Do stents need to be placed for vascular stenosis?
Do doctors always put stents on narrow blood vessels? There are three main arteries on the surface of the heart, which are responsible for the blood supply of the heart itself, which is equivalent to the "oil circuit" of the automobile engine itself. If the oil circuit is blocked, the engine will not work normally. Coronary heart disease can be diagnosed if the stenosis degree of any one of the three main coronary arteries exceeds 50%, but stent implantation is generally considered only when the stenosis degree is ≥70%. Because the degree of vascular stenosis is evaluated by clinicians with naked eyes in most cases, which is subjective, different surgeons have certain differences in judgment. Therefore, for the critical lesions of 60%-70% of vascular stenosis, it may be necessary for multiple doctors to negotiate a surgical treatment plan or use special instruments such as intravascular ultrasound and intracoronary pressure guide wire to evaluate. When the evidence of myocardial ischemia in patients is sufficient, or when the clinical symptoms of patients can not be well controlled by intensive drug treatment, cardiac stent implantation will be considered.
Is it better to put a stent or a heart bypass?
At present, there are three main treatments for coronary heart disease: drug therapy, interventional therapy (that is, intravascular stent implantation) and surgical bypass surgery, and each method has its own indications. After the patient has finished coronary angiography, the next treatment plan can be decided. Most patients with coronary heart disease with coronary artery stenosis less than 70% only need to take drugs orally for a long time, quit smoking, control the risk factors of coronary heart disease such as hypertension and diabetes, and improve their lifestyle. Most patients will not have coronary artery stenosis soon in the short term. However, for patients with localized lesions with stenosis degree ≥70%, stent implantation can alleviate coronary artery stenosis, relieve angina pectoris and reduce the risk of future myocardial infarction. Angiography revealed severe stenosis of three blood vessels, especially stenosis of the main left coronary artery (equivalent to the root of a big tree), severe calcification of blood vessels, diseases in which stents could not pass, severe dilatation of blood vessels or hemangioma. Surgery is needed for heart bypass surgery. Therefore, the objects of these three treatments are different, and there is no question of who is good or who is bad. Clinicians will make suggestions for the next treatment to patients or their families according to the results of coronary angiography, patients' systemic complications, age, economic conditions and other factors, but the final decision lies with patients or their families.
Is stent surgery out of date?
1977 German doctor Andreas Gruenzig performed the first coronary balloon dilatation (PTCA) in Switzerland, 1984 China performed the first PTCA. At present, the first patient who performed PTCA in the world still exists in the world, but the doctor who operated on it has died in an air crash. 1986 is the first case of coronary stent surgery, and drug-eluting stent was only available after 2000. Since then, this technology has been widely used in the world to improve myocardial ischemia caused by coronary heart disease and myocardial infarction caused by coronary artery occlusion. At present, cardiac stent surgery is widely used in the world. There are more than 6,543,800 cases of cardiac stent surgery in the United States every year, and there are currently more than 300,000 cases of cardiac stent surgery in China, ranking second in the world. Coronary stent surgery has saved a large number of patients with acute coronary syndrome such as acute myocardial infarction and unstable angina pectoris because of its advantages of rapid and lasting opening of coronary blood vessels. Therefore, stent surgery is not out of date, but widely used in clinic.
What is the difference between imported stents and domestic stents?
At present, the domestic drug-eluting stents used in clinic are mainly Lepu, Firebird, Axel and other brands, but the domestic stents are still the second generation drug-eluting stents. Imported stents include Abbott's Xience series, Medtronic's Resolute series and Boston Scientific's Element series, all of which are the third generation drug-eluting stents. The new generation stent is obviously superior to the second generation drug-eluting stent in restenosis, late stent thrombosis rate, stent technology, stent development effect and stent passing rate. In terms of price, each imported stent is nearly 7000- 10000 yuan more expensive than the domestic stent. The second generation stent has been widely used in China for many years, and its exact effect has been widely recognized by clinicians and patients. Therefore, the effect of the second generation stent in treating coronary heart disease is beyond doubt, and it is still widely used in clinic because of its low price.
What are the risks of stent surgery itself?
Strictly speaking, cardiac vascular stent implantation does not require thoracotomy and general anesthesia, so it cannot be called surgery. The more accurate name should be "procedure". After local anesthesia, the doctor punctured the artery (the root of the arm or thigh) through the skin, and performed balloon dilation and/or stent implantation on the narrowed or blocked part of the coronary artery under X-ray, so that the vascular cavity was restored and the blood flow was unblocked again (see figure 1). During the whole operation, the patient was conscious and generally had no obvious conscious discomfort. Generally, the operation time for common lesions is about 1 hour. After operation, the blood vessel puncture site needs to be compressed for 4-6 hours, and the patient with thigh puncture needs to stay in bed for 6- 12 hours. General patients can be discharged from the hospital within/0/-2 days after operation. The death risk of simple coronary angiography is about one in ten thousand, and the death risk of patients with stent implantation is about two in ten thousand. High-risk patients include the elderly, patients with severe cardiac and renal insufficiency, patients with chronic obstructive pulmonary disease, patients with multiple coronary artery stenosis and women.
Does the stent have a "life"?
Many patients are worried that the stent will "age" after being implanted in the human body for several years, and some people think that the stent will "break" or "fall off" after a few years. Each patient's stent was completely covered by vascular endothelium. 1 year, most patients completely cover the trabecular meshwork of metal stent with endothelial cells, and no metal stent wire is exposed to blood, so the probability of stent thrombosis will be significantly reduced. This is also the reason for taking 1 year dual antiplatelet drugs after stent implantation. After the surface of the stent is completely covered by the new endothelium, the stent becomes a part of the blood vessel wall and plays a role in supporting the blood vessel, which will accompany the patient for life, so the stent implanted in the blood vessel cannot be taken out. If 1 year after stent implantation, the stent is still not completely covered by endothelium, it is still necessary to appropriately extend the administration time of the above drugs. The stent successfully implanted in the body will not fall off, and patients can move and participate in various sports with peace of mind. Moreover, so far, no rejection reaction to the stent has been found.
Generally speaking, cardiac stent implantation is a mature and scientific medical technology, which has been widely used in clinic at home and abroad, successfully saved a large number of patients with critical and complex heart diseases and greatly promoted medical progress. We should look at the extensive popularization and use of this new technology scientifically, rationally and objectively, so that advanced technology can better serve mankind.