Contraindications after stenting of coronary arteries. How is stenting performed? Indications for vascular stenting

Coronary angiography is currently the gold standard for diagnosing vascular diseases of the heart. If vascular pathology is detected (stenosis, occlusion), angioplasty and stenting may be performed coronary vessels- a low-traumatic technique that allows you to restore blood flow in the heart.

Coronary examination (coronary angiography) – highly informative modern method diagnostics, allowing timely tracking pathological processes, occurring in the coronary (coronary) arteries. Deposition of lipid plaques on the inner walls of blood vessels leads to their narrowing (stenosis) or complete blockage (occlusion), which leads to heart attacks and strokes. Early detection of pathology and adequate treatment save the patient's life.

How is coronary angiography (CAG) performed?

Coronary vessels are radiographic examination, during which iodine-containing contrast is injected into the arteries that supply the heart tissue with blood. Next, a number of series are digitally recorded in several projections. On the monitor screen, the doctor sees how the heart functions, determines areas of stenosis and the presence of other pathologies.

X-ray surgical setup: table, C-arm, monitors

The angiographic unit consists of the following main components:

Angiographic table. Made of carbon fiber, equipped with a removable mattress with an antistatic coating. The table moves freely in a horizontal plane.
An X-ray tube in combination with an electron-optical converter or flat panel detector. The equipment is equipped with a monitor to monitor the progress of the operation, as well as an image recording and playback system.
Power source (generator). Ensures uninterrupted operation of the main unit and protects the system from overload.
Workstation with software for image analysis and processing.

To carry out the procedure, coronary approaches through radial ( transradial) or through the femoral ( transfemoral) arteries. How to do coronary angiography of the heart, which access to choose - the doctor decides. CAG is performed under local anesthesia solutions of lidocaine or novocaine, advancement of the catheter is painless for the patient, although sometimes there is slight discomfort.

The access artery is punctured with a needle, through which a guidewire and then an introducer are inserted into the lumen of the target vessel using the Seldinger technique. Next, contrast is injected into the artery. The drug contains iodine, so if the patient is allergic to it, it is imperative to notify the doctor about this.

The process of performing coronary angiography of the heart vessels

The results of coronary angiography are recorded on a CD or other digital media and handed over to the patient. According to doctors' reviews of coronary angiography, this study provides the most complete diagnostic picture and allows timely decision on treatment tactics - surgical or medicinal.

Is hospitalization necessary?

Removal of the sheath from the radial artery after coronary angiography using transradial access
The introducer is installed in the radial artery when performing coronary angiography of the heart

If the surgeon has chosen a transradial approach (a. radialis - radial artery), then the procedure in some cases can be performed on an outpatient basis, and the patient can leave the clinic on the same day. At home, you must adhere to a number of rules regarding the puncture site. In case of shortness of breath, weakness, hypotension ( low pressure), swelling, redness and pain in the puncture area, numbness and whitening of the hand - you should urgently seek medical help.
The operation performed transfemorally (through the a. femoralis - femoral artery) requires strict bed rest within 24 hours under supervision medical personnel in the hospital.

Basic rules for preparing for coronary angiography

blood tests (general and biochemistry);
determination of blood group, Rh factor;
assessment of PH factor (blood plasma acidity);
coagulogram (analysis of blood clotting indicators);
tests for HIV, hepatitis B and C, RW;
echocardiogram and ECG.

If the history indicates accompanying illnesses or previous heart attacks or strokes - consultations with specialized specialists will be required. The patient must inform the doctor about the medications he is taking.

Angiography is performed on an empty stomach, so you cannot eat in the evening. A cleansing enema is indicated. All hair should be removed from the area where the catheter is inserted. You should consult your doctor to see if it can be taken in the morning. regular medications and antidiabetic drugs. Often the doctor prescribes a course special medicines before the study.

Indications

The main indication for coronary angiography is coronary heart disease (CHD). In this case, the study is aimed not so much at diagnosis, but at resolving the issue of the need surgical intervention and the choice of the most preferable type of operation. Other indications:

angina pectoris – post-infarction or not amenable to medication;
upcoming heart surgery (correction of myocardial defects, valve replacement, etc.);
differential diagnosis with other heart diseases (non-coronary);
pulmonary edema of ischemic origin;
suspicion of asymptomatic ischemic heart disease, especially in people of dangerous professions;
chest pain unknown origin to exclude the diagnosis of ischemic heart disease;
deterioration of condition after endovascular operations (stenting, angioplasty);

An indication for emergency coronary angiography is a group of symptoms that may indicate the development of unstable angina or myocardial infarction.

At the same time as coronary angiography, if necessary, a stent can be implanted into the affected area.

Contraindications

Doctors say that absolute contraindications no to KAG. But there is relative contraindications, in which the procedure will have to be postponed until the patient’s condition improves for the following diseases:

uncontrolled ventricular arrhythmia or hypertension;
diabetes mellitus in the stage of decompensation;
blood clotting pathologies;
exacerbation of manifestations of peptic ulcer;
mental disorders;
severe renal failure;
allergy to X-ray contrast agents (urografin, iodine);
increased body temperature;
exacerbation of other chronic diseases.

After stabilizing the patient’s condition, the cardiologist decides on the possibility of conducting an angiographic study.

Complications of coronary angiography

Reviews of the consequences of coronary angiography of the heart vessels from doctors and patients allow us to conclude that this study is safe for correct actions surgeon and the patient’s compliance with all recommendations. However, the possibility of complications cannot be ruled out, such as:

hematoma or swelling in the area where the puncture needle was inserted;
bleeding from the puncture site;
allergic reactions for contrast agents;
arrhythmia;
nephropathy;
thrombosis of coronary vessels;
vegetative-vascular manifestations (weakness, hypotension, sweating and others);

Life-threatening complications (heart attack or stroke) are extremely rare, but the doctor must take their likelihood into account when deciding whether to perform a coronary angiography. The specialist assesses the patient’s age, the presence of heart pathologies and chronic diseases in the decompensation stage.

