Stenting of the coronary arteries involves a procedure related to the implantation of stents in order to restore blood flow through blocked vessels. A coronary stent is a medical device that resembles a small diameter hollow tube in its structure. Its walls are made of metal mesh. In the folded state, the stent is inserted into the artery and, under X-ray control, it is placed at the site of the narrowing of the vessel. Then the surgeons inflate it with a balloon.
Straightening under pressure, the stent expands the diseased vessel, restoring blood flow through it. Such an operation is performed by cardiac surgeons along with interventional cardiologists. In our article, we will consider the essence of this procedure, find out how patients are rehabilitated after such an operation, and also find out with what medications postoperative treatment is carried out.
What are the indications for stenting?
Coronary artery stenting is performed to expand the arteries, which can be blocked or narrowed by an atherosclerotic plaque. Such plaques are composed of cholesterol and fats that accumulate inside the vascular walls. Thus, there are the following indications for stenting of the coronary arteries:
- Blockade of the coronary artery on the background of a heart attack or after it.
- Blockade or narrowing of one or several arteries at once, which can lead to impaired normal functioning of the heart.
- A narrowing of the blood vessels of the heart, restricting blood flow and invoking severe angina pectoris in the form of painful prolapse in the chest when the use of drugs does not help.
It should be borne in mind that stenting of coronary arteries in patients with stable coronary heart disease cannot improve the prognosis, although it can alleviate the clinical picture, increasing the quality of life. For some people, stenting rather than coronary artery bypass surgery, in which open heart surgery is performed, is more suitable. In this case, a cardiac surgeon creates a workaround that allows blood flow to bypass the area of vasoconstriction. Now let's try to figure out if there can be any contraindications to angioplasty and stenting of the coronary arteries.
What are the contraindications for this operation?
For stenting, which is carried out in order to treat a heart attack, there are no absolute contraindications. In planned situations, surgeons, as a rule, weigh all the pros and cons compared to the optimal medication or bypass surgery. Numerous concomitant diseases may increase the risk of complications, which is why drug treatment is more suitable for such patients.
Since in order to prevent thrombosis after stenting, the use of antiplatelet agents plays a decisive role, when deciding on this operation, the doctor should also consider the answers to a number of the following questions:
- Is it likely that the patient will soon need surgery? It should be noted that when taking antiplatelet medications, the risk of bleeding increases, and if they are canceled, there is a risk of stent thrombosis.
- Will the patient be able to comply with the recommendations for antiplatelet treatment and does he have enough money for this?
- Are there any contraindications to the use of antiplatelet drugs?
Preparing the patient for stenting
As part of the planned coronary stenting, the patient needs to discuss with the doctor recommendations regarding preoperative preparation. The following tips are usually given:
- In the event that a person takes any blood-thinning medication in the form of, for example, Warfarin, Xarelto, or other anticoagulants, he may need to stop using them three days before the stenting procedure. This must be done in order to prevent excessive bleeding from the area of vascular access.
- In the event that a person is taking insulin or sugar-lowering medications to treat diabetes, he may need to change the time they are taken. The use of some of them should be canceled two days before the operation. Detailed questions are discussed with your doctor.
- The patient may be asked not to drink or eat eight hours before stenting.
- The patient may also be asked to carefully shave the groin on both sides.
In relation to the patient, electrocardiography is usually performed along with echocardiography and laboratory examination. To find out in which place the stent is to be installed, coronary angiography is performed, which consists in visualizing the coronary arteries by entering contrast with further x-ray examination. Coronary angiography can be performed immediately before stenting or some time before the operation. So, now we will find out how angioplasty and stenting of the coronary arteries are performed.
The essence of the procedure and the operation process
The stenting operation is performed in the operating room, which is equipped with an angiograph, which is an x-ray unit that allows the surgeon to obtain an arterial image in real time. During the operation, the patient lies on his back on the surgical table, and electrodes are attached directly to his chest and limbs, which allow observing the electrocardiogram. For permanent venous access, vein catheterization is performed on the forearm.
During the percutaneous coronary intervention and stenting of the coronary arteries, the patient is conscious. At the same time, sedatives are often administered intravenously, making him drowsy and extremely calm, but, nevertheless, he retains the ability to cooperate with medical staff. Coronary stenting is performed through the femoral artery. The radial artery can also be used. Such arteries pass on the forearm and groin.
The essence of balloon angioplasty and stenting of the coronary arteries is as follows - a special instrument is introduced into the narrowed section of the artery - a balloon catheter. With this procedure, narrowed vessels are opened non-surgically. The cause of the disease is not eliminated, but the consequences and symptoms of ischemia are removed very effectively. True, there is a drawback - an artificially expanded vessel due to elasticity will probably narrow again. To fix the result, a tubular spacer made of thin material is left in the expanded vessel, which is called the stent.
The sequence of medical procedures for installing stents is as follows:
- The area of vascular access is treated with an antiseptic solution and covered with sterile linen. Next, local anesthesia is performed, which allows you to puncture the radial or femoral artery with a needle almost painlessly.
- A thin conductor similar to a metal wire is inserted through a needle into a vessel. Then the needle is removed, after which an introducer is inserted into the artery through the conductor, which is a special short catheter of large diameter. Further, through it, doctors will introduce all other instruments.
- After the conductor is removed by the doctor in the folded state, a long and at the same time very thin catheter with a stent at the end is started. It is slowly moving towards the heart. After the catheter reaches the mouth of the coronary artery, the doctor introduces a contrast medium and fluoroscopy is performed. This is done in order to accurately see the area where you want to put the stent.
