Stenting of the coronary arteries is performed under local anesthesia and with mandatory x-ray control. To perform the operation, a balloon catheter of the required diameter and a metal frame (stent) are required. Such a frame may be uncoated or have a special polymer on top. Polymer-coated stents cost a lot more, but give better results.
The essence of the operation is that a catheter is inserted into the human femoral artery, which is equipped at the end with a small balloon with a stent. After it reaches the problem area at the site of narrowing of the vessel, the balloon begins to inflate to the required size and presses the atherosclerotic deposits into the walls. After deflating the balloon, an expanded metal frame remains in its place, which will prevent the vessel from narrowing again.
In time, coronary stenting of the vessels of the heart takes about 1-3 hours. Immediately prior to surgery, the patient should take blood thinners to prevent thrombosis.
The stenting procedure has advantages over other manipulations and procedures that should be considered when choosing a treatment method:
- low invasiveness;
- lack of need for general anesthesia;
- short rehabilitation period;
- minimum number of complications.
The body recovers quite quickly after such a surgical intervention, and the patient does not need prolonged hospitalization. Compared with other operations, stenting of the vessels of the heart is considered less expensive. Since there is no need to do general anesthesia, this type of treatment can be used even for patients with contraindications to standard surgical intervention.
Stenting of the coronary arteries can be carried out only after a complete diagnosis, including angiography – examination by x-ray and contrast of the cardiovascular system. This helps to determine the presence of narrowings in the vessels, their localization, extent, and other nuances. Based on the data, the doctor decides whether stenting is acceptable for the patient, and selects the appropriate type of tube.
Surgical intervention is also under the control of radiography. Sometimes coronary angiography and stenosis are performed on the same day. However, the second operation is not suitable for everyone, but only:
- patients with ischemia who are not helped by medications;
- those patients who, according to the results of the tests, were allowed to install a stent in the heart (if atherosclerosis d >
Not all patients with cardiac ischemia have stenting.
It is carried out only in the following cases:
- Preinfarction condition with a threat of acute myocardial infarction;
- Unstable angina pectoris;
- Progression of angina pectoris with frequent severe seizures, not removable with nitroglycerin;
- Acute heart attack;
- The occurrence of angina attacks in the first 2 weeks after acute heart attack;
- Stable angina pectoris 3 and 4 functional class;
- Repeated narrowing of the artery after stent placement.
These include patients:
- Diabetes mellitus;
- On hemodialysis;
- With repeated stenosis after installing a holometallic stent;
- With the development of shunt stenosis after coronary artery bypass grafting.
Detonic – a unique medicine that helps fight hypertension at all stages of its development.
The complex effect of plant components of the drug Detonic on the walls of blood vessels and the autonomic nervous system contribute to a rapid decrease in blood pressure. In addition, this drug prevents the development of atherosclerosis, thanks to the unique components that are involved in the synthesis of lecithin, an amino acid that regulates cholesterol metabolism and prevents the formation of atherosclerotic plaques.
Detonic not addictive and withdrawal syndrome, since all components of the product are natural.
Detailed information about Detonic is located on the manufacturer’s page.
There are a number of contraindications for stent placement (even in emergency cases):
- Severe respiratory, hepatic, and renal failure;
- Period of acute stroke;
- Current infectious diseases;
- Internal bleeding;
- Reduced blood coagulation with the threat of bleeding.
The procedure for installing the stent requires preparation of the patient. At this stage, coronary angiography is performed to clarify the localization of the clogged vessel and to determine the degree of its damage. In an emergency, blood and ECG tests are additionally done. In the case of a planned operation, a more thorough examination of the patient is carried out.
- Laboratory tests of urine and blood – general and biochemical, determination of blood coagulation, for hepatitis and HIV;
- Cardiac studies – echocardiography, daily ECG monitoring, ultrasound of the coronary vessels with duplex scanning and dopplerography.
How is a stent placed?
Access to the coronary arteries is through the femoral artery or through the arm. Second way
– introduction of an introducer with a stent through the radial artery of the forearm
– It is used more often because of easier access to coronary vessels.