Which doctor gives a referral for coronary angiography?

A referral for coronary angiography is given by a cardiac surgeon. But you can get to him only after an in-depth examination by a therapist and cardiologist. Immediately before the operation, the patient is consulted by an anesthesiologist and a radiosurgeon who is directly performing the intervention.

Cost of coronary angiography in Moscow

Angiography of the coronary vessels is mainly a paid study. It can be done for free by emergency indications in some public clinics with appropriate equipment.

The price of coronary angiography depends on the clinic’s expenses for the angiographic installation and its maintenance, on the cost Supplies And medical supplies. Also great importance have:

status of the clinic and its pricing policy;
qualifications of the doctor performing the procedure;
length of stay of the patient in the hospital;
type of coronary access (access through the femoral artery is cheaper than through the radial artery);
circumstances complicating the procedure, resulting in increased consumption of materials and drugs.

The price of coronary angiography of the heart in Moscow varies from 15,000 to 61,000 rubles. If stenting or vasodilation using balloon dilatation is performed simultaneously with CAG, the cost of the operation increases.

It is not for nothing that coronary angiography is called the “gold standard” of diagnostics in cardiology. Reviews from patients about coronary angiography of the heart posted on the Internet indicate that if the procedure is carried out correctly, Negative consequences health problems are rarely observed. The minimally invasive operation is easily tolerated and allows you to accurately determine the presence of cardiac pathologies, develop the correct treatment tactics and preserve the patient’s health and vitality for a long time.

Angioplasty and stenting of coronary arteries

This kind of heart surgery (stenting) is the process of increasing the diameter of damaged heart vessels to their original state. When using this technique, a special mesh metal structure (stent) is placed inside the arteries, which is installed in a narrow section of the artery and, opening (a special balloon temporarily located inside the stent is used for this), expands its walls, while at the same time, as if “pressing” into them atherosclerotic plaques. Thanks to this, normal blood flow through the vessel is restored almost instantly, and the risk of reoccurrence of stenosis in the operated patient is reduced many times. In addition, stenting of cardiac vessels has a relatively low cost, which makes it possible to use this operation a large number of people.

Stenting scheme coronary artery

Pros and cons of the method

Thanks to a combination of non-traumatic surgery and high efficiency Installation of a stent in the vessels of the heart has a significant number of advantages over other techniques. These include:

the entire operation is performed through a puncture on the thigh or forearm, and does not require deep tissue incisions;
carried out under local anesthesia;
does not require long and complex postoperative treatment;
well tolerated by most patients (more than 90%);
sharply reduces the likelihood re-development stenosis;
can be carried out not only as planned, but also in emergency cases;
on average takes no more than 30 minutes;
low cost of stenting heart vessels in Moscow and other regions.

Stenting stage: inflating the balloon on which the coronary stent is mounted using a syringe-manometer

It is important to note that, although in the vast majority of cases this operation is well tolerated by patients, and they a short time are starting to get better, but it also has a number of disadvantages that you need to know:

violation of the integrity of the lining of the arterial wall;
possible large blood loss;
disruption of the excretory system;
formation of hematomas at the puncture point;
repeated stenosis at the site of stent placement (fortunately, extremely rare).

Preoperative examination, indications and contraindications

The main indication for installing a stent in the heart is coronary artery disease (CHD), which also develops after a myocardial infarction. At the same time, for staging the most accurate diagnosis, as well as the choice of future treatment (bypass surgery, stenting or other methods), coronary angiography is used. To carry it out, a special radiopaque substance is injected into the arteries of the heart, after which X-ray examination is carried out. As a result, it is possible to obtain a clear and accurate image of the coronary arteries, as well as accurately identify the affected areas on them. The results of coronary angiography are the main material for bypass surgery. It is also worth immediately noting that both before and after the examination, the patient may be diagnosed with various contraindications, the presence of which excludes the possibility of stenting. These include:

- dysfunction of the excretory organs;

— dysfunction of the respiratory system;

- low blood clotting;

- allergic reactions to iodine-based substances;

— the internal diameter of the vessels in which the stent is supposed to be installed is less than 2 millimeters;

— mass destruction coronary arteries, in which it is not possible to determine a specific site for the operation.

Main types of stents

This is what a stent looks like

All stents for coronary vessels can be divided into two large groups - all-metal and with drug coating. Prostheses of the first type are frames made of surgical stainless steel of various grades or chromium-cobalt alloy. They have a lower cost, but their installation is associated with the risk of developing a number of complications: thrombosis (especially in the first month after surgery), as well as re-stenosis. That is why, after their introduction, antiplatelet (double antiplatelet) therapy is carried out and long-term monitoring of the patient is required (the risk of restenosis is possible within a year after the operation). In turn, a drug-eluting stent allows one to avoid this type of complications and reliably protects the vessel wall from repeated narrowing. This is achieved due to the fact that its chromium-cobalt frame is covered with a thin layer of polymer (biocompatible), which, after installation of the stent, begins to slowly release medicinal substance, directly penetrating the affected area and preventing the re-formation of stenosis.

Metal stent in the hands of a doctor

Rehabilitation after surgery and physical activity

Initial rehabilitation after myocardial infarction and vascular stenting consists of temporary adherence to a sedentary (and then vice versa) regimen, diet (the goal of which is to eat foods with low percentage cholesterol) and taking a number of medications, the purpose of which is to normalize blood flow through the vessel, as well as the final healing of the puncture site through which the operation was performed. The prescribed medications include the following categories:

- blood thinners (usually based on acetylsalicylic acid);

- cholesterol-lowering drugs (statins);

- lowering blood pressure (if the patient has persistently elevated blood pressure).

