Coronary stenting is a method of intravascular prosthetics of heart arteries for various pathological changes in the structure of their wall. Stents are used to reconstruct the cornary arteries.
A stent is a metal frame, which is a small metal tube made of wire meshes . The stent is inserted into the artery after it is widened and placed at the site of the artery lesion. The stent supports the walls of the artery.
The stents are located on the balloons, which allows them to be very small in the unopened state, and after inflation of the balloon inside the coronary artery, expand, remaining in this position forever. Currently, in interventional cardiology, a variety of stent models are used, differing from each other in certain design features. All of them are absolutely compatible with human organs and tissues, have a flexible structure and elastic enough to support the artery wall. In addition, they are all made of radiopaque materials, which is a prerequisite for subsequent monitoring of their condition.
Recently, in order to prevent restenosis, specialists began to actively use drug-eluting stents, from which, after implantation into a coronary vessel, for several weeks a pharmacological drug is released that prevents excessive growth of the intima (inner lining) of the artery and an increase in atherosclerotic plaque. Taking into account modern possibilities, successful results of stenting are observed in 95% of patients who underwent it. The feasibility of this operation and the choice of a specific type of stent is determined by the cardiac surgeon based on the diagnostic data obtained during the preliminary examination of the patient.
Stenting can be either planned or emergency. It is performed under the control of X-ray equipment, under local anesthesia, through a puncture of the skin on the wrist, forearm or thigh, without the need for large incisions, anesthesia and connection to a heart-lung machine. This intervention does not require strict bed rest and is fairly well tolerated by patients.
During the intervention, a stent attached to a balloon catheter is inserted into the artery and advanced directly to the site of the narrowing of the vessel. The balloon is then inflated under high pressure and the stent is deployed. The correct placement of the stent is controlled on the monitor screen.
Usually, the results of the operation are good, it is relatively safe and the risk of complications after it is minimal. Sometimes an allergic reaction of the body to a substance introduced during the operation for X-ray observation is possible. There is also a hematoma or bleeding at the puncture site of the artery. To prevent complications, the patient remains in the intensive care unit in bed rest. Within a few days, after the wound at the puncture site has healed, the operated patient is discharged from the hospital. Restrictions are usually removed after that, the person returns to normal life, and observation is carried out periodically by a doctor at the place of residence.
The bloodlessness and apparent simplicity of the operation, the short postoperative period and the effectiveness of coronary stenting make it a modern and popular solution to the problem of many cardiovascular diseases. In contrast to the surgical operation, which takes place with the use of artificial circulation, the stenting procedure lasts 30-40 minutes and practically does not cause complications.
Stenting is not absolutely effective; in about 15-20 % of cases, the opposite process occurs, and the vessel narrows again. One of the reasons for this process is the excessive growth of muscle tissue, and, as a result, the narrowing of the vessel wall. However, the research of cardiologists does not stop, improving the technology of coronary stenting and achieving more and more stable positive statistics of results.
Currently, about 400 different stent models have been developed, and the development of the method leads to their constant modernization. These stents differ in the alloy of which they are made, the length, the shape of the holes, the coating of the surface in contact with the blood, the delivery system to the coronary vessels. So, in addition to balloon-expandable, there are self-expanding stents, etc.
However, it is worth remembering that even the most advanced methods of cardiac surgery do not negate the need for prevention and an attentive attitude to your health and the health of your heart. Regular physical activity, commensurate with age and physical capabilities, fresh air, balanced nutrition, enriched with vitamins and excluding weight gain, limiting the consumption of foods containing cholesterol – these are concepts that never lose their relevance.
The apparent simplicity of stenting, the absence of the need for a long recovery after it, as well as the noticeable therapeutic effect of the operation, often create the illusion of complete recovery in patients. However, stenting is aimed only at eliminating the symptoms of the disease. The cause of coronary heart disease – atherosclerosis – continues to exist and progress, creating a threat of the reappearance of angina pectoris, the development of myocardial infarction, heart failure and other very serious problems.
