with erectile dysfunction who is a candidate for internal pudendal artery stenting has the diagnosis of arteriogenic erectile dysfunction.

Treating a blocked internal pudendal artery in a man with arteriogenic erectile dysfunction happens as follows. The interventional cardiologist or radiologist uses x-rays of the arteries (arteriography) to assess the location and estimate the size of the artery blockage. The physician injects an x-ray dye (contrast medium) through a guide catheter and viewing the flow of blood through the internal pudendal arteries. The physician uses this information to decide whether to treat the artery blockage with a stent.

The internal pudendal artery blockage is first dilated. Dilation is accomplished by threading through the blockage with an ordinary balloon catheter (with no stent attached) and expanding it to the artery's original diameter.

Drug eluting stents have anti-proliferation chemicals on the tiny wire tube that helps prevent blood clotting. The stent is in its collapsed form attached onto the outside of a balloon catheter. The physician withdraws the balloon catheter and threads the stent on its balloon catheter through the blockage. The physician expands the balloon that deforms the metal stent to its expanded size.

The internal pudendal artery stent consists of a tiny (2-4 mm) metal framework that can be placed inside the artery to help keep it open. The stent, however, is a foreign object that induces an immune response and the tendancy for the devlopment of scar tissue (cell proliferation) to develop over the stent. The drug eluting stent helps prevent this scar tissue growth. The stent releases an antiproliferative drug to help avoid re-narrowing of the artery. There is also a strong tendency for blood clots to form at the site where the stent is placed against the arterial wall. Antiplatelet therapy helps prevent clots. Patients should take clopidogrel (plavix) for at least six months or more and aspirin indefinitely.

Internal pudendal artery stent are currently being placed as clinical research trials. Long-term safety and efficacy data are not yet available.

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