Stand in the heart for how long it serves. Complications after coronary artery stenting

Modern cardiology has a whole arsenal of means to combat coronary heart disease and prevent myocardial infarction, which claims millions of lives every year. One of the methods is stenting of the coronary arteries. What is it, and what results can be expected after cardiostenting?

Why is a stent needed in a vessel?

Angina pectoris and myocardial infarction are manifestations of cardiac ischemia - a disease associated with oxygen starvation of the heart muscle. The deterioration of her nutrition is the result of a violation of blood circulation in the coronary arteries that supply blood to the heart.

Insufficient blood supply due to narrowing (stenosis) of the arteries as a result of clogging cholesterol plaques. Blood clots are no less dangerous.

To increase the lumen in the vessel, a stent is placed in it. It is a flexible mesh structure that expands the vascular bed, restoring normal blood flow. Today in specialized cardiology centers such an operation is done to all patients with myocardial infarction.

Stents are placed in the right coronary artery (RCA), anterior interventricular branch (LAD), left coronary artery (LCA) and aorta.

Types of stents and their features

A stent is a cylindrical spring made of a special metal or plastic. It is introduced into the affected vessel in a compressed form and straightened in the right place with the help of a balloon, which is pressurized. The balloon is then removed, and the spring remains in place, holding the vascular wall.

Types of stents differ in design, as well as in the material from which they are made.

In cardiac surgery, the following designs are used:

Made of thin wire, they are called so - wire;
Consisting of separate links in the form of rings;
Representing a solid tube - tubular;
Made in the form of a grid.

At acute conditions(during a heart attack or an attack of unstable angina), bare metal stents are more often used. They are used when narrowing coronary arteries does not reach critical level and the likelihood of further stenosis is low.

Drug-eluting stents

New generation stents are manufactured with a drug coating that prevents complications and reduces the risk of re-occlusion of the artery.

There are several types of such stents. They are metal structures with a polymer coating, on which a layer of a drug is applied that inhibits the growth of vessel tissue.

Gradually, this medicine enters the body, and the polymer dissolves. There remains a metal frame that supports the walls of the artery. Biocompatible drug-eluting stents are widely used in European and Russian clinics.

Biosoluble stent

State of the art stent- scaffold. It performs the role of scaffolding in the vessel. The principle of operation is as follows- after insertion into the artery, the stent maintains its walls in the desired state.

An atherosclerotic plaque previously destroyed by a special spray must heal so that blood clots do not form on it. In the period from 3 to 6 months, the stent “works”, releasing a drug that heals the vascular endothelium (inner shell) and prevents it from growing pathologically.

The scaffold is made of the thinnest metal mesh (almost 20 times thinner human hair) with a biosoluble polymer coating . Six months later, the structure is completely covered with endothelium, and the polymer coating containing the drug dissolves. As a result, the normal lumen is preserved in the artery, and its walls remain elastic.

Advantages, disadvantages and service life of stents

Coronary stenting solves many problems associated with atherosclerotic lesions of the arteries. It allows you to restore blood circulation, improves the quality of life of patients with coronary heart disease, prevents myocardial infarction. Still, stents are not perfect, along with advantages, they also have disadvantages.

The advantages of stenting surgery are:

Less traumatic compared to open surgery on the heart;
Using only local anesthesia;
Short rehabilitation period;
High result - more than 85% of operations are successful.

The disadvantages of stenting include:

The risk of complications and re-stenosis is lower with drug-eluting stents;
The complexity of the operation in the presence of calcium deposits in the vessels;
The presence of contraindications.

In addition, the metal structure remaining in the vessel wall impairs its ability to contract and relax. Incompletely resorbed polymeric material containing the drug can cause separated effects in the form of allergies.

How long will the stent last?

The service life of stents depends on many factors:

Survival of the stent (rejections are extremely rare);
Compliance by the patient with all the prescriptions of the cardiologist for the next year (in some cases, this is how long the special therapy lasts);
Good patient tolerance of the necessary drugs;
The presence or absence of others serious illnesses such as diabetes, trophic ulcers or stomach ulcers.

Under all favorable conditions, the stent will serve until the end of life.

Indications and contraindications for surgery

Not all patients with ischemia of the heart require stenting.

It is carried out only in the following cases:

Pre-infarction state with the threat of development acute infarction myocardium;
Unstable angina;
Progression of angina pectoris with frequent severe attacks that are not relieved by nitroglycerin;
Acute heart attack;
The occurrence of angina attacks the first 2 weeks after an acute heart attack;
Stable angina 3 and 4 functional class;
Re-narrowing of the artery after stent placement.

There is a group of patients who are indicated for the placement of a drug-eluting stent.

These include patients:

diabetes mellitus;
On hemodialysis;
With re-stenosis after the installation of a bare-metal stent;
With the development of graft stenosis after coronary artery bypass grafting.

Contraindications

There are a number of contraindications for stent placement (even in emergency cases):

Severe respiratory, hepatic and kidney failure;
The period of acute stroke;
Current infectious diseases;
internal bleeding;
Reduced blood clotting with the threat of bleeding.

The contrast agent for X-ray control of the operation contains iodine. Therefore, people who are allergic to it cannot have a stent placed. Do not use this method with an arterial lumen of less than 3 mm and with general atherosclerotic damage. vascular bed.

