From this article you will learn: what kind of operation is stenting of the blood vessels of the heart, why is it considered one of the best methods of treating various forms of coronary artery disease, especially its implementation.
Stenting of the coronary vessels of the heart is a minimally invasive (sparing) endovascular (intravascular) operation on the arteries supplying the heart, which consists in the expansion of their narrowed and clogged areas by installing a vascular stent in the lumen.
Such surgical interventions are performed by endovascular surgeons, cardiac surgeons and vascular surgeons in specialized centers of endovascular cardiac surgery.
Atherosclerosis of the coronary arteries, manifested by the formation of cholesterol plaques in the lumen of these vessels, is a typical causative mechanism for the development of coronary heart disease. These plaques have the appearance of protrusions and tubercles in which inflammation, scarring, destruction of the inner layer of the vessel and the formation of blood clots occur.
The meaning of stenting of the vessels of the heart is to restore the lumen of the coronary arteries at the sites of narrowing with atherosclerotic plaques using special dilators – coronary stents. Thus, it is possible to reliably and fully restore normal blood circulation in the heart.
Stenting does not relieve atherosclerosis, but only temporarily (several years) eliminates its manifestations, symptoms and negative consequences of coronary artery disease.
Features of the coronary stenting technique:
- This operation is endovascular – all manipulations are performed exclusively within the lumen of blood vessels, without skin incisions and violation of their integrity in the affected areas.
- The lumen of the clogged artery is not restored by removing the atherosclerotic plaque, but with the help of a stent – a thin metal vascular prosthesis in the form of a mesh tube.
- The task of the stent inserted into the narrowed section of the artery is to press atherosclerotic plaques into the walls of the vessel and push them apart. This action allows you to expand the lumen, and the stent itself is so strong that it acts as a frame that stably holds it.
- During one operation, as many stents can be installed as needed depending on the number of narrowed sections (from one to three to four).
- Performing stenting requires the introduction of a patient radiopaque substances (drugs), which fill the coronary vessels. High-precision x-ray equipment is used to register their image, as well as to control the progress of contrast.
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- More about stents
- More about stents
- Types of stents, their features
- What tests should be done before stenting
- Conservative treatment in the rehabilitation period
- Postoperative period
- Strict diet
- Specificity of the procedure
- Possible complications
- Stenting Result and Forecast
- How much does coronary stenting cost in Russia and Ukraine
More about stents
A stent placed in the lumen of a narrowed coronary artery should become a reliable internal framework that will prevent the vessel from narrowing again. But such a requirement against him is not the only one.
Any implant introduced into the body is foreign to the tissues. Therefore, avoiding the rejection reaction is difficult to avoid. But modern coronary stents are so well thought out and designed that they hardly cause any additional changes.
The main characteristics of new generation stents are:
- They are made of a metal alloy of cobalt and chromium. The first provides good susceptibility to tissues, the second – strength.
- In appearance it resembles a tube with a length of about 1 cm, from 2,5 to 5-6 mm in diameter, the walls of which have the appearance of a grid.
- The mesh structure allows you to change the diameter of the stent from the minimum that is needed during the passage to the place of blockage, to the maximum that is needed to expand the narrowed area.
- It is covered with special substances that block blood coagulation. They are gradually released, preventing the reaction of the coagulation system and the formation of blood clots on the stent itself.
Click on the photo to enlarge
Old stent samples have significant drawbacks, the main of which is the lack of anticoagulant coating. This is one of the main reasons for stent failure due to clotting.
More about stents
Stenting is a minimally invasive surgical procedure in which a stent is placed inside the coronary artery. The need for this usually arises in the case when the lumen of the vessel narrows, or completely overlaps due to the proliferation of atherosclerotic plaques.
A stent is a metal lattice tube that is inserted by the endovascular method directly to the localization site of the plaque. The technique can be planned, or it can be part of emergency care for myocardial infarction. Sometimes used in combination with angioplasty. The procedure is often prescribed to patients suffering from bouts of angina pectoris or another type of arrhythmia.
In order for rehabilitation after coronary artery stenting to be easy, and the result of surgery to last for a long time, some measures need to be taken.
Types of stents, their features
|By novelty and material|
|By material and coating|
A stent is a cylindrical spring made of special metal or plastic. It is introduced into the affected vessel in a compressed form and straightened in the right place with the help of a cylinder into which pressure is supplied. The can is then removed, and the spring remains in place, holding the vascular wall.
The types of stents differ in design as well as in the material from which they are made.
The following designs are used in cardiac surgery:
- Made of thin wire, they are called wire wires;
- Consisting of individual links in the form of rings;
- Representing a continuous tube – tubular;
- Made in the form of a grid.
In acute conditions (during a heart attack or an attack of unstable angina), bare metal stents are more often used. They are used when the narrowing of the coronary arteries does not reach a critical level and the likelihood of further stenosis is small.