For this reason, a person who has undergone surgery should be fully aware of all the possible dangers of his position and the need for further treatment.
Physical activity is one of the most important post-stent lifestyle conditions. Regular exercise slows down the development of atherosclerosis, trains the heart muscle, helps to stabilize blood pressure, and has a general health effect on the body. It is also important that sports help the body burn fat, and therefore maintain a normal weight and blood cholesterol levels.
There is no set of exercises that would suit every single patient after stenting. The mode and intensity of training are built individually, depending on the condition of the person, the list of his diseases, and the tolerance of loads. All this is established by a cardiologist.
A patient who has undergone this operation should be prepared for the fact that from now on he will go in for sports at least 4-5 times a week. Of the specific types of loads, special exercises are recommended for exercise therapy, walking, cycling, swimming, jogging. Sports that are accompanied by “explosive” loads, require significant physical effort and potentially threaten to get injured (lifting weights, boxing) are not recommended.
Speaking about physical activity, it is important to mention sexual activity after undergoing stenting. Sexual life can be carried out in the usual mode, it is allowed to resume it at any time, as soon as the patient feels the need for it. On the recommendation of a doctor, nitroglycerin can be taken before intercourse, as well as before another type of exercise. However, this is not always required.
The second critical component of therapy is diet.
“Food is medicine.” These words are attributed to Hippocrates, and even now we can still confirm their reliability. Special nutrition after stenting is not just the prevention of heart problems that may or may not arise in the future. This is a cure.
Sadly, not all patients adhere to the recommended dietary guidelines. And it can be argued without a doubt that this plays a large role in the high incidence of relapses of angina pectoris and repeated stenting.
Diet therapy after stenting of coronary vessels should be based on the following principles.
- restriction in the diet of animal fats. This means a decrease in the consumption of such products as fatty meats (lamb, pork), lard, semi-finished products, margarine. Do not eat large quantities of butter, cheeses, sour cream, cream. It is also worth limiting the consumption of eggs to 3-4 pieces per week. All fatty foods are future plaques of cholesterol that will reactivate CHD symptoms after stenting.
- restriction of refined carbohydrates, sweets. From the products that are often on your table, you will have to cross out sweets (it is better to replace them with dried fruits), excess sugar, pastries, carbonated drinks, etc. In the body, carbohydrates are converted into fats, which is why it is worth giving up sweets as much as possible.
- salt restriction. It causes fluid retention and high blood pressure. Many patients with coronary artery disease who have undergone stenting have hypertension. They should pay particular attention to this recommendation. The amount of salt should be reduced to 3-4 g per day (half a teaspoon). Be careful: many ready-made foods (canned food, bread, etc.) contain salt, so its consumption should be limited to more or less, depending on what foods are present in your diet.
- limiting the consumption of coffee and other drinks and products containing caffeine (strong tea, chocolate, cocoa). Caffeine causes vasospasm and an increase in the work of the heart, which puts an increased load on the cardiovascular system and harms patients with coronary artery disease and underwent stenting. However, it is worth understanding: the diet does not require a complete rejection of coffee, with controlled blood pressure and the absence of pronounced symptoms, it can be consumed in small quantities. It is better to choose natural Arabica – it has less caffeine than Robusta and, moreover, than in instant coffee.
- adding vegetable oils, fresh vegetables and fruits, fish to the diet (consume at least 2 times a week). All this prevents the development of atherosclerosis. Dietary fibers of plant food bind and remove cholesterol from the intestines, omega-polyunsaturated fatty acids of fish and vegetable oils reduce the content of harmful lipids in the blood (low density lipoproteins, triglycerides) and increase the content of useful lipids (high density lipoproteins).
If a cardiologist has recommended taking medications, be sure to follow this advice. The volume of drug therapy after surgery will decrease, however, it is impossible to completely abandon drugs for coronary artery disease. Treat according to the scheme and do not forget: your well-being after the operation is largely preserved due to the fact that you follow the therapy regimen.
If any complaints appear and the condition worsens, it is imperative to consult a doctor for examination and correction of treatment.
