In the past month, 69-year-old Master Wang always felt pain in the anterior chest area, accompanied by family members to the hospital for examination, found that the original hypertension, hyperlipidemia and coronary heart disease are aggravated, especially the imaging examination found that one of the coronary vessels has been severely blocked, the other two also mildly blocked, confirmed the diagnosis of myocardial infarction.

The doctor immediately recommended surgery to open the blood vessels to relieve the symptoms of myocardial ischemia, but Master Wang is afraid of surgery, worried that after the heart is put in the stent, the heart will no longer beat, despite the doctor's detailed explanation is still doubtful, but the heart attack is serious, without surgery will be very dangerous situation.

Luckily, Wang's son arrived and finally convinced him to agree to the surgery. During the operation, the doctor opened the occluded blood vessel and put in a stent, which quickly relieved the myocardial ischemia after the operation.

Stent implantation is the most common treatment for heart disease, which can relieve angina and heart attack and protect heart function and reduce mortality, but there are still many patients who do not know about heart stents and even have misunderstandings about them.

One, put on the bracket, the person is ruined?

Many patients worry that life expectancy will be reduced after stent surgery and that people will be wasted.

As far as the current medical level is concerned, it is unlikely that heart stent surgery will harm the body, although there are risks but most of them can be avoided, and stent surgery does not affect the life span of patients.

Depending on your post-operative condition, you can develop an exercise program that suits your intensity, frequency and duration under the guidance of your doctor, adhere to your medication and regular review, and live completely like a normal person.

Does a heart stent have a "life span" and does it need to be replaced every few years? First of all, this is a false proposition. As the endothelial cells on the intima grow, they gradually cover the stent trabeculae and finally, the stent and the vessel wall fuse together.

It is also a misconception that the term "once every few years" is used. In the early years, cardiac stent is a kind of "bare metal stent" supported by medical stainless steel, which will stimulate the endothelial overgrowth after being put into the blood vessel and make the stent surface lining thicken excessively, and even the blood vessel will be stented and narrowed again, and the restenosis rate is up to 50%.

However, these bare metal stents are rarely used nowadays, and are replaced by "drug-eluting stents", which are coated with drugs that inhibit endothelial proliferation on the surface of bare metal stents, reducing the probability of restenosis to 10%.

It is important to note that although drug-eluting stents reduce restenosis rates, they may also result in a failure of the endothelium to uniformly cover the stent trabeculae. There are certain procedural risks and adverse effects.

Second, why do some people put 1 bracket, while others want 3 brackets?

It's all coronary heart disease, why do some patients have less stents put in and some have more? In fact, the doctor's judgment is mainly related to the following factors.

-Clogging site

Different blockage sites lead to differences in the number of stents. If the blockage is in the main vessel and the lesion is short, 1 stent can be placed, while if the blockage is in the bifurcation and both vessels in the fork have problems, then at least 2 stents may have to be placed. In addition, for smaller blockages of less than 2 cm in diameter, there are usually not as many stents available.

-Blocking length

Currently, the longest stent is 38 mm (48 mm imported) and the shortest is 12 mm. If the lesion vessel is within 30 mm then only one stent is required, if the lesion length is 50 mm then at least 2 stents are required.

-Vessel diameter

If the length of the vessel lesion is not long, but the difference in diameter between the front and back of the same vessel is large, 2 stents may be required in this case.

-Number of blockages

If there are two blockages in one vessel and they are far apart, at least two stents should be placed, and if there are multiple blockages in different vessels, again multiple stents are required.

Third, the "invisible stent" drug balloon is misused?

The drug-coated balloon is a new interventional technique, in which the ordinary dilating balloon is coated with anti-proliferative drugs and delivered to the coronary stenosis, the balloon expands and releases the drugs against the inner wall of the blood vessel for 30-60 seconds. Especially in recent years, the use has increased significantly, and there are even rumors that it will replace stents.

Previously, CCTV News Investigation reported that after the price of stents was reduced, some doctors did not use stents and used balloons instead.

At the beginning of 2021, cardiovascular doctor Hu Dayi predicted the current situation of stent application after the "collection": the reduction of stent price does not mean the end of overmedication, instead, many doctors may turn to drug balloons and biodegradable stents.

At a briefing at the State Information Office in March, Chen Jinfu, deputy director of the National Health Insurance Administration, responded to a reporter's question. The previous year, the use of stents rose after stent procurement, and the use of drug balloons also increased significantly. But the drug balloon is not included in the collection, there is price space, so there is an inflated component. Last year in Jiangdu and other places to carry out drug balloon collection, this year will be expanded to the whole country, blocking this inflated space.

As for whether drug balloons can replace stents? At present, it is unlikely. Stent implantation is still the mainstream of interventional treatment for coronary heart disease, and drug balloons are only suitable for a small number of patients and are about ten times more expensive than stents, so there are still limitations in clinical practice.

In addition, both stents and drug balloons have a strict group of users.

Cardiac stents are mainly indicated for patients with moderate to severe stable angina pectoris who are not well treated with medication and have more than 75% stenosis in coronary vessels as shown by coronary angiography, and are also indicated for acute heart attacks.

Drug balloons are primarily indicated for patients with in-stent restenosis, bifurcation lesions, small vessel lesions, and a tendency to bleed.

Whether it is a drug stent or a drug balloon, no treatment is perfect. But with the continuous development of new technologies for coronary intervention, we believe that in the future, patients with coronary artery disease will have more options and a better tomorrow in terms of treatment! #HealthTruth Project

Reference.

[1] "Can I get a heart stent if I want it when the price drops? All your concerns are here". Popular Health Magazine. 2020-12-15

[2] "Do Cardiac Stents Have a "Lifespan"? Why do you need to take medication after having a heart stent? . Human Health.2022-04-07

[3] "Does heart stenting reduce life expectancy? Still alive 18 years after stenting, his experience in two words". Chronic Disease World.2021-03-07

[4] "Drug-coated balloons or stents, which is better? . Health China.2022-01-08

[5] "Stents of Abuse: What Can Be Done to Save You, Heart? . Trinity Life Weekly.2021-06-23

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