- The puncture site is anesthetized and a conductor with a canister is inserted into it.
- With the flow of blood under X-ray control, he reaches the right place in the artery;
- After the can is fixed in the right place, it is inflated with a syringe;
- Under pressure, the destruction of the atherosclerotic plaque occurs;
- The conductor with the balloon is removed and a stent with a balloon inside is installed in its place;
- The catheter is again inserted into the affected vessel, the balloon expands under pressure and opens the stent, firmly fixing it on the walls of the artery in place of the destroyed plaque.
Subject to a healthy active lifestyle, all medical recommendations and the absence of other serious diseases, the life expectancy of patients with cardiac ischemia increases significantly. This is also evidenced by patient reviews.
After the intervention, drugs are prescribed that reduce the risk of stent thrombosis. The most famous drug in this group is Plavix. The duration of the drug is negotiated separately and depends on the installed stent:
- After suffering acute coronary syndrome for at least 1 year.
- When installing a drug-eluting stent for at least 1 year.
- When installing a stent without drug coating for at least 1 month.
The main errors and errors regarding stenting of the vessels of the heart:
After the operation, you do not need to drink medicine, because there is a cure.
Extremely dangerous misconception. After stenting of the coronary arteries, the importance of drug therapy increases many times.
The cure does not occur, the quality of life improves significantly, the risks of cardiovascular catastrophes and cardiovascular death can be reduced if the operation is performed according to indications.
After surgery, the cost of drug treatment will decrease.
This is not true. Stenting is an indication for the use of Plavix, the cost of this drug is quite significant today, so there will be no reduction in the cost of treatment. But, of course, the patient’s ability to work will improve.
There will be no restrictions after the operation.
This is not so, you should also carefully monitor the level of blood pressure and treat arterial hypertension (if it was previously or first appeared), it is just as carefully necessary to monitor the level of sugar and glycated hemoglobin in patients with diabetes, you still can not smoke and you need to monitor for weight.
Plavix is very expensive, can it be replaced with a zilt.
Formally, sylt is a generic of Plavix, but you should be aware that there are no studies that prove the same as Plavix’s effectiveness, so replacement is possible only at your own peril and risk. We cannot give such a recommendation.
Such a method of therapy is characterized by some advantages that force specialists to choose surgical intervention.
These benefits are:
- short duration of the control period from the parties Specialists in recovery;
- there is no need for cutting the breast;
- short rehabilitation period;
- relatively inexpensive price.
Many patients who are prescribed this operation are interested in how safe it is and how many people who have had it after the operation live.
Adverse effects occur quite infrequently, in approximately 10% of patients. But such a risk should not be completely discarded.
Cardiac stenting is considered the safest measure of therapy. The patient should significantly more closely monitor his health, adhere to the recommendations of a specialist, take the necessary medications and undergo examinations according to the plan.
It happens that after surgery, the probability of narrowing of the artery remains, but it is small, and scientists continue to research in this area, and the number of improvements is growing.
Stenting of the heart after a heart attack can be characterized by dangerous complications that arise during the surgical procedure, after a short period of time after it or after a long period.
After the operation, you need to adhere to bed rest for some time. The doctor monitors the occurrence of complications, recommends a diet, the use of medicines, restrictions.
Life after stenting means compliance with certain requirements. When a stent is installed, cardiorehabilitation of the patient occurs.
Its main requirements are diet, physiotherapy exercises and a positive mood:
- For 1 week, the rehabilitation process is associated with limitations of physical activity, baths are prohibited. 2 months, experts do not advise driving. The following recommendations are a cholesterol-free diet, dosed physical activity, regular use of medications.
- It is necessary to remove fats of animal origin from the diet and limit carbohydrates. You should not take fatty pork, beef, lamb, butter, lard, mayonnaise and hot spices, sausages, cheese, caviar, soft wheat pasta, chocolate products, sweet and flour, white bread, coffee, strong tea, alcoholic drinks, soda.