Operation steps

The procedure for installing a stent requires preparation of the patient. At this stage, coronary angiography is performed to clarify the localization of the blocked vessel and determine the degree of its damage. In an emergency, additional blood tests and ECG are done, in case of planned operation a more thorough examination of the patient.

It includes:

Laboratory tests of urine and blood - general and biochemical, determination of blood clotting, hepatitis and HIV;
Cardiac examinations - echocardiography, daily ECG monitoring, ultrasound of the coronary vessels with duplex scanning and dopplerography.

If necessary, magnetic resonance or computed tomography is also prescribed. Before the operation, the patient is given drugs that thin the blood and prevent the formation of blood clots, as well as a sedative medicine.

How is a stent placed?

Access to the coronary arteries is through femoral artery or by hand. Second way – introduction of an introducer with a stent through the radial artery of the forearm- is used more often due to more easy access to the coronary vessels.

Operation procedure:

The puncture site is anesthetized and a conductor with a balloon is inserted into it.
With the blood flow under X-ray control, it reaches the right place in the artery;
After the balloon is fixed in the right place, it is inflated with a syringe;
Under pressure, atherosclerotic plaque is destroyed;
The conductor with the balloon is removed and a stent with a balloon inside is installed in its place;
The catheter is re-introduced into the affected vessel, the balloon expands under pressure and opens the stent, firmly fixing it on the walls of the artery at the site of the destroyed plaque.

After the operation, the patient is in the ward intensive care within 1 - 2 days, then transferred to the general. Rehabilitation after stenting consists in limiting mobility and takes from 5 to 7 days, after which the patient is discharged from the hospital.

How to live with a stent?

Life after the operation must be subject to certain rules. Before discharge, the doctor gives recommendations on taking medications, physical activity and diet.

Video: All about cardiac stenting

After the operation, the patient immediately feels relief.- shortness of breath, retrosternal pain and other symptoms of angina disappear.

In order to avoid complications and re-stenosis in the future, the following conditions must be observed:

Constantly take during the first year medicines prescribed by the doctor. These are drugs that prevent the formation of blood clots (Plavix, Aspirin Cardio or Cardiomagnyl). After a year, you can reduce their dosage.
Eliminate or severely limit food containing animal fats, refuse salted, smoked and pickled foods. If necessary, take statins that lower blood cholesterol levels.
Hypertensive patients need constant pressure monitoring and intake antihypertensive drugs prescribed by a doctor. This will help reduce the risk of heart attack and stroke after stenting.
Should get rid of bad habits.
Mandatory dosed physical activity. Enough to do daily hiking for 30 - 40 minutes.

During the year, while taking drugs that reduce blood clotting, it is worth avoiding injuries and cuts. If urgent surgery is needed during this period, the attending physician should know how much time has passed since the stent was placed. These conditions must be strictly observed when installing a drug stent. Simple bare metal does not require such therapy.

Heart disease in our time is much "younger". Cardiac stenting is often performed on very young men. A successful operation without complications allows them to continue to live a full life.

How long do people live after stent placement

With a healthy active image life, all medical advice and the absence of others serious illnesses the life expectancy of patients with ischemia of the heart is significantly increased. Patient reviews also testify to this.

Possible Complications

The operation of stenting today is considered routine and fully technically developed. Therefore, complications after its implementation are rare.

However, they do exist and are as follows:

During the operation this may be an allergy to the drugs used, bleeding (no more than 1.5% of cases), the occurrence of arrhythmia, the development of an angina attack and myocardial infarction;
Postoperative- this is a hematoma at the entrance to the femoral or radial artery (common), aneurysm, arrhythmia, thrombosis;
distant- thrombosis, re-narrowing of the artery.

How much does coronary stenting cost in Russia and Ukraine

In emergency cases, when the installation of a stent is carried out for health reasons, it is done as part of compulsory medical insurance. That is, it is free for the patient.

The cost of a planned operation consists of many components and is calculated individually depending on the cost of the operation. The price of stenting for Ukraine and the Russian Federation is approximately comparable. In Russia, a stent can be placed for 100-150 thousand rubles, in Ukraine the operation will cost 30-40 thousand hryvnias.

Coronary stenting is one of the most sparing and modern ways treatment of constricted blood vessels hearts in cardiac surgery. It allows you to expand the lumen of blood vessels, restore normal blood circulation and tissue nutrition, and prevent the development of heart attacks and strokes.

The procedure is fast, carried out under local anesthesia painless for the patient.

The first operation was performed in the late seventies of the 20th century by the German cardiologist Andreas Grunzig. His patient was a young thirty-seven-year-old man suffering from hypertension and on the verge of a stroke.

To rid him of severe pain the doctor decided to try surgically expand the lumen of the vessels with a simple inflatable balloon, made literally from improvised means. The experiment was successful. Cardiac catheterization performed after 20 years showed that the treated artery still remains open.

This method was later called balloon dilatation. Then it was improved and modern cardiac surgery began to use new types of structures - stents.

Modern stenting

Grunzig's developments formed the basis for the birth of the method and became the basis for the creation of modern methods for performing an operation to expand blood vessels.

Currently, more than 2 million patients have been stented in Germany alone. Successfully This method is practiced in our country as well..

What is a stent?

