If percutaneous coronary angioplasty was performed successfully, it means that the following positive results were achieved:
- elimination of symptoms of coronary heart disease;
- stopping the development of myocardial infarction;
- improved prognosis in patients with angina pectoris.
If this procedure is used together with stenting, the need for urgent coronary bypass surgery is reduced to one percent, especially if modern stents with a drug coating are used. In addition, the risk of re-stenosis is reduced below ten percent.
Scheme of balloon angioplasty
As soon as percutaneous angioplasty of the coronary vessels appeared, various methods of removing atheromatous plaques were tried, for example, rotational aterectomy, directional atherectomy and excimer laser for photoablation. If it was believed that these methods reduce the risk of stenosis, then a clinical study proved that they are not very effective, therefore today they are rarely used and as additions to the main procedure.
The effectiveness of using the procedure is observed in 90-95% of patients. It rarely happens that the operation was not performed due to technical complications, for example, due to the inability to conduct a catheter through a narrowed place.
The most dangerous complication that can occur during the operation is the sudden closure of the affected coronary artery, which can occur in the first hours after the procedure.
This complication occurs in five percent of patients. Sudden closure of an artery occurs for several reasons:
- rupture of the internal arterial wall;
- the formation of a blood clot where the canister opened;
- spasm in the place of opening of the can.
In order to prevent thrombosis, during the procedure and after it, the patient is given aspirin, which prevents platelets from sticking to the arterial wall. The risk of such a dangerous complication is especially great in the following patients:
- patients with myocardial infarction;
- patients with unstable angina pectoris.
It is worth noting that the frequency of occurrence of such a complication decreased after the use of coronary stents that prevent vessel spasm. The formation of a blood clot also prevents the use of intravenous drugs.
There are some complications after the procedure that are quite rare:
- a stroke, if the procedure is performed in the carotid artery;
- heavy bleeding from where the catheter was inserted;
- myocardial infarction;
- sudden cardiac arrest;
- kidney failure;
- damage to blood vessels.
Despite the fact that coronary angioplasty is not a very complicated operation, after its implementation important rules are followed. For example, a catheter is removed after 4-12 hours after the procedure. It all depends on how long you need to reduce blood coagulation. The catheter removal area is clamped by hand or weight for 20 minutes.
Most often, patients are discharged the day after surgery. In the first two weeks they can’t lift weights, and after a few days they return to normal life activity. To prevent blood clots, aspirin is taken.
If the patient has a stent installed, he will be prescribed aspirin along with Plavix for 1-3 months. After angioplasty, the rehabilitation course lasts about three months. During this period, loads increase gradually.
As you can see, these surgical interventions are very important, and the process is simple and effective, so if your doctor recommends them, you should listen to him. This will have a positive effect on health and quality of life.
All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines. All recommendations are indicative and are not applicable without consulting a doctor.
(angio-vessel, plastic – sculpt, shape) is one of the methods of endovascular surgery to restore blood flow during narrowing or complete occlusion (blockage) of arteries (less often veins).
Endovascular (intravascular) surgery is a low-invasive, minimally invasive intervention that can solve the same problems as traditional surgical methods of treatment, but without large incisions, but only by puncture of the vessel.
The full medical name for this method is
percutaneous transluminal balloon angioplasty
, i.e. surgical intervention on the vessel is carried out through a small puncture in the skin (percutaneously), by introducing a flexible instrument (transluminally) into the vessel and a catheter with a balloon is used to restore the lumen of the vessel, followed by its ballooning.
When a stent is installed inside the vessel, the name of the technique will sound “percutaneous transluminal balloon angioplasty with stenting”
. However, the terms “percutaneous vascular interventions”, “angioplasty”, “angioplasty with stenting” or “balloon angioplasty”, “balloon angioplasty with stenting” are widely used in the literature.
And in ordinary speech, the term “stenting” is often used.
Angioplasty with carotid stenting is one of the most promising and complex areas in endovascular surgery to restore blood supply to the brain.
Surgery on the carotid arteries is indicated for narrowing of the carotid arteries of 60% or more in the presence of symptoms such as transient ischemic attacks, syncope or a stroke. With a narrowing of the carotid arteries of more than 70%, even in the absence of obvious symptoms, surgical treatment is indicated.
carotid angioplasty with stenting
– open surgical treatment (endarterectomy) or angioplasty with stenting is a task of paramount importance, as in patients with symptoms of the disease. and in “asymptomatic” patients.
A limiting factor in performing angioplasty with stenting of the carotid arteries is a high risk of possible embolism of the brain vessels during surgery. The invention of special occlusal cylinders and filters located distal to the operation site significantly reduces the frequency of embolism and stroke.
Vascular angioplasty of the lower extremities is indicated for severe clinical manifestations of ischemia, as well as ulcerative necrotic changes in the lower extremities. The choice of surgical intervention in favor of percutaneous intervention depends on the type of stenosis and its extent. High direct success of angioplasty is noted – about 90%, while maintaining patency of the vessel after 5 years of observation, about 80%.
- Minimal physical and mental trauma for the patient. The operation is performed without an incision, under local anesthesia and is practically painless.
- The time spent in the hospital is reduced to one to two days. The patient quickly returns to normal life after discharge.
- High efficiency of endovascular interventions.
- The procedure can be performed for patients with severe illnesses when traditional surgical operations are not feasible.