Besides this, if undergone surgery the patient is diabetic, then he is prescribed special diet and a number of additional drugs.

As for physical exercise after stenting the coronary arteries, they are a mandatory part rehabilitation therapy, but can be prescribed no earlier than one and a half to two months after the operation (and during the first week strict rest should be maintained). Such exercises should be regular, but the load should be moderate (more than precise recommendations can only be given by the attending physician monitoring the patient).

One more important issue What is of interest to all people who have undergone cardiac stenting is how long they live after the operation. Answer this question definitely impossible - after all, everything depends on the person himself (and large quantity external factors). It is only worth noting that the majority of patients who have undergone stenting of cardiac vessels report only good feedback, and life expectancy (subject to compliance with instructions and absence excessive loads, both physical and nervous), reaches many years.

Administrator

To consult with a specialist, you can write to email mail@site

Stenosis is a narrowing of a vessel that partially or completely blocks blood flow. This anomaly occurs due to atherosclerosis and may be a consequence traumas suffered. Vessels can become deformed in any organ and cause such dangerous diseases, like, like coronary heart disease, atherosclerosis lower limbs and the rest dangerous diseases. In order for there to be good blood permeability, stenting of blood vessels is required.

What it is

Stenting of cardiac vessels is the surgical insertion of a stent into a vessel, thereby restoring its function. In simple words This operation is to prolong a person’s life.

When the disease just begins to manifest itself, a person does not notice it. At further development stenosis, manifests itself in internal organs. Standard drug treatment inappropriate here - surgical intervention is required.

Stenting of coronary arteries– when coronary heart disease is detected. The myocardium cannot receive the required amount of ozone to function well. Myocardial cells starve and this happens. The main source of ischemia is atherosclerosis of the coronary vessels, they supply blood to the heart. Also pre-infarction state. IN in some cases the operation is performed during a heart attack, thereby saving a person’s life.

Stenting of lower extremity arteries. With stenosis, a person feels sharp pains in the legs and hips. If measures were not taken when identifying the disease of stenosis, then it may begin.

Stenting carotid arteries. The carotid arteries supply blood to the head. With stenosis, the consequences can be different from headaches to more serious problems. When stenting of the carotid arteries is done, in addition to inserting the stent, they also add protective agent with a membrane that traps microthrombi.

Coronary artery restenosis after surgery for treatment ischemic disease. Six months after this procedure, the thickening of the vessels - restenosis - is repeated. To prevent this from happening during angioplasty, stenting is added.

In patients with coronary disease hearts that have undergone aortocoronary surgery (surgically, the blood supply to the heart is restored using a shunt), after such an operation, after about ten years, a narrowing of the shunt may occur. In this case, stenting is required.

Types of stents

The purpose of the stent is to stabilize the walls of the diseased vessel. The stent does a very hard job, so it is made from materials highest quality. In most cases these are metal alloys. There are many types of stents that differ in many ways.

The main ones:

Uncoated, metal. Often used in narrowed arteries.
Coated. A special polymer that covers the stent. Releases medicine. Used in small arteries where there is a high risk of blockage. But, this type of stent requires taking antiplatelet medications for a year.

pros

vascular stenting does not require a long hospital stay;
not required long recovery after stenting;
The operation is performed under local anesthesia. This greatly facilitates the work of doctors and human well-being;
Stenting does not require extensive opening, as with bypass surgery;
There are practically no complications after stenting surgery;
the price of vascular stenting will please the patient because it is significantly lower compared to other operations.

Contraindications

Even with such an extensive list positive aspects, there are some contraindications for stenting:

artery diameter<2.5 мм;
diseases associated with blood functions (clotting). It is possible that this is HIV infection, jaundice;
problem with the kidneys or respiratory system - kidney failure, renal colic, asthma, bronchial diseases;
diffuse stenosis. Large area of narrowing;
allergy to iodine.

Indications for vascular stenting surgery:

acute myocardial infarction;
angina pectoris;
primary stenosis;
spicy;
restenosis;

Before performing surgery on a patient, he undergoes a thorough examination. The first thing you need is to undergo a series of tests (detection of allergic reactions to medications). Afterwards, the person must undergo an x-ray, the results of which clearly show the problem area. The doctor also prescribes echocardiography, as well as intravascular ultrasound (helps assess the degree of damage to the vessel). Also, judging by the test results, the doctor may refer you for additional examinations. In addition to all of the above, the patient takes prescribed medications for several days to prepare the body for stenting.

The stenting operation takes from one to three hours, depending on the complexity.

Before the operation begins, an injection is given to reduce blood clotting. Afterwards, manipulations are carried out by an anesthesiologist, the required area of skin is cleaned with an antiseptic. When everything is ready, the doctor makes a puncture on the treated skin, in the area of the bad artery. A catheter is inserted. Through it, a balloon is inserted into the artery, within 20 - 30 seconds the balloon is inflated, thereby expanding the lumen. A stent is installed in this place, it is attached to the walls of the vessel and prevents the artery from returning to its original position. If the artery has a long deformity, several stents are inserted using several catheters. The person’s condition is constantly monitored through an X-ray monitor.

When the operation is completed, all instruments are removed. The person does not feel any pain during the operation.

Complications

Basically, there are no complications during the stent installation operation or after it.

