Stands on the vessels of the heart. Stenting and stable angina pectoris. Real advantages of the method

Vascular stenting: indications, surgery, rehabilitation

Initially, the narrowing of the lumen has virtually no effect on the person’s condition. But when the stenosis increases by more than half, signs of a lack of oxygen in organs and tissues (ischemia) appear. In this case conservative treatment usually turns out to be powerless. More effective methods of therapy are required - intravascular surgical interventions.

One of the ways to treat ischemia is stenting. This is a minimally invasive endovascular intervention method, the purpose of which is to restore the lumens in the arteries affected.

A special catheter is inserted percutaneously into the affected area of ​​the vessel, at the end of which there is a balloon. At the point where blood flow is disrupted, the balloon inflates and expands the walls of the vessel. To maintain the lumen, a special structure is installed in the artery, which subsequently plays the role of a frame. This design is called a stent.

Scope of stenting

• Stenting of coronary arteries required when symptoms appear coronary disease heart (CHD), as well as increased likelihood. With ischemic heart disease, the blood supply to the myocardium is disrupted, and the heart does not receive enough oxygen for normal functioning. Cardiac muscle cells begin to starve, and then tissue necrosis (myocardial infarction) may occur. Basic cause of ischemic heart disease is atherosclerosis coronary vessels that deliver blood to the heart. Because of it, heart lumen is formed inside the walls of the arteries, narrowing the lumen. Sometimes heart stenting is carried out in acute period myocardial infarction. If the operation is performed within the first six hours after the onset of a heart attack, restoring normal blood flow often saves the patient’s life and certainly reduces the risk of developing irreversible changes in the myocardium.

Stenting during running

• Arterial stenting lower limbs – the least traumatic and at the same time very effective method of treating vascular diseases of the legs. When plaques form and blood flow is disrupted when walking, the patient experiences pain in the thighs, buttocks, feet and legs. As the disease develops, it leads to the most severe consequences, including gangrene.
• Carotid artery stenting– low-traumatic treatment that allows you to restore the lumen of blood vessels. Carotid arteries supply blood to the brain, and with their stenosis, the cerebral circulation. During the operation, in addition to the stent, special protective devices with a membrane are installed - filters. They are able to retain microthrombi, protecting small vessels brain from blockage, but without interfering with blood flow.
• Coronary artery restenosis after angioplasty. After this procedure, after 3-6 months, 50% of patients experience restenosis - repeated narrowing of the vessel in the same place. Therefore, to reduce the likelihood of restenosis, angioplasty is usually complemented by coronary stenting.
• In patients with coronary artery disease who have undergone coronary artery bypass grafting, ten to fifteen years after surgery, stenosis of the shunt may occur. In this case, stenting becomes an alternative to repeat coronary artery bypass surgery.

Video: 3D animation of the stenting process

Types of stents

The purpose of stents is to provide support to the walls of a blocked vessel. They bear a heavy load, so these structures are made from advanced high-tech materials highest quality. These are mainly inert metal alloys.

IN modern medicine There are several hundred types of stents. They differ in design, type of cells, type of metal, coating, and method of delivery to the arteries.

Main types of coronary stents:

1. Simple metal without coating. This is the most commonly used type of stent. Typically used in narrowed medium-sized arteries.
2. Stents coated with a special polymer, dosed releasing the medicinal substance. They can significantly reduce the risk of restenosis. However, the cost of such stents is significantly higher than the price of conventional ones. In addition, they require longer-term use of antiplatelet drugs - about 12 months while the stent releases the drug. Discontinuation of therapy may lead to thrombosis of the structure itself. The use of a covered stent is recommended in arteries small size, where the probability of a new blockage is higher than in average.

Benefits of stenting

• Does not require long-term hospitalization.
• The body recovers quickly after surgery.
• Carried out under local anesthesia, which allows treatment even for those patients for whom traditional surgical intervention.
• The operation is low-traumatic - it does not require opening various parts of the body, for example, the sternum during bypass surgery when heart surgery is performed.
• The likelihood of complications occurring is minimal.
• Less expensive treatment compared to conventional surgeries.

Contraindications to vascular stenting

• The diameter of the artery is less than 2.5–3 mm;
• Poor blood clotting;
• Severe renal or respiratory failure;
• Diffuse stenosis - damage to too large an area;
• An allergic reaction to iodine, a component of a radiocontrast drug.

How is stenting performed?

Before the intervention, the patient undergoes a series of examinations, one of them is an x-ray examination, which can be used to identify the condition of the arteries and accurately determine the location.

Before surgery, the patient is given a drug that reduces blood clotting. Anesthesia is performed - usually local anesthesia. The skin is treated with an antiseptic before inserting the catheter.

