Coronary angioplasty and stenting
Cardiovascular Diseases / / May 02, 2016
What Is Coronary Angioplasty?
This treatment method, which is performed percutaneous coronary intervention (PCI) to open blocked cholesterol coronary arteries (which are likely to be caused by ischemic heart disease - coronary artery disease), and to restore blood flow to the heart tissue without open-heart surgery.A special catheter (long hollow tube) is inserted into the coronary artery, and which need to cure, freeing it from the lock.This catheter has a balloon on the end of tiny.The balloon is inflated once the catheter is placed in the neck (ie, damaged, unhealthy) region of the coronary artery.Swelling balloon compresses the fatty tissue in the artery, and relieves the blockage of an artery, making it open inside, which improves blood flow in it.
The use of fluoroscopy.A special type of X-rays help doctors more accurately assess the amount of damage to the vessel, where it is blocking a coronary artery and to show how the contrast agent flows through the arteries.
method called "fractional (fractional) flow reserve" (FFR) is often used during catheterization to aid in determining the significance of moderate narrowing of the coronary artery.The technique includes diagnostic significance of arterial stenosis, i.e.to evaluate the significance of the defeat and accurately determine whether the lesion causing ischemic heart disease.PRK is determined at the time of coronary angiography by measuring the pressure through the affected area.This can help the doctor to make the right decision on the application of PCI or stenting.
doctor can determine whether a different type of procedure is necessary - for example, the use of atherectomy (removal of plaque) in the place of narrowing arteries.In atherectomy tiny blade in a balloon or a rotating tip at the end of the catheter can be used.When the catheter reaches the narrowed space in the artery plaques destroyed or cut to open the artery.
What is a stent?
Coronary stents are now almost universally used in the procedures for percutaneous coronary intervention, often after balloon angioplasty, which opens the narrowed artery and facilitates the advancement of the stent.A stent is a tiny expandable rolled metal fragment, which is inserted into the open in the operation area of the artery to keep the artery by subsequent constriction or closure.
Once the stent is placed within a few days after the treatment the fabric starts to be formed on it.The stent will be completely covered with a cloth in a month or so.It is necessary to take medication - Aspirin, Clopidogrel (Plavix), prasugrel (Effient) or Ticagrelor (Brilinta), which reduce the "stickiness" of platelets (special blood cells that clump together to stop the bleeding), in order to prevent the formation of blood clots within the stent.The physician must provide the patient with specific instructions on what medications you need to take and for how long.
new generation of stents coated with drugs to prevent them in the formation of scar tissue.The drug inhibits the growth of tissue, which may occur within the entire length of the stent.The effect of the drug - prevention of new narrowing of stented blood vessels.Due to the fact that the stents can become clogged, it is important to talk to your doctor about what should be done to the patient, if after stent placement, he feels pain in his chest.If
scar tissue located inside the stent, the second procedure can be carried out with either balloon angioplasty or stent with a second and sometimes a local radiation therapy (so-called brachytherapy) to clean the area of the vessel opening and scars.
other related angioplasty procedures that may be used to diagnose heart:
- Electrocardiogram (ECG);
- Holter monitor;
- signal averaged ECG;
- cardiac catheterization;
- chest X-ray;
- computed tomography (CT) of the chest;
- electrophysiological studies;
- magnetic resonance imaging (MRI) of the heart;
- myocardial perfusion scan;
- radionuclide angiography;
- Cardiac CT.
Another technique - rotational atherectomy, it is sometimes used to help with stenting.
Indications for angioplasty and stenting
patients do not need these procedures if he eschev able to perform most of their daily activities.The physician can try primarily drugs and other treatments.
Indications for angioplasty:
- symptoms that do not allow the patient to perform daily tasks;
- skin ulcers and wounds on his leg;
- infection or gangrene in the leg;
- leg pain caused by narrowing of the arteries, even when a person is resting.