But, each organism is individual and complications of stenting can still arise:

Arterial disruption. The walls of the artery may become deformed or occur.
Various types of bleeding may occur.
In other cases, kidney problems may arise
At the site of the incision or puncture, a bruise or swelling appears on the skin.

A blood clot occurs at the site of the procedure. In this case, the person is urgently sent for coronary artery bypass surgery. But it can occur in rare cases.

Rehabilitation after vascular stenting is easy and unnoticed if you follow the advice of your doctor. Bed rest is required for several days. The doctor carefully monitors the patient and looks for complications. If the result is positive, the person is sent home, but with a list of “dos and don’ts.” You cannot lift anything heavy or engage in physical labor or sports. You can't swim in the bathroom - you can shower. You can't drive a car (two months). But, you can do physical therapy exercises, following a diet is an important procedure.

Do not overfill your stomach with heavy fatty foods:

You can’t eat fatty foods (fatty meat, sour cream, etc.);
you need to include foods with omega-3 and omega-6 fats (tuna, flaxseed oil) in your diet;
you need to eat more fruits and berries - vitamins;
no butter;
exclude salt and pickles;
You need to eat little by little, but often.

And also after stenting, medication is required. It is very important. Since there is a risk of repeating the operation.

Price

The price of stenting depends on many factors. In which country will the operation be performed, in which clinic, with what instruments and what specialists? All this must be taken into account when preparing for such an operation.

Stenting is a high-tech procedure. It involves special X-ray surgical mechanisms. They are expensive equipment. Such operations should be performed by highly qualified doctors with such equipment.

In Israel, the average cost of a vascular stenting operation costs about six thousand euros, in Germany - an average of 8 thousand, in Turkey - about 5 thousand euros. In Russia it is approximately 130 thousand rubles.

Vessel stenting is a very well-known operation in vascular surgery. This operation is low-traumatic, there are practically no complications, the rehabilitation period passes quickly and without unnecessary worries. The patient must not only during the rehabilitation period, but also at all times, avoid overeating, lift heavy things, and not be nervous (avoid all kinds of stress). Take medications for some time.

Cardiology has a variety of methods for treating cardiovascular pathologies, among which the greatest effect is provided by vascular stenting and angioplasty. They can be performed simultaneously or separately, depending on the individual problem.

Indications for stenting

If vascular patency is impaired as a result of atherosclerosis, there is a risk of developing coronary heart disease, cerebrovascular accident and other life-threatening conditions. Therefore, to restore the patency of the artery or aorta, the following methods are used: stenting of the coronary arteries, and. Most often, surgery is prescribed in cases where repeated treatment with conservative methods has not helped.

The largest vessel in the human body is the aorta, which supplies oxygen to all organs and tissues. At the very beginning of a narrowing of a blood vessel, there are usually no signs of oxygen deficiency. As the narrowing of the aorta (coarctation) progresses, patients experience high blood pressure and other problems may occur. The most serious complication is considered to be aortic rupture, as this can lead to rapid death of the patient. Surgical treatment will help avoid this consequence and normalize blood pressure.

Cardiac stenting is a surgical procedure during which the lumen of the affected artery is restored to normal diameter. A special stent is installed inside the vessel, thereby normalizing blood flow. Modern surgery helps prevent tissue necrosis and the development of myocardial infarction. The main indication for stenting is the results of examinations, namely coronography (x-ray contrast examination of the coronary arteries), which confirm the presence of pathology and the patient’s complaints.

Benefits of the operation

Stenting of the coronary arteries is performed under local anesthesia and with mandatory x-ray control. To perform the operation, a balloon catheter of the required diameter and a metal frame (stent) are required. Such a frame may be uncoated or have a special polymer on top. Polymer-coated stents cost much more but provide better results.

The essence of the operation is that a catheter is inserted into the human femoral artery, which is equipped with a small balloon with a stent at the end. After it reaches the problem area at the site of narrowing of the vessel, the balloon begins to inflate to the required size and presses atherosclerotic deposits into the walls. After the balloon is deflated, an expanded metal frame remains in its place, which will prevent the vessel from narrowing again.

Coronary stenting of the heart vessels takes about 1-3 hours. Immediately before surgery, the patient should take blood thinners to prevent thrombosis.

The stenting procedure has advantages over other manipulations and procedures that should be taken into account when choosing a treatment method:

low morbidity;
no need for general anesthesia;
short rehabilitation period;
minimal number of complications.

The body recovers quite quickly after such surgery, and the patient does not need long-term hospitalization. Compared to other operations, cardiac stenting is considered less expensive. Since there is no need for general anesthesia, this type of treatment can be used even for patients with contraindications to standard surgery.

Complications and rehabilitation

Serious consequences or complications after stenting are extremely rare. In rare cases, the patient may experience bleeding, kidney function may be impaired, or a hematoma may form in the puncture area. If after the manipulation there is a blockage of the artery, urgent coronary artery bypass grafting is recommended.

In order for the rehabilitation period to pass without complications, it is necessary to strictly follow the doctor’s instructions. Immediately after surgery, you must stay in bed and limit physical activity for the first week. It is prohibited to visit a sauna, steam bath or take a bath, lift heavy objects, or drive a car.

Video

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!

It is a medical surgical intervention that is performed to install a stent - a special frame placed in the space of hollow human organs, for example, coronary heart vessels, and allowing to expand the area narrowed by pathological processes.

Vessels may narrow as a result of atherosclerosis, and this poses a huge threat to human health and life. Depending on which vessels are damaged, a decrease in the lumen leads to ischemia, disruption of cerebral circulation, atherosclerosis of the legs and other dangerous diseases.

To restore the patency of the arteries, several techniques are known, the main ones are:

conservative therapy,
angioplasty,
stenting of heart vessels and other affected arteries,
coronary bypass surgery. ?

