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What is coronary stenting?
A stent is a tiny wire frame. He opens the artery and remains inside it. When the coronary arteries leading to the heart muscle, is narrowed due to fatty deposits in the form of plaques, reduced blood flow to the body. The deterioration of blood supply causes chest pain. In the case of formation of a blood clot in the artery of a heart attack occurs. The stent helps to keep the coronary artery open and decreases the likelihood of an attack.
To open a narrowed artery, the doctor performs percutaneous coronary intervention or angioplasty. The catheter is introduced into the artery and moved to the site of blockage. Balloon placed inside inflated, it compresses the plaque and widens the narrowed place. When the hole in the vessel increases, the balloon catheter is deflated and removed.
Coronary stenting was designed to eliminate some of the shortcomings of angioplasty. Angioplasty - a technique that is used to expand the area of the blockage of the arteries using a catheter with a small inflatable balloon at its tip. Despite the fact that this method was introduced over two decades ago, it still remains the most frequently used procedure in cardiac surgery.
However, coronary angioplasty has two drawbacks. First, the opening of the artery inhomogeneous because the balloon expands its unevenly in all directions. Channel formed irregular shape with a rough surface, which is covered with the surface or deep cracks. A very small number of patients, this increases the risk of complete closure of the artery.
Secondly, part of the compressed material tends to "expand to a". This leads to the fact that the channel becomes smaller. In addition, deposits in the extended channel start to increase, causing it gradually narrowing. In 30-60% of cases, the patient's condition is returned to the original later or worsens. This occurs during the next period of time - from 6 weeks to 6 months, and is called restenosis.
Stent - a metal "grid", which is set during the angioplasty the artery. The balloon is inflated, the stent expands the opening in the end diseased segment has a round, flat and large opening. Stents provide a more predictable result, reduce the risk of a sudden closure of the artery during the procedure, reduce the likelihood of restenosis is almost 50%.
Like angioplasty, coronary stenting opens a channel of the affected artery segment, removes pain in the chest, improves quality of life and reduces the risk of other complications of the disease. Since the procedure is performed through a small hole in the groin (sometimes hand region), it is much safer than invasive surgery.
In recent years, doctors have used new types of stents - drug-coated. Used in coating formulations to help prevent re-narrowing of the artery. It is important that patients with any type of stent take anticoagulation medications. If this method proves to be ineffective, turning to aortokoronaromu bypass.
Despite the benefits of coronary stenting compared with angioplasty, why it is not used in every case?
Stents are difficult to deliver through the complex bends of blood vessels (especially if there are large deposits of calcium), as they are not suitable for use in very small blood vessels. According to statistics, this technique is used almost 50-75% of cases.
Price coronary stenting vessels of the heart
The cost of procedures in Assuta is $ 17 900. It involves the payment of the surgical team, anesthesiologist and surgeon; hospitalization in intensive care and in hospital, and the cost of operating the stent.
Indications for coronary artery stenting
This technology is used in the treatment of coronary heart disease. Coronary stenting is usually carried out in a "planned procedure" - is assigned to the date and time of the procedure.
However, it is accessed in an emergency, a heart attack, which is due to produce insufficient amounts of blood. The reason is a blockage artery supplying blood to the heart.
Angina pectoris is accompanied by pain. The reason for it - the narrowing of one or more coronary arteries. This reduces blood flow to a part or the entire body. Lack of blood supply, generally arises with increasing exercise, requiring additional blood volume delivery.
How to perform coronary stenting in Assuta?
Before the procedure, the doctor determines the location and type of occlusion, the shape and size of the coronary arteries. This helps the cardiologist to decide on the choice of treatment - whether it is advisable to proceed with angioplasty or consider other treatment options - angioplastku, atherectomy, drugs or surgery.
Performed cardiac catheterization - a specialized study, in which a catheter is inserted into an artery in the groin or arm and guided under X-ray control to the heart. During catheterization the physician can measure the pressure or introduce contrast agent through a catheter that allows to visualize the arteries which are not usually visible under X-ray examination.
After analyzing the results of diagnosis doctor determines the dimensions of the coronary artery and selects the type of balloon catheter and stent. The patient is administered heparin. In most cases, stenting is preceded by angioplasty. Applicable blood vessel dilation balloon smaller (predilatation). This helps open up the area and put a stent occlusion.
Conductor, which is a very thin wire with a flexible tip is inserted into the catheter. It is directed through the lock and move on. He - "conductor" or "rails" in which a catheter is moved. The balloon catheter is positioned across the lesion. The balloon is inflated by connecting the special manual pump and using a mixture of saline solution and contrast agent. The balloon catheter has a metal markers (on either side of the balloon). Unopened stent mounted within these visible markers that help the cardiologist to be aware of the location of the stent, where the visibility is very poor.