- In the diet, it is mandatory to include in the menu vegetable and fruit salads or fresh juices, boiled poultry, fish, cereals, pasta, cottage cheese, sour milk, green tea.
- You need to eat a little. but often, 5-6 times, observe the weight. If possible, do fasting days.
- Every morning, gymnastics in the morning helps increase metabolism, sets up in a positive way. Do not do difficult exercises instantly. Walking is recommended, at first for a short distance, then – increasing the distance. Useful unhurried walking on the stairs, >
The stent looks horrific to many, although it is not
Life must go on regardless of the entries in the card
- disability document, rehabilitation program;
- statement and referral
Is it possible to fly a plane after stenting
If the patient has pain at the site of the puncture of the artery or in the chest area, the usual painkillers like paracetamol, ibuprofen or other drugs can help. If stenting was performed according to planned indications, and not for the treatment of acute coronary syndrome (myocardial infarction, unstable angina), the patient is usually discharged home on the second day, giving detailed instructions for further recovery.
Recovery after stenting Recovery after stenting of the vessels of the heart depends on many factors, including the cause of the disease, the severity of the patient’s condition, the degree of deterioration of heart function and the site of vascular access. Care of the site of vascular access Interventional procedures are performed through the femoral artery into the groin or the radial artery on the forearm.
The diseases that are the basis for prescribing disability to a minor patient in 2018 are as follows:
- mental retardation;
- impaired mental and physical development;
- mental disorder;
- organ dysfunction:
- external deformities that are not amenable to correction;
- metabolic dysfunction;
- impaired motor reaction;
Attention: an unlimited certificate may be issued to a minor patient. In this case, regular re-examination is not required. The list of violations in which a group is established for a child is quite wide. It includes almost all the ailments from the first list. More specifically, the attending doctor should understand the situation.
Most often, the appearance of the disease contributes to the presence of stressful situations. A small definition In fact, a heart attack is an acute phase of ischemic disease, consists in the fact that blood ceases to flow to any part of the heart. With the duration of this phenomenon about 20 minutes, some part of the heart is deadened.
- impaired renal function (against the background of an allergy to a contrast medium);
- arterial obstruction;
- hematoma in the puncture area;
- bleeding associated with damage to the artery wall.
Due to continuous blood flow, the above complications may appear on other arteries. The risk group includes diabetics and people suffering from severe kidney diseases and clotting pathologies. These patients require a thorough examination before surgery. Then special preparation for stenting is carried out.
When the patient is discharged home, a bandage may remain in the appropriate place. Recommendations for the care of the vascular access site:
- The day after the procedure, you can remove the bandage from the puncture site of the artery. It is easiest to do this in the shower, where you can wet it if necessary.
- After removing the dressing, stick a small patch on this area.
Within a few days, the catheter site may be black or blue, slightly swollen and slightly painful.
- Wash the catheter insertion site at least once a day with soap and water. To do this, collect soapy water in the palm of your hand or moisten a washcloth in it and gently wash the desired area.
This helps prevent myocardial infarction, stroke, kidney disease, and heart failure.
- Blood cholesterol control.
Psychological support Postponed stenting, as well as the disease that caused it, expose the patient to stress. In everyday life, any person is constantly faced with stressful situations. He can be helped by close people – friends and relatives, who should provide psychological support to cope with these problems.
You can turn to a psychologist who can professionally help a person cope with stressful events in life. Drug therapy after stenting Taking medications after stenting is required, regardless of the reason for which it was carried out. Most people take drugs that reduce the risk of thrombosis within a year of surgery.
But the diagnosis itself does not contribute to the determination of disability. It is assigned taking into account indicators such as the patient’s ability to work and self-care. When passing a medical and social examination, special indicator systems are used. Such an examination is intended to determine the degree of loss of physical abilities.
Therefore, disability is given to patients who, prior to a heart attack, held a difficult position that required significant physical effort. If the patient’s condition has stabilized after surgery, then he can travel. In this case, the patient must comply with all the recommendations of the attending physician. Active rest is a quick rehabilitation after stenting. Some patients can use saunas and baths. 5 Life expectancy. A diagnosis of coronary heart disease requires constant consultation with a cardiologist.
