How can I remove the installed coronary stent. Cardiac stenting surgery, why it is different for everyone, and what are the key differences during the operation

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What is stenting?

A stent is a small, tubular metal mesh used to treat narrow, weak arteries.

It is installed in the artery as part of the procedure - angioplasty. This method restores blood flow through narrow or blocked blood vessels. The stent helps support the inner wall of the vessel for months or years after treatment.

Stents are also placed in weak arteries to improve blood supply and prevent rupture.

These structures, as a rule, are made of a metal mesh, sometimes on a fabric basis. Tissue stents are used in large arteries.

Some stents are coated with a drug that is gradually introduced into a blood vessel on a permanent basis. These are drug-eluting stents. The medication helps prevent restenosis (re-narrowing).

Indications for vascular stenting in Assuta

Treatment of coronary arteries

Doctors use stents to treat coronary heart disease (CHD). This is a disease in which waxy atherosclerotic plaques form inside the coronary arteries. They supply blood to the heart muscle, saturating it with oxygen.

A condition in which plaque forms in the blood vessels is called atherosclerosis.

The plaque narrows the artery, reducing the flow of oxygenated blood to the heart. This results in chest pain or an uncomfortable condition known as angina.

Atherosclerotic plaques increase the likelihood of blood clots in the coronary artery. If blood clots block it, a heart attack occurs.

Doctors use coronary angioplasty and stenting to treat CAD. During the procedure, a balloon catheter is inserted into a blood vessel and led to a blocked coronary artery. Having reached the desired zone, the balloon is inflated, compressing the plaque. This restores blood flow, reducing angina and other symptoms of CAD.

After that, a stent is placed inside the artery. It supports the walls of the vessel, reduces the likelihood of restenosis or blockage. In addition, a stent is used if an artery is torn or damaged during percutaneous coronary intervention.

Even with the use of stents, according to statistics, in 10-20% of cases, re-narrowing or blocking occurs in the first year after coronary stenting. If this technology is not used, the likelihood of complications increases 10 times. The benefits of coronary artery stenting far outweigh the surgical risks, but patients are more likely to develop type 2 diabetes and kidney failure.

Treatment of carotid arteries

Doctors use for the treatment of diseases of the carotid artery. Atherosclerotic plaques form in the blood vessels that run along each side of the neck. They carry oxygenated blood to the brain.

Plaque formation limits the blood supply to the brain and poses a risk of stroke. Doctors place stents after angioplasty. Researchers continue to study the risks and benefits of carotid stenting.

Treatment of other blood vessels

Atherosclerotic plaques can also narrow other blood vessels, such as those in the kidneys or extremities. This will affect the functioning of the kidneys and may cause high blood pressure. When blood vessels narrow in the extremities, peripheral arterial disease develops, causing pain and spasms in the affected arm or leg. The blockage will completely cut off blood flow, requiring surgery.

To eliminate these problems, doctors turn to angioplasty and stenting. The stent supports the vessels by keeping them open.

Treatment of the aorta

The aorta is the main artery that carries oxygenated blood from the left side of the heart to the body. It passes through the chest, descending into the abdominal cavity.

Over time, parts of the wall of the aorta can weaken, leading to bulges, or aneurysms, usually in the abdomen. An aneurysm can suddenly burst, causing severe internal bleeding.

To avoid rupture, doctors place a stent, which creates a support base for the artery.

Aneurysms can also occur in the part of the artery that passes through the chest cavity. Stents are also used to treat them.

Closure of a torn aorta

Another problem that can occur in the aorta is a tear in its inner wall. If the blood flow increases, the hole will expand. This will reduce blood flow to the tissues. Over time, the artery will rupture, blocking the blood supply. It usually occurs in part of the thoracic aorta.

Researchers will develop and test new types of stents that prevent blood from flowing through aortic ruptures. The stent is placed in the damaged area, helping to restore normal blood flow and reduce the risk of rupture of the artery.

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How is vascular stenting performed at the Assuta clinic?

Doctors place stents during an angioplasty procedure. Through a small opening in a blood vessel in the groin (upper thigh), less often in the arm or leg, the doctor inserts a balloon catheter and advances it to the site of the narrowing.

It uses a contrast agent to visualize narrow or blocked areas in an artery. Reaching the desired zone, the doctor inflates the balloon, displacing the atherosclerotic plaque. This expands the artery and helps restore blood flow. The stent is then placed. The balloon is deflated and removed along with the catheter. The stent remains inside the artery. Over time, the cells in the artery grow, covering the mesh of the stent. They create an inner layer that looks like a regular blood vessel.

If the vessel is very narrow or difficult to reach with a catheter, a large number of steps may be required to place the stent. First, the doctor uses a small balloon to expand the artery, then removes it. After that, he takes a larger balloon, inside of which the stent is placed. This is the standard step - plaque compression and stent placement.