Initially, the narrowing of the lumen does not actually affect the patient’s condition. But in a situation where the stenosis increases by more than half, signs of a lack of oxygen in the body and tissues appear (ischemia). In such a situation, conservative therapy is often powerless. More significant methods of treatment are needed - intravascular surgery.

Coronary stenting of heart vessels is considered one of the most effective methods of intravascular replacement of cardiac arteries during various pathologies.

Indications for stenting

The heart is a powerful pump that provides blood circulation. Along with blood circulation, nutrients and oxygen begin to flow to organs and tissues; in their absence, their functioning will be impossible.

Atherosclerosis is considered the most common chronic disease that affects the arteries. Over time, atherosclerotic plaques that grow inside the lining of the vessel wall, either single or multiple, are considered cholesterol deposits.

In the case of proliferation of connective tissue in the artery and calcification of the vascular walls lead to gradually developing deformation, the lumen will narrow, sometimes to the point of complete obliteration of the artery, which will entail a constant, growing lack of blood circulation to the organ that is fed through the damaged artery.

When there is insufficient blood circulation in the heart muscle, a person experiences the following symptoms:

pain in the chest, which is accompanied by fear of death;
nausea;
dyspnea;
cardiopalmus;
excessive sweating.

Selection of patients with ischemia for surgical intervention is performed by a cardiac surgeon. The patient must undergo the necessary examination, which includes all the necessary blood and urine tests to determine the functioning of internal organs, lipogram, and blood clotting.
Electrocardiogram will make it possible to clarify the location of damage to the heart muscle after a heart attack, the distribution and concentration of the process. An ultrasound of the heart will demonstrate the functioning of each section of the atria and ventricles.
Angiography should be performed. This process consists of introducing a contrast agent into the vessels and several x-rays, which are taken while filling the vascular bed. The most damaged branches, their concentration and degree of narrowing are detected.
Intravascular ultrasound helps to assess the capabilities of the arterial wall inside.

Indications for surgery:

difficult regular attacks of angina, which the cardiologist defines as a pre-infarction;
support for coronary artery bypass graft, which tends to narrow over 10 years;
by vital signs during severe transmural infarction.

Contraindications

The inability to insert a stent is established at the time of diagnosis:

Widespread damage to all coronary arteries, which will result in no sites for stenting.
The diameter of the narrowed artery is less than 3 mm.
Reduced blood clotting.
Renal and liver dysfunction, respiratory failure.
The patient is allergic to drugs containing iodine.

Effectiveness of the operation, consequences

This method of therapy is characterized by some advantages that force specialists to choose surgical intervention.

These advantages are:

Many patients who are prescribed this operation are interested in how safe it is, and how long people who have undergone it live after the operation.

Adverse consequences occur quite infrequently, in approximately 10% of patients. But such a risk should not be completely dismissed.

Cardiac stenting is considered the safest treatment measure. The patient must monitor his health much more closely, adhere to the specialist’s recommendations, take the necessary medications and undergo examinations as planned.

It happens that even after surgery, the likelihood of narrowing the artery remains, but it is small, and scientists continue research in this area, and the number of improvements is growing.

Cardiac stenting after a heart attack can be characterized by dangerous complications that arise during the surgical procedure, a short period of time after it, or after a long period.

Rehabilitation

After this operation, a person feels much better, the pain in the heart after stenting becomes less severe, but the process of atherosclerosis itself does not stop and does not contribute to a change in the dysfunction of fat metabolism. Therefore, the patient must follow the specialist’s recommendations and monitor the cholesterol and sugar levels in the bloodstream.

Goals of rehabilitation after surgery:

Restore the maximum possible functionality of the heart;
Prevention of postoperative complications, in particular, relapse of narrowing of stented vessels;
Slow down the progress of ischemia, improve the prognosis of the disease;
Increase the patient’s physical abilities, minimize lifestyle restrictions;
Reduce and optimize drug treatment received by the patient;
Normalize laboratory parameters;
Ensure the psychologically comfortable state of the patient;
Adjust the patient’s lifestyle and behavior, which will help preserve the results obtained during rehabilitation.

REVIEW FROM OUR READER!

After surgery, you must stay in bed for a certain period of time. The doctor monitors the occurrence of complications, recommends diet, medication, and restrictions.

Life after stenting means meeting certain requirements. When a stent is installed, the patient undergoes cardiac rehabilitation.

Its main requirements are diet, physical therapy and a positive mood:

For 1 week The rehabilitation process is associated with restrictions on physical activity, baths are prohibited. Experts advise against driving for 2 months. Subsequent recommendations include a cholesterol-free diet, dosed physical activity, and regular use of medications.
It is necessary to remove fats from the diet animal origin and limit carbohydrates. You should not take fatty pork, beef, lamb, butter, lard, mayonnaise and hot spices, sausages, cheese, caviar, soft wheat pasta, chocolate products, sweets and flour products, white bread, coffee, strong tea, alcoholic beverages, soda.
On a diet It is imperative to include vegetable and fruit salads or fresh juices, boiled poultry, fish, cereals, pasta, cottage cheese, sour milk, green tea in the menu.
You need to eat little by little, but often, 5-6 times, monitor your weight. If possible, do fasting days.
Every day gymnastics in the morning helps increase metabolism, puts you in a positive mood. Don't do difficult exercises right away. It is recommended to walk, first for a short distance, then increasing the distance. Slowly walking up the stairs and exercising on exercise machines are helpful. It is impossible to bring to a strong overload with tachycardia.
Drug treatment consists of taking drugs that lower blood pressure, statins to normalize cholesterol levels and drugs that reduce blood clots. People suffering from diabetes continue special therapy on the recommendation of an endocrinologist.
Optimal, when the rehabilitation process after surgery will take place in sanatoriums or resorts, under the supervision of doctors.