Inflation (inflation of the balloon) is first carried out at a pressure of 1-2 atmospheres, then it is increased to 8-12, and sometimes up to 20 atmospheres, depending on the type of stent. Cylinder kept in this state for 30-60 seconds, then deflated. Introducing the expanded stent to the affected area. If the cardiologist is not satisfied with the result, for the expansion of the stent it uses a different cylinder (often the same balloon catheter, which is used for pre-dilatation).
The patient remains conscious throughout the procedure, mild sedation is used for relaxation and comfort. The balloon catheter is withdrawn from the body after reaching the desired results.
The patient is directed into the chamber. After about 6 hours, he can walk with assistance. Prescribe it, as a rule, the next morning.
How long coronary stenting vessels of the heart?
The procedure takes from 30 minutes to two hours. The duration depends on the technical complexity and number of cases of balloon catheters, which need to be used.
Is it safe to coronary stenting?
As with all types of surgery, coronary stenting carries a risk of complications. However, the chance of serious problems - low.
Complications that may arise during and after the operation:
- Bleeding or bruising under the skin, wherein the catheter is inserted - is estimated that 1 out of 20 cases.
- Damage to the artery, where the catheter is inserted, there is less than 1 in 100 cases.
- Allergic reaction to the contrast agent used during stenting occurs in 1 out of 100 cases.
- Damage to the coronary artery, according to statistics, it happens in less than 1 out of 350 cases.
- Severe bleeding requiring blood transfusions - in 1 of 100 cases.
In the hands of experienced cardiologists with the presence of modern equipment, according to statistics, the risk of death during stenting is less than 1%, and the probability of requiring emergency bypass surgery is about 2% or less. It is a relatively safe procedure, which takes place all over the world. hospitalization period not exceeding 23 hours.
The risk of other serious complications of less than 4%, it is similar to cardiac catheterization procedure. Risk of heart attack and bleeding above. However, the risks are relatively low and acceptable in most cases, when an analysis of the potential benefits and risks.
The deterioration of kidney function (particularly in diabetics and in people with kidney disease) is higher compared to the catheter due to the large amount of contrast agent used. In such cases, the cardiologist takes extra precautions that prevent a possible complication.
The stent is fully covered by natural tissues for 4-6 weeks, and the risk of thrombus formation at this time is virtually nonexistent. In very rare cases (1 in 200), the thrombus formed in the first two weeks after the procedure. Such patients develop symptoms of heart attack.
Who is most at risk?
Several factors increase the risk of complications of coronary artery stenting:
- Age - the older the patient, the higher the chance of unwanted effects.
- Was the operation planned or actual treatment after a heart attack. Urgent treatment is always accompanied by a large number of risks. Because doctors have less time to prepare it, and the patient is in poor condition.
- If there are kidney diseases. The contrast agent used in the course of operation, sometimes causing further damage to the kidneys.
- When blocking occurs more than one coronary artery.
- If a history of severe heart disease, including heart failure.
Doctors Assuta blades provide more information about the level of risk, taking into account the individual characteristics of the patient's body.
Treatment after coronary stenting
Stents are foreign metallic objects inside the blood vessel. Therefore, special precautions are needed to prevent the formation of blood clots. Appointed by drugs that make blood platelets less active. For example, a combination of soluble aspirin and Plavix (clopidogrel). Drugs given before surgery or during it.
Aspirin patient can continue indefinitely if there is no allergy to the medication and do not develop any problems associated with it.
Receiving Plavix can last from one to 12 months (and possibly longer) after the operation depends on the type of stent. It can cause side effects, therefore, need periodic blood tests. It is important to carefully follow the Nominating cardiologist who has been treating coronary artery disease.
If the patient has an allergy to aspirin or Plavix, or he is not able to take these drugs because of bleeding or other problems, the cardiologist may use alternative medicine (depending on the problem) and even delay the placement of the stent, or to abandon this method.
Rehabilitation after coronary stenting
Before you leave the doctor Assuta Hospital provides guidance on:
- changes in diet and lifestyle;
- care of the operating area.
There will also be agreed upon date subsequent reception to check the status.
There are bruises on the skin where the catheter was inserted. This is not a serious injury, noted some discomfort for a few days. Sometimes the wound can become infected, it is important to make sure that healed normally.
Within a few days after stenting have pain in the chest. To resolve symptom taking paracetamol.
Assuta Hospital doctors advise how many will take the recovery process, and whether it is necessary to abandon any particular activity. In most cases, it recommends avoiding heavy lifting and strenuous exercise for a week or as long as the wound heals.
Approximately seven days after coronary stenting is impossible to drive a car.
After elective surgery returned to work after a week, in case of emergency, after a heart attack - it will take several weeks or even months for a full recovery.