- Contraindications are insignificant: severe allergy to contrast agents, bleeding disorders, acute renal failure.
- Lower cost in comparison with open operations.
It is important to remember that percutaneous intervention is the elimination of the consequences of the disease, not the disease itself.
In order to prevent the progression of atherosclerosis and the development of thrombosis:
- Clearly follow the doctor’s recommendations for taking antiplatelet drugs during the first 3 months – a year after stenting. The choice of antiplatelet treatment regimen is individual for each patient.
- Follow a lipid-lowering diet, take cholesterol-lowering drugs to reduce low-density lipoprotein cholesterol below 100 mg / dl.
- Monitor your blood pressure regularly. It is recommended to reduce blood pressure by changing lifestyle and prescribing individual drug treatment. Particular attention should be paid to limiting salt intake.
- Elimination of risk factors for the progression of atherosclerosis: reduction of overweight by reducing the calorie intake, quitting smoking and alcohol abuse, dosed physical training.
The cost of the procedure will depend on in which clinic and in which country the operation will be performed, on the degree and complexity of the lesion and the specific artery, the number of stenosed vessels, and the technical features of the procedure. But the main component of the price is the cost of the stent.
The cost of an angioplasty procedure in Russia ranges from 80 rubles to 000 rubles.
This includes manipulation, hospitalization, medication and nutrition. The cost of the stents themselves ranges from 40000 to 130000 rubles.
Angioplasty with stenting in coronary heart disease
with stenosis of 1-3 coronary arteries is included in the basic program of compulsory health insurance and can be provided free of charge.
Minimally invasive surgery, the purpose of which is to restore the lumen of a blood vessel, is called angioplasty. Angioplasty of coronary arteries is performed to expand the vessels that provide the heart with blood, oxygen and nutrients.
In scientific circles, the procedure is called percutaneous transluminal surgery or PTCA. The scientific name explains the essence of the technique – the operation is performed without incisions, a small puncture is needed to introduce a special catheter with a balloon into the vessel.
As a result of the operation, a flexible catheter is inserted into the artery on the thigh; sometimes a vessel on the arm is used. A catheter with a deflated balloon is pushed through the blood vessel until it reaches the narrowed area. There the balloon is inflated, expanding the walls of the blood vessel.
It remains to remove the catheter from the circulatory system. Thanks to angioplasty, the condition of people with ischemia and angina attacks improves, and it is possible to reduce the likelihood of myocardial infarction without coronary artery bypass grafting.
- less invasiveness compared with vascular bypass surgery;
- angioplasty is performed under local anesthesia;
- no need for surgical incisions;
- soon after angioplasty, one can return to normal daily activities.
- Serious complications of angioplasty are rare. However, introducing an introducer sheath may damage the vessel.
- Severe bleeding may develop at the site of the puncture of the vessel.
- With angioplasty of the carotid arteries, there is a risk of stroke.
- A relatively rare complication is a sudden closure of the artery, which usually develops within a day after the procedure.
- Rare complications include myocardial infarction and cardiac arrest.
- Any procedure during which the integrity of the skin is violated is associated with a risk of infectious complications.
- There is a slight risk of allergic reactions to the injected contrast agent.
- The contrast used for angioplasty can cause kidney failure.
- A large incision is not made on the skin, which is a great advantage over bypass surgery, since the time for rehabilitation and hospital stay is reduced.
- Angioplasty is done under local anesthesia, and not under general anesthesia, so the human body does not experience severe stress.
- An allergic reaction to the introduced balloon.
- Bleeding at the site of the operation.
- Damage to arterial walls.
- Repeated violation of blood flow in the artery.
- No major surgery is needed.
- Most patients do not require general anesthesia.
- Serious complications are rare.
- Intervention can be performed in a short time after the patient arrives at the medical institution, which allows salvaging ischemic tissues from death in acute blockage of the artery (especially with developing myocardial infarction).
- The cost of angioplasty is significantly lower than bypass surgery.
Table of Contents:
- low trauma – only a puncture for a catheter;
- short recovery period after surgery. Often the procedure is performed on an outpatient basis. In more serious cases, a short hospital treatment will be needed;
- lack of need to use anesthesia;
- high speed of the onset of the effect;
- low relapse and complications;
- simple preparation of patients for surgery, which allows you to perform an intervention in emergency cases.
- Intervention is carried out without incisions, through the puncture of the skin, an input port is installed in the artery – the intruder, through which all manipulations are performed.
- General anesthesia is not required, all interventions are performed under local or epidural anesthesia.
- The next day, the patient is free to get up and walk.
- The risk of complications of balloon angioplasty is several times lower than with open surgery with traumatic access.
- Endovascular surgery is significantly shorter
- Revascularization can be carried out without fear of infectious complications even in patients with extensive wound defects.
Koshgda, doctors choose angioplasty, and when bypass surgery
The main requirement when choosing a medical institution is the number of percutaneous vascular interventions performed at the clinic and the availability of a specialized surgical department for the possible conduct of advanced vascular surgery in case of complications during angioplasty.
Clear recommendations were made on choosing a clinic for percutaneous interventions on coronary vessels – at least 400 interventions per year, as well as the presence of a cardiac surgery department in the clinic.
- Discuss in detail with your doctor the risks and benefits of percutaneous intervention compared with traditional surgery and drug therapy. It is important to be sure that you consult with a highly qualified specialist with extensive experience in percutaneous interventions. As soon as the doctor makes a decision on all issues related to your treatment.