There are several types of such stents. They are metal structures with a polymer coating, on which is applied a layer of a drug that inhibits the growth of vessel tissue.
Gradually, this medicine enters the body, and the polymer dissolves. There remains a metal frame supporting the artery walls. Drug-compatible biocompatible stents are widely used in European and Russian clinics.
The atherosclerotic plaque previously destroyed by a special can should heal so that blood clots do not form on it. In the period from 3 to 6 months, the stent “works”, secreting a medicine that heals the endothelium of the vessel (inner membrane) and prevents it from growing pathologically.
A scaffold is made of the thinnest metal mesh (almost 20 times thinner than a human hair) with a bio-soluble polymer coating. After six months, the design is completely covered with endothelium, and the polymer coating containing the drug dissolves. As a result, a normal lumen is maintained in the artery, and its walls remain elastic.
The type of stent is selected by the surgeon. Specialists in the field of cardiology, as a rule, offer patients the best equipment available to them. When choosing a stent, a lot depends on the individual characteristics of the patient, for example, if he has increased blood coagulability, put a better coated type.
- Without cover. These are tubes made of metal alloys that look like mesh frames. In the right place of a modern stent, an extension of a suitable diameter can be made. The latest generation of medical equipment has a special coating with medicinal substances. Due to this, the risk of re-stenosis inside the delivered stent is significantly reduced. Substances deposited on the tubes prevent the formation of repeated narrowing of the vessel inside the stent, including if there is such a reaction of the artery to an established foreign object.
- Coated with a special polymer. Previously used stents with a monocomponent coating led to negative consequences: the healing process increased, inflammation appeared on the vascular stacks, and the risk of thrombosis increased. Patients with such tubes had to take thienoperidines for life. New stents with a multicomponent polymer coating have a high level of biocompatibility and ensures uniform release of the drug from the tube.
What tests should be done before stenting
Before the patient receives a referral for stenting, he must undergo a series of diagnostic tests. These studies will give the doctor an idea of the general state of health, and also help to identify hidden pathologies of the heart and blood vessels, which for some reason were not detected immediately.
Mandatory studies include:
- general and biochemical blood tests, including testing for hepatitis, HIV and syphilis;
- coagulogram (analysis gives an idea of the processes of coagulation and helps to identify their violations);
- Ultrasound examination of the upper or lower extremities with dopplerography (depending on which access will be selected);
- general urine analysis.
Based on the results, conclusions are drawn about the general state of the patient’s health, and possible complications of surgical intervention are predicted.
Conservative treatment in the rehabilitation period
It will not be possible to completely refuse to take medications after surgery, but their volume consumed will be much reduced. The doctor establishes the treatment regimen in the rehabilitation period, and the patient strictly observes all points, the speedy restoration of well-being will depend on this. It is mandatory to take blood-thinning drugs, for example, clopidogrel.
Stenting does not guarantee complete elimination of coronary heart disease. In the future, the occurrence of relapses is not excluded, therefore all patients who underwent this operation should be under the supervision of a cardiologist. This will help in time to identify the formation of atherosclerotic plaques in the arteries or the appearance of blood clots in the wall, and, accordingly, measures to eliminate them will be taken as soon as possible.
Before surgery, the patient is examined standardly, in accordance with the standards of preoperative preparation. If the presence of any concomitant disease is detected, the doctor may prescribe an additional examination.
The established time before the planned operation, the person should do without food, and, accordingly, the intake of previously prescribed drugs that correct diabetes mellitus is canceled.
Although its purpose is shown 72 hours before surgery, it is possible that a significant dosage can be taken right before stenting. This option is undesirable, as its consequences may be some gastric complications.
Stenting can be performed on an emergency or scheduled basis. In an emergency operation, coronary angiography (CAG) is first performed, the results of which immediately decide on the introduction of the stent into the vessels.
On the evening before the operation, a light dinner is allowed. It is likely that it will require the abolition of certain cardiac drugs, but only as directed by the attending physician. Breakfast before surgery is not permitted.
Before a planned operation, drugs are often administered to patients who stop high blood coagulation. Typically, drugs such as: Warfarin, Heparin, etc. are used to prevent thrombosis. After the introduction of blood thinners, cardiac surgeons act according to the following steps:
- Local anesthesia for catheter placement.
- Introducer installation – a tube for which a puncture is made in the femoral or inguinal artery after anesthesia.
- Introduction of iodide contrast agent into the vessels so that it is possible to control the process through x-ray equipment.
- Introduction to the affected vessel of the stent with a balloon to the blockade under the control of a computer scan.
- Balloon inflation, in which the stent opens and presses atherosclerotic plaques into the vascular wall.
- Repeated balloon inflating for normal stent fixation.