Doctors use a special device called a filter when they place a stent in the carotid artery. It prevents the movement of blood clots and pieces of plaque into the brain during the procedure.

Aortic aneurysms

The procedure for placing a stent in an artery with an aneurysm is similar to that described above. However, the stent used to treat it is different. It is made from fabric instead of metal mesh and often has one or more tiny hooks.

The stent expands until it fits snugly against the artery wall. Hooks cling to the walls, holding the structure in place. The stent creates a new lining for this area of ​​the vessel. Over time, the cells in the artery proliferate, covering the tissue. An inner layer is formed that looks like a normal blood vessel.

Preparation for the stenting procedure

Most stenting procedures require hospitalization. The doctor will advise on the following issues:

• When to stop eating and drinking.
• What medications should be taken on the day of the procedure.
• When is it necessary to come to the clinic, etc.

When making a decision, the doctor will definitely take into account the presence of diseases such as diabetes, kidney disease, in order to prevent the development of complications.

Before the procedure, the doctor will tell you about the drugs that will need to be taken after. They prevent the formation of blood clots associated with the presence of a stent.

During vascular stenting at the Assuta clinic

The procedure usually takes about an hour. But it may take longer if stents are placed in multiple arteries. Before starting, the patient will be given a medication to help calm them down. He will be conscious while lying on his back.

Local anesthesia is applied to the area where the catheter will be inserted. The patient will not feel the catheter moving through the artery. You may feel some pain when the balloon is inflated to place the stent.

Stenting for aortic aneurysms

Although this procedure only takes a few hours, hospitalization of 2 to 3 days is often required.

Before stenting, the patient is prescribed a sedative. If it is planned to install a stent in the aorta in the abdominal cavity, local anesthesia in the abdomen is used. The patient is conscious.

When a stent is planned to be placed in the aorta in the chest cavity, general anesthesia is used.

After local or general anesthesia, the doctor will make a small incision in the groin and insert a catheter into a blood vessel to lead through it to the affected area.

Sometimes two incisions are made (in the groin area on each leg) if a stent is to be placed in two areas. The patient will not feel the progress of the catheter, balloon and stent inside the artery.

Rehabilitation after vascular stenting

After any procedure for placing a stent, the doctor removes the catheter from the artery, the site of its introduction is bandaged.

A light weight is placed on top of the bandage to apply pressure and prevent bleeding. The patient will be in the intensive care unit for a limited time, then in the ward, his movement will be limited.

The nurse regularly checks the heart rate and blood pressure, and also monitors for bleeding from the site of the catheter. A small hematoma or hard "knot" is possible here, some soreness can be observed within a week.

It is important to see a doctor under the following conditions:

• Constantly flowing blood from the site of the catheter, or in large quantities, does not stop when using a bandage.
• There is unusual pain, swelling, redness, or other signs of infection in the area.

General Precautions

Treatment after stenting

Most likely, the doctor will prescribe aspirin and other antiplatelet drugs that have a suppressive effect on blood clotting. They prevent the formation of blood clots due to the presence of a stent inside the artery. A clot can cause a heart attack, stroke, or other serious problems.

If a metal stent is used, aspirin and other anti-clotting drugs are taken for at least one month. If the stent is drug-eluting, the duration of treatment may be 12 months or more. The attending physician will accurately determine the optimal course of therapy.

The risk of blood clots increases significantly if anticoagulant drugs are stopped early. It is important to follow the doctor's instructions exactly. You may have to take aspirin for the rest of your life.

If you plan to have surgery for any other reason, be sure to tell your doctor that you are taking these medications, as they increase the risk of bleeding. In addition, they can cause side effects such as allergic rashes.

Other Precautions

Strenuous exercise and heavy lifting should be avoided for a short time after stenting. The doctor will specify when the patient can return to normal activities.

Airport metal detectors and other similar devices do not affect these structures inside the body.

If a stent was placed in the aortic tissue, the doctor will order a series of x-rays during the first year, then the test will need to be done annually.

Lifestyle after stenting

Stents help prevent arteries from narrowing and blocking months or years later. However, they are not a cure for atherosclerosis or its risk factors.

Lifestyle changes will help prevent the formation of sclerotic plaques in the arteries. The doctor will advise in detail on these issues.

Lifestyle changes can include dietary changes, smoking cessation, regular physical activity, weight loss, stress reduction. It is also important to take all the medicines prescribed by the doctor. Your doctor may recommend taking statins, drugs to lower blood cholesterol levels.

Possible complications after vascular stenting

Risks associated with stents

About 1-2% of people with a stented artery develop a blood clot at the site of the stent. Blood clots can cause a heart attack, stroke, or other serious problems. The greatest risk of thrombosis occurs in the first few months after the installation of the structure.

The length of time these drugs are taken depends on the type of stent. Aspirin treatment can be lifelong.

