When talking with a family about a planned operation, she raised the claim that the coronary stent was said to be a "time bomb" on WeChat. It shocked me very much. Since the introduction of the coronary stent in the 1980s, it has become coronary heart disease. The standard treatment method is the representative of global minimally invasive surgery. Numerous evidence-based medical evidence around the world show that coronary stent significantly improves the survival rate of patients with myocardial infarction and unstable angina pectoris, and significantly improves the quality of life of patients with coronary heart disease Countless lives of patients. Exaggerated publicity has been made for a few cases of accidents after stent implantation, so that there is a "time bomb", which is really biased. Below, I will make a specific analysis of several common sacrifice of coronary stent to look at it.
1. Sudden sudden death after stent?
First of all, this is a very, very rare report, and the reasons need to meet two at the same time: one is the stent placed on the left trunk (the location of the coronary source), and the other is the acute occlusion in the stent (mainly thrombosis). The main reasons for stent thrombosis are related to inadequate antiplatelet treatment. The reasons are as follows: First, some patients do not follow the doctor's advice, discontinue the dual antiplatelet drugs (aspirin + clopidogrel) without permission, or need surgery Contingent invasive examination, did not stop antiplatelet drugs under the guidance of specialist doctors; second, some patients responded poorly to the drug, especially clopidogrel as a prodrug, in some patients there was resistance, resulting in antiplatelet effects The third is the issue of stent technology and experience. The above problems are currently well prevented in experienced heart centers. Left main stenting is no longer a restricted area in the eyes of experienced cardiac intervention doctors. Intravascular ultrasound (IVUS) is like the eye that a doctor stretches into a blood vessel, which can accurately determine the size, adherence, and dissection of the left main stent. For patients with clopidogrel resistance, effective screening can be performed by means of thromboelastography, drug genotyping and other means, and the shortage of antiplatelet therapy can be effectively prevented by doubling the drug or replacing it with alternative drugs such as ticagrelor.
Therefore, for open lesions such as the left trunk, it is necessary to visit an experienced heart center to develop a comprehensive treatment plan. Patients must also attach great importance to them and strictly follow the doctor's order to effectively prevent the occurrence of sudden death after the stent.
2. Will the stenosis be repeatedly narrowed after the stent and cannot be treated after the restenosis occurs?
This is an old problem. In the era of bare metal stents in the last century, the rate of restenosis in the stent was about 30%. In response to the problem of scratching the head, the advent of drug-eluting stents in 2000 effectively solved the problem of restenosis. Drug-eluting stents are coated with anti-endothelial antitumor drugs (rapamycin or paclitaxel) on the surface of the original bare metal stents, which can effectively control the occurrence of in-stent restenosis. At present, the restenosis rate of drug-eluting stents is controlled at About 5%, the incidence is still very low, and there is no need to worry too much; once the restenosis occurs in the stent, experienced heart centers can analyze specific problems and find out the reasons, such as risk factor control, antiplatelet drug resistance, newborn For atherosclerosis, stent technology, metal allergies, etc., specific treatment suggestions are given for different reasons. Our intervention methods include: high-pressure expanded balloon expansion, cutting balloon expansion, drug-eluting stent implantation, drug balloon expansion, etc., based on which we strengthen the control of risk factors (see "What kind of people are easily available" Coronary heart disease? How to avoid coronary heart disease? "), Adjusting antiplatelet treatment strategies, etc., most patients can effectively control the restenosis in the stent, and for a very small number of poorly controlled cases (such as metal allergy, coronary aneurysm-like expansion) Etc.), you can also choose coronary bypass surgery.
3. Is the risk or pain great during stent surgery?
The current complication rate of stent surgery (PCI) is less than 1%, and it is even lower in experienced heart centers. Stent surgery only requires local anesthesia, and the patient is awake during the entire operation. At present, more than 95% of patients in our center are operated from the forearm radial artery approach with high comfort. Small, fast recovery after surgery, fully reflects the characteristics of minimally invasive surgery.
4. Do I need to take medicine for life after stent?
After the stent, you need to take medicine for life, but not because you have the stent, but because you have coronary heart disease, which is a chronic disease, such as high blood pressure and diabetes, you need to take medicine for life. The direct relationship is that the double antiplatelet (aspirin + clopidogrel) cannot be stopped without permission within one year after placing the stent. I often warn patients that during the year, two meals can be eaten less, but antiplatelet drugs Never stop! The risks have already been discussed in Article 1.
5. The stent is a foreign body that is harmful or repellent to the body?
The stent is a metal foreign body, but it has no antigenicity. Unlike kidney transplantation and bone marrow transplantation, it does not need to eat immunosuppressants and there is no rejection. Drug-eluting stents are usually covered by vascular endothelial cells within 6 months to 1 year, becoming the "bone" in the blood vessels and becoming part of the body. The absorbable stent, which is still in the clinical trial stage, can be completely metabolized into water and carbon dioxide within two years. This is also the direction of the next development of the stent. At present, our center has launched a phase II clinical study of the absorbable stent. Patients who are interested You can come to us for consultation.
6. The bracket has a life span, how many years can it only be used?
The stent has no useful life. As mentioned in Article 5, after the stent is covered by vascular endothelial cells, it becomes a part of the body. There is no useful life. As long as there is no restenosis or new atherosclerosis in the stent, it can be used for life. .
7. Will the stent be displaced during vigorous activities?
The stents are memory alloys released by balloon expansion, and the release pressure is generally above 10 atmospheres (atm), so that the stent is embedded in the blood vessel wall and cannot be displaced after successful release. I often inform patients that they will participate in the bungee stent Can't move, not to mention flying, sports and other activities.
8. Can't do magnetic resonance examination after stent?
This is a common problem encountered after stent surgery. The current stents are mostly nickel-chromium or platinum-chromium alloy materials, in which the iron content is small and will not be displaced in the magnetic field. Many stent instructions clearly indicate that the magnetic resonance can be safely performed about 1 week after the stent. scanning.
In summary, the argument that coronary stent is a "time bomb" is completely nonsense. The key is to strictly grasp the indications for stent implantation, strictly control entrance, fully weigh the risk-benefit ratio, and formulate individuals for different patients. In order to maximize the patient's benefit, a personalized treatment plan can be achieved.