- Extraction of microsurgical equipment from a vessel.
- Suture the incision site.
Mostly qualified cardiac surgeons perform successful endovascular operations, after which the patient is in the hospital for only 3-5 days, after which the person is discharged. However, in order to consolidate the result and maintain vascular patency for many years, some recommendations should be observed:
Minimal physical activity.
Within 1 to 2 weeks after surgery, the patient is contraindicated in physical activity. A person can return to his usual life after 1,5 months. But at the same time, heavy physical labor should be excluded.
To restore the body faster, doctors prescribe exercise therapy procedures. Doctors do not recommend driving a car for the first 2 to 3 months.
With such lesions of the cardiovascular system, it is strictly forbidden to eat foods high in fat and carbohydrates. Salty and spicy foods should be discarded.
Only dietary meats, fruits, vegetables, fish and vegetable fats should be in the diet. It is necessary to monitor the amount of sugar and cholesterol in the blood.
Reception of medicines.
With this pathology, a constant intake of medications is indicated. Doctors prescribe beta-blockers for heart palpitations and bouts of pain (Egilok, Anaprilin, etc.). Atorvastatin or Atoris is prescribed to reduce the risk of atherosclerosis.
In addition, it is necessary to take anticoagulants: Clopidogrel, Fluvastatin, Warfarin, Plavix, Magnikor, etc. To normalize cholesterol, take statins.
Surveys. A couple of weeks after stenting, it is necessary to do an ECG, undergo a course of studies on lipid parameters and blood coagulation. A year later, coronarography is required.
After such surgical intervention as stenting, the patient should observe bed rest for some time. The attending physician monitors the appearance of possible complications, and at discharge gives recommendations on diet, medication, restrictions, etc.
Life after stenting involves following some recommendations. After installing the stent, cardiological rehabilitation of the patient begins. Its basis is diet, exercise therapy and a positive attitude.
Physical therapy should be practiced almost daily for at least 30 minutes.
The patient should get rid of excess weight, bring into shape muscle, normalize blood pressure. The latter significantly reduces the likelihood of developing myocardial infarction and hemorrhage.
Physical activity should not be reduced even after rehabilitation is completed.
Particular attention should be paid to nutrition – it is necessary to follow a certain diet, which will help not only normalize weight, but also affect the risk factors for the manifestation of coronary heart disease and atherosclerosis.
The diet after stenting the vessels of the heart or other vessels should be aimed at reducing the indicators of “bad” cholesterol – LDL (low density lipoproteins).
Nutrition after a heart attack and stenting should be subject to the following rules:
- Minimize fats – it is necessary to exclude products containing animal fats: fatty varieties of meat and fish, high-fat dairy products, caviar, shellfish. In addition, strong coffee, tea, cocoa, chocolate and spices should be discarded.
- The number of foods high in polyunsaturated fatty acids, on the contrary, needs to be increased.
- Include more vegetables, fruits, berries and cereals in the menu – they contain complex carbohydrates and fiber.
- Instead of using butter, use only vegetable oil for cooking.
- Limit salt intake to no more than 5 g per day.
- Divide the food into 5-6 receptions, and the latter should be done no later than three hours before bedtime.
- The daily calorie content of all consumed foods should not exceed 2300 kcal.
Angina pectoris and other manifestations of ischemia and atherosclerosis are no more, but the cause of atherosclerosis remains, as well as risk factors.
Even if the patient feels well, after the introduction of the stent, he should:
- Take medications prescribed by your doctor to prevent the risk of blood clots. Usually it is plavix and aspirin. This effectively prevents thrombosis and clogging of blood vessels, and as a result, reduces the risk of heart attack and increases life expectancy.
- Follow an anticholesterol diet and take drugs that lower blood cholesterol. Otherwise, the development of atherosclerosis will continue, which means that new plaques will appear that narrow the vessels.
- With elevated pressure, take medications to normalize it – ACE inhibitors and beta-blockers. This will help reduce the risk of developing myocardial infarction and stroke.
- If the patient suffers from diabetes mellitus, follow a strict diet and take medications to normalize blood sugar levels.
Therefore, stenting in itself is not an indication for the appointment of disability. But in the presence of concomitant conditions, the patient can be referred to ITU.
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.
Specificity of the procedure
Not all diseases can be cured conservatively, sometimes you have to resort to radical intervention. Fortunately, modern developments minimize the invasiveness of such an intervention. One of the methods is angioplasty of coronary arteries with stenting. Consider what is a stent and stenting, what is the peculiarity of this procedure.
A stent is a metal microtube with cells resembling a spring. This design is permanently installed in the narrowing of the artery, expanding it and restoring blood flow in the damaged area. Length – about 10 mm, diameter – from 2,7 to 7 mm.