First, angioplasty is usually done: a puncture is made in the skin in the area of ​​the affected artery and a balloon is carefully inserted using a catheter; Having reached the point of narrowing, the balloon is inflated, expanding the lumen.

At the same stage, a special filter can be installed behind the narrowing site to prevent further blockage and the development of a stroke.

As a result of the operation, the lumen of the artery is opened, but a stent is installed to maintain normal blood flow. It will support the walls of the vessel to prevent possible narrowing.

To install the stent, the doctor inserts another catheter equipped with an inflatable balloon. The stent is inserted in a compressed form, and when the balloon is inflated at the site of narrowing, the metal structure is straightened and fixed on the vascular walls. If the lesion is extensive, then several stents can be installed simultaneously.

At the end of the operation, the instruments are removed. The surgeon controls all actions using an X-ray monitor. The operation lasts from 1 to 3 hours and does not cause the patient pain. It will be a little unpleasant only at the moment when the balloon inflates - the blood flow is briefly disrupted at this time.

Video: report from coronary stenting surgery

Possible complications after the procedure

In approximately 90% of cases, after installation of a stent, normal blood flow through the arteries is restored and no problems arise. But in some cases the following complications are possible:

1. Violation of the integrity of the artery walls;
2. Bleeding;
3. Problems with kidney function;
4. Formation of hematomas at the puncture site;
5. Restenosis or thrombosis in the stenting area.

One possible complication is a blocked artery. This is extremely rare, and when it occurs, the patient is urgently referred for coronary artery bypass grafting. Only in 5 cases out of 1000 is it required emergency surgery, but the patient needs to be prepared for this possibility.

Complications from this operation are quite rare, so vascular stenting is one of the safest surgical procedures.

Postoperative period and rehabilitation

After a surgical intervention such as stenting, the patient must observe for some time bed rest. The attending physician monitors the occurrence of possible complications, and upon discharge gives recommendations on diet, medication, restrictions, etc.

In the first week after surgery, you should limit physical activity and avoid lifting heavy objects; you should not take a bath (shower only). At this time, it is not advisable to drive a car, and if the patient’s work involves transporting goods or passengers, then you should not drive, as at least, within 6 weeks.

Life after stenting involves following some recommendations. After the stent is installed, it begins. Its basis is diet, exercise therapy and a positive attitude.

• you need to practice almost every day for at least 30 minutes. The patient must get rid of excess weight, shape the muscles, normalize blood pressure. The latter significantly reduces the likelihood of developing myocardial infarction and hemorrhage. You should not reduce physical activity even after rehabilitation.
• Particular attention should be paid to nutrition– it is necessary to follow a certain diet, which will help not only normalize weight, but also influence the risk factors for the manifestation of coronary artery disease and atherosclerosis. The diet after stenting of the heart vessels or other vessels should be aimed at reducing the indicators of “bad” -.
  Nutrition after a heart attack and stenting should follow the following rules:
  1. Minimize fats – it is necessary to exclude products containing animal fats: fatty varieties meat and fish, high-fat dairy products, caviar, shellfish. In addition, you should avoid strong coffee, tea, cocoa, chocolate and spices.
  2. Number of products with high content polyunsaturated fatty acids, on the contrary, need to be increased.
  3. Include more vegetables, fruits, berries and grains in the menu - they contain complex carbohydrates and fiber.
  4. For cooking, use only vegetable oil instead of butter.
  5. Limit salt intake to no more than 5 g per day.
  6. Divide meals into 5-6 meals, with the last one done no later than three hours before bedtime.
  7. The daily calorie content of all foods consumed should not exceed 2300 kcal.
• Treatment after stenting is very important, therefore, after the operation, the patient will have to take medications daily for six months to a year. Angina pectoris and other manifestations of ischemia and atherosclerosis are no longer present, but the cause of atherosclerosis remains, as well as risk factors.

Even if the patient feels well, after insertion of the stent he should:

1. Take medications prescribed by your doctor to prevent the risk of blood clots. Usually it's Plavix and aspirin. This effectively prevents blood clots and blockage of blood vessels, and as a result, reduces the risk of heart attack and increases life expectancy.
2. Follow and take medications that lower blood cholesterol. Otherwise, the development of atherosclerosis will continue, which means new plaques will appear, narrowing the blood vessels.
3. At high blood pressure take medications to normalize it - ACE inhibitors and beta blockers. This will help reduce the risk of developing myocardial infarction and.
4. If the patient suffers from diabetes, follow a strict diet and take medications to normalize blood sugar levels.