In them, as a result of the illness, their working capacity is significantly reduced. The first group of disabilities is established for patients who have lost the ability to work and have lost their legal capacity. In addition, there are cases of establishing perpetual disability. It is assigned when the treatment used shows a negative result.
Chosen types of work after a heart attack Regardless of the group of disability, positive or negative prognosis, having had a myocardial infarction, it is contraindicated to work in the specialty: – public and freight transport operator; – pilots of aviation equipment; – electrical installer; – employees of security companies; – high-altitude workers;
– where there are toxic substances; – where there are night shifts; – postmen; – catering workers; – in a remote area where there are no settlements. Under what circumstances is a child group assigned? The state of health of minors is monitored from the moment of birth. With certain ailments, a child can be recognized as disabled. This happens if the state of his body interferes normally:
- to learn;
- interact with the environment and society.
Diseases arise for various reasons. There are congenital (intrauterine) and acquired. The causes of dysfunctions do not affect the ITU decision. The commission analyzes the state of health and the likelihood of a cure. Based on the results, a decision is made to provide a disability certificate. After a heart attack, a person is prohibited from working:
- flight pilot, flight attendant, crane operator;
- electrician, high-altitude worker, security guard;
- postman, courier, transport dispatcher;
- seller, employee of catering and other services where psycho-emotional and physical activity are increased;
- at enterprises producing or processing harmful chemicals and poisons;
- at the works providing night shifts and daily performance of works;
- in hazardous work and in places with a climate unfavorable to health;
- at work with high speed: machines and conveyor;
- far from cities and other settlements, in the field.
A return to the previous work that is difficult for the body is unacceptable. The transferred heart attack does not exclude the recurrence of an attack in a more severe form.
Due to continuous blood flow, the above complications may appear on other arteries. The risk group includes diabetics and people suffering from severe kidney diseases and blood clotting pathologies. These patients require a thorough examination before surgery. Then special preparation for stenting is carried out. If necessary, the patient is prescribed drugs. According to the signs of a beginning complication, experts include:
- bleeding of the puncture site;
- change in temperature and skin color around the place where the stent was installed;
- chest pain.
The above symptoms indicate restenosis. In this case, urgent cardiological care is required. After surgery, the patient is in intensive care under the constant supervision of a doctor. How many days the sick leave lasts after a heart attack and stenting depends on the general condition of the patient, the success of the surgery. On average – 2-3 months.
After surgery on the heart, the patient should stop smoking.
Quitting smoking is recommended before surgery. Scientists have proven that passive and active smoking negatively affect the performance of the main organ and blood vessels. At the same time, atherosclerosis progresses, the risk of developing a heart attack and arrhythmia increases. It is forbidden to drink alcohol after a heart attack and stenting. A small amount of dry red wine has a healing effect on the heart and the course of atherosclerosis. In doing so, the following rules must be observed:
- drink 1 glass of wine per day;
- consume high quality wine.
Movement and moderate physical activity after stenting of the blood vessels of the heart is the key to a successful recovery of the patient. With the help of regular sports, you can prevent the development of atherosclerosis, strengthen the immune system, train the heart muscle, stabilize blood pressure, lose weight.
For patients undergoing stenting, there are no special exercises. Physical activity is taking into account the general condition of the patient, his age and the presence of chronic ailments. Rehabilitation after stenting involves performing physical exercises 4 times a week. It is recommended to go swimming, ride a bike, run.
You can not do weightlifting and boxing. Rehabilitation after myocardial infarction does not provide for the abandonment of the usual sexual life. After surgery, the amount of drugs used is reduced. The treatment regimen during the rehabilitation period is selected individually by the doctor. The patient is prescribed a hemorrhaging agent (clopidogrel).
With the help of stenting, it is impossible to completely get rid of ischemia. In later life, relapses are not excluded, so patients who undergo such an operation are under the supervision of a doctor. This contributes to the timely detection of the formation of AB in the arteries or the appearance of blood clots. Rehabilitation after stenting is aimed at returning the patient to a previous life.