After undergoing stenting, it is recommended to quit smoking. Actually, this should be done even before the operation, and it is best to never start smoking at all. However, if you have undergone surgery and still smoke, you can give you advice that will definitely help: quit your cigarettes immediately!
Some patients console themselves with the thought that two or three cigarettes a day is not enough, and there will be no harm from them. This is not true. Any type of smoking (active or passive) with any number of cigarettes smoked negatively affects the heart and blood vessels. It increases blood pressure, has a cardiotoxic effect, accelerates the progression of atherosclerosis, increases the likelihood of developing arrhythmias and the risk of heart attack. The pleasure of smoking is not justified by the enormous harm it causes.
Now about alcohol. It is a known fact that dry red wine has a healing effect on the heart. In some places, you can even find information that it protects against atherosclerosis and almost causes the resorption of cholesterol plaques in the vessels. Indeed, small amounts of such wine have a beneficial effect on the course of atherosclerosis. But:
- we are talking about small amounts of drink, no more than 1 glass of wine a day.
- only high-quality expensive alcohol is beneficial, and not the names of alcohol that can be bought in any supermarket
- the benefits of red wine are not so obvious that it is mandatory to drink it regularly. The notorious smoking cessation will be of great benefit many times over.
After the stenting operation, the patient can return to his usual work. The specific terms of restoration of working capacity may be different, it depends on the person’s condition (the severity of coronary artery disease, the presence of a recent heart attack, etc.) and his profession. Knowledge workers can start working almost immediately after stenting, and those whose specialty is related to physical activity are allowed to start work later.
The stenting operation eliminates the symptoms of ischemic heart disease, the person’s condition improves after it, therefore, the issue of disability registration in patients who underwent it is rarely discussed.
In the event that stenting did not lead to improvement, the patient resumed angina pectoris early or had a heart attack after the operation, assignment of a disability group to a person is possible. However, this operation is not performed for people at risk of deterioration and complications, so stenting usually still gives a positive result and helps to restore a person’s working capacity, and not its final loss.
When a person’s condition after the operation stabilizes, he is allowed to travel by any means and without restrictions. The main thing is that the person regularly takes medications and observes other doctor’s recommendations. Among all types of recreation, it is better to choose an active one, taking into account the tolerance of physical activity. Patients are often not contraindicated in baths and saunas, although a more specific conclusion on this matter should be given by a cardiologist.
A cardiologist is a doctor who often leads and monitors his patients for years. Ischemic heart disease is a chronic phenomenon, so this is not surprising.
Sometimes one has to deal with such stories: a person develops hypertension, angina pectoris, then he suffers a heart attack, he undergoes stenting. However, even after this, the “adventures” do not end: periodically the patient is hospitalized with hypertensive crises, after a while his angina recurs, he is again undergoing stenting or even coronary artery bypass grafting … Repeated heart attacks, heart failure are not uncommon even after repeated operations. As a result, a person feels much worse than he could, and his life expectancy is reduced.
Why is this happening? The reason is not only in the insidiousness and danger of the disease, although, undoubtedly, both are fully inherent in coronary heart disease. Most often, an unfavorable outcome of the disease is determined by the fact that a person does not make enough efforts to improve his condition and prolong life.
If you have undergone stent surgery and you do not follow all the recommendations for lifestyle, it is high time to think about changing your attitude towards treatment. All of the above tips are clear, simple and doable, you just need to follow them, constantly and conscientiously.
After stenting, hemodynamics change in the heart and throughout the body, so it takes time for the body to adapt to this. In addition, during stenting, a foreign body is actually inserted into the coronary vessel. This causes a reaction from the immune system and blood clotting, creates an increased readiness in the body to accelerate the development of coronary atherosclerosis, the appearance of blood clots in the vessels, etc.
The period of inpatient treatment is not enough for the body to fully recover, therefore, cardiac rehabilitation is recommended for patients after stenting.
A complex of wellness procedures will consolidate the results of therapy and improve the human condition. A special training program will help the patient get used to the new lifestyle.