Drug-eluting stents may increase the risk of thrombosis. However, studies have not proven that these stents increase the chance of a heart attack or death if used as directed by a physician.

Potential Consequences of Cardiac Stenting

Angioplasty and stenting carry a small risk of serious complications such as:

• Bleeding from the site where the catheter was inserted.
• Damage to an artery by a catheter.
• Arrhythmia (irregular heartbeat).
• Kidney damage caused by the contrast agent used during stenting.
• Allergic reaction to contrast.
• development of infection.

Another problem that can occur after angioplasty and stenting is significant tissue growth in the affected area. This leads to narrowing or blockage of the artery. This condition is called restenosis.

The use of drug-eluting stents helps prevent this problem. The drug used stops the growth of excess tissue.

The use of radiation in this area contributes to the delay in tissue growth. To do this, the doctor inserts a wire through the catheter to the structure. It emits radiation, stopping the growth of cells around the stent, preventing blockage.

Possible complications after abdominal aortic stenting

Although rare, some serious problems arise when a stent is used for abdominal aortic aneurysms. These include:

• Aneurysm rupture.
• Blockage of the blood supply to the stomach and lower body.
• Paralysis of the legs due to interruption of blood flow to the spinal cord (extremely rare).

Another possible problem is moving the stent further down the aorta. Sometimes this happens several years after stenting. This will require the placement of a new stent in the area of ​​the aneurysm.

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stent in the coronary artery of the heart

A patient with myocardial ischemia is forced to constantly take certain drugs that prevent the formation of blood clots, high blood pressure and high blood cholesterol. However, despite medical treatment, patients with significant stenosis often develop acute myocardial infarctions. An excellent method of treating coronary disease and preventing a heart attack is the placement of a stent in the lumen of the coronary artery.

The stent is a thin metal frame in the form of a flexible mesh, which is inserted into the lumen of the artery in a compressed state, and then straightens out like a spring. Due to this, atherosclerotic plaques are “pressed” into the wall of the artery and the vessel wall expanded in this way is no longer stenotic.

Types of stents

modern stents

Currently, stents made of an alloy of cobalt and chromium are used in vascular surgery in the form of wire, mesh, tubular and ring structures. The main qualities of stents should be radiopacity and good survival in the wall of the lumen. Recently, many stents are coated with drugs that prevent the growth of the inner wall of the vessel (intima), and thus reduce the risk of re-stenosis (restenosis). In addition, such a coating eliminates the settling of blood clots on a foreign body in the lumen of the vessel, which is the stent. Thus, drug coating reduces the risk of recurrent myocardial infarction.

Directly the design of the stent for a particular patient is chosen by the attending cardiac surgeon. To date, there is no fundamental difference between the shape of stents, since all of them are designed in accordance with the anatomical differences in different patients and fully perform their function.

How is stenting different from shunting?

Both operations are currently methods of radical treatment of coronary artery stenosis. But they differ significantly from each other. The operation of stenting the vessels of the heart is the introduction into the human body of a kind of conductor that helps the stenotic artery to function normally. The stent is a foreign body.

When - as a vessel that allows blood flow to the heart, the patient's own artery or vein is used. That is, a bypass path is created that overcomes the obstacle in the form of a stenosis site, and the affected coronary artery is turned off from the bloodstream.

Despite the differences in the technique of the operation, the indications for them are almost the same.

Indications for stenting surgery

Surgery for coronary artery stenting is indicated for patients with the following forms of coronary heart disease:

• Progressive angina pectoris - an increase in the duration and intensity of attacks of retrosternal pain that is not stopped by taking nitroglycerin under the tongue,
• Acute coronary syndrome (pre-infarction condition), threatening the development of acute myocardial infarction in the near future without treatment,
• acute myocardial infarction,
• Early post-infarction angina - attacks of heart pain that occur in the first weeks after an acute heart attack,
• Stable angina 3-4 FC, when frequent, prolonged pain attacks significantly reduce the quality of life of the patient,
• Re-stenosis or thrombosis of a previously placed stent or bypass (after coronary artery bypass grafting).

stenosing atherosclerosis of the coronary arteries is the main prerequisite for the operation

A drug-coated stent is preferred in the following categories of patients:

1. Persons with diabetes mellitus, impaired kidney function (patients receiving hemodialysis),
2. Individuals at high risk of developing restenosis
3. Patients undergoing bare stent surgery who develop recurrent stenosis
4. Patients with recurrent graft stenosis after CABG.

Contraindications for surgery

A stent for emergency indications, for example, in acute myocardial infarction, can be installed even in a patient in serious condition, if it is due to cardiac pathology. Nonetheless, surgery may be contraindicated in the following cases:

• acute stroke,
• Acute infectious diseases
• End-stage hepatic and renal failure,
• Internal bleeding (gastrointestinal, pulmonary),
• Violation of the blood coagulation system with a high risk of life-threatening bleeding.