Many patients are concerned about the question: can they become disabled after stenting? The operation improves the person’s condition and returns him to normal working capacity. Therefore, stenting itself is not an indication for disability. But if available accompanying conditions, the patient may be referred for MTU.

Comparison of stenting and bypass surgery: their pros and cons

If you compare what is better – stenting or bypass surgery, you first need to decide how they differ.

Stenting, unlike bypass surgery, is an endovascular method and is performed without opening chest and making large cuts. Shunting is most often abdominal surgery. On the other hand, installing a shunt is a more radical method that allows you to cope with stenosis with multiple blockages or complete occlusion. Stenting in such situations is often useless or impossible.

Principle of heart bypass

Stenting is most often used to treat young patients with minor vascular changes. Elderly patients with serious lesions are still advised to install a shunt.

During a stenting operation, local anesthesia is sufficient, but when installing a shunt, it is necessary not only to use general anesthesia, but also to connect the patient to a heart-lung machine.

The risk of blood clots after stenting forces patients for a long time accept special drugs. In addition, restenosis is also possible. New generations of stents, of course, help solve these problems, but, nevertheless, this happens. Shunts are also not ideal - they, like any vessels, are subject to degenerative processes, atherosclerosis, etc., so after some time they can fail.

Recovery times also vary. After minimally invasive stenting, the patient can leave the clinic the very next day. Bypass surgery involves a longer period of recovery and rehabilitation.

Both methods have their disadvantages and advantages, and their costs also differ. The choice of treatment method occurs individually and depends solely on the characteristics of the disease in each specific case.

Cost of stenting surgery

How much does cardiac stenting cost? First of all, the cost of the operation depends on which arteries will have to be worked on, as well as on the country, clinic, instruments, equipment, type, number of stents and other factors.

This high tech operation, requiring the use of a special x-ray surgical operating room equipped with complex expensive equipment. In Russia, as in other countries where such operations are carried out, they are performed according to the latest techniques highly qualified specialists. therefore it cannot be cheap.

Prices for cardiac stenting vary from country to country. For example, stenting in Israel costs from 6 thousand euros, in Germany – from 8 thousand, in Turkey – from 3.5 thousand euros. In Russian clinics, this procedure is slightly lower in price - from 130 thousand rubles.

Stenting is one of the most popular operations in vascular surgery. It is low-traumatic and brings good results and does not require long-term recovery. All the patient must do during the rehabilitation period is to follow a diet, do not avoid physical activity and take medications.

Vascular diseases - TREATMENT ABROAD – TreatmentAbroad.ru – 2007

Stent installation process monitored using an x-ray monitor. To ensure that the stent is secured to the vascular wall, the balloon is inflated several times.

Usually, stenting operation carried out under local anesthesia, although it can also be performed under general anesthesia. The stent is placed through the femoral artery. For this in the area inguinal fold A small incision is made and the artery is found. Next, under X-ray control, a stent attached to the end of a special balloon catheter is inserted into the artery and brought to the site of narrowing. After which the balloon is inflated, expanding the lumen of the artery, and the stent is pressed into its wall.

Possible complications during stenting

Most often they refer to blood clot formation in the field of stenting. Therefore, all patients after stenting surgery are prescribed drugs that prevent thrombus formation.

Other complications are less common, e.g. bleeding, which leads to the formation of a hematoma in groin area. This is mainly due to the use of drugs that reduce blood clotting during stenting. Sometimes it may be infection catheter insertion sites. There is also a complication such as allergic reaction for x-ray contrast agent(that is, a substance used for x-ray control during surgery).

Complications after stenting of cardiac vessels and coronary arteries

Operations with the installation of stents are considered the most preferable method of interventional surgical treatment pathological narrowing vessels in many cases. This method allows you to effectively combat coronary heart disease and its consequences without resorting to coronary artery bypass grafting. But even when choosing stenting, complications are still possible.

What complications can occur after stenting of the coronary arteries and heart vessels?

Complications after stenting can occur both immediately after surgery and during long term. Immediately after implantation of the endoprosthesis, it is possible to develop allergic reactions to medications used during the intervention or over the next few days. Some stents have special coatings that contain substances whose action is aimed at preventing re-narrowing of the vessel. Patients predisposed to allergies may have a reaction to their release into the blood.

When performing stenting of cardiac vessels, complications may include repeated narrowing of the lumen of blood vessels and the formation of blood clots. These are the most common complications, and the attention of medical scientists is currently focused on combating and preventing them. Complications after stenting cannot be excluded, such as the occurrence of perforation of the vessel walls, the development of bleeding and the formation of hematomas at the site of catheter insertion or other parts of the path of passage of the balloon with the stent.