- The stent is slowly advanced through the artery to the desired location. Immediately after confirming the correct location of the stent, the surgeon inflates it with a balloon, pressing atherosclerotic plaques to the walls of the vessel.
- Sometimes patients require stenting of several narrowing sites in one or more arteries at once. In this case, a new stent is inserted into the lumen, after which the procedure is repeated.
- At the end of the operation, the catheter with the introducer is removed from the vessel, then the doctor strongly presses the insertion point for fifteen minutes, and then applies a pressure bandage. There are special devices that can seal a hole in the femoral artery, in which case pressure is not required. In addition, special cuffs are available that compress the punctured radial artery when inflated.
We will understand why outpatient management of patients after stenting of the coronary arteries is necessary.
Rehabilitation and postoperative period
In the postoperative period, the patient is transferred to the ward, in which the medical staff carefully monitors his general condition. In this case, the patient is regularly measured pressure along with the heart rate and urination is monitored.
In the event that stenting was performed through the femoral artery, the patient after the intervention should lie on his back and in no case should bend the corresponding leg for about six hours. The most accurate time for compliance with this situation in each specific situation is indicated by the doctor. To reduce the length of the lying position can be through the use of special devices that seal the puncture hole in the artery. In such cases, it will take only two hours to be horizontal.
In the event that stenting was performed through the radial artery, the patient immediately after the operation will be allowed to sit in bed. You can walk only after a few hours. Given that the contrast that was introduced during the operation to visualize the coronary artery comes out through the kidneys, immediately after returning to the ward, the patient will need to drink plenty of fluids to stimulate urination.
As a rule, the patient after planned stenting is discharged from the hospital the very next day, giving him detailed recommendations regarding recovery at home. In addition, advice is given regarding further medication and a general lifestyle change.
Outpatient management of patients after stenting of the coronary arteries is carried out.
What are the possible complications?
Complications that can occur during or after this operation are possible as follows:
- The appearance of bleeding or hemorrhage in the area of introduction of the introducer sheath. This phenomenon is observed in five percent of patients.
- The occurrence of damage to the artery into which the introducer was introduced. Something similar is observed in less than one percent of patients.
- The appearance of allergic reactions to contrast, which was introduced during the procedure. Such a complication develops in less than one percent of patients.
- The occurrence of damage to an artery in the heart. This phenomenon is observed less than in one case in three hundred and fifty procedures.
- The appearance of severe bleeding. Such a complication develops in less than one percent of patients.
- The occurrence of myocardial infarction, stroke, or cardiac arrest. Such severe complications are less likely than in one percent of patients.
How fast is rehabilitation during coronary artery stenting?
Recovery period
Within a couple of days after stenting, a person may experience some discomfort present in the chest along with pain in the area of vascular access. If necessary, it is advisable to take "Paracetamol" for pain relief. Management of patients after stenting of the coronary arteries involves regular examinations. Within exactly one week after the procedure, the patient must not lift any weights, but, in addition, drive a car or play sports.
For two weeks, it is completely forbidden to take a bath, and, in addition, to go to saunas, baths or pools. It is allowed to wash in the shower, starting from the next day after stenting. In that case, if the operation was performed under planned conditions, then a person can return to work after a week.
Treatment is also performed after stenting the coronary arteries.
Conducting drug therapy
A stent is a foreign body within the body. And, despite the fact that such devices are specially made from the most biologically compatible materials, their property does not always completely coincide with the natural tissue of blood vessels. In this regard, in the vascular walls around the stent, the risk of developing inflammatory processes may increase, and on the inner surface that is in contact with the blood, an increased risk of blood clots is not excluded. Similar processes can lead to re-overlapping of the prostated arteries and the subsequent development of myocardial infarction.
In order to reduce the likelihood of such complications, in addition to the use of a new generation stent, doctors prescribe a double antiplatelet therapy consisting of the following drugs after stenting the coronary arteries - Aspirin in small doses and one of such drugs as Clopidogrel, along with Ticagrelor ”And“ Overheated ”. The duration of such treatment depends on the type of stent and can be up to one year. At the end of this time, the patient continues to take only one antiplatelet drug, as a rule, “Aspirin” serves as his.
In addition to antiplatelet treatment, doctors also often prescribe drugs for the treatment of atherosclerosis, coronary heart disease or hypertension, because stenting is mainly performed in patients who have these diseases.
How should the lifestyle change after the operation of stenting the coronary arteries?
In order to be able to avoid the re-development of this problem in the future, people after undergoing stenting are strongly recommended to completely change their lifestyle for the better:
- Thus, if a person is overweight, then it is very important for him to at least try to normalize it.
- In the event that the patient who has undergone stenting of the coronary arteries smokes, then he simply needs to get rid of this bad habit, especially given the existing diseases.
- It is necessary to eat only healthy food, which contains a low amount of fat and salt.
- It is mandatory to maintain regular physical activity.
- It is equally important to reduce the amount of stress that the body is regularly exposed to.
What is the prognosis after coronary artery stenting surgery?
Prognosis for patients
The prognosis against the background of stenting of the coronary arteries directly depends on the disease for the treatment of which it is used. Also, much depends on the condition of the contractile functions of the heart and other factors. It is believed that performed stenting for myocardial infarction makes it possible to significantly reduce mortality due to this dangerous disease by almost half. Thus, such an operation is superior in its effectiveness to conservative treatment methods.
True, in planned situations, the overall effectiveness of such a procedure as stenting is in doubt. The fact is that scientific studies have demonstrated the absence of the effect of planned stenting on the overall life expectancy of patients, compared with the implementation of optimal conservative treatment. But it is indisputable that this operation helps to improve the quality of life of patients, greatly alleviating the symptoms.