The mesh structure makes it possible to change the lumen of the stent, which facilitates its passage to the site of blockage, and special coatings prevent thrombosis at the site of installation. The metal alloy provides structural strength and good susceptibility to its tissues, which prevents the prosthesis rejection reaction.
Stenting of the blood vessels of the heart allows for long-term retention of the walls of the blood vessels, thereby improving myocardial trophism in the lesion site and, as a result, eliminating the symptoms of coronary heart disease and reducing the risk of heart attack. The intervention is endovascular (intravascular access).
Complications are most likely to occur in patients with severe forms of coronary heart disease. Increased blood coagulation and diabetes mellitus require attention. You can reduce the risk of restenosis and speed up the recovery process by strictly observing the doctor’s instructions. As a rule, the expected benefits of vascular stenting exceed the possible risks, so most patients with symptoms of atherosclerosis undergo surgery. Possible complications of vascular stenting include:
- an allergic reaction to a contrast agent;
- thrombosis of a vessel that has been punctured;
- bleeding from a punctured vessel;
- heart attack during stenting;
- punctured artery restenosis;
- early angina after surgery.
The main indication for stenting is coronary heart disease. However, the procedure is not performed for all patients with this diagnosis. Manipulation is performed in the following cases:
- 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.
Despite the high safety of intravascular surgery, there are several important contraindications to this technique for restoring blood flow. As a rule, cardiologists exclude stenting with such factors:
- the impossibility of introducing a stent due to large-scale vascular damage, when after the diagnosis the exact location of the blockade was not determined;
- hemophilia and low blood coagulability; diameter of the affected artery is less than 2 mm;
- the patient is allergic to a contrast medium, in particular to an iodine preparation;
- respiratory failure; pathology of the kidneys and liver; acute infectious diseases;
- severe condition of the patient (low blood pressure, impaired consciousness, shock, etc.);
- advanced cancers.
It is important to understand that coronary stenting of the vessels of the heart has certain risks, therefore, indications should predict a benefit that far exceeds them. This usually happens in the following situations:
- early myocardial infarction or acute coronary syndrome;
- progressive angina pectoris. in which the patient very often calls an ambulance;
- stable angina pectoris in case of poor quality of life even when using adequate drug therapy;
- early post-infarction angina pectoris, when seizures develop in the treatment of myocardial infarction;
- high risk of death or cardiovascular disaster.
Of course, stenting is carried out only after confirmation of the technical feasibility of surgical intervention, using previously performed coronary angiography. Today, stenting is an alternative method of coronary artery bypass surgery.
It is also worth noting that spasm of the coronary arteries can occur during balloon angioplasty, and stenting avoids such a complication. In addition, about ten years after coronary artery bypass grafting is performed, half of patients develop shunt stenosis. However, its stenting is also an alternative to re-bypass surgery.
There are some contraindications that do not allow this operation:
- diffuse stenosis of the coronary bed;
- small diameter of the stenosed vessel (less than 3,0-2,8 mm).
Stenting surgery is prescribed for patients when the passage of arteries is narrowed due to existing atherosclerotic plaques. They significantly reduce blood flow, causing oxygen starvation and a deficiency of elements designed to nourish the heart. As a result, paroxysms of angina pectoris occur in a patient.
Indications for the procedure for any patient are determined only by the cardiac surgeon. A preliminary coronary angiography is carried out without fail, demonstrating the extent to which the vessels are affected, how many stents and where exactly should be installed. Stenting of the vessels of the heart in comparison with bypass surgery does not need to open the chest, suture and prolonged recovery after the procedure.
And yet, it is the attending physician who decides which of the operations is necessary in this case. The final choice is affected by the massiveness of the damage to the cardiac arteries and the patient’s condition. None of the operations can be a panacea. Subsequent conservative treatment by a cardiologist is required.
- acute cerebrovascular accident;
- terminal state, shock;
- internal hemorrhage;
- a sharp violation of blood coagulation with a threat to life (coagulopathy, hemophilia);
- uncontrolled arterial hypertension;
- hypersensitivity to radiopaque substances;
- infectious diseases in the acute period, fever.
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.
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.
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 did not affect the main trunk of the artery);
- patients with angina pectoris, whose professional activity is closely associated with serious physical exertion;
- having unstable angina or recently survived myocardial infarction:
- if in the institution where they were taken they can do such an operation;
- and if the patient’s condition allows it.
- You can not perform stenting if the patient has a common stenosis, which occupies most of the aorta. In this case, the stent is not enough to cover the entire vessel and restore its patency.
- Putting a stent in the heart is not recommended in old age. There is a risk of developing interventricular artery stent thrombosis in such patients.
- Coronary aortic stenting is prohibited with a significant narrowing of the lumen of several vessels.
- If vascular atherosclerosis has spread to the capillaries or small arteries, the stent is not installed due to significant differences in diameter.