How to avoid complications after stenting of heart vessels and coronary arteries

Patients most prone to complications after coronary artery stenting are those with various serious chronic diseases- kidney pathologies, diabetes, various disorders hematopoietic and coagulation functions. Factors that increase the risk include old age and poor general condition of the patient’s body at the time of surgery.

In order to prevent the development of complications associated with the above reasons during coronary artery stenting, a thorough examination of the health status of the candidate for angioplasty is carried out even at the stage of preparation for the operation. This includes not only an assessment of the condition of the blood vessels, but also a comprehensive examination with attentive attitude to all the patient’s complaints, taking into account all the medicines and them possible reactions with medications administered during and after surgery.

How to identify complications after vascular stenting at an early stage and what to do if they occur

The occurrence of complications after stenting of the coronary arteries may be indicated by a deterioration in the general condition of the patient or long absence any effect after the intervention. If medications are poorly tolerated, symptoms of intoxication appear - nausea, vomiting, weakness, fever - all depending on the intensity of the reaction. This condition can be corrected by changing patient management tactics, prescribing other doses or replacing existing drugs.

If thrombosis develops, restenosis with repeated narrowing of the vessel at the site of stent installation or in other areas of the arteries may require repeated surgical intervention. The urgency of the operation will depend on the current condition of the patient.

Every patient suffering from coronary heart disease who experiences angina pectoris should undergo regular medical examination. After angioplasty with stenting, the disease that led to complications does not disappear and requires further observation and treatment.

The heart muscle begins to function poorly after atherosclerosis affects the artery walls. Due to the deposition of atherosclerotic plaques, the walls of blood vessels lose their elasticity and cannot expand normally.

Constriction of blood vessels leads to difficulties in delivering nutrients to the heart muscle. As a result, symptoms of hypoxia are observed. Lack of oxygen produces angina attacks. If the diameter of the vasoconstriction is more than 50%, there is blockage of the artery and subsequent necrosis, which leads to a heart attack and often death.

Innovative stenting of cardiac vessels, which was developed not so long ago, can prevent such consequences.

Stenting process

Stenting is a minimally invasive surgical procedure on the arteries that supply the heart. To relieve chest pain, relieve angina pectoris and prevent myocardial infarction, a coronary stent is used, which is a thin frame tube with a structure in the form of a flexible metal mesh.

The stent is inserted into the artery in a compressed state, after which it expands like a spring, expanding the walls of the vessels. The stent is expanded using a special balloon. As a result, the lumen of the coronary artery becomes wider after indentation of atherosclerotic plaques, and blood flow to the heart is restored. In this case, the implanted stent does not change its shape, keeping the lumen open.

Treatment of a blocked (mural) coronary artery with a stent is performed in essentially the same way as an angioplasty procedure, but with several important differences.

The interventional cardiologist uses angiography to assess the location and size of the block (lesion) by injecting a contrast agent through a guide catheter. This makes it possible to view the flow of blood through the downstream coronary arteries.

Intravascular ultrasonography used to assess the thickness and hardness of a lesion (calcification). The surgeon uses this information to decide whether the lesion needs to be treated with a stent, and if so, what type and size of stent to use.

To elute the drug, a stent attached to outside balloon catheter. Therefore, doctors can perform “direct stenting,” in which a stent passes through the blocked vessel and widens it.

It is essential that the stent frame is in direct contact with the vessel walls to minimize possible complications, as blood clots may form. Very long lesions may require more than one stent, and this type of therapy is called "full metal sheath."

Since the operation is gentle, local anesthesia is used. The patient can contact the surgeon during stenting of the heart vessels. After successful operational process blood circulates perfectly, allowing the heart tissues to receive everything they need nutrients and oxygen.

Intravascular stenting is performed by highly qualified specialists who specialize in endovascular operations.

Besides, this operation stent installation requires maximum technical equipment, so stenting is carried out in the cardiovascular department.

Main features and goals of the method:

1. Endovascular surgery is performed without violating the integrity of the affected area.
2. The arterial lumen is restored only with the help of a tube in the form of a metal mesh (prosthesis), and not by removing atherosclerotic plaques.
3. The purpose of the inserted stent is to press and expand atherosclerotic plaques.
4. Sometimes up to 3–4 stents are used for a large number of narrowed vascular areas.
5. Introduction of contrast agents into the coronary vessels to monitor the process using X-ray equipment.

Used to restore normal blood flow different types stents Since this implant is required to relieve narrowing over a long period of time, its reliability should not be in doubt.

The main requirement for a stent is to prevent re-narrowing of the vessel. However, due to the fact that a foreign body is sometimes rejected by the body, developers have thought through various modifications of stents.