There are no exact terms for the restoration of disability. It depends on the severity of ischemia, the profession of the patient. If the patient specializes in intellectual work, then you can work immediately after surgery. If the patient’s profession is associated with physical activity, then proceed to work later.
- clogging of the operated artery ,
- damage to the vascular wall,
- the appearance of bleeding or the formation of a hematoma at the puncture site,
- allergies to contrast media of varying severity, including renal dysfunction.
- Taking into account the fact that blood circulation occurs in the human body, in some cases during stenting the consequences also occur in other arteries that are not affected during surgery.
- An increased risk of complications after surgery in people suffering from severe k >
Inside or in the trash
Yes, most of the drugs that patients took before the intervention also remain with them after it, for some this amount increases, so which groups of drugs still need to be taken.
Sometimes a specialist prescribes drugs in doses that are contrary to the instructions, in this case, you should trust your doctor.
- Antiplatelet drugs. Assign immediately after angioplasty and stenting, to reduce the risk of thrombosis both in the area of the installed stent and beyond.
- Statins Lipid-lowering drugs are prescribed to lower blood cholesterol, under the supervision of a biochemical analysis. Typically, patients take lipid-lowering drugs long before angioplasty surgery begins. After the operation, it is possible to prescribe an additional drug of the same group.
- Beta blockers. Assign to patients not only after angioplasty, but also as a medical treatment for coronary artery disease.
- Calcium antagonists. As well as other drugs can be used as drug therapy in the preoperative period. The doctor thus provides the prevention of repeated attacks of angina pectoris.
How many live after heart stenting surgery, do disability give
The largest vessel in the human body is the aorta, which supplies oxygen to all organs and tissues. At the very beginning of a narrowing of a blood vessel, usually there are no signs of a lack of oxygen. With the progression of aortic narrowing (coarctation), patients have high blood pressure, and other problems may occur.
Stenting of the vessels of the heart is a surgical operation during which the lumen of the affected artery is restored to a normal diameter. A special stent is installed inside the vessel, due to which the blood flow is normalized. Modern surgery prevents the death of tissue and the development of myocardial infarction.
How is a stent placed?
- drug therapy does not effectively eliminate the symptoms of coronary heart disease;
- with the help of coronarography, the possibility of installing a stent and the effectiveness of manipulation was confirmed (narrowing is limited in area, the trunk of the left coronary artery is not affected, the distal artery, which is the thinnest, is not affected);
- a patient with angina pectoris is required to maintain physical activity;
- diagnosed with severe angina pectoris, accompanied by severe pain behind the sternum, the patient’s condition is regarded as pre-infarction;
- early period of myocardial infarction (the sooner the better), if the hospital has equipment for the intervention;
- the rehabilitation period after myocardial infarction, regardless of the stage of rehabilitation (the earlier the patient will have a stent installed that restores oxygen access to the myocardium, the better);
- restenosis on the background of an already performed angioplasty of the heart vessels.
- allergic reactions;
In fact, such complications arise extremely rarely, however, they cannot be completely ruled out, even if such cases are extremely rare. The fact that stenting is a percutaneous minimally invasive intervention that still remains an ideal treatment for angina pectoris cannot be ruled out.
Coronary heart disease sometimes goes too far, which is why disability after stenting of the vessels of the heart is a common occurrence in our country.
Products – instructions with side effects not included
Atherosclerosis is considered the most common chronic disease that affects the arteries. Over time, atherosclerotic plaques that grow inside the membrane of the vessel wall, single or multiple, are considered cholesterol deposits.
In case of growth of connective tissue in the artery and calcification of the vascular walls lead to a gradually developing deformation, the lumen will sometimes narrow until the artery is completely obliterated, which will entail a constant, growing lack of blood circulation of the organ that feeds through the damaged artery.
With insufficient blood circulation in the muscle of the heart, a person feels the appearance of such symptoms:
- pain in the chest, which is accompanied by a fear of death;
- excessive sweating.