A stent is a special elastic structure in the form of a cylindrical frame made of metal or plastic. In the body, it provides an expansion of a certain area for better fluid permeability. In this case we are talking about installation in an artery to improve blood flow, but can also be installed in the intestines, esophagus, ureter and biliary tract.

Types of stents

In surgical practice, they are divided into the following types.

Bare metal

Successfully used in acute situations (myocardial infarction, unstable angina), for the treatment of stenosis of the large coronary arteries of the heart with a low risk of restenosis (re-narrowing). They are made from various metal alloys - tantalum, nitinol, iridium, platinum, cobalt alloys.

With drug coating

Found wide application in surgical therapy ischemic heart disease. Cytostatic (drug coating) prevents the development of complications - reocclusion and restenosis. Subdivided into different types:

The fourth generation constructs (suits) are the most modern and relevant for cardiac surgery. Their main advantage is complete resorption. The diameter of the lumen of the vessels remains almost identical to the physiological size.
Third-generation constructs are made with or without a bioresorbable polymer coating. The drug is then fixed on the porous wall of the structure, gradually releasing it into the body. Most European clinics work with them.
Second-generation stents (biocompatible) show good results in the treatment of coronary stenosis, have a low risk of thrombosis. Often used in Russia.
First generation designs are almost never used due to frequent occurrence complications - early and late thrombosis, microaneurysms, development of a heart attack.

In addition, coronary stents subdivided into:

Wire - made of one thin wire.
Ring - assembled from individual links.
Mesh - in the form of a woven mesh.
Tubular - from a cylindrical tube.

Advantages

Compared to others surgical methods stenting has obvious benefits:

The main one is that the operation belongs to minimally invasive surgery. The doctor does not need to open the sternum, as in open heart surgery. The process is carried out through a small puncture in the skin (about 2 mm) at the site of the catheter.
The procedure is performed with the introduction of local anesthesia. The patient is conscious throughout the entire time. This eliminates possible complications and side effects associated with the introduction of deep anesthesia.
You do not need to stay in a hospital for a long time. The patient is discharged home for 3-4 days.
High efficiency - in about 80-95% of cases (depending on the type of stand and coverage).

Flaws

The disadvantages of the method are:

The risk of developing complications (heart attack, thrombosis, etc.) and restenosis (in 15% of cases out of 100%). In patients with a high risk of developing restenosis, drug-eluting constructs are recommended.
Despite the convenience of the procedure, the installation process is quite laborious, especially if there are large calcium deposits in the body.
The disadvantage of the method is also its limited application in cardiac surgery. It is impossible to use it in case of detection of prolonged vasoconstriction, damage to the arteries at the branching site. It is impossible to install a stent in the small blood vessels of the heart.

Indications and contraindications

The operation may be appointed in the following cases:

myocardial infarction in acute stage(the first hours of its development).
Progression of angina pectoris with frequent unpredictable attacks, as well as early post-infarction angina pectoris, when attacks recur during the treatment of myocardial infarction.
To maintain artificial blood flow after shunting. Within 10 years, it has the property of narrowing.
Complications after a previously installed stent (restenosis, thrombosis).

Contraindications:

Relative contraindications may be:

Diffuse coronary disease
Respiratory and renal failure in severe form.
Blood clotting disorders.
The diameter of the artery is less than 3 mm.
Allergy to iodine and iodine-containing drugs. In this case before surgical intervention the patient may be given drug therapy reducing the risk of complications.

Preparing for the operation

Before the operation, the patient is assigned all the necessary tests and examinations to assess the physiological state of the patient, assess the nature of the blood supply to the affected area, the degree of narrowing of the arteries and their blockage, blood flow rate, etc. These include:

Examination and detailed study of the anamnesis. The doctor collects data on the presence chronic diseases conducted medical interventions, past illnesses hearts, etc.
General analysis of blood and urine, biochemistry, coagulogram, blood test for HIV and hepatitis.
Diagnosis of cardiac activity and blood vessels: echocardiography, ECG, Doppler mapping, Holter monitoring, MRI, CT scan heart, ultrasound (dopplerography and duplex examination), coronary angiography.

It should be noted that the types of research are selected by the doctor individually based on each specific case.

Preparation rules

On the eve of the procedure, the doctor asks the patient to perform some simple rules:

The last meal should be no later than 8-9 pm. On the eve you can not eat anything fatty, smoked, salty, drink carbonated sweet drinks and alcohol. Dinner should be light, and in the morning it is allowed to drink only plain water.
Blood thinners (aspirin) are prescribed beforehand to reduce the frequency of ischemic complications. Clopidogrel, ticarelor, ticlopidine, and other platelet P2Y12 receptor inhibitors may also be given.
The patient must notify the doctor about the reception medications and their dosage. It is possible that some of them will have to be temporarily canceled. It is also important to report any allergies to local anesthetics and iodine.
Before the procedure, you will need to remove contact lenses and jewelry (chains, earrings, rings).
The catheter will be punctured in the arm or leg. If you plan to make a puncture in the groin area, you will need to shave off the hair in this area.

