Coronary heart disease, narrowed coronary arteries but stable, belongs to the stable coronary heart disease.
Experts do not recommend stents for all patients with stable coronary heart disease.
One patient had coronary stents a few years ago. He said he had a complete occlusion of one of his major blood vessels at the time and already had collateral circulation, so symptoms were mild and he tolerated physical activity well. However, as soon as he arrived at the cardiovascular hospital, the doctor worked hard to open the blood vessel that was completely blocked for him and put a stent.
He asked me. Why?
I said, for insurance.
Because one of your most important coronary arteries is completely blocked, it depends on another blood vessel for supply, but this blood supply vessel also has lesions, and if it is blocked, the whole heart will have no blood supply. So, opening up blood vessels to improve blood supply is one thing, and insurance for you is the main one.
This is one of the reasons why some patients with stable coronary heart disease do stents. Of course, there are others.
Why put a stent in a narrow coronary vein?
In order to open the narrowed, blocked coronary arteries, improve the blood supply to the myocardium. In addition to alleviating the symptoms caused by myocardial ischemia, more importantly, it is to reduce the apoptosis and necrosis of the myocardium due to ischemia, protect the function of the heart, and reduce the decline in the quality of life and even shortening of the life expectancy of patients due to the loss of cardiac function. In medical terms, it is to reduce cardiovascular deaths and all-cause deaths. Of course, the way to open blood vessels is also coronary artery bypass.
The placement of stents is also an invasive treatment, albeit minimally invasive.
When the stent is placed, the blood vessel is punctured, the guide wire is placed, the catheter is released, the contrast agent is injected, and the balloon is dilated and implanted into the stent, which is a mechanical method to open the blood vessel.
After opening the blood vessels, it also undergoes the process of blood vessel remodeling. In this process, the blood vessels may be narrowed and may be thromboembolic, requiring a certain period of intensive antiplatelet therapy, so the risk of bleeding is also borne.
This is not to mention the other risks of doing catheter placement stents.
Therefore, coronary stenting is a treatment with rupture, standing, injury and reconstruction, which is a treatment with advantages and disadvantages, and whether the patient can ultimately benefit and whether the benefits outweigh the disadvantages require a good trade-off.
For patients with unstable angina with coronary heart disease, patients benefit most from stenting to open the coronary artery. Because unstable angina is a precursor to myocardial infarction, it is most advantageous to block the progression of the disease at this time. Acute myocardial infarction requires emergency opening of blood vessels, which is a life-saving measure.
However, for stable coronary heart disease, it is not the same. Because the patient's condition is relatively stable and there are not so critical situations, it needs to be well weighed.
First of all, is there obvious ischemia in the myocardium that supplies blood to narrow blood vessels? Second, for individuals, what are the pros and cons of putting a stent? Third, is it better to put a stent on coronary blood vessel reconstruction or to bridge?
* The benefits of stenting to open blood vessels, improve myocardial blood supply, prevent myocardial infarction, protect patients' heart function, and reduce deaths due to cardiovascular disease or other causes are beneficial.
* However, if stenting has little effect on improving ischemia, or although it can improve local blood supply, it cannot change the final result, and it also bears the loss of stenting, it will also benefit patients little or no benefit.
* Of course, there are also options for stenting or coronary bypass which is more beneficial.
Patients with stable coronary heart disease are stable and generally have a low risk of developing acute myocardial infarction. Although the patient's coronary arteries are narrowed, the plaque is relatively stable, and the relationship between myocardial ischemic attacks and cardiac load is relatively stable and controllable. For example, activity can cause angina, which has a relatively stable load (exercise), and if the activity cannot reach that load, angina will not occur. For example, the speed of fast walking, the distance of walking, the floor of the upper floor, the strength of doing housework, and even the amount of food eaten, etc., within a certain load, generally do not cause angina attacks.
There are several possibilities here, one is that a collateral circulation is established between the blood vessels; then, the blood supply area of the narrow blood vessel is not necessarily ischemic; and the myocardium has ischemic pre-adaptation, just like altitude sickness, often with hypoxia, it adapts.
Such a condition, to achieve a relatively stable state, drug treatment is effective, patients can also carry out a certain amount of physical activity, relatively safe, can be drug treatment and lifestyle interventions.
Also, there is significant evidence to support such an approach. The study found that for patients with coronary heart disease and stable angina, coronary stent implantation does not change the long-term prognosis, which is the final outcome of the disease. For such patients, the long-term consequences of long-term drug therapy and stent placement are the same.
Therefore, if the condition of coronary heart disease is stable, the drug treatment is effective, and there is no obvious angina attack and myocardial ischemia, it is possible to continue drug treatment without stenting.
Stable coronary heart disease is also at high risk in patients. If it is a left main trunk lesion, multiple vascular lesions, as mentioned at the beginning of the patient; or coronary artery stenosis caused by myocardial ischemia is serious, the load capacity of the heart is significantly reduced, a slight load on the attack of angina; or the heart function is significantly reduced; ischemia can also cause arrhythmia attacks, such a patient risk is greater. Studies have also confirmed that for such high-risk patients, stenting or bypass can significantly alleviate symptoms, improve quality of life, improve exercise ability, and reduce the occurrence of acute myocardial infarction.
Therefore, for such high-risk patients, it is necessary to consider stenting or coronary artery bypass to open blood vessels.
In summary, cardiovascular experts' treatment strategies for stabilizing coronary heart disease also include drug therapy and blood revascularization, which include coronary stents and bypass.
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