- Decide on the choice of stent. Drug stents are significantly more expensive than simple metal stents. Their advantage has been proven to reduce the number of restenoses after coronary angioplasty with stenting.
There is no study demonstrating the advantage of one type of stent over another (coated or conventional metal) in terms of reducing the number of neurological complications in angioplasty with stenting of the carotid arteries.
It should be remembered that stents that release drugs will require long-term use of serious antiplatelet therapy:
- Decide for yourself whether you can clearly implement all the recommendations for taking antiplatelet therapy and evaluate your financial capabilities;
- If you are planning any invasive procedures or surgical interventions in the next 12 months, which will require cancellation of antiplatelet drugs because of the risk of bleeding, preference should be given to the implantation of a standard metal stent.
If the doctor insists on the use of a stent that releases drugs in connection with the peculiarities of atherosclerotic lesions of the vessel or associated diseases, then one should listen to this. However, the choice is yours.
Indications for balloon angioplasty
Surgery is not recommended for all patients. After preliminary angiography (x-ray of the affected vessels), only a third of patients go to angioplasty. The rest are prescribed coronary artery bypass grafting (CABG) or drug therapy.
Nevertheless, the list of indications for intravascular surgery is quite wide:
- The narrowing of the main arteries.
- Atherosclerosis of the vessels of the legs. Initially, the technique was created to expand the vessels of the lower extremities, since their stenosis often ends with gangrene and subsequent amputation. Balloon angioplasty of lower limb arteries is a good alternative to surgery.
- Insufficiency of blood supply to a specific organ.
- Damage to peripheral vessels.
- Renal or carotid artery stenosis.
- Ulcers, gangrene, leg pain in the absence of physical exertion.
Any surgical intervention is a risk of complications and stress for a person. And while the patient satisfactorily copes with his daily tasks, doctors recommend limiting himself to taking medications.
- Postponed myocardial infarction;
- Severe arteriosclerosis of the arteries with the formation of calcifications;
- Severe stages of hypertension, diabetes;
- Endocardial inflammation;
- The presence of narrowing in the artery that feeds a significant part of the myocardium;
- Stenosis in the left coronary artery;
- Infectious diseases;
- Blood clotting disorder;
- Pulmonary edema;
- Allergy to iodine, which is part of radiopaque solutions.
Medical technology does not stand still, so the indications for the CTBA are expanding every year. The main treatment strategy is to delay CABG surgery as far as possible.
The general indication for angioplasty with a balloon catheter is hemodynamic narrowing of vascular patency by more than half.
Frequent headaches, cerebral stroke, ischemic attack are indications for plastic surgery of the brachycephalic arteries – the main vessels that take part in the blood supply to the brain and soft tissues of the head.
With myocardial infarction, heart pain, angina pectoris, coronary artery stenosis, transluminal balloon angioplasty of coronary vessels is prescribed. The term “transluminal” means the introduction of a catheter into an organ cavity without a large incision to provide direct access.
Coronary angioplasty of the blood vessels of the heart is designed to restore the level of cardiac blood supply, eliminate oxygen starvation of myocardial tissue.
With renal hypoxia, high blood pressure caused by narrowing of the renal arteries, angioplasty of the renal vessels is prescribed.
Balloon angioplasty of the arteries of the lower extremities is performed with severe stenosis of the vessels of the legs and intermittent claudication.
Percutaneous transluminal coronary angioplasty has contraindications:
- Severe physical condition of the patient. Any surgical intervention can lead to deterioration or death.
- Vasoconstriction less than 50%.
- Artery aneurysm in the immediate vicinity of the narrowing.
• Localization of stenosis in the main trunk of the left coronary artery, in this situation, coronary artery bypass grafting (CABG) is indicated. • The presence of stenosis in the coronary artery, supplying the entire remaining living myocardium.
• Refusal of the patient from treatment. • Severe left ventricular dysfunction.
• Multivascular damage to the coronary arteries. • Complex anatomical lesion of the coronary artery (high tortuosity), supplying a significant volume of the myocardium.
• Inability to achieve full or almost complete restoration of blood flow. • Recent stroke.
• Gastrointestinal bleeding. • Chronic renal failure.
• Acute infectious diseases, in particular, endocarditis (inflammatory heart disease) is a strict contraindication. • Severe arterial hypertension.
• Anemia. • Violation of blood coagulability.
• Atherosclerotic lesion of the vessel with the formation of calcifications. • Heart failure in the decompensation stage.
• Severe stage of diabetes. • Severe hypoglycemia (lowering blood sugar).
• Pulmonary edema. • Allergic reaction to iodine.
It is a contraindication, as in the process of conducting coronary balloon angioplasty, a contrast iodine-containing substance is used to determine the level and degree of damage to the vessel.
If there are contraindications for balloon angioplasty with stenosis of the coronary arteries, consider the option of coronary artery bypass grafting.
Balloon angioplasty as a method of surgical enlargement of the lumen of the vessel has been widely used in the treatment of such serious diseases:
- Diseases of the peripheral arteries, mainly atherosclerosis, ischemia of the internal organs, chronic arterial insufficiency.
- The pathology of the coronary arteries is myocardial infarction (including in the initial stages), atherosclerosis of the blood vessels of the heart, etc. This type of operation is called coronary angioplasty.