How the operation is performed

The procedure is carried out in several stages:

First, the doctor establishes monitoring of physiologically important body functions (observation of blood pressure and respiratory rate, ECG).
25-30 minutes before the start of the procedure, premedication is carried out, sedatives are administered.
The patient lies on the table, the doctor treats the puncture area, disinfects, injects local anesthetic. The process is performed under local anesthesia. The patient will be conscious throughout the entire time and strictly follow the instructions of the doctor.
Intravenous access is through the common femoral artery (transfemorally) or through the radial artery of the forearm (transradially).
After puncture, a conductor with a diagnostic catheter is inserted into the artery and brought to the ascending aorta. Then a balloon catheter is installed along the conductor in the place of the narrowed artery and inflated with a special syringe. When the balloon is inflated, the atherosclerotic plaque is pressed against the vessel wall, the lumen increases. The procedure is painless and is carried out under X-ray control.
After that, the doctor proceeds to transplant the stent. To do this, the installed balloon catheter is removed, and a new catheter with a stent is installed in its place. The balloon is again inflated under a certain pressure and removed from the artery. The stent forms a reliable supporting frame that helps the artery stay open.
After the procedure, the patient is transferred to the intensive observation unit, and then transferred to the ward, where he stays until discharge.

rehabilitation period

As a rule, the patient is discharged from the hospital for 2-3 days. After the operation, it is very important to follow all the recommendations of the attending physician so that the recovery is successful.

In the first few days after the hospital, you should limit physical activity, do not lift weights.
Recommended within two days plentiful drink to cleanse the body of the remnants of anesthesia and contrast medium.
You can not take a shower during the first day.
It is important to rest more, gain strength and monitor proper nutrition.

Diet

The diet should be light, healthy and balanced.

The diet should be aimed at regulating weight and blood cholesterol levels. This is very hazards that cause heart disease.

Diet principles

Exclusion from the diet of fatty, high-calorie foods. Products must contain minimal amount animal fats. Excluded: lamb, pork, sour cream, semi-finished products, lard.
Reduce sugar and salt intake.
Limit consumption of refined carbohydrates (sweets, pastries).
Exclude the consumption of various sauces and additives (margarine, ketchup, mayonnaise). Replace butter for vegetable.
Do not drink black tea and coffee. They can be replaced with chicory, weak green and herbal teas.
It is necessary to add more fresh fruits and vegetables, cereals, vegetable soups, stews and salads, lean meats, seafood, compotes, berry fruit drinks, kefir, acidophilus, bread to the diet.
It is recommended to refuse smoked, salted, fried foods. It is preferable to cook food in the oven or in a double boiler.
You need to eat fractionally (small portions 5-6 times a day). The last meal is three hours before bedtime.

Drug therapy

The appointment of drugs is necessary to strengthen the body, good rehabilitation, prevention of thrombosis and other possible complications. As a rule, these include:

Aspirin - for a long time.
Clopidogrel or others similar preparations(Cardutol, Agregal, Trombex, Troken).
Statins for high cholesterol.
General strengthening vitamin and mineral complexes for the heart.

Physical exercises

Moderate exercise is good for heart disease. They help slow down the development of atherosclerosis, normalize blood pressure, train the heart muscle, strengthen the body, help maintain normal weight.

The intensity and mode of training are selected individually depending on physiological state sick. During the recovery period, exercise therapy courses, walking, swimming, cycling are useful.

Complications

As with any other operation, during stenting complications may develop.

Intraoperative complications (arising during work): angina pectoris, myocardial infarction, cardiac arrhythmias, allergic reactions for medicines. In about 1.5% of cases, bleeding may develop.
Early postoperative complications: tachycardia, arrhythmia, hematoma in the puncture area, thrombosis, aneurysm, heart attack.
Late complications: heart attack, thrombosis, restenosis.

Probability lethal outcome- 0.1%. Interestingly, according to statistics, every year in the world 0.3% of women die in childbirth, and 9.3% of deaths occur in road accidents. That's why percentage is quite low.

Where to do the operation

Stenting of the coronary arteries can be done on a paid and free basis.

To receive a service on a budgetary basis, you need to contact city polyclinic at the place of residence to a therapist or cardiologist and learn in detail about the conditions. Some clinics provide medical service by quotas. In Moscow, for example, you can apply for a quota to the Russian Cardiology Research and Production Complex.
On a paid basis in Russia, you can have an operation at the Moscow Center for Cardiovascular Surgery. Burdenko, in Medical Center GMS Clinic, NII SP im. I.I. Dzhanelidze in St. Petersburg and other medical institutions. average cost is 100-136 thousand rubles.
They provide this service in other countries, for example, in Israeli clinic Asaf ha Rofe. The cost of the operation here is 13 thousand dollars, including three stents. Common stenting in clinics South Korea- Gil Hospital at Gachon University in Incheon, Ilsan Medical Complex at Dongguk University in Goyang, as well as in many institutions in Germany, where the cost of stenting reaches 10,000 euros. Despite such high price, patients leave very positive reviews about treatment in European clinics.

The price is individual in each case and can be made up of many factors: medical institution, type of stent used, prescribed additional research and analyses.

Forecast

The effectiveness of coronary stenting is quite high. The procedure is enough modern, painless, invasive, takes a little time, has positive reviews. This makes it in demand in the field of cardiology.

As for long-term prognosis, they directly depend on the quality of the procedure performed, the type of stent and restorative therapy that the patient will receive. Restenosis occurs in about 15% of cases.

