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What is a stent?
Stent - a small metal mesh tube shape, used for the treatment of narrow and weak arteries.
It is set into an artery in the procedure - angioplasty. This method restores the blood flow through narrow or blocked blood vessels. The stent helps to keep the interior wall of the vessel for a few months or years after treatment.
Also, stents are placed in a weak artery to improve blood flow and prevent their rupture.
These structures are usually made of metal mesh, sometimes - cloth. Fabric stents are used in large arteries.
Some stents coated with a drug which gradually falls on a continuous basis into the blood vessel. This drug-eluting stents. Medication helps prevent restenosis (re-narrowing).
Indications for stenting a vessel Assuta
Treatment of coronary artery
Doctors use stents for treatment of coronary heart disease (CHD). This disease, wherein the waxy substance - atherosclerotic plaques formed within the coronary arteries. They supply blood to the heart muscle, saturating it with oxygen.
Condition in which the plaques formed in blood vessels, called atherosclerosis.
Plaque narrows the artery, reducing the influx of oxygenated blood to the heart. This leads to chest pain or discomfort known as angina pectoris.
Atherosclerotic plaques increase the likelihood of blood clots in the coronary arteries. If blood clots block it, there a heart attack.
Doctors use coronary angioplasty and stenting for the treatment of coronary artery disease. During the procedure, a balloon catheter is inserted into a blood vessel and lead to a blocked coronary artery. Upon reaching the desired area, the balloon is inflated, compressing the plaque. This restores blood flow, reducing angina and other symptoms of coronary artery disease.
Thereafter, the stent is placed inside the artery. It supports the vessel wall and reduces the chance of restenosis or blocking. In addition, the stent is used if the artery is damaged or torn during the percutaneous coronary intervention.
Even with stents, according to statistics, 10-20% is re-narrowing or blockage in the first year after coronary stenting. If this technology is not being used, the likelihood of complications increases 10 times. Benefits of coronary stenting is much higher than the surgical risks, but patients have an increased likelihood of developing type 2 diabetes and renal failure.
Treatment of carotid arteries
Doctors use stents for the treatment of diseases in the carotid artery. Atherosclerotic plaques formed in blood vessels that extend along each side of the neck. According to him the blood enriched with oxygen to the brain.
Formation of plaque restricts blood flow to the brain and creates the risk of stroke. Physicians place stents after angioplasty. Researchers continue to study the risks and benefits of carotid stenting.
Treatment of other blood vessels
Atherosclerotic plaques can narrow and other blood vessels, eg, in the kidneys or limbs. This will affect the work of the kidneys, may cause high blood pressure. When the constriction of vessels in the limbs, peripheral arterial disease develops, causing pain and spasm in the injured arm or leg. Lock completely cut off the blood supply that will require surgery.
To resolve these problems, doctors are turning to angioplasty and stenting. The stent supports the blood vessels, keeping them open.
treatment of aortic
The aorta - a main artery carrying oxygen-rich blood from the left side of the heart to the body. It passes through the chest, sinking into the abdominal cavity.
Over time, some portions of the aortic wall can weaken, resulting in the formation of convexes - aneurysm formation, usually in the abdomen. Aneurysm is able to burst suddenly, causing severe internal bleeding.
To avoid tearing, doctors put a stent, which creates a supportive framework for the artery.
Aneurysms may also occur in the part of the artery, which passes through the thoracic cavity. For their use as treatment of the stents.
Closing a torn aorta
Another problem that can occur in the aorta - the gap of its inner wall. If the blood flow will increase, tear will expand. This will reduce the flow of blood to the tissues. Over time, it will tear the artery, the blood supply is blocked. This usually occurs in the part of the thoracic aorta.
Researchers will develop and test new types of stents that prevent the flow of blood through the aorta ruptures. The stent is placed in the affected area, contributing to the restoration of normal blood flow and reduce the risk of artery rupture.
How do stenting vessels in clinic Assuta?
Doctors set stents during angioplasty procedures. Through a small opening in a blood vessel in the groin (upper thigh), at least in an arm or leg, the doctor inserts a balloon catheter and advances it to the site of constriction.
It uses a contrast agent for the visualization of narrow or blocked areas in the artery. Reaching the desired area, the doctor inflates the balloon, shifting atherosclerotic plaque. It dilates the arteries and help restore blood flow. Thereafter, the stent is placed. The balloon is deflated and removed along with the catheter. The stent stays in the artery. Over time, the cells in the arteries expand, covering the mesh of the stent. They create an inner layer, which looks like a normal blood vessel.
If the vessel is very narrow and it is difficult to achieve with the help of a catheter, may require a large number of steps for the placement of the stent. First, a physician uses a small balloon to widen the artery, and then deletes it. Thereafter, the balloon takes the larger of which is located inside the stent. It - Standard stage - compression of the plaque and stent placement.
Physicians use a special device - filter when the stent in a carotid artery. It prevents the movement of blood clots and plaques in the brain slices during the procedure.
The installation procedure of the stent in an artery with an aneurysm is similar to that described above. However, the stent is used to treat it, it is different. It is made of fabric instead of metal mesh, and often have one or more tiny hooks.
The stent is expanded to a snug fit to the wall of the artery. Hooks cling to the wall, while holding structure in place. The stent creates a new inner lining to this section of the vessel. Over time, the cells in the arteries expand, covering fabric. Forming an inner layer, which looks like a normal blood vessel.
Preparing for the stenting procedure
Most of stenting procedures require hospitalization. The doctor will advise on the following matters:
- When to stop taking food and liquids.