- Coronary heart disease.
- Angina pectoris.
- Narrowing of the renal arteries.
- Cramps and decreased lumen of the vessels of the brain and cervical region.
- Thrombosis and embolism of medium and large blood vessels.
- Pathology of peripheral veins.
The most common causes of vascular disease requiring angioplasty are atherosclerosis, arteritis (inflammation), and thrombosis.
Contraindications to the operation are:
- severe conditions for diabetes;
- severe forms of chronic kidney failure;
- severe damage to the vessel with atherosclerotic plaques;
- pathologies accompanied by disorders of the blood coagulation process;
- severe forms of anemia;
- extreme degrees of hypertension;
- acute stages of infectious diseases;
- endocardial inflammation (endocarditis);
- acute stage of heart failure;
- pulmonary edema;
- allergic to iodine. This element is applied during the operation.
Often, very little time is given to make a decision on the operation. In this case, the surgeon should be able to quickly eliminate the presence of contraindications in order to avoid serious threats to the patient’s life.
- atherosclerotic lesion of large bringing vessels (aorta, iliac arteries);
- narrowing or obstruction of the vascular bed of the upper or lower extremities;
- renal artery stenosis complicated by renovascular hypertension;
- atherosclerotic damage to carotid vessels carrying blood to the brain;
- IHD (coronary heart disease), especially complicated by heart muscle infarction;
- stenosis of large venous trunks in any anatomical region.
ChKV at a heart attack – the “gold standard” of treatment. The interpretation of this abbreviation is percutaneous coronary intervention. TLAP in cardiology is a reliable minimally invasive method that allows doctors to deal with severe complications of the atherosclerotic process, restoring health to their patients.
Angioplasty (with or without stenting) is used to treat diseases caused by narrowing or complete blockage of blood vessels anywhere in the body, including:
- The narrowing of the large arteries (aorta and its branches) due to atherosclerosis is a gradual process in which cholesterol and other fatty substances accumulate in the vascular wall, forming atherosclerotic plaques.
- Stenosis or blocked arteries in the arms and legs caused by obliterating atherosclerosis.
- Renovascular hypertension is an increase in blood pressure caused by narrowing of the renal arteries.
- Atherosclerosis of the carotid arteries, which are located on the neck and supply the brain with blood.
- Myocardial infarction and coronary heart disease caused by overlapping or stenosis of the coronary arteries that supply the heart muscle.
- Narrowing of large veins in the chest or abdomen, pelvis.
Click on the photo to enlarge
The full medical name for this method is percutaneous transluminal balloon angioplasty, i.e. surgical intervention on the vessel is carried out through a small puncture in the skin (percutaneously), by introducing a flexible instrument (transluminally) into the vessel and a catheter with a balloon is used to restore the lumen of the vessel, followed by ballooning.
When a stent is installed inside the vessel, the name of the technique will be “percutaneous transluminal balloon angioplasty with stenting”. However, the terms “percutaneous vascular interventions”, “angioplasty”, “angioplasty with stenting” or “balloon angioplasty”, “balloon angioplasty with stenting” are widely used in the literature.
Found the most frequent use of angioplasty for stenotic atherosclerosis of the heart vessels (coronary angioplasty); vessels of the legs; blood vessels involved in the blood supply to the brain and head tissues; renal artery stenosis.
- Duplex ultrasound examination of blood vessels
- Computed tomography
- Magnetic resonance imaging
If stenosing atherosclerosis is detected, angiography may be prescribed in some cases. When conducting angiography, it is possible to simultaneously conduct an angioplasty procedure.
The choice in favor of surgical treatment of narrowing of the vessel is taken when revealing severe stenosis, in which the diameter of the vessel decreases by more than 50% (hemodynamically significant stenosis). With such stenosis, oxygen starvation of tissues (ischemia) develops due to a pronounced decrease in blood flow.
The clinical manifestations of ischemia depend on the affected vessel:
- Coronary heart disease – with damage to the coronary arteries
- Pain in the calf muscles, ulcers and gangrene of the lower extremities – in the case of atherosclerotic changes in the vessels of the legs
- Transient ischemic attacks, short-term loss of consciousness – with narrowing of the carotid arteries
- Increased blood pressure – with stenosis of the renal arteries.
Coronary angioplasty and its other types require preparation before the procedure.
The main recommendations are as follows:
- detection of patient allergies to contrast;
- familiarization with the list of drugs that the patient takes;
- cessation of the use of anti-inflammatory drugs and drugs that prevent blood coagulation, including acetylsalicylic acid;
- obtaining information about the diseases that the patient suffers;
- clarification of the fact of pregnancy and lactation in women;
- the exception of food and fluid eight hours before the procedure.
How is the procedure performed
The person who is going to have angioplasty should tell the doctor about all the medicines he takes, including herbal remedies. Information about the presence of any allergy is also important, especially for local anesthetics, anesthetics or contrast agents containing iodine.
A doctor may recommend that you stop taking acetylsalicylic acid (aspirin), non-steroidal anti-inflammatory drugs, and blood thinners before performing angioplasty.
You should also inform your doctor about the presence of any chronic or recent acute illness.
Women should talk about whether there is at least the slightest possibility that they are pregnant. During pregnancy, angioplasty is performed only in extreme cases, since it is performed using x-ray radiation, which can harm the fetus.