Unlike an open surgical operation under deep anesthesia, stenting lasts only 30-40 minutes and has virtually no complications.

Cardiac stenting is a type of angioplasty. An operation is performed when it is necessary to restore blood flow in the artery due to the narrowing of its lumen. It is prescribed to reduce the risk of death due to diseases such as myocardial infarction and thromboembolism. The main advantage of the operation is that it does not require anesthesia and opening chest which significantly improves the prognosis.

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Angioplasty

Vessels that feed the heart with blood eventually become covered with atherosclerotic plaques. This happens due to high cholesterol levels and the development of atherosclerosis. They narrow the lumen of the arteries, which leads to a significant reduction in blood flow to the heart.

At a certain minimum level of myocardial blood supply, an adjustment of the state is required medical methods. With narrowing of the lumen, conditions are created for the formation of a thrombus, which can lead to a complete cessation of blood supply and myocardial infarction.

Medical treatment reduces the risks only by certain time. Then you need surgical correction. The most common is angioplasty. During such an operation, large vessels a catheter is inserted, which is directed to the coronary arteries, and the lumen in them is restored using a balloon or stent.

Cardiac stenting - how long do patients live after surgery?

Types of stents and their features

The level of development of cardiology today makes it possible to diagnose and prevent damage to the heart muscle, which for many people is fatal. One of the effective modern methods of treating such diseases is coronary artery stenting.

With a lack of oxygen in the myocardium, diseases associated with impaired blood supply begin to develop, for example, angina pectoris and myocardial infarction. The causes of insufficient blood supply can be cholesterol formations in the vessels, narrowing of the lumen of the arteries, blood clots.

To restore and normalize the flow of blood and oxygen into the vessel, a stent is surgically installed. This is a special flexible mesh cylindrical frame that expands the areas hollow organs restores proper blood flow.

stent in vessel

Stents are different shapes and are made from various materials. The type is selected individually after coronary angiography.

Bare metal

In cardiovascular surgery, the following constructions without "medication" are used:

wire - stents made of a single wire, ø 0006 inches;
ring - which consist of links;
tubular - made from a cylindrical tube;
mesh - made in the form of a wicker mesh;
bifurcation - designed for stenosis of bifurcations of coronary vessels.

A "bare" metal stent is most often used in the unstable condition of the patient and in critical cases.

Drug stents

These stents are coated with cytostatic and are often used in cardiac specialist centers. This view includes three generations:

1. Durable polymer Stents - have a number of disadvantages, cases of thrombosis in the stent and infarction have been recorded.
2. Biocompatible - have proven themselves in our country, are more reliable than the first generation.
3. Abluminal preference - in this option, the drug acts only on the walls of blood vessels. The most popular representatives are Calypso, Graft, Abbott and others. Calypso was developed and produced in Russia.
4. Scaffold - stents of the 4th generation, self-absorbable and completely remodulating the vessel wall. This biosoluble stent is not placed in patients suffering from vascular calcification.

The order of the procedure

Pros and cons of using stents

The advantages of installing a stent are as follows:

minimally invasive procedure;
the duration of the operation is not more than 3 hours;
no need to connect an artificial blood supply system;
no incision;
local anesthesia;
recovery within a few weeks;
the possibility of surgical work with small vessels (from 3 mm);
a high rate of effectiveness of the operations performed - more than 85%.

With all the positive aspects and the possibility of restoring blood flow, there are also fixed disadvantages of this revolutionary method. These include:

the likelihood of blood clots;
the risk of re-narrowing;
the complexity of the operation in the presence of calcium deposits;
a large number of contraindications;
inability to operate vessels with a diameter of up to 3 mm.

Term of operation

The life of a stent can be affected by the following factors:

rejection or survival of the stent;
compliance with the recommendations of the attending physician for 12 months;
lack of response to the drug;
diabetes, non-healing wounds, ulcers skin, infection bacterium Helicobacter pylori, which is the cause of stomach ulcers.

In the absence of negative effects on the stent, it can function in the human body until the end of its life.

Indications and contraindications for the operation

Not all patients can be operated on with coronary stenting. Some patients are shown other operations.

Indications for stenting:

the risk of a heart attack;
angina;
atherosclerosis;
ischemic disease;
overlap of arteries by more than 50%;
the first 6 hours of myocardial infarction with a relatively stable condition of the patient;
secondary stenosis.

In some cases, the operation by stenting cannot be performed on the patient due to such reasons:

severe insufficiency - renal, respiratory, hepatic;
general serious condition the patient;
disturbances of consciousness;
an allergic reaction to iodine, which is contained in the control substance;
period of acute stroke;
the presence of infections and oncological formations in the body;
violation of the work of small vessels;
low blood clotting, which is associated with a risk of bleeding.

Preparing for the operation

First, coronary angiography is prescribed to clarify the diagnosis and determine the exact location of the vessel lesion. Additionally, blood tests and electrocardiography may be performed. If the operation is scheduled, the patient is assigned a preliminary full examination which includes:

KLA and urine analysis;
ELISA (enzymatic immunoassay);
a complete examination of the heart - monitoring the work of the body during the day, ultrasound;
additionally - MRI.

Insertion of a stent

At the beginning of the operation, the patient is given blood thinners to prevent the formation of blood clots, and sedatives.