Modern vascular implants have the following characteristics:

1. Covered with substances that can block blood clotting. In this case, blood clots do not form on the implant itself.
2. To change the required diameter, the developers came up with a structure that allows you to maximize the area of ​​the blockade. Now ring, mesh or tube structures are being installed.
3. Externally, the stent resembles a tube up to 1 cm long. The diameter can vary from 2 to 6 mm.
4. Manufactured from special metal alloys according to high technology. Typically, mesh tubes are made from an alloy of chromium or cobalt. Currently, most stents have begun to be coated with drugs to minimize the risk of re-stenosis and myocardial infarction. Typically, stents with medicinal substances are indicated for those who have one of the following diagnoses: diabetes mellitus, repeated stenosis, renal dysfunction.

Only the attending cardiac surgeon can select a stent design taking into account anatomical features patient. Today, there are more than 100 types of stents, which differ in material, structure and size.

Diagnosis and indications for endovascular surgery

One cardiologist was found guilty of overbilling patients for unnecessary expenses. medical point vision coronary stenting. It is generally accepted that sometimes the use of this method is impractical. Before deciding to undergo endovascular surgery, you should undergo full examination.

The research course includes procedures such as:

• laboratory analysis of blood and urine;
• lipid profile - to study cholesterol levels;
• Ultrasound of the heart (echocardioscopy) - to study the functioning of all departments;
• TEE - transesophageal electrophysiological study;
• electrocardiography - to clarify the affected areas and the extent of the blockade process;
• coagulogram - to determine the level of blood clotting;
• angiography with the introduction of a contrast agent - to identify the degree of vascular narrowing and the number of affected arterial branches.

After a full course of diagnostics has been completed, the cardiologist considers the feasibility of the operation, taking into account all the examination factors.

As a rule, coronary stenting of heart vessels has several indications:

• pre-infarction condition, provoked by constant attacks of angina pectoris;
• chronic attacks of ischemia, which are caused by the blocking of 50% of the lumen by atherosclerotic plaques;
• frequent angina after minor physical exertion;
• narrowing of a blocked vessel after bypass surgery or balloon angioplasty, techniques that lose effectiveness after 8–10 years.

In addition to the listed clinical pictures, stenting of cardiac vessels is mainly indicated for heart attacks and acute coronary circulatory disorders. Sometimes surgery is performed to remove severe pain in the area of ​​the heart. Moreover, this procedure does not guarantee longevity and the absence of any problems with cardiac activity.

Contraindications

Despite the high safety of intravascular surgery, there are several important contraindications to this technique for restoring blood flow.

As a rule, cardiologists exclude stenting for the following factors:

• the impossibility of inserting a stent due to large-scale vascular damage, when after diagnosis the exact localization of the blockade was not determined;
• hemophilia and low clotting blood;
• the diameter of the affected artery is less than 2 mm;
• the patient is allergic to a contrast agent, in particular to an iodide preparation;
• respiratory failure;
• kidney and liver pathologies;
• acute infectious diseases;
• serious condition of the patient (low blood pressure, impaired consciousness, shock, etc.);
• cancerous tumors in an advanced stage.

Stages of the operation

After the attending physician has determined accurate diagnosis, the patient is being prepared for endovascular surgery. Before stenting the heart vessels, only a dietary dinner is allowed; food should not be eaten in the morning.

Before a planned operation, patients are often given drugs that stop high blood clotting. To avoid blood clots, drugs such as Warfarin, Heparin, etc. are usually used.

After administering blood thinners, cardiac surgeons proceed according to the following steps:

1. Local anesthesia in the area where the catheter is installed.
2. Installation of an introducer - a tube for which, after anesthesia, a puncture is made in the femoral or inguinal artery.
3. Introduction of iodide contrast agent into the vessels so that it is possible to monitor the process through X-ray equipment.
4. Insertion of a stent with a balloon into the affected vessel to the site of blockade under the control of computer scanning.
5. Balloon inflation, in which the stent expands and presses into vascular wall atherosclerotic plaques.
6. Repeated inflation of the balloon to secure the stent normally.
7. Removing microsurgical equipment from the vessel.
8. Apply a suture to the incision site.

There are usually no complications after this operation, but sometimes minor damage to the heart vessels and bleeding may occur. IN in rare cases circulatory disorders of the kidneys and brain activity. In addition, thrombosis is possible - blockage of the stent by blood clots.

Basically, qualified cardiac surgeons perform successful endovascular operations, after which the patient remains in the hospital for only 3 to 5 days, after which the person is discharged.

