Release date: 2015-09-02 First, why should coronary heart disease be placed? Stenting surgery is an interventional treatment for coronary heart disease. The treatment of coronary heart disease consists of three troikas: drug therapy, interventional stent surgery and surgical bypass surgery. What is coronary heart disease? Coronary heart disease is mainly caused by atherosclerosis in the blood vessels that supply blood to the heart. Arteriosclerosis is the consumption of large fish and junk food, no exercise, no consumption, excess heat is converted into cholesterol, and cholesterol is deposited on the blood vessel wall to form plaques, causing blood vessels to narrow, just as water impurities become scales and block the pipes. If the vascular stenosis exceeds 50%, it can be diagnosed as coronary heart disease. More than 70% of stenosis affects myocardial blood supply and causes angina pectoris; plaque rupture forms a thrombus that completely blocks blood vessels, and myocardial necrosis is a myocardial infarction, causing sudden death! Insertion of the stent can open the blood vessels that have been narrowed or occluded, restore blood flow to the coronary arteries, and restore blood supply to the heart. Figure 1 illustrates coronary heart disease Second, is stent surgery a technology that has been eliminated abroad? (development history of the stent) There is no other method for early treatment of coronary heart disease, only drug therapy. Drug treatment can not remove the narrowing of blood vessels, and the effect is not satisfactory. Until 1969, Favaloro completed the first thoracotomy bypass surgery, which pioneered the surgical treatment of coronary heart disease. However, early surgical treatment requires cardiac arrest, large trauma, and high risk of perioperative death, which has certain limitations. World cardiologists have been exploring new ways to treat coronary heart disease. German doctor Grüentzig is a clinician with extraordinary innovation and perseverance. He used the balloon to dilate the lower extremity arteries to treat lower limb ischemia as early as 1974-1977. His flash of light flashed: Can balloon expansion also expand? Coronary artery treatment of coronary heart disease? He made a special balloon for the expansion of the coronary arteries and also convinced his mentor and other experts. Regrettably, he did not receive the support he expected, and was criticized for being delusional. The results of animal experiments published at the annual meeting of the American Heart Association were also ridiculed. Many people thought he was crazy, but Grüentzig withstood the pressure to cling to his ideals and laughed at criticism and mockery. In 1977, he selected a patient with coronary artery disease with a proximal anterior descending stenosis and performed the world's first percutaneous coronary balloon dilatation (PTCA) (Lancet. 1978; 1:263-264). He used a special balloon catheter for coronary artery to expand the stenosis of the left anterior descending artery twice, and the stenosis was significantly improved, and the patient responded well. The operation was successful! Shortly thereafter, Grüentzig successfully completed the second case, inviting worldwide cardiologists to observe the operation, promoting the popularization and development of interventional therapy, and opening a new era of coronary heart disease treatment. The main problems of early interventional surgery are acute occlusion of up to 3%, and the rate of postoperative restenosis is about 30% to 50%, which affects the interventional effect. In the 1980s, scientists invented coronary stents to reduce the incidence of postoperative acute occlusion, reduce emergency bypass and acute myocardial infarction, and the incidence of restenosis also decreased to 20% to 30%, which is the second milestone in interventional cardiology. . However, restenosis is still the main problem affecting the interventional effect of coronary heart disease. In the 21st century, scientists discovered that loading anti-proliferative drugs on the surface of the stent can reduce restenosis to less than 10%. In September 2001, the annual meeting of the European Society of Cardiology announced the publication of the first drug-eluting stent (DES) clinical trial RAVEL results marked a new chapter in the intervention of coronary heart disease, 6 after the rapamycin eluting stent The monthly restenosis rate was 0, ranking first in the top ten research progress of the American Heart Association (N Engl J Med. 2002; 346: 1773-80). In 2012, the New England Journal of Medicine listed Grüentzig's invention of coronary intervention and drug-eluting stents as a great technique for changing the course of coronary heart disease, driving a decline in cardiovascular mortality (N Engl J Med 2012;366 :54-63). In 2010, the United States completed a total of 490,000 stenting procedures (Circulation.2014; 129:e28-e292). In 2013, former US President George W. Bush was diagnosed with coronary heart disease at a hospital in Dallas, Texas, and successfully underwent cardiac stenting. Do you still think that the bracket is a technology that is eliminated in Europe and America? Figure 2 Great technology in the history of coronary heart disease treatment Third, what does the bracket look like? Most of the clinically applied stents are made of non-rusting metal materials. The walls of the stents are very thin at about 90-120 microns. The metal stent girders hold the blood vessels to prevent the narrowing of the blood vessels and then retract them. The bracket is designed in a mesh structure to avoid clogging the branches that are issued. On the stent, there is also a micropore that is not visible to the naked eye, and the drug is prevented from restenosis by the carrier load, and the drug is released after the blood vessel is placed to prevent restenosis. The stents are available in various diameters from 2.25 to 4 mm and lengths from 8 to 36 mm to accommodate different thickness vessels and lesions of different lengths. Figure 3 bracket body 4. How is the stent placed into the blood vessels of the heart? Stenting surgery is strictly called coronary intervention and should not be considered surgery. It should only be considered as minimally invasive interventional therapy. It does not require thoracotomy. It only needs to open a small mouth from the root of the hand or thigh. Then, the catheter is sent from the peripheral artery to the site of the opening of the heart vessel, and then the stent is sent along the catheter to the lesion of the blood vessel, and the stent is released to support the stenotic vessel. Source: Cardiovascular Shenzhen Jie Zhong Lian Investment Co., Ltd. , https://www.szmeizons.com