- A cardiac surgeon selects patients with ischemia for surgery. The patient must undergo the necessary examination, which includes all the necessary blood and urine tests to determine the work of internal organs, lipogram, blood coagulation.
- An electrocardiogram will provide an opportunity to clarify the location of damage to the heart muscle after a heart attack, the distribution and concentration of the process. Ultrasound of the heart will demonstrate the work of each department of the atria and ventricles.
- An angiography should be performed. This process consists of introducing a contrast medium and several X-ray photographs into the vessels, which are carried out when filling the bloodstream. The most damaged branches are detected, their concentration and degree of narrowing.
- Intravascular ultrasound helps to assess the capabilities of the arterial wall inside.
Indications for surgery:
- difficult regular angina attacks, which the cardiologist defines as a pre-infarction;
- support of the coronary artery bypass graft, which tends to narrow over 10 years;
- vital signs during a severe transmural infarction.
- Common damage to all coronary arteries, due to which there will be no places for stenting.
- The diameter of the narrowed artery is less than 3 mm.
- Decreased blood coagulation.
- Dysfunction of the kidneys, liver, respiratory failure.
- Allergy of the patient to drugs containing iodine.
Do not forget. that with an ideal cardiac surgery technique, the need to properly take care of one’s health is not canceled.
After stenting, a rather short postoperative period follows, lasting up to 1-2 weeks, associated with the procedure itself.
Further recovery and rehabilitation depends on the disease for which stenting was performed, as well as on the degree of damage to the heart muscle and the presence of concomitant pathology. The forecast, the need to assign a disability group, the availability of disability, depend on this. See the following sections of the article for more details.
The probe is inserted into the vessel, and under the control of a computed tomography or ultrasound probe moves in the direction of clogging. There is the installation and inflation of the balloon. The inflated balloon opens the stent, thereby installing it inside the vessel.
This installation technology can significantly reduce the morbidity during surgery, because the incision must be done not at the installation site, but at a certain distance. It should also be noted that stenting is widely used in cases of plaque formation in hard to reach places.
Indications for the use of the stent are pathological conditions that can provoke discirculatory disorders. Installation is carried out with the threat of coronary heart disease (CHD) or atherosclerosis.
In case of increased risk of myocardial infarction, this procedure can also be used. Endarterectomy can also be used to treat atherosclerosis, allowing direct removal of the plaque. However, it is much easier to install a stent on the coronary vessels, and recovery after such an operation is much easier than after removing the plaque itself from the lumen.
It should be noted that, despite its safety and a quick period of remission, such an operation has certain contraindications:
- reduction of the diameter of the artery to 3 mm;
- decreased blood coagulation and hemophilia;
- chronic respiratory or renal failure in the acute stage;
- diffuse stenosis – damage to an overly large area;
- allergy to iodine – it is a component of a contrast agent in radiography.
The main task performed by the stent is to maintain the diameter of the vascular lumen. This implies a large load on the frame, and therefore it is manufactured using advanced technologies and high quality materials.
Most often, an inert alloy of several metals is used to create it. More than 100 different types of stents have been developed, which differ in the composition of the alloy, design, type of cells, coating and method of delivery to the site of narrowing.
Most commonly used are conventional metal stents that simply support the required vessel diameter. There are also stents that are coated with a special polymer – it releases a drug substance dosed.
Using this technology can significantly reduce the risk of restenosis, and their cost is significantly higher than usual. In addition, with the introduction of such a stent for up to 12 months, antiplatelet drugs must be taken to prevent the occurrence of thrombosis. Such stents are recommended to be installed in small vessels where the likelihood of clogging is significantly increased.
Like any other operation, stenting involves conducting preliminary studies and special training. This allows you to increase the chances of a favorable outcome, reduce the likelihood of complications, reduce the duration of the recovery period.
First, an examination is carried out. It consists of several parts:
- Doppler ultrasound helps to track blood flow in the vessels.
- Biochemical and general blood tests determine coagulation disorders, the level of low density lipoproteins (LDL) in the blood.