The operation of coronary artery stenting seems inappropriate when the atherosclerotic lesion has a large extent, and the process diffusely covers the arteries. In this case, it is better to resort to bypass surgery.

Preparation and conduct of the operation

Stenting can be done on an emergency or elective basis. In an emergency operation, coronary angiography (CAG) is first performed, based on the results of which a decision is immediately made on the introduction of a stent into the vessels. Preoperative preparation in this case is reduced to the introduction into the patient's body of antiplatelet agents and anticoagulants - drugs that prevent increased blood clotting (to avoid thrombosis). As a rule, heparin and / or clopidogrel (warfarin, xarelto, etc.) are used.

Before a planned operation, the patient must perform the necessary research methods to clarify the degree of vascular damage, as well as assess the contractile activity of the myocardium, the ischemic zone, etc. For this, the patient is prescribed CAG, ultrasound of the heart (echocardioscopy), standard and stress ECG, transesophageal electrical stimulation myocardium (TEFI - transesophageal electrophysiological study). After performing all the diagnostic methods, the patient is hospitalized in the clinic where the operation will be performed.

A light dinner is allowed the night before the operation. It is likely that the abolition of certain cardiac drugs will be required, but only as prescribed by the attending physician. Breakfast before the operation is not allowed.

Stenting is performed directly under local anesthesia. General anesthesia, dissection of the chest and sternum, as well as connection of the heart to a heart-lung machine (AIC) is not required. At the beginning of the operation, local anesthesia of the skin is performed in the projection of the femoral artery, which is accessed through a small incision. An introducer is inserted into the artery - a conductor, through which a catheter with a stent installed at the end is brought to the affected coronary artery. Under the control of X-ray equipment, the exact location of the stent at the site of stenosis is controlled.

Next, the balloon, which is always in a compressed state inside the stent, is inflated with the help of air injection, and the stent, being a springy structure, expands, fixing tightly in the lumen of the artery.

After that, the catheter with the balloon is removed, a tight aseptic bandage is applied to the skin incision, and the patient is transferred to the intensive care unit for further observation. The whole procedure lasts about three hours, and is painless.

After stenting, the patient is observed for the first day in the intensive care unit, then transferred to a regular ward, where he stays for about 5-7 days before discharge from the hospital.

Video: stenting, medical animation

Possible Complications

Due to the fact that stenting of the coronary arteries is an invasive method of treating ischemia, that is, it is introduced into the tissues of the body, the development of postoperative complications is quite possible. But thanks to modern materials and intervention techniques, the risk of complications is minimized.

So, intraoperative (during surgery) complications are the occurrence of life-threatening arrhythmias (ventricular fibrillation, ventricular tachycardia), coronary artery incision (dissection), extensive myocardial infarction.

Early postoperative complications are acute thrombosis (settlement of blood clots at the site of stent placement), aneurysms of the vascular wall with the possibility of its rupture, and cardiac arrhythmias.

A late complication after surgery is restenosis, the growth of the inner lining of the vessel on the surface of the stent from the inside with the appearance of new atherosclerotic plaques and blood clots.

Prevention of complications consists in careful X-ray control of stent placement, in the use of materials of the highest quality, as well as in taking the necessary drugs after surgery. for the treatment of atherosclerosis and reduction of blood clots. The correct mood of the patient also plays a significant role here, because in any field of surgery it is known that in positively minded patients the postoperative period proceeds more favorably than in persons prone to anxiety and anxiety. Moreover, complications develop in less than 10% of cases.

Lifestyle after surgery

As a rule, in 90% of cases, patients note the absence of angina attacks. However, this does not mean that you can forget about your health and continue to live as if nothing had happened. Now You must take care of your lifestyle and, if necessary, correct it.. To do this, it is enough to follow simple rules:

1. Stop smoking and drinking strong alcoholic beverages.
2. Follow the principles of a healthy diet. No need to exhaust yourself with constant starvation diets in the hope of normalizing high blood cholesterol levels (as the basis for the development of atherosclerosis). On the contrary, you should get proteins, fats and carbohydrates from food, but their intake should be balanced, and fats should be “healthy”. Fatty meats, fish and poultry should be replaced with lean ones, and fried foods and fast food should be completely excluded from the diet. Get more greens, fresh vegetables and fruits, dairy products. Also useful are cereals and vegetable oils - olive, linseed, sunflower, corn.
3. Take drugs prescribed by a doctor - lipid-lowering (if cholesterol levels are high), antihypertensive drugs, antiplatelet agents and anticoagulants (under monthly monitoring of blood clotting). Particular attention should be paid to the appointment of the last group of drugs. So, in the case of a simple stent, the “double prevention” of its thrombosis consists in taking Plavix and aspirin in the first month after surgery, and in the case of a drug-coated stent, in the first 12 months. Premature discontinuation of medication according to the scheme prescribed by the doctor is unacceptable.
4. Avoid significant physical activity and sports. Sufficiently adequate to the patient's condition loads in the form of walking, light running or swimming.
5. After the operation, visit a cardiologist at the place of residence according to his appointments.
6. Stenting is not a disabling operation, and if the patient remains able to work, he can continue to work.