Percutaneous coronary intervention is performed to restore blood flow in coronary arteries when the arteries are narrowed in a place that can be achieved just by angioplasty and stenting.However, not all coronary artery disease can be treated with percutaneous coronary intervention.
- Coronary heart disease (CHD). coronary artery disease - a narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle) caused by the accumulation of fat in the walls of arteries.Coronary heart disease - a process that causes the inside of artery narrowing, limiting the supply of oxygen-rich blood to the heart muscle.
Heart - this kind of pump.The heart consists of specialized muscle - the myocardium.The main function of the heart - to pump blood throughout the body, so that all the body's tissues can receive oxygen and nutrients.
Like any pump, the heart requires fuel for its operation.The myocardium requires oxygen and nutrients, as well as any other tissue in the body.However, the blood that passes through the chambers of the heart enters the rest of the body.This prevents blood oxygen and nutrients to the myocardium.The myocardium receives oxygen and nutrients from the coronary arteries, which lie outside of the heart.
- Angina. When the heart tissue does not receive an adequate blood supply, it can not function as it should.If the myocardial blood flow was reduced by a period, then ischemia develops.Ischemia can decrease the pumping function of the heart, because due to lack of nutrients and oxygen to the heart muscle is weakened.
Unfortunately, the patient may not have any symptoms of early coronary artery disease, but the disease may continue to progress until there is a serious blockage of arteries that lead to angina pectoris (chest pain is or discomfort due to coronary artery disease).Symptoms of angina include chest pain, or arm, the pressure in the chest, fatigue, indigestion, palpitations, and shortness of breath.
- Myocardial infarction. If a coronary artery is completely closed by a blood clot, then myocardial infarction may occur (heart attack).The thrombus may occur due to plaque (accumulation of fat in artery walls) or ruptures, resulting in a dramatic accumulation of blood clots at the site and blocking blood vessels.If blood flow to a particular area of the affected heart muscle can not be restored quickly, the tissue dies.
There may be other reasons to recommend the patient to the doctor PCI.
Risks related angioplasty and stenting
Possible risks associated with percutaneous coronary intervention, stent, atherectomy and similar procedures:
- bleeding at the catheter insertion site (usually in the groin, wrist or shoulder);
- a blood clot or damage to the blood vessels at the site of the catheter;
- infection at the site of the catheter;
- cardiac arrhythmia (abnormal heart rhythms);
- myocardial infarction;
- pain or discomfort in the chest;
- rupture of the coronary artery, requiring open-heart surgery;
- an allergic reaction to a drug used in a stent that releases the drug into the patient's body;
- allergic reactions to x-ray dye;
- a blood clot (thrombus) in the legs or in the lungs;
- damage to blood vessels;
- nerve damage, which can cause pain or numbness in the leg;
- renal failure (higher risk of its development in people who already have kidney problems);
- displacement of the stent;
- stroke (rarely).
There may be other risks - depending on the patient's health.It is necessary before the procedure to discuss any health concerns with your physician.
Preparing for angioplasty and stenting
- The doctor will explain the procedure to the patient and offer him the opportunity to ask any possible questions about the procedure.
- The patient will be asked to sign a consent form, which confirms his consent to the test.It is necessary to carefully read this form and ask questions if something is not clear.
- If the patient ever had a reaction to the contrast dye, or if he has an allergy to iodine, it must report it to your doctor.
- It is necessary to inform the doctor if the patient is sensitive to any medications, latex, tape, and anesthetic (local and general) or if he has an allergy to them.
- The patient will have to go without food for a certain period of time before the procedure.The doctor informs how long - for several hours or overnight.
- If a woman is pregnant or suspect you may become pregnant, she should inform your doctor so that he could take this into account during the procedure.
- Patients should inform their doctor if he has a piercing on the chest and / or abdomen.
- The patient should call your doctor all the medicines (prescription and over-the-counter) and herbal supplements he takes.