Postoperative therapy is important because after surgery, the patient must take medications every day for 6 to 12 months. Angina pectoris and other manifestations of ischemia and atherosclerosis are eliminated, but the cause of atherosclerosis remains, as do the risk factors.

Many patients ask the question: Is it possible to apply for disability after surgery? Stenting helps to improve the patient's condition and will return him to proper performance, and therefore there is no need for this procedure.

Prognosis after surgery

Cardiac stenting is a safe operation that brings the desired effect. The likelihood of adverse effects occurring is low. Even after stenting, a person will return to his usual lifestyle and restore his ability to work.
Shouldn't be forgotten that the poor lifestyle habits that caused the ischemia can again cause artery blockages if they are not changed. The operation is characterized by a short postoperative recovery period.
Regarding subsequent prognosis, then stenting is effective in approximately 80% of situations. It happens that the process is reversed, despite the efforts made, the artery will narrow again. But scientists continue to conduct research and improve the technology of the operation. The number of positive outcomes is growing.
Now cardiac surgeons completely new stents are used that minimize the likelihood of reverse narrowing of the coronary arteries.

Possible complications after surgery

Various adverse effects occur during stenting, the most well-known of which are:

Taking into account The fact that blood circulation occurs in the human body, in some cases, during stenting, consequences also occur in other arteries not affected by the operation.
Increased risk the occurrence of complications after surgery in people suffering from severe kidney diseases, diabetes mellitus and malfunctions in the blood coagulation system. Therefore, such patients are carefully examined before stenting, additionally prepared by prescribing special medications, and then after the operation they are monitored in the intensive care or intensive care unit.
Stenting does not guarantee from complete relief from ischemia. The disease may develop, other atherosclerotic plaques may form in the arteries, or the existing ones may increase. The stent itself can become overgrown or create a blood clot over time. Therefore, all patients who have undergone stenting of the coronary arteries are under regular medical supervision in order, if necessary, to promptly identify a recurrence of the disease and refer them back to a specialist.
Stent thrombosis is one of the most dangerous consequences after surgery. The dangerous thing is that it develops at any time: both in the early and late postoperative period. Often, this consequence leads to severe pain, and if left untreated, leads to myocardial infarction.
Less dangerous consequence, but stent restenosis, which develops due to the “ingrowth” of the stent into the vascular wall, is considered more common. This is a natural process, but in some patients it develops too actively. The lumen of the operated artery begins to narrow significantly, causing relapse of angina.
If medication is not followed, diet and regimen prescribed by the doctor, the formation of atherosclerotic plaques inside the body will develop, which will lead to the emergence of new areas of damage in previously healthy arteries.

Signs of complications

In approximately 90% of situations where a stent is placed, proper blood flow in the arteries is restored and problems do not occur.

But there are cases when adverse consequences are likely:

Failure of the integrity of the arterial walls;
Bleeding;
Difficulty with kidney function;
The appearance of hematomas at the puncture site;
Restenosis or thrombosis at the stenting sites.

One of the likely complications is arterial blockage. It happens quite infrequently, when pathology occurs, the patient is immediately sent for coronary artery bypass surgery.

Adverse consequences from such an operation are extremely rare, therefore vascular stenting is considered the safest surgical operation.

Cost of the operation

The cost of stenting varies depending on the arteries that need to be operated on, as well as on the state, medical institution, instrumentation, equipment, type, total number of stents and other circumstances.
It is a high-tech operation that requires the use of a special operating room, which is equipped with complex expensive equipment. Stenting is performed using new techniques by qualified cardiac surgeons. In this regard, the operation will not be cheap.
The cost of stenting varies in each country. For example, in Israel from about 6,000 euros, in Germany - from 8,000, in Turkey - from 3,500 euros.
Stenting is considered one of the most common operations in vascular surgery. It is characterized by low trauma, gives the proper effect and does not require long-term recovery.

(FAQ)

How long does stenting last?

This depends on the difficulty of placing the stent in the right place, which can be very individual. On average, 30 minutes - an hour.

Is it possible to do stenting for myocardial infarction ?

Stenting in the acute period of myocardial infarction is effective if it is performed as early as possible, no later than the first 6 hours from the moment of development of the infarction, optimally - up to 2-3 hours. Restoring blood flow in a clogged artery in this time period, before the development of irreversible changes in the myocardium, sharply reduces the area of the heart muscle involved in a heart attack, and sometimes makes it possible to “break off” its course and prevent it. Often, stenting in the acute period saves the life of a patient with a heart attack.

If stenting is not possible within the first hours, then there is usually no further urgency in its use. However, the return of angina at any time after a heart attack is an indication for normalization of coronary blood flow, so it is necessary to do coronary angiography without delay.

Which rehabilitation. where and for what duration is needed after stenting?

The huge advantage of intravascular methods for restoring coronary blood flow is precisely that they not only do not require any rehabilitation, but they themselves are the best rehabilitation (literally, the return of capabilities, i.e. adaptation to life) of a patient with IHD.

Restrictions on work ability after stenting end the next day - after the puncture site of the femoral artery has healed.

During the first 3 weeks after stent implantation, it is undesirable to provoke sharp fluctuations in vascular tone, so you should refrain from drinking alcohol, stress loads and contrasting effects such as saunas and cold baths. In addition, it is necessary to take Plavix for a year after stenting to prevent stent thrombosis, since in coronary artery disease there is an initial predisposition to coronary thrombosis.

I was found to have two stenoses on coronary angiography. But the doctor says that stenting cannot be done because I still have stomach ulcer. Is this really true?