Prognosis, life expectancy after surgery

The prognosis after stenting surgery is undoubtedly favorable, as blood flow in the affected artery is restored, attacks of chest pain disappear, and the risk of developing myocardial infarction and sudden cardiac death decreases.

Life expectancy also increases - more than 90% of patients live quietly in the first five years after surgery. This is also evidenced by the reviews of patients whose quality of life is significantly improved. According to the patients and their relatives, angina attacks almost completely disappear, the problem of constant use of nitroglycerin is eliminated, the psychological state of the patient improves - the fear of death during a painful attack disappears. The relatives of the patient, of course, also become calmer, because the coronary vessels become passable, which means that the risk of a fatal heart attack is minimal.

Where is stenting performed?

Currently, the operation is widespread and is performed in almost all major cities of Russia. So, in Moscow, for example, today there are many medical institutions that practice stenting of the heart vessels. Institute of Surgery. Vishnevsky, Volyn Hospital, Research Institute. Sklifosovsky, Cardiology Center. Myasnikov, Federal State Budgetary Institution named after A.I. Bakuleva is not a complete list of hospitals providing such services.

Stenting refers to high-tech medical care (HTMC), and can be carried out under the compulsory medical insurance policy (on an emergency basis) or according to a quota allocated from the regional budget (in a planned manner). To obtain a quota, it is necessary to submit an application to the regional department of the Ministry of Health, with attached copies of medical studies confirming the need for an intervention. If the patient can afford to pay for the operation, he can be operated on for a fee. So, the approximate cost of the operation in Moscow is: preoperative coronary angiography - about 10 thousand rubles, installation of a stent without coverage - about 70 thousand rubles, with coverage - about 200 thousand rubles.

Which is better - CABG or stenting?

Only a cardiac surgeon can answer this question regarding each specific patient with angina pectoris during an internal examination. However, some benefits have been identified for both treatments.

Yes, stenting is different. less traumatic operation, better tolerance by patients, no need for general anesthesia. In addition, the patient spends fewer bed-days in the hospital, and can start work earlier.

shunting performed with the help of its own tissues (veins or arteries), that is, there is no foreign body in the body. Also, the probability of re-stenosis of the shunt is lower than that of the stent. If the patient has diffuse coronary artery disease, bypass surgery may solve this problem, unlike a stent.

So, in conclusion, I would like to note that despite the fact that many patients perceive with apprehension the possibility of surgical intervention on the heart, they should listen to the recommendations of the attending physician and, if stenting is necessary, they should give their thoughts a positive attitude and boldly go for the operation. Moreover, over the decades of successful operations on coronary vessels, doctors have been able to accumulate a sufficient evidence base indicating that stenting significantly prolongs life and reduces the risk of myocardial infarction.

Video: report on angioplasty and stenting of the heart vessels

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

What is stenting?

Stents are made of durable and hypoallergenic materials, which allows them to be used in any age group and even those with a tendency to allergies. The operation to install a shunt in the lumen of the vessel has practically no contraindications and is performed from the first months of life.

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

Operation efficiency

Until the end of the 20th century, the only effective method of restoring normal blood supply to the heart muscle was the imposition of a shunt - a bypass anastomosis that allowed blood to bypass the narrowed part of the vessel. The operation was performed through a thoracotomy, which made it extremely traumatic.

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

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

Indications for cardiac stenting

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

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

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

Preparing for the operation

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

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

How is cardiac stenting done?

After anesthesia, the surgical field is treated - the groin area. A small incision is made through which the femoral artery is punctured. A special conductor is inserted into the resulting hole along a small-diameter catheter, on which the folded stent is already fixed.

Further progress along the vascular bed is carried out under the control of the X-ray unit. This is necessary in order to carefully monitor the bends of the vessels and prevent injury.

If a vessel perforates, it will require extensive surgery to stop the bleeding. Such problems are extremely rare, since all doctors who perform stenting have extensive experience and a high level of qualification.