If earlier sex life suffered as a result of the disease, once a patient recover after stenting, he can return to a more active sex life. In case of any problems, you should consult with your doctor. According to experts, sex - equivalent to climb two flights of stairs from the point of view of stress on the heart.
After surgery, the patient needs to take steps to reduce the risk of problems in the future:
- try to lose weight if you are overweight;
- quit smoking when the habit;
- follow a healthy diet low in fat and salt;
- be physically active on a regular basis.
Smoking and weight - two main causes of cardiovascular diseases. they also reduce the effectiveness of treatment.
What are the advantages of using stents?
It reduces the risk of stent restenosis by about 50% as compared to balloon angioplasty.
Furthermore, the procedure is minimally invasive. Patients recover much faster than after CABG.
Alternative to coronary stenting vessels of the heart
The most common alternative to surgery - coronary artery bypass grafting (CABG).
This operation, which creates the affected portion of the artery bypass. It is performed using healthy blood vessel segments - graft taken from another area of the body. Part of the vein or artery of the legs, arms and chest is used to create a new channel through which direct blood to bypass the blocked portion of the artery. This ensures a normal blood supply to the heart muscle.
Complications of CABG are rare, but are potentially serious. These include heart attack (15 of 50 cases), stroke (1 out of 50 cases).
CABG is recommended when there is a blockage and narrowing of multivessel coronary artery disease. However, this operation is not suitable for people with poor health.
Coronary artery bypass surgery is performed as if the anatomy of blood vessels prevents stenting.
CABG, as a rule - a more effective treatment option for people over 65 years, especially with the diagnosis - diabetes.
It is important to discuss the benefits and risks of treatment with both types of cardiology and cardiac surgery, before making a decision.
Other approaches angioplasty
Also can be applied other types of angioplasty in case of difficulties with the removal of deposits in the arteries:
- Percutaneous transluminal coronary rotational atherectomy, which uses a tiny drill to remove atherosclerotic calcified plaque.
- Percutaneous laser coronary angioplasty uses a laser to eliminate fat.
These procedures seek, if a coronary artery is at a high level of calcium, making it rigid and does not allow the proper use of balloons and stents to eliminate the restriction. Once the plaque is removed, carry out coronary stenting.
Coronary stent with a drug coating on the basis of delivering Endeavor®. He opens the blocked artery and restore blood flow, supports the blood vessel after the surgery. The system releases the drug to limit the excessive growth of cells during the healing.
The stent is made of cobalt alloy modern. The modular design makes it flexible to penetrate into hard to reach places. It significantly reduces the likelihood of restenosis in the treated area, compared with a stent without drug coating.
It is intended for the treatment of coronary heart disease. Increases blood flow to the arteries and keeps it open. A stent is a kind of scaffolding that provide ongoing support artery after angioplasty. Feature - ultrathin, round struts reduce the load on the fabric. Made of modern cobalt alloy.
Frequently asked questions and answers about coronary stenting vessels of the heart
It is important to know that the doctor - the best source of information and advice. Consider the most common questions.
1. What is a stent is suitable in a particular case, with or without drug coverage?
We need to discuss all treatment options with the cardiologist. After diagnosis it determines the best option.
2. How long will need a stent?
The stent will be used throughout the rest of his life. It is designed to be constantly within the coronary artery to provide long-term protection.
3. The stent Will be felt?
No, people will not feel the presence of the stent.
4. Can the stent move?
Once it will be placed inside a coronary artery, it will remain in place on a continuous basis. Vascular tissue will grow around it and hold in place.
5. Do the following procedure is safe - MRI, mammography, CT, x-ray, nuclear stress test?
Before you pass these tests, you must put in the doctor aware of the presence of the stent. Mammography, CT, X-ray and nuclear stress tests are considered safe. If you want to be an MRI technician will be required to operate the equipment within a certain range.
6. Will there be problems at airports or during the passage of checkpoints in stores?
human passage through metal detectors with a stent or checkpoints will not cause an alarm and will not harm the stent.
7. How long will you need to take medication?
The most important - to minimize the risk of thrombus formation. This means taking medications strictly prescribed by a doctor, even if the condition is greatly improved. Ate implanted drug-eluting stents may have to take drugs for a long period of time - a year or longer.
8. Vozobnovyatsya whether coronary heart disease symptoms again, for example, pain in the chest?
Manifestations of the disease can reappear due to restenosis or the emergence of a new blockage elsewhere. If these symptoms occur, it is important to inform your doctor immediately.
9. How do I determine that the artery is narrowed?
While stents are designed to prevent restenosis, it is still possible. If this occurs, symptoms similar to those experienced by earlier to stenting. This chest pain or shortness of breath, especially during physical activity.