Stent placement

The coronary arteries can be accessed in two ways. The first is through a large blood vessel in the leg or through the arm. The second option is simpler - this is the introduction of a plastic tube through the brachial artery a. radialis.

The general sequence of actions during the operation:

1. Local anesthesia is performed, novocaine or another drug is used.
2. The femoral artery is punctured, with blood flow and under X-ray control, the catheter reaches the affected area in the vessel.
3. A balloon-catheter is delivered through the conductor, and the place of narrowing of the artery expands.
4. An iodine preparation is introduced, which is a marker for searching for a catheter.
5. The guidewire is removed and a stent is placed in its place.
6. Superimposed pressure bandage for a day at the puncture site.

Angiogram before and after surgery

The illusion of simplicity of the operation and visible improvement should not give a reason to neglect your health after the intervention. There is always a threat of a heart attack, re-stenosis and other pathologies. It is necessary to adhere to the following rules during rehabilitation:

1. Regularly take medications prescribed by a doctor during the first year after surgery. These are drugs that prevent the formation of blood clots: Aspirin Cardio or Cardiomagnyl.
2. Take statins in the fight against excess cholesterol: Tevastor, Rosulip, Rosuvastatin. These drugs are the most effective.
3. Dieting is one of the most important rules. People who have undergone stenting should reduce the amount of animal fats, sweets and refined carbohydrates in their diet, reduce the intake of salt and sugar, caffeinated drinks, and exclude chocolate, carbonated drinks and strong tea.
4. Control the pressure. In case of sudden pressure drops, you should immediately consult a doctor.
5. Conduct an annual survey.
6. Constantly monitor vital signs: heart rate, arterial pressure, glucose level (in diabetes).
7. Completely give up bad habits. Even the widespread belief that wine cleanses the vessels should not force you to drink alcohol.
8. Go in for sports. Physical activity trains the heart muscle, accelerates blood, stabilizes blood pressure and simply improves general state organism. Recommended exercise therapy, walking, cycling, swimming pool. Heavy physical activity is a risk zone; you should also not lift weights.

After the patient's condition is stabilized, and when he feels better, he is allowed to return to ordinary life. You can travel by any convenient transport. Before entering into sexual contact, on the advice of doctors, you need to take nitroglycerin, as well as before other types of exercise.

Recovery depends on the patient's health status and working conditions. If a person, for example, works as a manager in an office, then he can quickly return to his work. With heavy physical exertion, it is recommended not to rush and extend the recovery course.

The main cause of the most serious manifestation of coronary heart disease is malnutrition of the muscle due to atherosclerotic vascular damage.

Atherosclerosis affects the wall of an artery. Due to the loss of elasticity, the possibility of sufficient expansion is lost. Deposition atherosclerotic plaques from the inside causes a narrowing of the diameter of the vessel, complicates the delivery nutrients. A critical reduction is considered to be 50% of the diameter. At the same time, they begin to show clinical symptoms hypoxia (lack of oxygen) of the heart. This is expressed in angina attacks.

Complete blockage of the coronary artery leads to the development of a site of necrosis (necrosis) in myocardial infarction. All over the world, this pathology is still considered one of the main causes of death in adults.

Timely stenting of the heart vessels can prevent the development of severe complications atherosclerosis.

What is "stenting"?

The term "stenting" refers to an operation to install a stent inside an artery, which results in mechanical expansion of the narrowed part and restoration of normal blood flow to the organ. The operation refers to endovascular (intravascular) surgical interventions. It is carried out in the departments of the vascular profile. It requires not only highly qualified surgeons, but also technical equipment.

In surgery, techniques have been established not only for coronary stenting (heart vessels), but also for the installation of stents in the carotid artery to eliminate signs of cerebral ischemia, in the femoral artery - to treat atherosclerotic changes in the legs, in abdominal aorta and iliac - if available pronounced signs atherosclerotic lesion.

What is a "stent", varieties

A stent is a lightweight mesh tube strong enough to provide a scaffold for an artery. long time. Stents are made of metal alloys (usually cobalt) in accordance with high technologies. There are many types. They differ in size, grid structure, the nature of the coating.

Stents differ in size, mesh structure, coverage

Two groups of stents can be distinguished:

uncoated - used in operations on medium-sized arteries;
covered with a special polymer shell that releases a medicinal substance during the year that prevents re-stenosis of the artery. The cost of such stents is much higher. They are recommended for installation in coronary vessels, require constant intake of drugs that reduce the formation of blood clots.

How is the operation going?

To stent the heart vessels, a catheter is inserted into the femoral artery, at the end of which there is a tiny balloon with a stent put on it. Under the control of the x-ray machine, the catheter is inserted into the mouth of the coronary arteries and moved to the required area of the narrowing. Then the balloon is inflated to the required diameter. In this case, atherosclerotic deposits are pressed into the wall. The stent, like a spring, expands and is left in place after the balloon is deflated and the catheter is removed. As a result, blood flow is restored.

Schematic of the location of the stent inside the vessel

The operation is usually performed under local anesthesia. Lasts from one to three hours. Before the operation, the patient is given drugs that thin the blood to prevent thrombosis. If necessary, install several stents.

After surgical intervention the patient spends in the hospital for up to seven days under the supervision of a doctor. He is advised to drink plenty of fluids to remove contrast agents in the urine. Anticoagulants are given to prevent platelets from sticking together and forming blood clots.