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

To understand exactly how the process of stenting in the vessel takes place, this visual video will help:

Rehabilitation

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

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

• Maintain an active lifestyle. A person should engage in physical exercises, as they are very important for maintaining normal vascular tone, including coronary ones. Patients are advised to walk or. Strong physical overload, such as when doing weightlifting, should be avoided. It is worth giving preference to athletics, aerobics or.
• Dieting. is an integral part of the prevention of atherosclerosis. Patients need to reduce the amount of foods with animal fats in their diet, completely exclude coffee, strong tea, and, as they can affect the tone of the vascular bed. In addition, it is necessary to limit sweet and salty. An excess amount is critical for patients with cardiovascular diseases.
• Take medications prescribed by your doctor. If a person has a stent in a coronary vessel, he is still at risk of developing angina pectoris or myocardial infarction. He needs to take drugs for prophylactic purposes, which will not allow the development of a new vasospasm.

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

Contraindications for surgery

• Acute myocardial infarction 2 hours after development. This condition requires emergency care, and after 2 hours, changes in the myocardium are already irreversible. Stenting can cause chemicals produced by tissue necrosis to enter the bloodstream, which can cause septic complications. In addition, increased blood flow can cause the heart to rupture.
• Tendency to bleed. If significant violations were noticed on the coagulogram before the operation, which cannot be compensated for by the use of coagulants (drugs that improve blood clotting), then the operation is prohibited. This is due to the fact that there is a high risk of bleeding from the femoral artery. Violation of this rule may result in death.
• Pathologies of blood vessels, which are accompanied by thinning of the walls. If the patient has very thin walls of the arteries, then the stent can provoke their rupture.
• Allergy to contrast agents. If it is impossible for the patient to inject a contrast agent, then the operation becomes technically impossible. "Blind" stenting should not be performed, as it can damage the artery and cause internal bleeding.

Complications

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

How much does stenting of the heart vessels cost?

The average prices for the procedure (including the pre- and post-operative period) are as follows:

• Moscow - 2000 c.u.
• Israel - $10,000
• Germany - 12000 c.u.
• Turkey - 4000 USD

Vascular stenting: indications, surgery, rehabilitation

Initially, the narrowing of the lumen has practically no effect on the human condition. But when the stenosis increases by more than half, there are signs of a lack of oxygen in organs and tissues (ischemia). In this case, conservative treatment is usually powerless. More effective methods of therapy are required - intravascular surgical interventions.

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

A special catheter is inserted percutaneously into the affected area of ​​the vessel, at the end of which there is a balloon. At the site of impaired blood flow, the balloon swells and expands the walls of the vessel. In order to preserve the lumen, a special structure is installed in the artery, which later plays the role of a frame. This design is called a stent.

Scope of stenting

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

Stenting while running

• Stenting of arteries of the lower extremities- the least traumatic and at the same time a very effective method of treating diseases of the vessels of the legs. With the formation of plaques and impaired blood flow when walking, the patient develops pain in the thighs, buttocks, feet and legs. Developing, the disease leads to the most serious consequences, up to gangrene.
• Carotid stenting- low-traumatic treatment that allows you to restore the lumen of blood vessels. The carotid arteries supply blood to the brain, and their stenosis disrupts cerebral circulation. During the operation, in addition to the stent, special protective devices with a membrane are installed - filters. They are able to delay microthrombi, protecting the small vessels of the brain from blockage, but without interfering with blood flow.
• Restenosis of the coronary artery after angioplasty. After this procedure, after 3-6 months, restenosis occurs in 50% of patients - re-narrowing of the vessel in the same place. Therefore, to reduce the likelihood of restenosis, angioplasty is usually supplemented by coronary stenting.
• In patients with coronary artery disease who underwent coronary artery bypass grafting, ten to fifteen years after surgery, shunt stenosis may occur. In this case, stenting becomes an alternative to repeated coronary bypass surgery.

Video: 3D animation of the stenting process

Types of stents

The purpose of stents is to maintain the walls of an occluded vessel. They bear a heavy load, so these structures are made from advanced high-tech materials of the highest quality. Basically, these are inert metal alloys.

In modern medicine, there are several hundred types of stents. They differ in design, type of cells, type of metal, coating, as well as the method of delivery to the arteries.

Main types of coronary stents:

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

Benefits of stenting

• Do not require prolonged hospitalization.
• The body recovers quickly after the operation.
• It is carried out under local anesthesia, which allows treatment even for those patients who are contraindicated in traditional surgical intervention.
• The operation is low-traumatic - it does not require opening various parts of the body, for example, the sternum during bypass surgery, when a heart operation is performed.
• The likelihood of complications is minimal.
• Less expensive treatment compared to conventional surgeries.

Contraindications for vascular stenting

• The diameter of the artery is less than 2.5–3 mm;
• Poor blood clotting;
• severe renal or respiratory failure;
• Diffuse stenosis - the defeat of too large an area;
• Allergic reaction to iodine - a component of the radiopaque preparation.

How is stenting performed?

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

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

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

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

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

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

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

Video: reportage from coronary stenting surgery

Possible complications after the procedure

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

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

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

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

Postoperative period and rehabilitation

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

In the first week after surgery, you should limit physical activity and not lift weights, you should not take a bath (only shower). At this time, it is undesirable to drive a car, and if the patient's work is related to the transport of goods or passengers, then you should not drive for at least 6 weeks.