- Refrain from stenting the vessels of the heart if the patient has any obstacles to the operation (even those performed by minimally invasive method).
Despite all the advantages of stenting of the coronary vessels of the heart, it is not worth performing for all patients with coronary artery disease, but only to those to whom it will bring the most positive result compared to other methods. The main indications for the operation are as follows:
- Chronic forms of coronary artery disease due to atherosclerotic plaques that block the lumen of the arteries by more than 50%.
- Frequent bouts of angina pectoris. especially if it provokes minor physical exertion.
- The threat of myocardial infarction and acute coronary syndrome are a pre-infarction condition.
- The first 6 hours of an extensive or small myocardial infarction with a relatively stable general condition of the patient.
- Repeated stenosis (lumen closure) of the coronary arteries after balloon angioplasty. stenting and coronary artery bypass grafting.
Of all the indications, the most interesting are acute coronary circulation disorders – acute coronary syndrome and heart attack. This is due to much better treatment results compared to drug therapy (70–80%), if the intervention is performed within 6 hours after the appearance of severe pain behind the sternum.
Necrosis of the heart muscle
In some cases, patients in need of coronary stenting, it can not be performed due to contraindications. These include:
- An unstable or severe general condition of the patient – impaired consciousness, a persistent drop in blood pressure, shock, severe insufficiency of the function of internal organs (liver, kidney, respiratory).
- Allergy to iodine preparations;
- Diseases and conditions accompanied by a pronounced decrease in blood coagulability (overdose of drugs, hemophilia, various coagulopathies).
- Widespread, extended (more than 1-2 cm) and multiple atherosclerotic constrictions located in one or more arteries of the heart.
- Damage to small-caliber arteries with a diameter of less than 3 mm.
- The presence of malignant tumors, recognized as incurable.
Most contraindications are relative, as either they are temporary if there is a possibility of their complete or partial elimination, or they may not be taken into account if the patient insists on surgery.
Stenting cannot be performed under any circumstances if the patient has allergic reactions to iodine and preparations based on it.
In case of impaired vascular patency as a result of atherosclerosis, there is a risk of developing coronary heart disease, cerebrovascular accident and other life-threatening conditions. Therefore, to restore patency of an artery or aorta, the following methods are used: stenting of the coronary arteries, heart valve replacement surgery.
Common complications include:
- impaired kidney function;
- allergy to radiopaque substance;
- thrombosis in the area of the stent;
- myocardial infarction;
- damage to the walls of the coronary arteries;
- heart rhythm disorder.
Group of local complications:
- hematoma at the puncture site;
- throbbing hematoma;
- puncture bleeding.
The likelihood of developing complications is increased by:
- elderly age;
- allergic reactions to drugs;
- recent myocardial infarction or pneumonia;
Unfortunately, stenting is not an operation in which all possible complications are excluded. Usually negative consequences are divided into two types.
- Intraoperative complications. They occur during surgery. These include myocardial infarction, cardiac arrhythmias, vascular dissection, angina attack, death.
- Early postoperative complications: stent thrombosis, cardiac arrhythmias, hematoma, false or true aneurysm.
- Late postoperative complications: restenosis.
Carrying out stenting of the heart with a balloon can cause a variety of undesirable consequences. The most popular complications include: allergic reactions, renal impairment, damage to the vascular walls, the formation of hemorrhages, plugs of operated vessels, the formation of a hematoma.
Given the circulation of blood, you should pay attention to possible complications in other vessels that are not affected during the operation. The highest percentage of formation of undesirable effects was found in patients with impaired blood coagulation, renal failure, advanced form of diabetes.
Surgery cannot guarantee absolute elimination of ischemia. The disease has every chance of resuming, new plaques may form in the blood vessels or the remaining old ones may increase. The possibility of restenosis or thrombosis of the stent itself is not excluded. As a result of this, all patients who underwent arterial stenting are under the constant supervision of a cardiologist. This measure allows you to identify relapse in time and visit the cardiac surgeon a second time.
Stent thrombosis is called the most dangerous complication. Its formation can occur at any time, regardless of the time of the operation. With complication, an acute attack of pain develops. Lack of treatment leads to a heart attack.
A little less danger, but more frequent, is stent restenosis. The natural process of stent ingrowth can take place so dynamically that the operated passage becomes very narrow and angina pectoris resumes.
If there is a violation of drug therapy indicated by the cardiologist of the regimen and diet, the development of plaques will continue. This inevitably leads to the formation of new lesions in previously healthy blood vessels.
Despite the small volume of surgical intervention, there is a likelihood of developing certain complications during the operation:
- Blood loss
- Allergy to radiopaque substance;
- Rupture of aneurysm of the heart;
- Rupture of the coronary artery;
- The formation of a blood clot.