- What medications should be taken of the procedure.
- When it is necessary to come into the clinic and others.
When deciding whether a doctor is bound to be taken into account the presence of diseases such as diabetes, kidney disease to prevent complications.
Before the procedure, the doctor will tell about the preparations that will need to take after. They prevent thrombus formation associated with the presence of the stent.
During vascular stenting clinic Assuta
The procedure usually takes about an hour. But it may take longer if the stents placed in several arteries. Before the start of the patient will be given medicine that promotes calm. He will be awake, lying on his back.
Local anesthesia is applied to the area where the catheter will be inserted. The patient will not feel the catheter moves through the arteries. Perhaps feeling some pain when the balloon will be inflated to fix the stent.
Stenting for aortic aneurysms
Although this procedure takes only a few hours, often require hospitalization of 2 to 3 days.
Before stenting patient is prescribed a sedative. If you plan to install a stent in the aorta in the abdomen area, local anesthesia in the abdominal area. The patient is conscious.
When the planned placement of the stent in the aorta in the chest cavity, using general anesthesia.
After a local or general anesthesia, the doctor makes a small incision in the groin, will insert a catheter into a blood vessel to carry through to the affected area.
Sometimes perform two cuts (in the groin area on each foot), if it is assumed stent in two zones. The patient will not feel the advancement of the catheter, balloon and stent inside the artery.
Rehabilitation after vascular stenting
After any stent placement procedure, the doctor removes the catheter from an artery, a place of its introduction - ligated.
On top of the bandage placed little weight to apply pressure and prevent bleeding. The patient will be for a limited time in the intensive care unit, and then in the House, his movement will be limited.
Nurse regularly checks the heart rate and blood pressure, also ensures that there are no bleeding from the catheter site. There may be a slight bruise or hard "knot", some pain may occur within a week.
It is important to consult a doctor if:
- Constantly flowing blood from the catheter site, either in a large amount, it does not stop using the bandage.
- There is an unusual pain, swelling, redness, or other signs of infection in the field.
Treatment after stenting
Most likely, the doctor will prescribe aspirin and other antiplatelet drugs-drugs that have a suppressive effect on blood clotting. They prevent thrombus formation due to the presence of the stent within the artery. The thrombus can cause heart attack, stroke or other serious problems.
When using metal stent, aspirin and other medications antisvertyvayuschey lasts at least one month. If the stent has a coating drug, duration of treatment can be 12 months or more. The attending physician to ascertain the best course of therapy.
The risk of blood clots increases significantly if early stop taking drugs antisvertyvayuschey. It is important to strictly follow the doctor's recommendations. You may need to take aspirin for the rest of life.
If the operation is scheduled for any other reason, it is necessary to inform the doctor about taking these drugs because they increase the risk of bleeding. In addition, they can cause side effects such as an allergic rash.
You should avoid intense exercise and heavy lifting shortly after stenting. Doctor say when the patient can return to normal activities.
Metal detectors at airports and other similar devices do not affect the data structures within the body.
If the stent is mounted in the aortic tissue, the doctor will prescribe a series of X-ray studies in the first year, then you need to test will be held annually.
Lifestyle after stenting
Stents help prevent narrowing of the arteries and block them months or years later. However, they are not a cure for atherosclerosis or risk factors.
Changing your lifestyle can help prevent the formation of sclerotic plaques in the arteries. The doctor will advise in detail on these matters.
Lifestyle changes can include changing diet, not smoking, regular physical activity, weight loss, stress reduction level. It is also important to take all the medicines prescribed by a doctor. The doctor may recommend statins - drugs to reduce blood cholesterol levels.
Possible complications after stenting vessels
Risks associated with stents
Approximately 1-2% of people with the stented artery thrombus formed at the site of the stent. Blood clots can cause heart attack, stroke or other serious problems. The greatest risk of thrombotic events occur during the first few months after installation of the structure.
Most likely, the doctor recommends aspirin and antisvertyvayuschey drugs such as clopidogrel, from a month to a year or more. They help to prevent this complication.
The length of time of reception of these preparations depends on the type of stent. Aspirin treatment can be life-long.
Drug-eluting stents may increase the risk of blood clots. However, studies have not shown that these stents increase the risk of heart attack or death when used in accordance with the doctor's recommendations.
The potential consequences of cardiac stenting
Angioplasty and stenting carries a small risk of serious complications, such as:
- Bleeding from the portion where the catheter was inserted.
- Damage to the artery catheter.
- Arrhythmia (irregular heartbeat).
- Kidney damage provoked contrast agent used during stenting.
- Allergic reaction to the contrast.
- The development of infection.
Another problem that may occur following angioplasty and stenting - significant growth of tissue in the affected area. This leads to a narrowing or blockage of the artery. This condition is called restenosis.
The use of drug-eluting stents help prevent this problem. As used drug stops the growth of excess tissue.
The use of radiation in this zone promotes tissue growth delay. For this purpose, the physician introduces the wire through the catheter to the structure. It emits light by stopping the growth of cells around the stent, preventing blockage.
Possible complications after stenting of the aorta in the abdomen
Although rare, some serious problems arise, when the stent is used for aortic aneurysm in the abdominal cavity. These include:
- Aneurysm rupture.
- Blocking the blood supply to the stomach and lower body.
- Paralysis of the legs due to blood flow interruption to the spinal cord (extremely rare).
Another possible problem is to move the stent further down the aorta. Sometimes it comes a few years after stenting. This will require the installation of a new stent in the area of the aneurysm.