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

• You need to practice almost every day for at least 30 minutes. The patient must get rid of excess weight, bring the muscles into shape, and normalize blood pressure. The latter significantly reduces the likelihood of developing myocardial infarction and hemorrhage. Reduce physical activity should not be after the end of rehabilitation.
• Particular attention should be paid to nutrition- it is necessary to follow a certain diet, which will help not only normalize weight, but also affect the risk factors for the manifestation of coronary artery disease and atherosclerosis. The diet after stenting of the vessels of the heart or other vessels should be aimed at reducing the indicators of "bad" -.
  Nutrition after a heart attack and stenting should be subject to the following rules:
  1. Minimize fats - it is necessary to exclude products containing animal fats: fatty meats and fish, high-fat dairy products, caviar, shellfish. In addition, you should give up strong coffee, tea, cocoa, chocolate and spices.
  2. The number of foods high in polyunsaturated fatty acids, on the contrary, needs to be increased.
  3. Include more vegetables, fruits, berries and cereals in the menu - they contain complex carbohydrates and fiber.
  4. For cooking, use only vegetable oil instead of butter.
  5. Limit salt intake - no more than 5 g per day.
  6. Divide the food into 5-6 doses, and the last one should be done no later than three hours before bedtime.
  7. The daily calorie content of all consumed products should not exceed 2300 kcal.
• Treatment after stenting is very important, so after surgery for six months to a year, the patient will have to take medication daily. 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 inserting the stent, he should:

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

Many patients are concerned about the question: can they get disability after stenting? The operation improves the condition of a person and returns him to normal working capacity. 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 the MSE.

Comparison of stenting and shunting: their pros and cons

If we compare which is better - stenting or shunting, first you need to decide how they differ.

Stenting, unlike shunting, is an endovascular method and is performed without opening the chest and making large incisions. Bypass is most often an abdominal operation. On the other hand, the installation of a shunt is a more radical method that allows you to cope with stenosis with multiple blockage or complete occlusion. Stenting in such situations is often useless or impossible.

Principle of heart bypass

Stenting is most commonly used to treat young patients with minor vascular changes. Elderly patients with serious lesions are still shown to have a shunt.

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

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

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

Both methods have their advantages and disadvantages, and their cost is also different. The choice of treatment method is individual and depends solely on the characteristics of the disease in each case.

Cost of stent surgery

How much does stenting of the heart vessels cost? First of all, the cost of the operation depends on which arteries you have to work with, as well as on the country, clinic, instruments, equipment, type, number of stents and other factors.

This is a high-tech operation that requires the use of a special X-ray surgical operating room equipped with sophisticated expensive equipment. In Russia, as in other countries where such operations are carried out, they are performed using the latest methods by highly qualified specialists. so it can't be cheap.

Prices for stenting of the vessels of the heart vary in different countries. So, for example, stenting in Israel costs from 6 thousand euros, in Germany - from 8 thousand, in Turkey - from 3.5 thousand euros. In Russian clinics, this procedure is somewhat lower in price - from 130 thousand rubles.

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

The narrowing of the lumen of the blood vessels can lead to a number of serious diseases of the cardiovascular system, which are not always possible to treat with conservative therapy. Cerebral circulation disorders, coronary heart disease, atherosclerosis of the vessels of the lower extremities lead to a significant deterioration in the quality of life of the patient and can cause death. More often, these pathologies occur in people over 50 years old, but the deterioration of the environmental situation and the modern rhythm of life lead people and younger people to the risk group for developing these diseases.

At first, the narrowed vessel practically does not affect the patient's well-being, but when the lumen of the artery is blocked by more than 50%, ischemia of the tissues of one or another organ develops, and its functions are impaired. One of the ways to eliminate arterial stenosis and oxygen starvation is a minimally invasive endovascular type of surgical intervention: stenting. We will talk about what it is and who is shown such a procedure in this article. For the first time, the concept of this technique for unblocking vessels affected by calcification was proposed about 50 years ago by the American vascular radiologist Charles Dotter. In 1964, he developed stent catheters and a technique that could be used to perform a minimally invasive operation to restore blood flow in peripheral arterial diseases. Further development of this technique and expansion of its application took a long time. In 1993, the effectiveness of coronary artery stenting was proven.

The stent is a miniature cylindrical frame made of thin titanium wire. It is introduced into the lumen of the blood vessel through a special probe, at the end of which there is a pump, and delivered to the site of stenosis. At the site of narrowing, the balloon is inflated with air and expands the walls of the artery, after which a stent is inserted into the affected vessel. When expanded, the stent is held in place by a special frame. If necessary, several stents can be used to expand the lumen of the vessel. The correctness of the installation of such structures is controlled by X-ray.