In most cases, the patient should take all medicines prescribed by doctors, especially drugs for high blood pressure. On the day of angioplasty, they can be washed down with a sip of water.
Before the intervention, the patient should not eat or drink for several hours.
Minimally invasive procedures, such as balloon angioplasty and stenting, are performed in a catheterization laboratory or operating room. These interventions are often performed on an outpatient basis. However, many patients after angioplasty need to remain in the hospital at least for the night.
The sequence of this procedure:
- You will be placed on the radiographic table in a supine position.
- You will be connected to monitors, with the help of which doctors can monitor your heart rate, blood pressure and pulse during the procedure.
- A nurse or doctor puts a catheter into a vein in her arm through which sedatives and other drugs are administered.
- The area through which the vessel will be catheterized is treated with antiseptic solutions and covered with sterile surgical underwear. this is usually a groin or forearm.
- The doctor conducts local anesthesia of the area in which the vessel is catheterized.
- First, the doctor punctures the artery or vein with a needle through which a special conductor is inserted into the lumen of the vessel. After removing the needle through this conductor, an introducer is introduced into an artery or vein.
- Through the introducer, the doctor starts a diagnostic catheter, which guides along the vascular bed under fluoroscopic control to the site of narrowing. After reaching this place, a contrast agent is introduced through the catheter and an X-ray photograph is taken, with which the affected area of the vessel is revealed. During the administration of a contrast medium, you may feel heat or heat all over your body.
- Then, a guidewire is drawn to the narrowing site under the control of fluoroscopy, and a balloon catheter is passed through it. When the balloon reaches the narrowing point, it is briefly inflated and then deflated. The inflated balloon increases in diameter and expands the narrowing of the vessel, restoring impaired blood flow.
- After that, the doctor does a control angiography, assessing the restoration of blood flow. If the result is satisfactory, he removes the balloon catheter and conductor from the vascular bed.
- Often the procedure for angioplasty is also supplemented by stenting of the affected vessel. In this case, a stent is inserted into the affected area when folded, an intravascular prosthesis, which is a flexible tube made of a metal mesh. Then this stent is straightened by inflating the balloon, due to which it expands the narrowed vessel and presses against its walls. The stent maintains the open state of the vessel and prevents its narrowing in the future.
- After the completion of angioplasty, the doctor removes the introducer sheath and presses on the injection site to stop the bleeding. Then the puncture site in the skin is covered with a sterile dressing.
- You are being transferred to the ward. If the procedure was performed through the artery in the groin, you may need to lie on your back for several hours without bending your legs.
Operations of this kind are carried out in angiographic laboratories. The patient is hospitalized in the clinic. After obtaining written consent for medical manipulations, the cardiologist prescribes the necessary tests, angiography of the vessels, radiography and electrocardiography. It is necessary to inform the doctor about pregnancy and the medications taken.
Each hospital has its own individual work protocols with the patient. Usually, a conversation is held with the patient about the stages of treatment, but sometimes this moment is missed.
Then it is best to find out from the doctor and nurse how the intervention will be carried out. The patient has the right to discuss issues of concern to him with a heart surgeon.
Before the operation, it is better not to have breakfast. Prepare one and a half to two liters of mineral water in advance. Heavy drinking speeds up the elimination of contrast agents from the body.
If access to the affected area is through the femoral artery, the hair in the groin area is shaved off. The patient undergoes sedation – intramuscular administration of sedatives and painkillers, under the influence of which he may not remember the procedure itself.
Electrodes for ECG removal are attached to the limbs of the patient: the doctor constantly monitors the work of the heart during the operation. A cubital catheter is inserted into the vein of the arm to administer the desired drugs.
Another common postoperative problem is bleeding and pain at the puncture site. Sometimes, with the introduction of a catheter, a tear (dissection) of the inner layer of the artery occurs. Small damage heals on its own, but a significant defect requires immediate treatment. To stop dissection, repeated angioplasty with stenting is performed.
In severe cases, emergency coronary bypass surgery is indicated.
One of the formidable complications is stent thrombosis. A blood clot (blood clot) forms inside the wire frame. This occurs as a result of the interaction of the metal with blood components. A blood clot can cause blood flow to stop, with serious consequences.
You must immediately inform your doctor if shortness of breath, fever, leg pain, numbness or bleeding at the puncture site appear after surgery.
These signs may be symptoms of such complications.
- Allergy to a contrast medium;
- Perforation or stratification of the artery wall;
- Hematoma formation at the puncture site;
- Stent displacement;
- Myocardial infarction;
- The development of a stroke during the carvation of the carotid arteries;
- Vessel blockage below the stent.
Most of these episodes occur in the first 30 days of the postoperative period. The risk of complications increases if the patient smokes, avoids physical exertion, suffers from overweight and high blood pressure.
- An allergic reaction to anesthetizing or radiopaque substances is rare;
- The artery may be damaged by the conductor, which will require surgical intervention;
- At the site of puncture of the artery, the development of a hematoma is not excluded;
- The likelihood of developing a stroke is not excluded.
Angioplasty with stenting in coronary heart disease with stenosis of 1-3 coronary arteries is included in the basic program of compulsory medical insurance and can be provided free of charge.
A patient preparing for surgery should inform the doctor about all the medications he is taking. This also includes traditional medicine. The doctor should collect an allergic history from the patient, find out if there is an allergy to medications, especially iodine. It is equally important to inform the specialist about tolerable chronic or acute diseases.
