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Stenting - a lifesaving procedure
The advances in cardiac surgery have been enormous over the past 20 years. We
have gone from some fairly primitive high-risk surgery, to some very, very
sophisticated interventional techniques, which have given cardiac patients a new
lease of life. In fact, if the techniques that are available now, were able to
be carried out 30 years ago, my father would in all probability, still be alive
today.
However, before getting into modern life-saving techniques, a short review of
cardiac pathology is in order. Myocardial infarction is the common cause of
cardiac muscle death, and finally ours. (Make that “yours” as I’m not going
yet!)
The heart muscle is supplied with oxygenated blood by its own system of
arteries. The heart does not get its oxygen from the blood in its chambers.
Instead, there is a network of ‘heart’ arteries (called the coronary arteries)
which supply the cardiac muscle. If any of these get blocked, this is known as a
“stenosis” or an “occlusion”, which in turn can bring on the coronary
“conclusion”! The death of the muscle is called “infarction”.
The blockage is most often caused by Cholesterol, which gets deposited on the
inside wall of the arteries and is called “plaque”, and then red cells stick on
the surface of the deposit and it builds up from there. If you are overweight, a
diabetic or a smoker, you have an even greater chance of a blockage. If you have
a 50 percent stenosis, you will start to get chest pains on exercise. If you
have a 100 percent stenosis, you may drop dead during the exercise.
To correct this problem, the only way we knew was to carry out an open heart
operation, replace the blocked coronary arteries with vessels taken from other
parts of the body, usually veins from the leg. However, now we can leave your
arteries where they are, but do something to relieve the stenosis, or blockage.
This is called “Angioplasty”.
One way is to send an inflatable balloon to dilate the blocked area, and this is
known as Coronary balloon angioplasty. It is more formally known as percutaneous
transluminal coronary angioplasty (PTCA): percutaneous meaning “through the
skin,” transluminal meaning “inside the blood vessel,” coronary meaning “related
to the heart,” and angioplasty meaning “blood vessel repair.”
Angioplasty involves creating space in the blocked artery by inserting and
inflating a tiny balloon, which compresses some of the blocking plaque against
the arterial wall. When the balloon is deflated and removed, the plaque still
remains compressed, clearing a space in the artery and improving blood flow.
While angioplasty does not always completely clear an artery, more than 90
percent of all procedures are immediately successful.
There are other techniques available, and the most common is by using “stents”.
This is called percutanous coronary intervention (PCI). The success in today’s
cardiac surgery is due in part to the increased use of these tiny wire mesh
tubes called stents, which cardiologists began using in the 1990s to help keep
arteries open following angioplasty. About 70 to 90 percent of all angioplasty
patients receive a stent, which is inserted permanently at the site of the
blockage.
Stents can be used in a number of ways with angioplasty procedures. A stent may
be inserted during an original angioplasty to prevent possible arterial collapse
and lower the chance of heart attack and re-narrowing of the artery (called
re-stenosis). A stent also may be inserted during a second angioplasty to
prevent recurrent restenosis. Stents can also be used in the unlikely event that
an artery is injured by the catheter. Experienced doctors are able to install
stents in one or more arteries with a high probability of success.
The use of stents has decreased the abrupt and unpredictable closure of an
artery, which necessitated emergency coronary artery bypass surgery. Studies
show stents are better than angioplasty alone in preventing re-stenosis, which
is one of the most common problems associated with angioplasty.
Evidence suggests that angioplasty patients are doing better today because
doctors are better able to target blockages, by using such techniques as an
angiogram, so your interventionist is able to pinpoint the blockage with greater
accuracy. Do not ignore chest pains!
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