About 400 types of stents can currently be used for implantation, which differ from each other in alloy composition, hole design, length, delivery system to the vessel, and coating of the surface that is in contact with arterial walls and blood.

Stents used to dilate coronary vessels can be:

• wire: made from one wire;
• ring: made from separate links;
• mesh: made from woven mesh;
• tubular: made from tubes.

Stents can deploy on their own or with balloons. To expand the lumen of peripheral vessels, self-expanding nitinol (nickel-titanium alloy) stents are mainly used, and for coronary arteries, metal or cobalt-chromium alloy stents are used, which are expanded using balloons.

Thanks to continuous improvement in the quality of stents, vascular surgeons are able to minimize the frequency of occlusions of stented vessels and reduce the risk of acute thrombosis. Various models of stents have been introduced into clinical practice, which are coated with special polymers that release medicinal substances in doses: cytostatics, substances that can reduce the risk of re-narrowing of the vessel (restenosis) and thrombosis. Many stents currently in use are equipped with a special hydrophilic coating, which increases the biocompatibility of the design with body tissues.

Areas of use

Stenting has found wide application in many branches of medicine.

1. Installation of stents in the coronary arteries is carried out for the treatment of such pathologies of the cardiovascular system:

• high risk of development;
• acute period of myocardial infarction.

2. Installation of stents in the arteries of the lower extremities is performed when:

• atherosclerosis of the superficial femoral artery;
• thrombosis of the superficial femoral artery;
• blockage of the popliteal artery;
• blockage of the arteries of the lower leg.

1. Installation of stents in the carotid arteries is performed when:

• stenosis of the carotid arteries;
• high risk of blood clots (in addition, a special filter is installed with the stent to keep blood clots);
• the need to prevent stroke in diabetes mellitus and atherosclerosis.

1. Placement of stents in coronary arteries after their restenosis as a result of angioplasty or coronary artery bypass grafting.
2. The installation of stents in the renal arteries is performed when these vessels are occluded by atherosclerotic plaques and renovascular hypertension.
3. The installation of stents in the vessels of the abdominal cavity and pelvic cavity is performed when they are affected by atherosclerosis.

How is stenting performed?

Before stenting is performed, patients undergo a series of diagnostic examinations. To identify the site of arterial stenosis, the vascular surgeon examines data or angiography, which allow you to study in detail the state of the vessel and the place of its narrowing.

Before the intervention, the patient is given local anesthesia and a drug is administered that helps to reduce blood clotting. First, the doctor pierces the skin for further puncture of the affected vessel and, after performing the puncture, inserts a probe with a balloon into it. After delivery of the balloon to the site of stenosis, which is performed under radiographic control, it is inflated. At this stage of the operation, if necessary, a special filter can be installed to prevent the penetration of blood clots into the vessels and the development of a stroke.

Further, to fix and unblock the lumen of the artery, a stent is installed in the vessel. To do this, the surgeon introduces another catheter with an inflating balloon. The stent is inserted into the artery in a compressed form, and with the help of balloon inflation it opens and is fixed on the vascular walls.

Once one or more stents have been placed, the instruments are removed from the artery. The duration of such a minimally invasive intervention can be about 1-3 hours. During the manipulations of the surgeon, the patient does not experience pain.

After completion of the operation, the patient is recommended to comply with bed rest (its duration is determined by the doctor). After discharge from the hospital, the patient receives detailed recommendations on taking medications, diet, exercise therapy, the necessary restrictions and the need for observation by the attending physician.

In the first week after stenting, the patient should refrain from taking baths, lifting weights and limiting physical activity.

Possible postoperative complications

Complications after stenting are rare, but in some cases, patients develop:

1. Bleeding.
2. The formation of hematomas at the puncture site of the vessel.
3. Violations of the integrity of blood vessels.
4. Disturbances in the functioning of the kidneys.
5. Thrombosis or re-stenosis at the stent site.

Benefits of stenting

1. Fast recovery after surgery.
2. It is possible to perform the intervention under local anesthesia.
3. The intervention is minimally traumatic.
4. The risk of complications is minimal.
5. Treatment does not require a long hospital stay and is less expensive.

Contraindications

1. Severe diseases with impaired blood clotting.
2. The diameter of the artery is less than 2.5-3 mm.
3. Excessive vascular damage.
4. Severe respiratory or renal failure.
5. Intolerance to iodine-containing preparations (iodine is part of the radiopaque preparation).

Cost of stenting

The cost of a stent placement operation depends on many factors:

• areas of affected arteries;
• the type of stents used, their number and the instruments used;
• the clinic where the operation is performed;
• countries;
• skill level of the surgeon, etc.

The effect of stenting is felt by the patient immediately after the completion of the operation.

Program "Health Expert" on the topic "Stenting and coronary angioplasty":