1. Minimal physical activity. Physical activity is contraindicated for the patient for 1–2 weeks after surgery. TO usual life a person can return after 1.5 months. But at the same time heavy physical work should be excluded. To quickly restore the body, doctors prescribe exercise therapy procedures. Doctors do not recommend driving a car for the first 2–3 months.
2. Diet. With such defeats of cardio-vascular system You should absolutely not eat foods high in fat and carbohydrates. Salty and spicy foods should be avoided. The diet should only contain dietary varieties meat, fruits, vegetables, fish and vegetable fats. You need to monitor the amount of sugar and cholesterol in your blood.
3. Taking medications. For this pathology it is indicated constant reception medicines. Doctors prescribe beta blockers for rapid heartbeat and attacks of pain (Egilok, Anaprilin, etc.). To reduce the risk of atherosclerosis, Atorvastatin or Atoris is prescribed. In addition, it is necessary to take anticoagulants: Clopidogrel, Fluvastatin, Warfarin, Plavix, Magnicor, etc. To normalize cholesterol levels, statins are taken.
4. Surveys. A couple of weeks after stenting, it is necessary to do an ECG and undergo a course of tests for lipid parameters and blood clotting. A year later, coronary angiography is required.

Forecast

Coronary artery stenting has several important advantages over other techniques for treating blocked heart vessels:

• low invasiveness of the operation, after which you are discharged home within 2–3 days;
• successful elimination of coronary heart disease;
• minimal risk of complications;
• fast recovery;
• improving the quality of life, contributing to its duration.

Thanks to these advantages, the prognosis for stenting is very favorable: only 20% of clinical cases experience repeated narrowing of the lumen (restenosis). On average, stents provide good vascular patency after surgery from 5 to 10 years, and sometimes up to 15.

However, prognosis depends to a greater extent not on the quality of the stent and the success of the operation, but on compliance with all the recommendations of the cardiologist: spend more time on fresh air, do morning exercises, follow a diet, undergo timely examinations and take maintenance medications.

Stenting is gentle surgery, which will help normalize the functioning of the cardiovascular system for a full life.

Often, heart disease occurs due to loss of elasticity of blood vessels. The vessels lose the ability to expand sufficiently, which prevents normal blood flow. In addition, cholesterol deposits accumulate on their walls. And if one of the vessels becomes clogged, necrosis of a certain area of ​​tissue develops.

Such a defect can be fatal. Therefore, doctors all over the world are conducting research into the treatment of this disease and looking for new methods to overcome it. One such method is cardiac stenting surgery.

Stenting is the installation of a stent inside a vessel. The result of this measure is the widening of the narrow part of the artery, and blood flow to the organ returns to normal.

This method of treatment is an intravascular surgical intervention, for the implementation of which surgeons require a high level of qualifications.

Stents are used during this operation. This device is in the form of a durable mesh tube, most often made of cobalt. It can become the framework of the artery. There are several types of stents, which differ in size, type of coating, and mesh structure.

Features of surgical intervention

During this procedure, a catheter with a stent at the tip is placed into the femoral artery. This catheter is moved to the desired area, a stent is installed, which forms the required width of the vessel. Once the catheter is removed, it remains in place, maintaining normal blood flow.

For this operation use local anesthesia. The duration of work is from 1 to 3 hours. If necessary, multiple stents can be placed.

Stenting of cardiac vessels

After this medical influence the patient must spend at least seven days under medical supervision, followed by an extract. But the process of full rehabilitation takes much longer.

Make a choice in favor this method Treatment can only be done by a cardiologist. He must conduct a thorough diagnosis and make sure that the operation is necessary, as well as its safety for the patient’s life.

The operation is necessary when:

• severe attacks of angina pectoris;
• the need for coronary artery bypass graft support;
• severe heart attack.

Examination of the patient can also reveal the reasons that are an obstacle to stenting of the heart vessels. The most common of them are:

This method of treatment has certain advantages that force doctors to choose this particular operation. These benefits are as follows:

• short period of medical control over recovery;
• no need to cut the chest;
• short rehabilitation period;
• acceptable cost.

The following can be said about this. After vascular stenting, the health of the vast majority of patients improves. But some may experience complications such as:

• bleeding;
• kidney problems;
• hematoma formation at the site of artery puncture;
• thrombus in the area of ​​the stent, which leads to the need to repeat the operation.

Complications occur very rarely, occurring in approximately 10% of patients. But this possibility cannot be ruled out. However, cardiac stenting is one of the safest treatment measures. Naturally, the patient will have to be more attentive to his health, follow the doctor’s recommendations, take necessary medications and undergo routine examinations.

If this is done conscientiously, a person who has undergone stenting has the opportunity to live as many years as he or she wants.

