The last fifteen years there has been frequent increase in the number of atherosclerotic cardiovascular diseases, including a partial or complete blockage (stenosis) of the arteries that supply the brain with blood. Of these four arteries, in most cases, two front get sick – a carotid arteries, usually are much larger in diameter than the vertebral arteries, leading to disturbance of blood flow and a number of consequences of which certainly the most serious is a stroke. The most important risk factors for the development of a partial or complete blockage of the carotid artery are: high blood pressure, diabetes and increased blood fats. In some patients, there is only one factor, in some two, three, which means you will almost inevitably get atherosclerotic disease, the only question is when. Apart from these, there are risk factors such as bad heritage, ways of living, low physical activity, stress…
Coronary stent procedure
Embedding coronary stent starts as well as coronary angiography. Some of arteries in the groin, on the wrist or upper arm are punctured. The wire is inserted into the artery, through which with the catheter the wire comes to the beginning of coronary arteries, which is just above the aortic valve. During the coronary stent procedure the patient is awake, all the time, in touch with the team that performs the procedure. This procedure is technically called percutaneous coronary intervention (PCI) and procedure is in the field of interventional cardiology.
Once the catheter is brought to the beginning of artery, catheter is in good position. A human has two arteries, right and left, which are divided into anterior descending artery and circumflex artery. Through the interior of a catheter into the coronary artery the coronary wire is introduced. The wire is made of steel, but with a specially designed head that can be soft or hard, depending on what kind of changes blood vessel have.
In the inside of the arteries, through the coronary wire, all the other systems are introduced: balloons, coronary stent, thrombus suction systems, cutting systems for plaque, systems for measurement of stenosis severity and even a special ultrasound probe that can capture the inside of coronary arteries.
Changes on the coronary arteries can range from light to complete blockage of a blood vessel. Once the wire passes narrowing or blockage, the balloon is set to smash the lipids, push against the wall and make room for the coronary stent. Balloon is inflate at very high pressures, which range from 10 to 20 atmospheres. To illustrate, in a car tire pressure is two to three atmospheres. After preparation of the vessel, coronary stent is inserted in a vessel.
A coronary stent is a small metal prosthesis like a spring from a ballpoint pen. The coronary stent comes mounted on a balloon, and after inflation of balloon, coronary stent remains forever in the interior of the blood vessel. During the coronary stent implantation a variety of complications are possible and they rarely require medical intervention of from some other areas: cardiac surgery, vascular surgery, transfusion, etc. The team that performs PCI must be prepared to recognize and deal with any complications that may arise during the performing of the procedure.
After coronary stent
After coronary stent implantation, there are two problems. The first problem is thrombosis, that is a formation of a blood clot in the coronary stent. Against this problem, we can fighting with dual antiplatelet therapy. Another problem is the reaction of the blood vessel on the presence of coronary stent, which is of course, a foreign body. This problem is particularly pronounced in patients with diabetes, with long lesions in small blood vessels… That is why the coronary stents is impregnated with special substances that prevent and reduce the reaction of the blood vessel.
Collected evidence shows that carotid artery stenting is certainly much less safe than carotid endarterectomy in patients with symptomatic and asymptomatic carotid artery stenosis. The rates of stroke and death were much higher in patients with an implanted stent carotid artery compared with those treated with endarterectomy.
Diagnostic procedures take on average 15-30 minutes, putting the stent, usually last for about 30-60 minutes. More complex procedures with several coronary stents, may last longer than two hours. Patient after 24 hours is released and can go home. For patients with acute myocardial infarction, hospitalization is prolonged a few days after the procedure. The consultations with a cardiologist are recommended, at least twice during the first two years.
After a coronary stent implantation in a coronary artery, the patient has to take regularly double antiplatelet therapy for several months to a year, sometimes longer, depending at what stage the stent was installed. This therapy is extremely important, given that one of the complications is thrombosis, which can occur on the first day, first week, or after a month. Any voluntarily interruption of dual antiplatelet therapy, without consultations with a cardiologist, can lead to the occurrence of coronary stent thrombosis.
After coronary stent implantation, patient should not be subjected to physical effort: for ordinary stents for three months and six months for coated. Under exertion, means lifting and pushing cargo load = effort that requires more physical tension. The usual exertion, means long stair climbing and cycling. Excessive physical effort may lead to the thrombus formation at the site of mounted stent.