The problem is that after the installation of drug-eluting stents, it is necessary to take drugs for a year, at least 6 months, to prevent stent thrombosis.

The presence of a stomach ulcer is exactly the case when taking these drugs, primarily Plavix, can provoke bleeding from an ulcerated vessel in the gastric mucosa. At the same time, the ability of platelets under the influence of these drugs to form a blood clot at the site of ulceration and thereby stop bleeding is reduced. In such a situation, stopping stomach bleeding is not easy.

Therefore, until the ulcer is cured and healed, stenting is extremely undesirable. It needs to be postponed for the period necessary for anti-ulcer therapy, and only then, after making sure with the help of FGS that the ulcer has been eliminated, stenting should be done. Today, gastroenterologists have quite strong and effective antiulcer drugs in their arsenal.

Coronary angiography

In medical practice, there are a number of diagnostic studies. However, a method such as coronary angiography is the most reliable way to determine coronary heart disease (CHD). Also, using this X-ray examination, you can establish the site, determine the nature and stenosis of the coronary arteries.

This research was introduced into medical practice in the 60s of the twentieth century. And over the past 50 years of its use, this technique has established itself as the safest, most effective and reliable method of diagnosis.

When the problem arises of choosing the volume of subsequent treatment procedures, such as coronary bypass surgery, stenting or balloon angioplasty, coronary angiography will help solve this issue. When performing this diagnosis, a special substance is injected into the patient’s vessels, thanks to which the radiograph is clear.

Indications for performing coronary angiography of the heart

This study is used to make a diagnosis if the patient has the following suspicions:

performing cardiopulmonary resuscitation;
chest pain;
angina pectoris;
cardiac ischemia;
heart attack;
ischemic pulmonary edema;
before surgery if a heart defect is observed;
heart failure.

What should a patient do before coronary angiography?

Before carrying out this procedure, the patient is required to donate blood to determine its group, general analysis, as well as HIV analysis and, as an exception, hepatitis viruses type B and C. The patient must have an echo and electrocardiogram. In addition, the cardiologist carefully collects anamnesis, identifying symptoms and directly related diseases.

In some cases, if necessary, before diagnosis, the patient is prescribed to perform additional studies, undergo a course of treatment with analgesics, antiallergic drugs or tranquilizers.

Before the procedure, the patient must remember the following:

it is necessary to prepare the area of the body where the puncture will be performed (groin area and wrist), this area must be clean and shaved;
diagnosis is performed on an empty stomach;
routine use of medications prescribed by the doctor.

Methods for studying the coronary vessels of the heart

There are several ways to perform this study. The first method is when the femoral artery is punctured in the groin area, through which an elastic catheter is inserted. In some cases, a catheter is inserted into the brachial artery.

How is coronary angiography performed?

Before this method of diagnosing the heart, local anesthesia is given. Then, as a rule, a catheter is inserted into the coronary artery located on the thigh, through which contrast passes and spreads through the vessels. Subsequently, the vessels become visible using special equipment (angiograph). Thanks to the angiograph, you can perform high-speed shooting in a large format, and with its help, the results obtained are processed by computer. Having established the size of the vascular lesion, the doctor makes a diagnosis and then prescribes appropriate treatment.

When performing coronary angiography of blood vessels, the following medical specialists are present: a cardioreanimatologist and an anesthesiologist monitor the patient’s condition and, if necessary, provide emergency care to the patient.

Complications after coronary angiography

When performing this method of heart examination, the risk of complications is extremely rare, however, there have still been cases when, during the procedure, in the place where the puncture was performed, the patient started bleeding, an allergic reaction to the contrast agent appeared, manifested in a decrease in pressure, rash, problems with breathing, itching, and even anaphylactic shock.

There is also a small probability that coronary artery thrombosis and heart rhythm disturbances may occur during the manipulation period.

However, it would be worth emphasizing once again that such complications are extremely rare (less than one percent) and usually do not require additional interventions.

In certain cases, the doctor, having agreed with the patient on the simultaneous performance of coronary angiography with therapeutic procedures, decides to perform balloon dilatation and stenting.

Because, as a rule, complications do not arise after catheterization and the patient returns to normal life on that day after the procedure is completed.

In order for the process of removing the contrast agent from the body to be accelerated, the patient should drink more fluid after the procedure.

In modern medical centers and clinics, 95% of this procedure is performed via transradial access.

What are the possible results of angiography?

This procedure may show:

how many coronary arteries are narrowed by atherosclerotic plaques, and which of them are blocked;
identify areas of narrowing of blood vessels and determine the volume of blood that passes through these places;
to clarify the results of surgical intervention of coronary artery bypass grafting.

Coronary angiography provides valuable information to the doctor, based on which he prescribes therapy, and he also determines the condition of the heart, establishing what danger there is to the patient’s health.

Vascular stenting, coronary artery stenting

Stenting of coronary arteries with angioplasty is a modern, low-traumatic operation performed on vessels with atherosclerotic changes and aimed at restoring the lumen of the arteries, most often the coronary artery. Angioplasty is a medical procedure in which a special balloon is inserted into a vessel damaged by plaque. At the site of damage to the vessel, the balloon is inflated under high pressure, destroys the plaque and presses it into the wall of the vessel. Typically, an additional supporting structure, a stent, is installed in the coronary artery. The stent in its initial state has the form of a mesh metal cylinder made of a special alloy and is compressed and placed on a balloon. When the balloon is delivered to the location of the plaque, it is inflated, the stent expands with it, after which the balloon is deflated and removed from the artery, and the stent remains in it forever.

