Precision treatment, protecting the heart

Author: Zhao Fengjuan, Anhui Province, Bengbu Second People's Hospital

Reviewer: Pang Zhanqi, Chief Physician, Second People's Hospital of Bengbu City, Anhui Province, Deputy Director of the Heart Center

Member of the Heart Failure Committee of Anhui Medical Association Member of the Structural Heart Disease Branch of Anhui General Practice Association

Guo Yuanli, Chief Nurse, The First Affiliated Hospital of Zhengzhou University

Today, when cardiovascular diseases are increasingly becoming a major threat to public health, accurate diagnosis and effective treatment are particularly critical. From the establishment of the "gold standard" of coronary angiography, to the widespread use of heart stents, to the innovation of drug-eluting balloon dilatation technology, every step embodies the medical community's unremitting pursuit of life and health. These treatments not only provide doctors with accurate diagnostic basis, but also bring hope to patients to regain heart health. This article will take you to understand coronary angiography, coronary stent implantation and drug-eluting balloon dilatation technology, aiming to help patients and their families better understand these medical methods, jointly protect cardiovascular health, and keep the tree of life evergreen.

1. Coronary Angiography

Coronary angiography is currently considered the "gold standard" for assessing the degree of cardiovascular stenosis and diagnosing coronary atherosclerotic heart disease. Doctors can use coronary angiography to accurately obtain detailed information about coronary artery lesions and then develop the best treatment plan. Specifically, coronary angiography is performed by puncturing the radial artery in the patient's upper limb or the femoral artery in the lower limb, and sending the catheter along the arterial vascular path into the root of the aorta until the opening of the coronary artery is found. Subsequently, contrast agent is injected into the coronary artery, and the image is taken using X-ray equipment to clearly show the shape and degree of stenosis of the coronary artery. This process can be figuratively likened to "taking a picture" of the heart's blood vessels.

Figure 1 Copyright image, no permission to reprint

2. Coronary Artery Stent Implantation

Coronary artery stenting, also known as "heart stenting" surgery, is a procedure that can be performed on the left main artery of a patient. When coronary angiography results show that the patient's left main artery stenosis is ≥50%, or the non-left main artery stenosis is ≥70%, or even if the stenosis does not reach this level but angina pectoris frequently occurs, the doctor will comprehensively assess the patient's overall condition and consider stenting.

The doctor will use the previously established pathway to insert a slightly larger diameter guide catheter and guidewire. Then, through this new pathway, the doctor will first deliver a balloon to the stenosis. After the balloon is expanded, it can open the narrowed blood vessels. The doctor will then deflate the balloon and remove it, and then deliver the delivery system consisting of "balloon + stent" to the lesion. The stent is a piece of mesh metal that is compressed and wrapped around the surface of the balloon in advance. When this combination reaches the predetermined position, the doctor will expand the balloon again to release the stent, and then withdraw the balloon. The stent will remain in the blood vessel to ensure smooth blood flow and restore blood supply.

Figure 2 Copyright image, no permission to reprint

Some patients worry about whether the stent will shift or fall off due to activities after being placed. In fact, there is no need to worry too much. Over time, the endothelial cells on the vascular lining will gradually grow and cover the stent, eventually wrapping it, making it integrated with the blood vessel, firmly "rooted" in the blood vessel, and remaining there for life.

Heart stents are mainly suitable for patients with moderate to severe stable angina pectoris who have coronary artery stenosis of more than 70% confirmed by coronary angiography, unstable angina pectoris who do not respond well to drug treatment, and acute myocardial infarction patients. For patients with acute myocardial infarction, time is life. The use of stents to quickly open occluded blood vessels is better than thrombolysis and simple drug treatment in promoting the recovery of cardiac function.

However, whether a patient is suitable for stent treatment depends on the specific type of coronary artery lesions. For simple lesions (such as 1-2 stenoses), stent implantation may be an appropriate choice; for complex or severe lesions, such as left main coronary artery lesions, diffuse lesions, and severely calcified lesions, coronary artery bypass grafting may be more suitable for treatment.

3. Drug-eluting balloon dilatation

Compared with ordinary balloons, the surface of drug-eluting balloons is attached with a layer of anti-proliferative drugs, which is usually paclitaxel. After the drug-eluting balloon is delivered to the location of coronary artery stenosis, the balloon will stick to the blood vessel wall when expanding, which lasts for 30 to 60 seconds. At this time, the drug will penetrate into the subendothelial tissue cells of the blood vessels, thereby preventing the restenosis of the blood vessels. The drug-eluting balloon is immediately withdrawn from the blood vessel after releasing the drug to ensure that the drug is effectively released to the blood vessel wall. Subsequently, the doctor withdraws the balloon, leaving only the drug on the tube wall to slowly and continuously work to prevent blood vessel stenosis. The drug can act for up to 2 to 4 weeks. This process does not leave any foreign matter in the body, avoiding the re-implantation of the stent, and providing patients with a treatment effect similar to that of an "invisible stent."

Figure 3 Copyright image, no permission to reprint

Compared with stents, drug-eluting balloons are more suitable for the following situations:

1. The site where the stent was implanted is narrowed again and it is not appropriate to implant the stent again;

2. The diseased blood vessels are extremely small and it is difficult for the stent to enter;

3. The diseased blood vessels have bifurcations, making it difficult to treat with stents;

4. The patient is at risk of bleeding and cannot take dual antiplatelet drugs orally for a long time.

It should be made clear that any treatment has its limitations. Whether you choose a heart stent or a drug-eluting balloon, you must strictly follow the following points after surgery:

1. Follow the doctor's advice and take antiplatelet drugs on time;

2. Go to the outpatient clinic for regular check-ups;

3. Maintain a low-salt, low-fat, and low-cholesterol diet;

4. Perform aerobic exercise that suits you, such as jogging, Tai Chi, walking, etc.;

5. Avoid adverse factors such as straining during bowel movements and emotional excitement to maintain cardiovascular health.

With the continuous advancement of medical technology, from the diagnosis of coronary angiography, to the direct intervention of coronary stent implantation, to the innovative application of drug-assisted balloon dilatation, each treatment method is working to improve the quality of life of patients and prolong their life. However, no matter which method is chosen, the key lies in scientific evaluation, precise treatment, and maintaining a healthy lifestyle after surgery, in order to truly achieve comprehensive protection of cardiovascular health. Let us work together to develop good living habits and protect cardiovascular health!

References:

[1] Expert Group on "Chinese Expert Consensus on the Clinical Application of Drug-Coated Balloons (Second Edition)". Chinese Expert Consensus on the Clinical Application of Drug-Coated Balloons (Second Edition)[J]. Chinese Journal of Interventional Cardiology, 2023, 31(6): 413-426.

[2] Ren Li, Zhang Dingguo. Interpretation of the 2021 ACC/AHA/SCAI Coronary Artery Revascularization Guidelines[J]. Journal of Practical Electrocardiology, 2022, 31(04): 229-237. DOI: 10.13308/j.issn.2095-9354.2022.04.001.