More prone to complications – patients with severe concomitant kidney disease, decompensated diabetes mellitus, and bleeding disorders. If the operation is performed as planned, then in the preoperative period it is recommended to carry out drug correction until the condition stabilizes. After surgery, such patients require special care and control in the intensive care unit.
At the late stage of the postoperative period, restenosis can create special problems. To prevent this condition, it is necessary to register with a cardiologist and periodically undergo an examination, do an echocardiography, stress tests, Holter monitoring and other tests to evaluate the work of the heart.
If repeated attacks of chest pain occur, it is recommended that you consult an interventionist doctor to assess patency of stented arteries. A degree of restenosis is observed in all patients who have undergone stenting, but for some this process is so lightning-fast that repeated narrowing of the artery occurs the very next day after surgery.
Another major problem is thrombosis. This process is very difficult to predict and control. The formation of a blood clot can occur both on the operating table and in the postoperative period. To normalize the blood coagulation process and prevent thrombosis, drugs from the group of antiplatelet agents and anticoagulants are used. It is very important to choose the right dosage during the procedure, because if it is exceeded, there is a high probability of bleeding.
The stenting operation today is considered routine and fully technically proven. Therefore, complications after it is a rarity.
However, they are and are as follows:
- During surgery, this may be an allergy to the drugs used, bleeding (not more than 1,5% of cases), the occurrence of arrhythmias, the development of angina pectoris and myocardial infarction;
- Postoperative – this is a hematoma at the entrance to the femoral or radial artery (common), aneurysm, arrhythmia, thrombosis;
- Distant – thrombosis, repeated narrowing of the artery.
Like any other surgical intervention, stenting can be accompanied by a number of complications, here are the main ones:
- Impaired renal function due to an allergy to a contrast medium;
- Other allergic reactions of varying severity;
- Obstruction of the operated artery;
- Large hematoma at the puncture site;
- Bleeding due to damage to the artery wall.
Since the blood in the human body is in constant motion, complications after stenting can appear on other arteries. First of all, diabetics, people with severe kidney diseases and blood clotting problems are at risk.
Serious consequences or complications after stenting are extremely rare. In rare cases, the patient may open up bleeding, impaired renal function or form a hematoma in the puncture area. If arterial blockage is observed after manipulation, urgent coronary artery bypass grafting is recommended.
In order for the rehabilitation period to go without complications, it is necessary to strictly follow the doctor’s instructions. Immediately after the operation, you must be in bed and limit physical activity for the first week. It is forbidden to visit the sauna, bathhouse or take a bath, to lift heavy objects, as well as to drive a car.
The basis of rehabilitation after stenting of the vessels of the heart should be physical therapy and proper nutrition. A set of exercises is compiled for each patient separately, taking into account his disease. You need to do exercises every day for at least 30 minutes. Exercise therapy will help to avoid obesity, restore pressure and strengthen muscles.
It is advisable to eat fractionally in small portions 5 times a day, and the calorie content of the food should not be higher than 2300 kcal
A proper diet will help reduce the risk factors for atherosclerosis and ischemia. In a minimal amount, it is allowed to eat foods that contain animal fats and salt. It is necessary to completely exclude coffee, black tea, spices, seasonings, spices and cocoa from the menu. The diet should include vegetable oil, cereals, vegetables, fruits and berries, nuts.
Within a year from the moment of the operation, the patient is prescribed medications against blood clots and repeated blockage of blood vessels (aorta, arteries).
At high pressure, drugs are also prescribed that help prevent myocardial infarction and stroke. Be sure to abandon all bad habits and stop smoking.
Tip: following all the doctor’s recommendations after stenting will help to avoid repeated blockage of blood vessels and significantly reduce the risk of myocardial infarction, stroke and thrombosis.
an allergic reaction to the injected contrast agent;
- bleeding at the site of skin puncture;
- infectious infection;
- restenosis (repeated blockage of the artery).
A competent approach by the team of doctors and round-the-clock observation of the patient after surgery will help to avoid these complications.
Stenting Result and Forecast
Stenting of the blood vessels of the heart – the operation is relatively safe, bringing good results. And while the risk of complications is minimal. Even after the operation, the patient not only returns to normal life, but his working capacity is restored. It is important to understand that the wrong lifestyle that provoked ischemia will again cause blockage of the arteries if it is not changed.
The operation, of course, has a short postoperative recovery period. The most famous scientific center dealing with cardiovascular surgery, A.N.Bakuleva, performs stenting of the heart vessels and conducts consultations, as well as a complete diagnosis. As for the further prognosis, the operation is stenting effective in about 80% of cases.
Sometimes the process is the opposite, that is, despite the efforts made, the artery narrows again. But scientists continue to conduct research and improve the technology of the operation. At the same time, statistics of positive results increase. Currently, specialists use completely new stents that minimize the risk of reverse narrowing of the coronary arteries.
