People with cardiovascular problems are increasingly likely to hear from doctors asking for stenting. It is sometimes difficult to decide on this step, because it is not known what this procedure means and how it will affect future life. In this regard, people ask such questions: stenting - what is it, why is it necessary and how much does this treatment method cost? Therefore, we consider these and other nuances relating to this procedure.
What is the essence of the operation?
To begin with, it is worth noting that this type of treatment is one of the most effective methods for certain cardiovascular diseases. So, what if the doctor recommended you have a stent? What is it and how is it performed? This procedure is an operative measure. If there is an atherosclerotic plaque in the vessel, it must be expanded to improve blood flow patency. For this, a special stent is introduced, which will not allow to narrow the lumen in the affected vessel.
Before starting stenting, a person undergoes coronary angiography to determine the location of atherosclerotic plaques and how narrow the coronary vessels of the heart are. After this, you can proceed to the operation, which is done under local anesthesia. In the process, not one stent can be installed, but several. It all depends on the number of affected vessels. The procedure itself is safe. An operation takes an average of up to an hour. And the recovery period is very short.
In what cases is vascular stenting prescribed?
Recommendations for vascular stenting are given by a heart surgeon individually for each patient. He can offer this operation to those people who have a narrowed lumen in the coronary arteries caused by atherosclerotic plaques. Vasodilation in this case is necessary, since the blood flow decreases markedly. This, in turn, leads to a reduction in the amount of oxygen that must enter the heart. It is this drawback that provokes the occurrence of angina attacks.
Operation cost
Since we found out how stenting is performed, what it is and why it is needed, the next important question is the cost of this operation. The final amount depends on many factors. They are affected by:
- Type of stent. It happens with and without coating. The doctor must decide which stent should be installed, since a lot depends on the condition of the vessel and some individual characteristics of the patient. Naturally, an uncoated stent is less expensive.
- The number of affected vessels.
- The place where the stenting is performed. The cost of the operation largely depends on the clinic in which it is performed. For example, a procedure can be done in Germany at a cardiology center. In addition to the operation, comfortable rooms are offered there for the period of rehabilitation. The cost of treatment can vary from 5,000 to 14,000 euros. Stenting in Moscow will cost approximately 100,000 to 200,000 rubles. But in any case, the cost largely depends on the first two factors.
Preparation for stenting
Before proceeding with the operation, preparations are made for successful stenting. For starters, coronarography is performed. It gives the cardiac surgeon a complete picture of vascular disease. It becomes clear how damaged they are, how many plaques there are and in what arteries they are. Also, if the patient has concomitant diseases, additional studies are conducted.
A few hours before the start of the operation, the person stops taking food and medications (taken to correct sugar for diabetes), since stenting is performed on an empty stomach. Acceptance or refusal of other medicines is at the discretion of the doctor. Also, in order for the vasodilation to be successful, a special drug called “Clopidogrel” is prescribed for three days. It does not allow blood clots to form. Sometimes the doctor decides to prescribe it immediately before surgery, while increasing the dose. But this approach is undesirable, since difficulties may arise on the part of the stomach.
Execution technique
The whole procedure is performed under local anesthesia. At the beginning of the operation, a large artery is punctured, which passes through the arm or leg. The choice of puncture area depends on the surgeon and the patient. But most often, access to the coronary vessels of the heart is obtained through the leg. A puncture in the inguinal region is simpler and more reliable. Next, an introducer is introduced into the artery (this is a small plastic tube), it serves as a kind of gate through which other instruments will be inserted. A catheter is inserted into the introducer, which reaches the damaged artery and is inserted into it. A stent is delivered through a catheter. He is wearing a blown balloon. To fix the stent in the right place and not make a mistake, modern x-ray equipment is used. After a check of the exact location of the instruments, the balloon inflates, straightening the stent, which is pressed into the walls of the vessel damaged by the plaque. After installation, all the tools go. Only the stent remains in the vessel forever (in very rare cases it has to be removed). The operational process itself usually lasts no more than an hour, but sometimes longer. Much depends on the state of the vessels and the specific case.
Possible complications
Like every operation, this one can also have its own further complications. The most common include:
- Obstruction of an artery that has been exposed to surgery.
- Allergy to a substance that inflates the balloon (the severity is different, sometimes the functioning of the kidneys is impaired).
- The appearance of a hematoma or bleeding in the place where the artery was punctured.
- New vascular diseases, in particular damage to their walls.
- The most dangerous complication is stent thrombosis. It can appear both after a few years, and in a shorter time. It is accompanied by an acute pain attack and requires an immediate response and treatment. Otherwise, myocardial infarction may occur.
In addition, it is worth noting that, since blood flow passes throughout the body, complications can appear in other arteries that are not directly related to the operation. In addition, it is important to adhere to the diet and drug therapy prescribed by the cardiologist.
Varieties of Stenting
But a stenting operation can be performed not only on the vessels of the heart. If necessary, this type of treatment is performed on the renal arteries and vessels of the lower extremities. Therefore, it is worthwhile to consider in more detail these two types of stenting and in what cases they are prescribed.
Renal stenting
The need for this type of surgical intervention may occur with the appearance of atherosclerotic plaques in the renal arteries. This disease is commonly called vasorenal hypertension. With this disease, plaques form at the mouth of the renal artery. If such a disease is detected, the doctor recommends stenting the kidney, since even high-quality drug therapy may not give the necessary results. Such an intervention is gentle therapy, since it is possible to avoid open surgery. The procedure is performed according to the principle of stenting of the coronary vessels of the heart. Balloon expandable stents are also used here. Before the operation, a kidney test is performed using x-ray equipment with the preliminary introduction of a contrast medium. This is necessary in order to determine the anatomy of the pathology.
After stenting, a sick person is in the intensive care room for several hours. After this time, he was sent to a regular ward. If the operation was performed through the arm, the patient can get up and walk on the same day. In case of femoral stent insertion, the patient rises only the next day.
Atherosclerosis and stenting of the vessels of the lower extremities
The peripheral arteries are responsible for the delivery of blood to the legs. But they can also form atherosclerotic plaques, which are the cause of impaired blood flow. There are several signs of a failure in the circulation of the lower extremities, but the appearance of
pain in the legs while walking is considered the main one. At rest, these sensations recede. Sometimes such pains may not be, but at the same time cramps, weakness or a feeling of
heaviness in the legs are not excluded
. These symptoms can occur over the entire surface of the limbs: in the feet, legs, hips, knees, buttocks. If this problem is found, the doctor may recommend stenting. This method is considered one of the most effective in this disease. The whole procedure is carried out on the same principle as during stenting of the coronary vessels of the heart.
We examined some issues that explain how stenting is performed, what it is, in what cases it is necessary, and what complications may be. But in order to decide on such an operation or refuse it, it is important to talk with a heart surgeon who can explain in more detail all the pros and cons of this procedure.