On the eve of surgery, the patient is advised to take disaggregants, NSAID drugs. If the woman is in the early stages of pregnancy, she is obliged to inform the surgeon about this. Pregnant women are only manipulated with strict indications. X-rays can cause irreparable harm to the unborn baby. On the day of angioplasty, you can not eat food, drink plenty of water.
As a rule, the patient is discharged the next day in the absence of complications and individual doctor’s instructions. The first 14 days it is forbidden to lift heavy loads. Normal patient activity is restored after three days.
Important! Be sure to prevent thrombosis after the procedure is completed, Acetylsalicylic acid is prescribed to the patient. Take the drug for at least three months.
Rehabilitation after coronary angioplasty (or another form) has been performed consists in performing physical exercises with a gradual increase in stress over three or four months.
In order for coronary angioplasty to bring as much benefit as possible, it is necessary to take into account some important points before it is performed. For example, the doctor should know what drugs the patient is taking and whether he is allergic to any anesthetics, drugs, or contrast agents. The doctor will recommend that you stop using anti-inflammatory and anticoagulant drugs before the procedure. He should also be aware of previous diseases and chronic ailments.
If, nevertheless, a procedure must be carried out even then, all precautions are taken to minimize harm to the fetus. Before angioplasty, all patients should not eat and drink for eight hours.
During the preparatory procedures, the doctor interviews the patient in detail what medicines he is taking, is there an allergy to medications / contrast medium. Before surgery, you need to stop taking Aspirin, NSAIDs and medicines that do not allow blood to clot.
The doctor gets acquainted with the patient’s medical history, you also need to mention those diseases that are not indicated on the medical card. Pregnant women should report their situation to the doctor, since the dose of x-ray for them must be reduced. Drugs for chronic diseases, including antihypertensive drugs, do not need to be canceled. Before surgery, they do not eat or drink for 8 hours.
Indications for angioplasty
To perform angioplasty, an x-ray unit (angiograph), balloon catheter, introducer sheath, stent and guidewire are used.
An angiograph usually consists of a radiographic table, one or two x-ray tubes, and monitors. To monitor the course of the procedure, fluoroscopy is used, which converts X-ray images into a video image displayed on the screen of monitors.
A conductor is a thin wire used to guide diagnostic or balloon catheters as well as vascular stents.
Click on the photo to enlarge
The introducer is a kind of catheter inserted into the artery through which access to the vascular bed is made. This is usually either the femoral artery in the groin or the radial artery on the forearm. During the entire procedure, the introducer sheath remains in the lumen of the vessel; all other instruments are inserted through it.
A balloon catheter is a long and thin tube with a tiny balloon at the end. A stent is a tiny intravascular prosthesis whose walls consist of a metal mesh. Cylinders and stents exist in various sizes and diameters so that the doctor can choose the appropriate size for the affected artery.
Coronary angioplasty is performed under local anesthesia. The skin incision does not exceed 2 mm. A long transparent tube (trocar) is inserted into the artery and carefully advanced along the vessel. Next, a radiopaque preparation is pumped into it to find the exact location of the stenosis. Everything that happens is displayed on the fluoroscope monitor.
Having determined the affected area, a wire bougie with a coating that provides maximum glide is brought to it. The conductor finds a balloon passage in the plaque. Further, a catheter with a miniature reservoir at the end is fed to the lesion site. The can slips into a bottleneck and is inflated with a syringe pressure gauge.
When straightening, the capacity destroys the lipid plaque and restores the patency of the vessel. At this point, the surgeon usually asks you to hold your breath for a few seconds, and the patient feels discomfort and pain behind the sternum.
To revise the vessel, the tube is again filled with a contrast medium. If CTBA is successful, the conductor with the balloon is removed. The catheter is in the artery for several hours after surgery. Angioplasty of the blood vessels of the heart lasts 1-2 hours, in difficult cases – longer.
A pressure dressing is applied to the puncture site and bed rest is prescribed for a day. If wound closure is used, the immobilization time is reduced to 6 hours.
Benefits of percutaneous angioplasty:
- High performance.
- Low invasiveness.
- Local anesthesia.
- Fast patient rehabilitation.
- Lack of operating scars.
With all the advantages of the technique, experts recommend CTBA if one or two coronary vessels are affected during normal activity of the left ventricle. More severe cases require coronary bypass surgery.
To exclude the risk of repeated narrowing (restenosis) of the vessel, the cardiac surgeon installs a stent in the enlarged area. This is a steel mesh frame of cylindrical shape, which holds the walls of the artery in a predetermined position. It is also needed in order to press the torn edges of the plaque to the vessel wall.
The frame is usually worn on the balloon and expands with it, but there are self-expanding structures. The direct stenting technique (without balloon) reduces the trauma of the vessel wall, reduces the time of surgery, and reduces the radiation load on the body. Stents with a drug coating that prevent the development of cicatricial stenosis have been developed.
The procedure of angioplasty is that the patient is guided through a puncture in the skin to the site of stenosis, through which a catheter is inserted with a tiny balloon at the end.
Under pressure, the balloon inflates and “crushes” the atherosclerotic plaque.
Most often, for this procedure, access to stenotic vessels through the femoral artery in the inguinal region is used. This technique is technically simpler than through the radial artery in the wrist (radial access). However, with radial access, the postoperative period is practically absent and the patient can immediately lead an active lifestyle.