According to statistics, with the use of new stents, the risk of reverse narrowing of the arteries is now only 55 of the total. But it is very important to understand one simple thing – even the most modern technology of the operation will never be able to replace the importance of prevention and the right healthy lifestyle for any patient.
The prognosis for life and work is favorable in fulfilling all the appointments of a doctor and maintaining a healthy lifestyle. It is difficult to give an exact answer to the question how many patients live with a stent, since each patient is individual and has his own history of life and illness.
According to patients and doctors, life expectancy is increasing, and its quality is improving. Patients also become more positive about all aspects of life.
Modern innovative technologies, such as stenting, can significantly improve the quality of life and its duration. The method has a large list of advantages, is easy to use and accessible to everyone.
Stenting restores the blood circulation of the heart, eliminating painful symptoms and the threat of heart attack, but not from the root cause of their appearance – coronary disease and atherosclerosis. No specialist can predict the life expectancy of a patient after surgery. But the prognosis of 90–95% is good – on average, the stent provides patency of the coronary artery for more than 5 years (maximum periods – 10–15 years, minimum – several days).
In 50-60%, stenting results in the disappearance of symptoms or residual manifestations of coronary heart disease. The remaining 40-50% have a different degree of improvement in well-being. The longer the service life of the stent, the higher the coagulability of the blood and the stronger the atherosclerotic process, the higher the likelihood of clogging.
Remember, life is short but beautiful, and coronary stenting is a gentle operation that returns sick people the opportunity to live longer and maximize!
The second extremely important component of therapy is dieting. “Food is the cure.” These words are attributed to Hippocrates, and even now we can still confirm their accuracy.
Special nutrition after stenting is not just the prevention of heart problems that may or may not arise in the future. This is a cure.
Sadly, not all patients adhere to the recommended diet. And it can be argued without a doubt that this plays a large role in the high frequency of relapse of angina pectoris and repeated stenting.
Diet therapy after stenting of the coronary vessels should be based on the following principles.
Restriction in the diet of animal fats.
This means a decrease in the consumption of products such as fatty meats (lamb, pork), lard, processed foods, margarine.
Do not eat large quantities of butter, cheeses, sour cream, cream. It is also worth limiting egg consumption to 3-4 pieces per week. All fatty foods are future cholesterol plaques that will resume symptoms of coronary heart disease after stenting.
Limitation of refined carbohydrates, sweets.
From the products that are often on your table, you will have to cross out sweets (it is better to replace them with dried fruits), excess sugar, pastries, carbonated drinks, etc. In the body, carbohydrates turn into fats, which is why it is worth abandoning sweets to the maximum.
It causes fluid retention and high blood pressure. Many stented patients with coronary artery disease have hypertension. They should be especially careful about this recommendation. The amount of salt should be reduced to 3-4 g per day (half a teaspoon).
Be careful: many prepared foods (canned food, bread, etc.) contain salt, so its consumption should be limited more or less depending on what foods are present in your diet.
Limiting the consumption of coffee and other drinks and products containing caffeine (strong tea, chocolate, cocoa).
Caffeine causes vasospasm and increased heart function, which creates an increased burden on the cardiovascular system and harms patients with coronary artery disease and stenting.
However, it is worth understanding: the diet does not require a complete rejection of coffee, with controlled blood pressure and the absence of pronounced symptoms, it can be consumed in small quantities. It is better to choose natural arabica – it has less caffeine than in robusta and, moreover, than in instant coffee.
Adding vegetable oils, fresh vegetables and fruits, fish to the diet (use at least 2 times a week).
All this prevents the development of atherosclerosis. Dietary fiber of plant foods binds and removes cholesterol from the intestines, omega-polyunsaturated fatty acids of fish and vegetable oils reduce the content of harmful lipids in the blood (low density lipoproteins, triglycerides) and increase the content of beneficial ones (high density lipoproteins).
Life after stenting of the vessels of the heart must change. Now the patient should eat right and lead a healthy active lifestyle. Of course, it is impossible to do it right away, but you can set a goal and gradually move towards it. Otherwise, the effectiveness of the operation will be practically reduced to zero.
The most important thing is the patient’s correct mood and gymnastics, as well as diet. It should be noted that the operation returns to a person full working capacity, therefore its benefits are obvious. So, a person who has undergone stenting should regularly perform exercises of physiotherapy exercises.
- Health gymnastics should be performed every day, allocating at least half an hour to complete a set of exercises. This helps to normalize weight, strengthen muscle tissue, and normalize blood pressure.
- It is important to remember that physical therapy should be performed not only during the rehabilitation period, but also after it. It is necessary that in your life there are less bad habits and as much movement, proper nutrition and activity as possible.