It happens that even after surgery, the tendency to narrow the artery persists. But the likelihood of this is low, and scientists continue research work in this area, and the number of improvements is increasing. The practice includes stents manufactured according to new technologies.

Factors influencing life expectancy after surgery

How many years a person will live after vascular stenting depends on him. Even use latest technologies does not guarantee good outcome if the patient continues to treat harmful image life. Therefore it is necessary to carry out preventive measures and follow the recommendations of doctors.

Reviews from patients who have undergone this operation say that it is more like a fairly simple medical procedure, and not for surgery.

Since there is no need for long period rehabilitation, patients feel that they have fully recovered.

However, stenting is only a method of overcoming the symptoms of the underlying heart disease, therefore additional treatment after the procedure is required.

Basic activities that will help prolong human existence:

Physical activity

With regular physical activity, the heart is trained, blood pressure stabilizes and the likelihood of further development atherosclerosis.

Exercising helps prevent excess weight and, therefore, reduces cholesterol and other harmful elements in the blood.

There are no special exercises that should be recommended to everyone who has undergone stenting. The schedule of classes, their duration and frequency, also needs to be built individually for each patient.

It is best to develop this schedule together with a cardiologist who knows the condition of the patient’s blood vessels better than others and clinical picture diseases.

After surgery, it is advisable to exercise at least 4 times a week. Main activities: swimming, walking, cycling, jogging. Excessive loads may be dangerous.

Sexual activity may occur with some restrictions for some time, but as soon as the patient feels that he is able to return to the previous rhythm of sexual activity, these restrictions can be lifted.

Compliance with diet

After the procedure, you must adhere to a special diet. Its basic rules:

Reviews from patients about such a diet are not always happy. But it is important to remember that you don’t need to completely avoid the listed products, you should just limit their quantity. The importance of this measure for health is difficult to overestimate.

Taking medications

Healthy lifestyle

When using this treatment method, you should stop smoking. This habit is very dangerous for the heart and blood vessels.

You should also be careful with alcohol. Red wine in small quantities good for blood vessels, but its benefits do not mean that it is necessary to drink it.

Labor activity

The patient can return to work fairly quickly, although the timing depends on his individual characteristics and type of employment. It is worth returning to physically hard work a little later than intellectual work.

But in general, reviews of patients who underwent cardiac stenting surgery are called different time their full return to work.

Recreation and entertainment

There is no travel ban imposed for this operation. Doctors advise choosing active types of recreation, but at the same time you need to focus on your individual characteristics.

While on vacation, you should never refuse to follow the cardiologist’s recommendations and take medications. If you have doubts whether a particular activity is allowed, you should ask your doctor.

“Three years later, my relative was advised to undergo repeat surgery. What could cause this?

“Repeated surgery is needed if a blood clot occurs in the stent. This treatment does not stop the development of atherosclerosis, so problems may reoccur.”

“The operation was carried out almost a year ago. He quickly returned to normal, excellent condition. Maybe we should stop taking medications?”

“You shouldn’t stop taking medications, especially if you don’t do it yourself. Consult your doctor; if your condition really does not cause any concern, the cardiologist will stop some of the medications.”

“Two years ago my husband had a stent installed. At first he felt well, but now he often has weakness in his legs, insomnia, and sometimes has difficulty breathing. What could this mean and how can I help him?

“It is best to consult with your doctor. A complete blood examination is necessary to rule out anemia. Listed symptoms may be a reaction to medications taken.”

Pathologies of the cardiovascular system pose an immediate danger to human life. Quite often they are associated with problems of the coronary vessels, which requires an operation called stenting.

What is stenting?

Stents are made from durable and hypoallergenic materials, which allows them to be used in any age category and even if you are prone to allergies. The operation to install a shunt in the lumen of a vessel has virtually no contraindications and is performed from the first months of life.

Stenting of the coronary vessels of the heart is a surgical intervention that is performed when it is necessary to restore the patency of the vessels that supply the heart muscle. Such processes can develop against the background various pathologies, the main one of which is .

Operation efficiency

Until the end of the twentieth century, the only effective method restoration of normal blood supply to the heart muscle was the application of a shunt - a bypass anastomosis, which allowed blood to bypass the narrowed section of the vessel. In this case, the operation was performed through a thoracotomy, which made it extremely traumatic.

The essence modern method consists in the fact that a rigid frame is installed on the narrowed area, which ensures the patency of the affected artery. In this case, the stent is inserted into the body using a special guide through a puncture in the artery, which helps reduce injuries to almost a minimum.

This operation, despite its advantages, is symptomatic and does not protect against further progression of atherosclerosis and damage to other areas of the arteries.