Currently, stenting angioplasty is widely used. For this procedure, balloon catheters with a circular metal mesh – a stent located around the balloon – are used. The stent is in a collapsed state, and when the balloon is inflated, it straightens out in a narrowed area. Lumen widens and blood flow is restored. The stent remains in the vessel as the supporting frame. The catheter is removed.
The procedure is carried out under a constant x-ray control, after the introduction of an x-ray substance that makes the vessel visible.
An intervention is carried out by an endovascular surgeon in an x-ray.
The procedure of angioplasty is painless and lasts from 1 to 3 hours.
Transluminal balloon angioplasty is considered minimally invasive manipulation, therefore, is performed in a catheter operating room. General anesthesia is not required for its implementation – the surgeon anesthetizes the point of vascular puncture with a local anesthetic. Despite this, an anesthesiologist is always present in the operating room in order to provide timely assistance to the patient in the event of an emergency.
The patient is placed on the operating table, giving him a position “on his back.” This is followed by the connection of devices that measure blood pressure, oxygen saturation, patient’s pulse rate. The next step will be the puncture and catheterization of the peripheral vein for the introduction of the necessary medications, infusion of solutions.
Initially, the surgeon performs a puncture of the vessel and installs a conductor in its lumen. Then it removes the puncture needle, and through the soft conductor introduces a balloon catheter. Controlling the process of catheter advancement using x-ray radiation, the surgeon conducts it along the vessel to the place where the stenosis site is supposedly located. Upon reaching the goal, a contrast agent is injected into the bloodstream, after which a picture is taken.
When the site of stenosis is verified, the balloon catheter advances towards it under X-ray control. Having reached the intended goal, the surgeon inflates and quickly deflates the cannula cuff. Thereby, a vasodilation effect is achieved. There is a stent inside the can. It is a soft metal mesh folded in the shape of a tube.
After stent placement, the surgeon performs a control image to assess its position, as well as the degree of revascularization. With a satisfactory result, the balloon catheter is removed from the vascular lumen. A pressure sterile dressing is applied to the puncture site. The patient on a gurney is transported to the postoperative ward.
Laser angioplasty is performed according to the same algorithm. Its difference is that fatty plaques are completely destroyed by the laser. An extension device is not installed.
To restore blood circulation in the vascular network supplying the heart muscle, coronary artery angioplasty (coronary angioplasty) is performed. This is an effective method of helping patients with coronary heart disease, especially complicated by a heart attack.
Coronary myocardial revascularization using stents significantly improves outcomes after stenosis or obstruction of the coronary arteries. When performing TLBAP, an expanding device is most often installed in the LAD (the anterior interventricular branch of the coronary artery supplying the heart). For this, a standard catheter for coronary angioplasty is used.
After surgery, patients are prescribed medications that improve blood flow and reduce the risk of thrombosis. Transluminal balloon coronary angioplasty (TBA) is considered successful if, after a control evaluation of the result, the residual narrowing of the vascular lumen is not more than 18-20%. You can also talk about success when the patient after recovery notes a regression of symptoms indicating ischemia.
Under pressure, the balloon inflates and “crushes” the atherosclerotic plaque.
Currently, stenting angioplasty is widely used.
For this procedure, balloon catheters with a circular metal mesh – a stent located around the balloon – are used. The stent is in a collapsed state, and when the balloon is inflated, it straightens out in a narrowed area. Lumen widens and blood flow is restored. The stent remains in the vessel as the supporting frame. The catheter is removed.
Ordinary people encounter x-rays at least once in a lifetime. This is an irradiation unit equipped with a patient table and a monitor where information is displayed.
The design of the balloon catheter is a thin tube with a cavity inside, at the end there is a deflated balloon. To open the balloon, it is filled with saline. A stent is called a thin wire tube, which will become a frame supporting the walls of the vessel. The stent is inserted into the artery in assembled form, and already in place it opens in a special way, pressing against the walls of the artery. Sometimes a medicine is applied to the surface of the stent.
The procedure does not require hospitalization, on the same day the patient is free if there are no complications and indications for treatment in a hospital. Coronary angioplasty is performed on the table, the patient is connected to devices that control pressure, pulse and respiration.
A dropper is injected into a vein, through which the necessary solutions, sedatives or anesthesia are supplied. In the groin area, where a puncture will be made to insert a catheter, the hair is removed, the skin is smeared with an antiseptic and local anesthesia is performed.
In the place where the catheter will be inserted, a puncture or small incision is made, where the trocar is placed. The progress of the operation is monitored by a doctor on an x-ray. A catheter is inserted into the trocar, pushed to the affected area of the artery. Upon reaching the desired site of the circulatory system, a contrast agent is introduced into the catheter, angiography is performed to accurately determine the localization of the narrowing in the vessel. After this, the catheter is removed.
Balloon angioplasty – with this surgical intervention, the doctor inserts a thin catheter with a deflated balloon at the end into the affected coronary artery, leading it to the narrowest area. The balloon is inflated, it straightens and either only by increasing its own size, or by cutting off a blood clot, it increases the lumen of the vessel, thereby restoring normal blood flow.
In recent years, to restore blood flow in the clogged arteries in women, both conventional percutaneous balloon angioplasty and more complex methods, such as coronary stenting and aterenderectomy, have been widely used. These methods are especially effective in clearing relatively short blocked areas, as well as in treating patients under the age of 65 who have recently developed symptoms of coronary heart disease.