Who is the operation, examination

Selection of patients with ischemic heart disease for surgical treatment is a consultant cardiac surgeon. In the polyclinic at the place of residence, the patient undergoes the necessary minimum examination, including all mandatory blood and urine tests to determine the functioning internal organs, lipogram (total cholesterol and its fractions), blood clotting. Electrocardiography allows you to clarify the areas of myocardial damage after a heart attack, the prevalence and localization of the process. Ultrasound examination of the heart clearly in the pictures shows the functioning of all departments of the atria and ventricles.

In the inpatient department, angiography is mandatory. This procedure consists of the intravascular injection of a contrast agent and a series of x-rays carried out as the vascular bed is filled. The most affected branches, their localization and the degree of narrowing are identified.

intravascular ultrasound procedure helps to assess the capabilities of the artery wall from the inside.

The examination allows the angiosurgeon to determine the exact location of the proposed stent insertion, to identify possible contraindications to the operation.

Indications for operation:

heavy frequent seizures angina, defined by a cardiologist as a pre-infarction condition;
support for a coronary artery bypass graft (bypass is the installation of artificial blood flow bypassing a blocked vessel), which tends to narrow over ten years;
according to vital indications in severe transmural infarction.

Contraindications

The inability to insert a stent is determined during the examination.

Widespread lesion of all coronary arteries, due to which there is no specific place for stenting.
The diameter of the narrowed artery is less than 3 mm.
Reduced blood clotting.
Violation of the function of the kidneys, liver, respiratory failure.
Allergic reaction of the patient to iodine preparations.

The advantage of stenting over other operations:

low invasiveness of the technique - there is no need to open the chest;
short period of stay of the patient in the hospital;
relatively low cost;
quick recovery, return to labor activity, the absence of long-term disability of the patient.

Operation complications

Statistics indicate that in 90% of patients after vascular stenting, a steady improvement in the state of blood circulation and well-being occurs. This is confirmed by control examinations.

However, 1/10 of the operated patients had complications or undesirable consequences:

perforation of the vessel wall;
bleeding;
the formation of accumulation of blood in the form of a hematoma at the puncture site of the femoral artery;
stent thrombosis and the need for re-stenting;
impaired renal function.

Video showing the essence of the operation:

Recovery period

The postponed stenting of the heart vessels can greatly improve the patient's well-being, but this does not stop the atherosclerotic process, does not change the disturbed fat metabolism. Therefore, the patient will have to follow the doctor's prescription, monitor the level of cholesterol and blood sugar.

During the first week, rehabilitation is associated with a limitation physical activity, baths are contraindicated (only hygienic shower). Doctors do not recommend driving for two months. Further advice comes down to an anti-cholesterol diet, dosed physical education, and constant medication.

We will have to exclude animal fats from the diet and limit carbohydrates. It is not recommended to eat fatty pork, beef, lamb, butter, lard, mayonnaise and spicy seasonings, sausages, cheese, caviar, non-durum wheat pasta, chocolate, sweets and pastries, White bread, coffee, strong tea, alcohol and beer, carbonated sweet drinks.

The diet requires that vegetables and fruits be included in the diet in salads or fresh juices, boiled poultry meat, fish, cereals, durum pasta, cottage cheese, dairy products, green tea.

It is necessary to establish 5 - 6 meals a day, monitor weight. If necessary, carry out unloading days.

Daily morning exercises increases metabolism, improves mood. You can not immediately take on heavy exercises. Walking is recommended, first for short distances, then with increasing distance. Slow walking up the stairs is popular. You can work out in the gym. Be sure to patients should learn to count their pulse. Avoid significant overload with increased heart rate. Of the sports, cycling and swimming are recommended.

Dosed load contributes to the restoration of coronary circulation

Drug therapy is reduced to drugs that lower blood pressure (in hypertensive patients), statins to normalize cholesterol levels and drugs that reduce blood clots. Patients with diabetes should continue specific treatment prescribed by an endocrinologist.

It is better if rehabilitation after stenting is carried out in a sanatorium-resort environment, under medical supervision.

The operation of stenting has been performed for about forty years. The methodology and technical support are constantly being improved. Expanding indications, no age restrictions. It is recommended that all patients with coronary heart disease not be afraid to consult a surgeon, this is an opportunity to prolong an active life.

The narrowing of the lumen of blood vessels can lead to a number of serious diseases. of cardio-vascular system which are not always possible to treat with conservative therapy. cerebrovascular accident, ischemic heart disease, vascular atherosclerosis lower extremities lead to a significant deterioration in the quality of life of the patient and can cause death. More often these pathologies occur in people over 50 years old, but worsening environmental situation and the modern rhythm of life lead people and younger people to the risk group for developing these diseases.

At first, the narrowed vessel practically does not affect the patient's well-being, but when the lumen of the artery is blocked by more than 50%, ischemia of the tissues of one or another organ develops, and its functions are impaired. One of the ways to eliminate arterial stenosis and oxygen starvation is a minimally invasive endovascular type of surgical intervention: stenting. We will talk about what it is and who is shown such a procedure in this article. For the first time, the concept of this technique for unblocking vessels affected by calcification was proposed about 50 years ago by the American vascular radiologist Charles Dotter. In 1964, he developed stent catheters and a technique that could be used to perform a minimally invasive operation to restore blood flow in diseases peripheral arteries. Further development of this technique and expansion of its application took a long time. In 1993, the effectiveness of coronary artery stenting was proven.