Indications for vascular stenting

Stenting surgery is performed on patients whose coronary arteries are narrowed due to existing atherosclerotic plaques. Plaques reduce blood flow through the arteries, which leads to a lack of oxygen and nutrients flowing to the heart, and as a result causes angina attacks in the patient.

Indications for surgery are determined for each patient by a cardiac surgeon. Before stenting, coronary angiography is required, which shows how damaged the vessels are, how many stents are available and in which areas of the arteries they need to be installed. Vascular stenting. Compared to bypass surgery, it does not require an incision in the chest, suturing and long recovery after surgery. However, the choice in favor of bypass surgery or stenting is made by the attending physician, based on the severity of the damage to the arteries of the heart and the general condition of the patient. Neither one nor the other operation is a panacea and does not exempt the patient from subsequent conservative treatment by cardiologists.

Preparation for vascular stenting

Before the operation, you will be examined in standard quantities that comply with the standards for preoperative preparation. Depending on whether you have any additional concomitant diseases, your attending physician may prescribe additional tests or studies. Vascular stenting surgery is performed on an empty stomach, so several hours before the procedure the patient is prohibited from eating, and, accordingly, all medications intended to correct diabetes are discontinued. Taking other medications is at the discretion of the attending physician. Additionally, before stenting, a drug (clopidogrel) is prescribed to prevent the formation of blood clots in the vessels. As a rule, it is prescribed three days before stenting surgery, but it is also possible to take a significant dose immediately before the procedure. True, the second option is less desirable, as it can lead to some complications from the stomach.

Method of performing stenting surgery

To begin coronary artery stenting surgery, a large artery in the leg or arm is punctured. The choice of access depends on the doctor performing the operation and the individual patient. As a rule, access through the leg (in the groin area) is used because it is simpler and more reliable. A special short plastic tube (introducer) is inserted into the artery through this puncture, which will act as a “gate” for all other instruments. A long plastic tube (catheter) is inserted through the introducer and brought to the damaged coronary artery. A catheter is installed in the artery and through it a stent placed on a special deflated balloon is brought to the site of the atherosclerotic plaque. Vascular stenting is carried out using the most modern X-ray equipment, which allows for precise positioning of the stent balloon at the location of the atherosclerotic plaque.

After checking the position of the stent at the site of the plaque in the coronary artery, the balloon is inflated by injecting a contrast agent into it at high pressure. When the balloon is inflated, the stent expands and is pressed into the walls of the vessel, where it remains forever. Angioplasty with stenting usually takes no more than an hour, but the total operation time depends on each specific case. In case of severe damage to the heart vessels, the operation can last several hours. When a surgeon inflates a balloon containing a stent in a heart artery, blood flow through that coronary artery is temporarily stopped, which can cause chest pain (angina). It is advisable to inform the operating doctor about any pain that occurs so that he can plan his further manipulations. After the stenting operation is completed, all instruments inserted inside are removed, except for the stent, which, as mentioned above, remains in the human body forever. There are various modifications of stents, which differ in the type of design and the alloy from which it is composed, but usually there are two main groups: simple (“bare”) and drug-eluting (“coated”). There are no ideal stents today.

All of their modifications have their pros and cons, so the choice of an implantable stent ultimately remains with the surgeon, who is based on his own experience and the characteristics of this particular patient. After the operation is completed, the puncture site is sutured or taped, or pressed for a while, and a special bandage is applied to the patient’s limb.

Complications of stenting

When performing balloon angioplasty and stenting, a wide variety of complications can occur, the most common of which are: blockage of the operated artery, damage to the vessel wall, the development of bleeding or the formation of a hematoma at the puncture site, allergic reactions to the contrast agent of varying severity, up to and including impaired renal function.

Considering that blood flow circulates in the human body, in some cases, when performing this operation, complications may arise in other arteries, even those that were not affected by the operation.

People with severe kidney disease, untreated diabetes, and bleeding disorders are more likely to develop complications after stenting and angioplasty surgery. Therefore, such patients are examined more thoroughly before surgery, additionally prepared, including by prescribing special medications, and subsequently, after the stenting procedure, they are observed in an intensive care unit or resuscitation room.

Stenting surgery does not guarantee complete relief from coronary heart disease. The disease can progress, new atherosclerotic plaques can form in the arteries or existing ones can increase. And the stent itself can restenose (“overgrow”) or thrombose (“clog”) over time. Therefore, all patients who underwent stenting of coronary arteries. are under constant supervision of a cardiologist in order to, if necessary, recognize a relapse of the disease in time and re-refer him to a cardiac surgeon.

Stent thrombosis is one of the most dangerous complications after stenting surgery. The most unpleasant thing about it is that no one is immune from it, and it can develop at any time: either in the early or late postoperative period. As a rule, this complication leads to the development of an acute painful attack, and if left untreated, can lead to myocardial infarction. A less dangerous complication, but much more common, is stent restenosis, which develops due to the “ingrowth” of the stent into the vessel wall. In fact, this is a natural process, but in some people it is so active that the lumen of the operated artery narrows greatly, causing the return of angina.

And of course, if you do not comply with drug therapy, diet and regimen prescribed by your cardiologist, the process of formation of atherosclerotic plaques in your body can progress, which will lead to the development of new lesions in previously healthy arteries.

After stenting, the patient is on bed rest in the hospital under the supervision of medical personnel. To prevent bleeding from the punctured artery, the patient after stenting surgery is limited in his movements and is prohibited from moving the limb through which the heart was accessed. Subsequently, as a rule, after 2-3 days the patient is discharged home with recommendations for a specific regimen and medications. In addition to the standard set of medications selected for you by a cardiologist, a blood thinning drug (clopidogrel) is added for a long period of time (from six months to 2 years). Stopping this medication may cause a blood clot to form in the installed stent.