- A coagulogram helps determine the level of blood coagulation.
- A coronarographic study determines the condition of the arteries, the degree of damage.
Ultrasound with dopplerography does not require special preparation, it is carried out exactly the same as any other ultrasound examination.
A blood test is performed after taking the test sample at the fold of the ulnar vein. Blood sampling is carried out on an empty stomach in the morning – this allows you to get the most objective research results. Coronarography requires, first, a coagulogram, a general urinalysis, and a check for the presence of the HIV virus and hepatitis in the blood.
Then, coronary angiography is performed directly – it shows the degree of narrowing of the vessel, the size of the plaque, and the condition of the vessel at its location.
The operation itself is carried out in several stages:
- Maintaining a blood thinner. It is necessary to prevent the formation of blood clots during the operation.
- Local anesthesia is performed at the catheter site.
- Puncture of an artery to install a special tube – introducer. Most often, it is installed in the inguinal region, because through this artery it is easiest to get to the coronary.
- Insertion of a catheter into the affected artery through the introducer sheath.
- Insertion of a stent with a balloon through a catheter into a damaged vessel.
- Under the control of ultrasound or CT, the balloon is brought to the site of narrowing.
- Balloon inflation made using a contrast medium. In this case, the stent opens and is pressed into the vessel wall. The balloon is inflated several times to secure the stent.
How is stenting performed?
- heart ischemia;
- atherosclerosis of the lower extremities.
Modern medicine (the industry is endovascular surgery) has several common methods for restoring arterial patency:
- conservative drug therapy;
- stenosis of the heart vessels;
- coronary artery bypass grafting;
- angioplasty (opening with a catheter of the affected artery).
The stenting procedure can be performed in an emergency (in the presence of unstable angina or myocardial infarction). In other cases, the operation is carried out as planned. According to the results of laboratory tests, during which the state of the patient’s blood vessels and heart is determined, the doctor approves or prohibits vascular stenting. Before installing the stent:
- the patient takes a general analysis of blood, urine;
- make an ECG, a coagulogram;
- perform ultrasound.
Stenting takes place under sterile conditions in the operating room using a local anesthetic. The installation of stents is done under the control of fluoroscopy. To gain access to damaged vessels, the doctor punctures a large artery. A small tube (introducer) is inserted through the hole. It is needed to introduce other instruments into the artery. A flexible catheter is brought through the introducer to the mouth of the affected artery. Through it, a stent is delivered directly to the site of narrowing of the vessel.
The specialist places the tube so that after opening it is located as well as possible. Next, the stent balloon is filled with contrast, which leads to its bloat. Under pressure, the tube straightens. If the stent is positioned correctly, the doctor takes out the instruments and bandages the puncture site. Stenting on average takes from 30 to 60 minutes, but is extended if several tubes are needed at once.
Early postoperative period
Immediately after the end of the procedure, the patient is taken to a postoperative ward, where medical personnel carefully monitor his condition. If vascular access was through the femoral artery, after surgery, the patient needs to lie in a horizontal position on his back with legs straight for 6-8 hours, and sometimes longer. This is associated with the risk of developing dangerous bleeding from the site of the puncture of the femoral artery.
There are special medical devices to reduce the length of the required horizontal stay in bed. They fill a hole in the vessel and reduce the chance of bleeding. When using them, it takes 2-3 hours. To remove the contrast agent introduced into the body during stenting, the patient is recommended to drink as much water as possible (up to 10 glasses per day), if he does not have any contraindications (such as severe heart failure).
If stenting was performed according to planned indications, and not for the treatment of acute coronary syndrome (myocardial infarction, unstable angina), the patient is usually discharged home on the second day, giving detailed instructions for further recovery.
Rehabilitation after stenting includes a set of measures that will help a person recover faster and reduce the risk of relapse. Immediately after surgery, the patient must observe strict bed rest in a hospital (1-2 days). The attending physician at this time constantly monitors the condition of the person.