- You must tell your doctor if the patient has a history of bleeding disorders or if he takes anticoagulants or antiplatelet (blood-thinning) medications, aspirin, or other drugs that affect blood clotting.It may be necessary for the patient - to pause before the procedure at a time (or stop entirely) the reception of some of these drugs.However, before planned PCI procedures the doctor is likely to recommend a patient to continue taking aspirin and antiplatelet drugs.
- The doctor may ask the patient a blood test before the procedure, to determine how much time his blood is required for coagulation.Other blood tests can be done as well.
- The patient should inform the doctor if he has a pacemaker.
- The patient may receive sedatives before the procedure - they will help him to relax.
- On the basis of the patient's health, the doctor may prescribe other types of training specific to the procedure.
stroke treatments angioplasty and stenting
Percutaneous coronary intervention can be performed during the patient's stay in hospital.The procedures may vary depending on the condition of the patient and the doctor's practice.
Generally, the operation is as follows:
- The patient will be asked to remove all jewelry or other objects that may interfere with the procedure.The patient may wear dentures or hearing aids, if he uses them.
- The patient is asked to remove clothing, he will be given a gown to wear.
- The patient will be asked to empty your bladder before the procedure.
- If the patient has excessive hair in the area of the catheter (groin), they may be cut off.
- c intravenous catheter injection of the drug into the patient's hand is inserted before the procedure.
- The patient is placed in the supine position (on your back).
- The patient is connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small electrodes.During the procedure are monitored all the vital functions (heart rate, blood pressure, breathing rate, and oxygenation level).Mounted
multiple displays that show life pulses, and then the catheter is moved in the patient's heart, and the heart structures where the dye is introduced.
- patient receives sedative medication before the procedure - they will help him to relax.Nevertheless, it may be awake during the procedure.
- pulses below the catheter insertion site checked and marked in such a way that after the procedure could be tested blood circulation in the limb below the site of the catheter.
- A local anesthetic is injected into the skin at the site of the catheter.Within seconds after the local anesthetic is administered, the patient may experience a burning sensation.
- As soon as the anesthetic takes effect, the shell for the introduction of a catheter inserted into a blood vessel.This is a plastic tube through which the catheter is placed into the blood vessel and advanced into the heart.Sheath (sheath) is inserted into a blood vessel in the groin or wrist (now mostly in radial artery or wrist).
- angioplasty catheter is inserted through the skin into a blood vessel.The physician advances the catheter through the aorta to the heart.Fluoroscopy is used to assist in advancing the catheter to the heart.
- The catheter is advanced into the coronary artery.Once the catheter is in place, the contrast medium is injected through the catheter into the coronary artery.This allows you to see the narrowed area (s).The patient can feel when a contrast agent is injected into a vein: feeling salty or metallic taste in the mouth, and / or a brief headache.These effects typically last for several minutes.
- Patients should inform the doctor if he feels shortness of breath, sweating, numbness, itching, nausea and vomiting, chills or heart palpitations.
- After the contrast agent is injected, is a series of rapid, successive X-ray images of the heart and coronary arteries.
- When a doctor finds a narrowed artery, in this place will advance the catheter and the balloon will open the artery.The patient can thus experience some chest pain or discomfort as a result of blood flow that can temporarily lock the inflated balloon.Any discomfort in the chest, and all pain should go away when the balloon is deflated.However, if the patient sees the continuation of ongoing discomfort or pain in the chest, neck, jaw, back or arm, shortness of breath or difficulty breathing, he should immediately tell your doctor.
- The doctor can inflate and deflate the balloon several times - this may be the time when you need to insert a stent to maintain an open artery.In some cases the stent may be inserted into the artery to blow up the balloon.Filling the balloon opens the artery and the stent fully expands.
- The doctor conducts measurements or angiography images after opening the artery.Once it determined that the artery is opened enough angioplasty catheter is removed.
- Your doctor may decide not to remove an IV or catheter for about 5-6 hours to allow the act blood thinning medication given during the procedure.The patient should be at this time is convenient lie.
- If the catheter site - hand, it must be kept on a high pillow directly (plastic board intended to immobilize the elbow).