Take you to the scene of coronary stent intervention

With the development of modern medicine, coronary stents are known by more and more people, and more than 500,000 people in China benefit from them every year.

But what does it look like?

How was it put into the heart?

Many people don't know.

Based on a real patient's coronary stent operation, this paper introduces the whole process of coronary stent implantation.

Voice-over: due to relatively small trauma, the patient is only under local anesthesia (wrist or leg). During the whole operation process, the patient is awake. Some patients are cheerful and communicate with the surgeon from time to time.

As for what is uncomfortable during the operation, you can also tell the surgeon at any time.

1.

The right hand radial artery is the most common route for the implantation of coronary artery stent under disinfection and local anesthesia. Before the operation, the arm needs to be fully sterilized, and then a towel is placed to ensure the operation surface is in a sterile state.

Local anesthesia is performed by injection of appropriate anesthetic.

2.

To find the correct puncture position, first make a small incision with a skin breaker and then puncture with a puncture needle;

After the blood return, the puncture was successful and the puncture guide wire was sent.

3.

Establish a channel to pull out the puncture needle, place the sheath tube (including inner sheath and outer sheath) along the puncture guide wire;

Then pull out the puncture guide wire and inner sheath and leave the outer sheath in the blood vessel to establish a channel for the subsequent entry of guide wire and catheter.

4.

To begin the angiography, the angiographic guidewire and the angiographic catheter are delivered to the blood vessel through the outer sheath. The guidewire here is not a normal metal wire, but a flexible guidewire that can be flexibly bent and turned by the doctor, passing through a complex vascular path, from the radial artery to the great blood vessel.

The catheter can wind its way through the blood vessels along the guide wire until it reaches the coronary orifice.

After the angiography catheter reached the coronary orifice, the angiography catheter was connected to the triple tee, which was connected to the pressure sensor, heparin saline (for anticoagulation) and contrast agent (for angiography), respectively.

The shape of blood vessels can be displayed on the computer screen through X-ray by pushing the contrast agent into the syringe with ring handle.

On the way to the destination, the doctor needs to know the situation through X-ray, through the catheter to push the contrast agent, this special liquid can clearly show the thickness and direction of blood vessels under the X-ray, so as to find the location of the occlusion, which is often referred to as the "criminal blood vessel".

5.

After balloon dilatation angiography is completed, the angiography guide wire and angiography catheter are pulled out and the guide wire and the guide wire are sent in after the blood vessels of the criminal are determined.

The main difference between the guiding catheter and the angiography catheter is that the lumen is large and it is convenient for balloon and stent to enter.

In the figure above, the newly unsealed balloon has not yet opened and is empty in the middle. It needs to be sent to the location of the diseased blood vessel along the guide wire.

After the balloon reaches the predetermined position, the doctor USES a pressure pump to pressurize the balloon.

On the right is a pressurized balloon, filling up.

The left figure is the balloon withdrawn after use (both the balloon and the guide wire are disposable, for safety reasons, to avoid cross-infection, can't be reused);

The above procedure requires a high degree of experience and manipulation on the part of the doctor to ensure that the balloon is properly opened.

6.

Stent placement

The guide wire is sent into the conveying system (balloon + stent). The above picture is made by computer, showing that after the balloon is pre-expanded, the plaque in the blood vessel is pressed against the inner wall of the blood vessel, and the balloon with stent can pass through smoothly.

After the delivery system reaches the predetermined position, the doctor USES a pressure pump to pressurize and prop open the bracket.

A support supported by a balloon in the shape of a network;

Three images, the left shows the location of the balloon belt stent into the lesion;

In the middle picture, the balloon expands and the bracket is pushed open after pressure.

The right figure shows the stent remaining in the vessel after the balloon and guide wire are withdrawn.

This is a screenshot from a computer. The red area shows a narrow blood vessel that has thickened after being placed on a stent, allowing blood to flow normally through.

In recent years, in order to avoid restenosis and obstruction after stenting, a new generation of stents has a drug coating on the surface, which greatly reduces the incidence of restenosis.

7.

Incision wound

Exit the catheter and guide wire;

Clean up the blood around your arm;

Draw out the sheath tube and apply pressure with gauze;

Placement of hemostatic compressors;

Fixed finish.

These are the main procedures for stenting coronary arteries, and they do not seem to be complicated, even simpler than traditional surgery.

At present, domestic hospitals above the prefecture-level can successfully carry out stent implantation, and some county-level hospitals are also gradually carrying out, so that a large number of patients with myocardial infarction won the operation time, for patients with coronary heart disease to reduce the pain.

There are also questions about coronary stents

Indications:

High risk patients with significant myocardial ischemia confirmed by examination;

Angina pectoris (moderate to severe stable angina pectoris or unstable angina pectoris drugs are not ideal);

Patients with myocardial infarction (coronary intervention is a very effective means of reconstructing coronary artery perfusion and is suitable for over 90% of patients with acute myocardial infarction).

In general, as long as the patient does not have bleeding disease, can lie flat on the operating table, basically can receive stent surgery.

Surgical risks:

Cardiac stent surgery is generally through the radial artery (in this case) or the femoral artery and other pathways, after puncture, the first angiography, according to the results of angiography to determine whether to do interventional treatment, and will consider the views of the patient and their families, families will begin to prepare for interventional treatment.

The risk in the operation is objective existence, on the one hand may appear a small probability of contrast agent allergy, on the other hand may have the risk of pericardial effusion and pericardial tamponade, this probability is very small, once it will cause very serious consequences.

About review:

After stenting, patients will take antithrombotic, lipid-regulating, vasodilator and complication drugs to consolidate the therapeutic effect. The purpose of review after discharge is to further examine the surgical efficacy, adjust the dosage of drugs, and detect and treat new diseases early.

It is suggested that the patient should be reexamined at one, three, six, nine, and twelve months after the operation, and the examination items include blood pressure, heart rate, blood glucose, blood lipid, and blood routine.

For patients with existing hypertension, diabetes and cerebrovascular diseases, more attention should be paid to the treatment of the primary disease and regular examination.

Notes:

Patients should adhere to the medication, pay attention to self-observation.

Some need to take a variety of drugs, if the occurrence of skin or gastrointestinal bleeding, fatigue and fatigue symptoms, should see a doctor as soon as possible.

Patients with stents undergoing other treatments and requiring discontinuation of medications should consult a cardiologist and follow their doctor's advice.