The stent is a miniature cylindrical frame made of thin titanium wire. He enters the light blood vessel through a special probe, at the end of which there is a pump, and delivered to the site of stenosis. At the site of narrowing, the balloon is inflated with air and expands the walls of the artery, after which a stent is inserted into the affected vessel. When expanded, the stent is held in place by a special frame. If necessary, several stents can be used to expand the lumen of the vessel. The correctness of the installation of such structures is controlled by X-ray.

About 400 types of stents can currently be used for implantation, which differ from each other in alloy composition, hole design, length, delivery system to the vessel, and coating of the surface that is in contact with arterial walls and blood.

Stents used to dilate coronary vessels can be:

wire: made from one wire;
ring: made from separate links;
mesh: made from woven mesh;
tubular: made from tubes.

Stents can deploy on their own or with balloons. To widen the gap peripheral vessels Nitinol (an alloy of nickel and titanium) self-expanding stents are predominantly used, and for coronary arteries, metal or cobalt-chromium alloy stents are used, which are expanded using balloons.

Through continuous improvement in the quality of stents, vascular surgeons are able to minimize the incidence of occlusion of stented vessels and reduce the risk of developing acute thrombosis. AT clinical practice implemented various models stents, which are coated with special polymers, dosed with releasing medicinal substances: cytostatics, substances that can reduce the risk of re-constriction of the vessel (restenosis) and thrombosis. Many stents currently in use are equipped with a special hydrophilic coating, which increases the biocompatibility of the design with body tissues.

Areas of use

Stenting has found wide application in many branches of medicine.

1. Installation of stents in the coronary arteries is carried out for the treatment of such pathologies of the cardiovascular system:

high risk of development;
acute period of myocardial infarction.

2. Installation of stents in the arteries of the lower extremities is performed when:

atherosclerosis of the superficial femoral artery;
thrombosis of the superficial femoral artery;
blockage of the popliteal artery;
blockage of the arteries of the lower leg.

Placement of stents in carotid arteries performed when:

stenosis of the carotid arteries;
high risk of blood clots (in addition, a special filter is installed with the stent to keep blood clots);
need for stroke prevention diabetes and atherosclerosis.

Placement of stents in coronary arteries after their restenosis as a result of angioplasty or coronary artery bypass grafting.
Placement of stents in renal arteries performed with occlusion of these vessels by atherosclerotic plaques and renovascular hypertension.
Placement of stents in vessels abdominal cavity and the pelvic cavity is performed when they are affected by atherosclerosis.

How is stenting performed?

Before stenting is performed, patients undergo a series of diagnostic examinations. To identify the site of arterial stenosis vascular surgeon studies data or angiography, which allow you to study in detail the state of the vessel and the place of its narrowing.

Before the intervention, the patient is given local anesthesia and a drug is administered that helps to reduce blood clotting. First, the doctor pierces the skin for further puncture of the affected vessel and, after performing the puncture, inserts a probe with a balloon into it. After delivery of the balloon to the site of stenosis, which is performed under radiographic control, it is inflated. At this stage of the operation, if necessary, a special filter can be installed to prevent the penetration of blood clots into the vessels and the development of a stroke.

Further, to fix and unblock the lumen of the artery, a stent is installed in the vessel. To do this, the surgeon introduces another catheter with an inflating balloon. The stent is inserted into the artery in a compressed form, and with the help of balloon inflation it opens and is fixed on the vascular walls.

Once one or more stents have been placed, the instruments are removed from the artery. The duration of such a minimally invasive intervention can be about 1-3 hours. During the manipulations of the surgeon, the patient does not experience pain.

After completion of the operation, the patient is recommended to comply with bed rest (its duration is determined by the doctor). After discharge from the hospital, the patient receives detailed recommendations for admission medicines, diet, physiotherapy exercises necessary restrictions and the need for supervision by the attending physician.

In the first week after stenting, the patient should refrain from taking baths, lifting weights and limiting physical activity.

Possible postoperative complications

Complications after stenting are rare, but in some cases, patients develop:

Bleeding.
The formation of hematomas at the puncture site of the vessel.
Violations of the integrity of blood vessels.
Disturbances in the functioning of the kidneys.
Thrombosis or re-stenosis at the stent site.

Benefits of stenting

Fast recovery after surgery.
It is possible to perform the intervention under local anesthesia.
The intervention is minimally traumatic.
The risk of complications is minimal.
Treatment does not require a long hospital stay and is less expensive.

Contraindications

Severe diseases with impaired blood clotting.
The diameter of the artery is less than 2.5-3 mm.
Excessive vascular damage.
Severe respiratory or renal failure.
Intolerance to iodine-containing preparations (iodine is part of the radiopaque preparation).

Cost of stenting

The cost of a stent placement operation depends on many factors:

areas of affected arteries;
the type of stents used, their number and the instruments used;
the clinic where the operation is performed;
countries;
skill level of the surgeon, etc.

The effect of stenting is felt by the patient immediately after the completion of the operation.

Program "Health Expert" on the topic "Stenting and coronary angioplasty":