Diet after illness is one of the most important factors leading to recovery, as well as full recovery of the body. The diet is aimed at ensuring that the patient’s weight is completely normalized, as well as minimizing the negative factors that contribute to the reappearance of coronary heart disease. Proper nutrition also helps to reduce the level of cholesterol so dangerous for ischemia. Nutrition after illness should take into account the following:
- All foods should contain a minimum of fat. Food products containing animal fats should be excluded from the patient’s diet once and for all after stenting surgery.
- In addition to fatty meat, fish and other foods, beverages such as coffee or strong tea should also be excluded.
- It is necessary to include as many vegetables, fruits, berries as possible in the food products of the new diet.
- The menu should contain a large number of products with polyunsaturated acids.
- It is advisable to completely exclude butter from the diet. Replace it better with vegetable.
- Salt must also be strictly limited.
- Eat better in small portions, 6 times a day. Do not eat at night. The break between the last meal and sleep should be at least three hours.
- Count calories. You can not consume more than 2300 calories per day.
Proper nutrition is one of the important components of rehabilitation after myocardial infarction and stenting of the coronary arteries. The patient should adhere to the following recommendations and principles when drawing up a diet menu:
- From the diet you will have to completely exclude sweet, flour, carbonated drinks and other products that contain refined carbohydrates. Such compounds during digestion turn into fats, which settle on the walls of blood vessels, forming the so-called cholesterol plaques. Instead of these products, it is better to eat dried fruits.
- Restriction in the use of animal fats. Such compounds are primarily found in fat, pork, lamb, margarine, and processed foods. You should also once again abandon the excessive intake of butter, sour cream, cheese, cream, eggs.
- People with heart and vessel problems are advised to consume fresh fruits and vegetables rich in trace elements and vitamins, as well as vegetable oils. Fiber contained in plant foods helps to remove cholesterol from the intestines and prevents the development of atherosclerosis (arterial pathology, which is chronic in nature and associated with impaired lipid-protein metabolism).
- You should eat fish at least twice a week. It contains omega-polyunsaturated fatty acids, which increase the content of high density lipoproteins.
- Proper nutrition, not only with ailments of the heart and arteries, but also any other diseases of the digestive tract implies the rejection of excess salt intake. It promotes fluid retention in the body and increases blood pressure.
- You should completely refuse to accept products containing caffeine. This is coffee, strong tea, cocoa and chocolate. This substance can cause vasospasm, which will lead to malfunctions of the entire circulatory system in people with coronary artery disease and stenting of the coronary arteries.
In order for the heart to work normally, the following foods should be excluded from the diet:
- fatty meats;
- semi-finished products;
- fatty dairy products.
A restriction should be introduced on the number of eggs, cheese and coffee consumed. When choosing dairy products, preference should be given to products with reduced fat content. Only natural, slightly brewed coffee is acceptable. You can only drink such a drink occasionally.
It is important to monitor the amount of salt consumed. You should not completely abandon the product, since this element is necessary for the body every day for full work. It is advisable that the daily amount does not exceed half a teaspoon. At the same time, one must not forget that salt is contained in some quantities in purchased goods.
Nevertheless, the diet after stenting of the coronary vessels should include foods rich in valuable vitamins and minerals. The diet should contain:
- fresh fruits and vegetables;
- lean meat.
Compliance with the diet will keep the vessels clean and the risk of secondary fouling of the stent with cholesterol is minimized.
How much does coronary stenting cost in Russia and Ukraine
The cost of a planned operation consists of many components and is calculated individually depending on the cost of the operation. The price of stenting for Ukraine and the Russian Federation is approximately comparable. In Russia, a stent can be delivered for 100 – 150 thousand rubles, in Ukraine the operation will cost 30 – 40 thousand hryvnias.
Marina Sergeevna, 58 years old, Kemerovo
Mikhail Mikhailovich, 60 years old, Voronezh
Alena, 32 years old: Recently, a stenting of the heart vessels was done to his father, 4 tubes were delivered. Until now, he is in intensive care, because after the operation, kidney failure was detected (due to low pressure, the kidneys can not cope with the fluid). The doctor said this could be a complication after stenting. My father also had shortness of breath, but doctors promise that this will pass soon.
Vasily, 48 years: A year ago, I had a stenting, the tubes were installed with a drug coating. The operation was done in a private clinic, so it cost me dearly. On rehabilitation, he drank 3 drugs for 12 months. There were no side effects and complications. I recovered after stenting of the vessels almost completely, I go in for sports, but I do not overload.
Lyudmila, 51 years: 3 years ago, I had a stenting of the vessels, putting 3 tubes. After she passed the prescribed course of drugs (Plavix, Thrombo ACC, Tulip, etc.). I felt great all the time, but a couple of months ago the pain returned. I plan to visit the doctor again, because, as I was told, there is an increased risk of blood clots and it’s worth checking.
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