Rehabilitation after stenting involves taking medication prescribed by a doctor. With the help of drugs, the risk of developing myocardial infarction is significantly reduced, and indicators such as the duration and quality of life with coronary heart disease are increased. The duration of the course is on average up to six months. The list of prescribed drugs after vascular stenting include:
- lowering the amount of cholesterol in the blood;
During the rehabilitation period, it is important to follow a diet. Fatty foods should be limited in the human diet. With hypertension, it is worth giving up salt. If the patient suffers from diabetes, his diet should contain exclusively products of the ninth table according to Pevzner. Obese people should minimize the calorie intake of food.
A person who has undergone stenting of heart vessels should perform regular physical therapy (physiotherapy exercises) 1-2 weeks after surgery. Rules:
- Hiking is ideal. Light homework shown.
- The duration of the load should be limited to 30-40 minutes and be carried out daily.
- Terrenkur is considered to be an excellent rehabilitation tool – limited in time, angle of inclination, and ascent distance along specially organized routes.
- Classes contribute to the soft training of the heart and gradually restore its function.
Cardiologists run the risk of losing their jobs – now hypertension is treatable!
- Drug therapy.
- Diet food.
- Classes of exercise therapy.
- Regular examinations (interrogation, examination, ECG, laboratory tests and other instrumental studies). Successful stenting surgery does not mean that you can forget about visits to a cardiologist, especially if rehabilitation is not carried out in a sanatorium.
- Educational work.
After the operation, patients are prescribed medications that prevent obstruction of the coronary vessels, statins to normalize lipid metabolism, as well as special cardiological drugs to protect the heart from overload. In addition, they are developing a set of exercises for physiotherapy exercises designed to train the heart and normalize body weight. Both drug therapy and exercise therapy are selected for each patient individually.
No less important than drugs and exercise therapy, has a diet. For patients who have undergone stenting, nutrition is needed, enriched with vitamins, useful fatty acids and fiber. But the use of harmful fats, “light” carbohydrates, caffeine and salt should be strictly dosed, since it is these substances that negatively affect the condition of the coronary vessels and blood pressure.
After stenting, vegetables, fruits, cereals, sea fish, lean meat and vegetable oils must be present in the diet of patients after stenting. You can drink coffee, but not strong, in small quantities and only natural. It is advisable to reduce the amount of salt used to 3 g per day, and the salt that is in ready-made products (for example, bread, hard cheese, etc.) should also be taken into account. Another important link in cardiac rehabilitation is the absolute rejection of bad habits.
There are special medical devices to reduce the length of the required horizontal stay in bed. They fill a hole in the vessel and reduce the chance of bleeding. When using them, you have to lie 2-3 hours.
To remove the contrast agent introduced into the body during stenting, the patient is recommended to drink as much water as possible (up to 10 glasses per day) if he does not have contraindications for this (such as severe heart failure).
If the patient has pain at the site of the puncture of the artery or in the chest area, the usual painkillers like paracetamol, ibuprofen or other drugs can help.
The 1st group of disability is given for 2 years. She is prescribed when the patient is incapable of work and incapable of self-care. In especially severe cases, lifelong disability may be assigned. Group 2 is assigned for a period of 1 year. The 2nd group of disability is assigned in cases of limited ability to work, when the performance of labor duties is not associated with physical activity.
A special commission must decide on the appointment of a specific disability group. After a year, the patient undergoes a medical examination again, which should determine the degree of disability. If the results of the examination are negative, in the presence of relapses of the disease, disability after a heart attack is again prescribed and the corresponding group is established.
An disabled person who has received the status of a disabled person must annually undergo a medical commission, which will decide on the extension or termination of disability. During a secondary examination, he must provide the same package of documents as during the first passage of the commission. But, in addition to the main package, he must have a rehabilitation card and a disability certificate obtained earlier.
The rehabilitation card must have marks confirming that the patient is seeking treatment, has passed the prescribed recovery measures and therapeutic procedures. The documents should also contain paper from the employer, confirming that he is ready to provide the established mode of work, to create certain conditions for the performance of production duties.