Usually, when a patient with a myocardial infarction enters the medical center, angioplasty, due to the rapid achievement of the result, prefers therapy with thrombolytic agents.
However, one should not forget that balloon angioplasty is sometimes fraught with serious side effects – rupture of the arterial wall, the formation of a new blood clot, which, if not immediately removed, can worsen the patient’s clinical condition up to a heart attack. If the surgical procedure is performed by a highly qualified cardiologist, such complications are extremely rare.
Other disadvantages of the method include the fact that approximately one year after angioplasty in every third patient, the lumen of the coronary artery narrows again and you have to either repeat this operation or perform an even more technically difficult coronary artery bypass grafting.
Although balloon angioplasty is usually done for men at a more severe stage of coronary heart disease, the therapeutic effect of the operation is still higher than that of women. In the latter, it is not possible to clear the lumen of the vessels so well and reduce pain in the chest. At first, cardiologists thought that this was due to the smaller size of the female coronary vessels, and tried to use smaller diameter cylinders.
But even with the foregoing, balloon angioplasty is an effective method of restoring normal blood flow in the coronary arteries in women, since in the long term both for them and for men its effectiveness is approximately the same, with the exception of the greater frequency of chest pain attacks characteristic of women.
In addition, with the successful completion of surgery and the unlocking of the heart arteries in women, relapse occurs much less frequently.
The effectiveness and long-term prognosis of angioplasty depends on very many factors, which include the reasons for its implementation, the nature and degree of vascular damage, patient compliance with the doctor’s recommendations for a healthy lifestyle and drug therapy.
If balloon angioplasty is not supplemented by stenting, repeated stenoses very often develop in the same place.
What medicines and how long to take when stenting the coranar arteries?
Dmitry, after stenting the coronary arteries, there should be a comprehensive rehabilitation with the use of antiatherosclerotic drugs (Atorvastatin, Atoris), Antihypertensive drugs (Bisoprolol, Enalapril), life-long anticoagulants (Warfarin), and metabolic cardioprotective therapy (Metamax), Preduk are important. All appointments are done only by the attending physician.
Balloon angioplasty is an endovascular method for restoring the normal lumen of an affected vessel. The whole procedure is carried out in the ward, which is equipped with an x-ray machine. The essence of the method is the introduction into the lumen of the affected blood vessel of a special long flexible catheter with a balloon at the end under x-ray control.
After the catheter reaches the narrowing area, contrast is injected, the vessel is examined – angiography. Only after this, a guide and balloon catheter are inserted into the vessel. After reaching the narrowing point, the balloon swells. The lumen of the vessel increases. At this point, often patients experience the same sensations as with angina (if angioplasty of the coronary arteries is performed). The catheter is removed after 4-12 hours. Duration – from 30 minutes to one hour.
If necessary, after angioplasty, a stenting (bypass) procedure is performed. Its essence lies in the introduction of a special metal device – a stent (resembles a mesh) into the affected part of the vessel. It is intended to maintain an extended lumen of the vessel for a long time. In modern cardiology, balloon angioplasty of the heart vessels and bypass surgery are performed simultaneously, effectively complementing each other.
Important! Bypass surgery and balloon angioplasty are different surgical procedures.
The main effects of the operation:
- Expansion of the lumen of the vessel.
- Improving blood flow in the affected area of the vessel.
- Treatment and prevention of many life-threatening diseases – ischemia, heart attack, renal artery stenosis, thrombosis, blockage of the most important vessels by atherosclerotic plaques, etc.
- Increased elasticity of the vascular wall.
- Normalization of age-related changes in the thickness of the lumen of blood vessels.
In modern medicine, this operation allows you to quickly and effectively restore the normal size of the lumen of the vessel and ensure optimal blood flow in the affected areas.
Coronary angioplasty is based on the insertion of a long thin catheter into an artery that is affected by atherosclerosis. Usually, a femoral artery located in the area of the inguinal fold is used for this.
There are times when a catheter is inserted through an artery located on the arm. A small incision must be made at the injection site.
First, a trocar is inserted into the artery, that is, a thin tube, which, under X-ray control, reaches the narrowing site. As soon as the catheter reaches the affected area, a radiopaque substance is injected through it and angiography is done, which will determine the exact location of the narrowing.
Then a conductor is inserted into the artery, and then a balloon catheter. This catheter at the end has a balloon that inflates when the end of the catheter is brought to the affected area of the vessel. Thus, ballooning occurs, after which the catheter is carefully removed from the artery.
At the site of insertion of the catheter, a load is installed in order to compress the artery and thereby stop the bleeding. The seams are not overlapping, the dressing is simply pasted on the code.
After the operation, the patient lies on a bed with a straight leg for several hours. Remove the infusion system from a vein. The duration of the procedure depends on the degree of damage to the artery.
A stent is placed in the lumen of an artery that has been dilated during angioplasty. This cylinder is a skeleton that prevents the artery from narrowing again.
Stenting is a very important addition to angioplasty, so today these two procedures are performed together.
Pure angioplasty is done only if the caliber of the vessels is less than two millimeters. The cause is also some lesions involving scar tissue and branches of the coronary artery. In its pure form, this procedure is performed when a person can not take anticoagulant drugs that are prescribed after the procedure.