Indications for cardiac stenting

This is due to the fact that physical and emotional stress causes activation of the sympathetic division of the autonomic system. nervous system, which causes an increase in vascular tone. Vasospasm will worsen the lack of blood supply, which will cause necrosis.

The most common pathology in which such a disorder is observed is atherosclerosis of the coronary vessels. With this disease, the formation occurs cholesterol plaques on the inner surface of the vessel wall, which causes a decrease in their lumen.

• predominance of fatty foods in the diet;
• excessive consumption of sweets;
• drinking alcoholic beverages and smoking;
• dysfunction of the pancreas and liver.

Preparing for surgery

So, the patient needs to undergo the following tests and examinations:

• are common clinical tests blood and urine;
• coagulogram (is mandatory to assess the risk of bleeding);
• coronary angiography (most important examination, allowing you to accurately determine the location of the stenosis);
• ECG (performed to assess the condition of the heart muscle).

How is cardiac stenting performed?

After anesthesia, treatment is carried out surgical field- groin area. A small incision is made through which the femoral artery is punctured. A special guide is inserted into the resulting hole through a small-diameter catheter, on which a folded stent is already attached.

Further advancement along the vascular bed is carried out under the control of an X-ray unit. This is necessary in order to carefully monitor the bends of the vessels and prevent them from being injured.

If vessel perforation occurs, this will require extensive surgery to eliminate bleeding. Such problems are extremely rare, since all doctors who perform stenting have extensive experience and a high level of qualifications.

Once the guidewire reaches the site of stenosis, the stent is deployed by inflating a special balloon. In this case, the stent is pressed very tightly into the walls of the vessel, which causes its expansion. Several sutures and an aseptic pressure bandage are applied to the artery puncture site.

This visual video will help you understand exactly how the stenting process occurs in a vessel:

Rehabilitation

In addition, there are a number of restrictions. These include:

• Do not bend your leg for 24 hours after surgery. This is necessary in order to eliminate the risk of bleeding from the femoral artery at the site where the puncture was performed.
• Follow bed rest and all doctor's recommendations.
• Drink plenty of fluids to speed up the process of removing the contrast agent used for x-rays from your body.

• Support active image life. A person must study physical exercise, since they are very important for maintaining normal vascular tone, including coronary ones. Patients are recommended to walk or. Strong physical overload, such as during weightlifting, should be avoided. Worth giving preference athletics, aerobics or .
• Dieting. is an integral part of the prevention of atherosclerosis. Patients need to reduce the amount of foods with animal fats in their diet, completely eliminate coffee, strong tea and, since they are able to influence the tone vascular bed. In addition, it is necessary to limit sweet and salty foods. Excessive amounts are critical for patients with cardiovascular diseases.
• Take medications prescribed by your doctor. If a person has a stent in a coronary vessel, he is still at risk of developing angina or myocardial infarction. He needs to take medications with for preventive purposes, which will not allow a new vasospasm to develop.

If you properly organize your lifestyle after stenting the heart vessels, the risk re-development dangerous manifestations illness will be minimal.

Contraindications for surgery

• Acute myocardial infarction 2 hours after development. This condition requires emergency care, and after 2 hours the changes in the myocardium are already irreversible. Stenting may cause chemical substances, which are formed during tissue necrosis, enter the bloodstream, which can cause septic complications. In addition, increased blood flow can cause heart rupture.
• Tendency to bleed. If before the operation the coagulogram showed significant violations that cannot be compensated for by the use of coagulants (drugs that improve blood clotting), then the operation is prohibited. This is due to the fact that there is a high risk of bleeding from the femoral artery. Violation of this rule may result in death.
• Pathologies of blood vessels, which are accompanied by thinning of the walls. If the patient has very thin arterial walls, the stent may cause them to rupture.
• Allergy to contrast agents. If it is impossible for the patient to administer a contrast agent, then the operation becomes impossible with technical side. Stenting cannot be performed “blindly”, as it can damage the artery and cause internal bleeding.

Complications

• bleeding from the femoral artery (observed with incorrect puncture);
• internal bleeding due to perforation during stent insertion (can provoke sudden movements doctor or the patient’s mobility during surgery);
• allergic reaction to a contrast agent (sometimes the dose used to test individual sensitivity to the drug does not cause a reaction, and massive administration of contrast provokes anaphylactic shock);
• infection (occurs when the rules of asepsis are violated or in immunosuppressive conditions).

How much does cardiac stenting cost?

Average prices for the procedure (with pre- and postoperative period) are:

• Moscow – 2000 USD
• Israel – 10,000 USD
• Germany – 12000 USD
• Türkiye – 4000 USD