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Stentbehandling of coronary arteries

Insertion of stent - short, tubular metal reinforcements - in narrow portions of the heart's coronary arteries has improved living prospects in cardiovascular disease.

Coronary artery disease means that one or more of the coronary arteries, coronary arteries, has been restricted or confined. As usually is the case that there is one or a few discrete narrowing of the coronary arteries - called stenosis. This makes it possible to treat such stenoses by inserting a catheter through the skin into an artery (artery), until the heart and into the coronary arteries or the like is narrowed. A balloon at the tip of the catheter is inserted into the stenosis, inflate and blow out (dilates) the stricture. This procedure is called in technical terms balloon dilation, balloon angioplasty or percutaneous coronary intervention (PKI).

Balloon angioplasty and percutaneous coronary intervention (PKI) has a central role in the treatment of coronary artery disease. Improvements in technology have expanded the indications for the procedure, led to greater safety and reduced the risk of new stenosis. The advancement came with the introduction of stents. A stent is a metal reinforcement to prevent the block blood vessel quickly sealed (see animation).

This article focuses on the types of stent, indications for their use, possible complications and recommendations regarding drug therapy after stenting.

Balloon angioplasty and stenting
A significant shortcoming of the balloon is the formation of a new stenosis (restenosis) of the same batch that has been blocked. Restenosis occurs in up to 40% of the treated patients. The purpose of developing coronary stents has been to reduce the tendency for restenosis.

A stent is an expandable, short, tubular metal structure that is inserted into the coronary artery using the balloon catheter. When the balloon is in place in the stenosis, the balloon is blown up, the stenosis is opened, the stent is placed in the flared portion of the artery, expanded and pressed out against the vessel wall. After the balloon is emptied and the catheter is removed, the stent remains in the artery.

A stent will limit the tendency for the creation of new stenosis, restenosis, to approx. 30% compared with 40% with balloon angioplasty alone.

Although the pure metal stents reduces the tendency for elastic forces draw together the artery again, so does not prevent the stent that the former stricture of the blood vessel after some time again becomes somewhat narrower. This is because the stent triggers a repair process in the artery wall, but this process usually causes no restenosis because the cavity of the vessel is significantly greater after a stent placement than after balloon angioplasty alone. In case of restenosis in a clean metal stent may rest discus be difficult to treat, and even if one manages to open the tub again, it will in most cases quickly go tight again.

Drug Liberating stents
During the past decade has developed a new type of stents coated with a drug - known drug releasing stents. These stents were developed to reduce the repair process and reduce the tendency for restenosis after angioplasty.

A drug releasing stent ensures that a controlled manner secreted small amounts of a cell inhibitory substance over time, usually for a period of 30 to 45 days after implantation, which is the period of greatest tendency repair.

These stents has reduced the incidence of early restenosis to less than 10%, if necessary. somewhat higher for more complex lesions.

The choice of stent
Balloon angioplasty is performed today almost always in combination with stent insertion.

Studies have shown that drug-releasing stents provide better prognosis than pure metallstenter in patients with diabetes, by long and / or complex stenoses, acute myocardial infarction 12 and by total blockage of a coronary artery. Nevertheless, the risk of restenosis in a major coronary artery (3.5-4 mm in diameter) with a limited stenosis is so low that the benefits of a drug-releasing stent in most cases is small compared with a plain metal stents.

Blood clot formation in the stent - stent thrombosis
It can form an acute clot inside the stent, one stent thrombosis, shortly after the procedure. The explanation may be that the stent has not been fully extended or that it has been against the vessel wall.

To avoid this acute complication, one must choose the right implantasjonsmetode and give blood clot prevention therapy with the two types of drug clopidogrel (eg Plavix) and aspirin (Albyl-E).

It has been shown that inhibition may also occur much later in the course of angioplasty. Early reports of increased incidence of late stent thrombosis in patients with drug-releasing stents, created concern about the safety of these stents. Recent studies have shown that the risk of death or myocardial infarction is not increased compared to pure metallstenter.

In 10% of those who have been stented with plain metal stents, leading the rest discus with acute myocardial infarction, often fatal - an argument for using the drug releasing stent.

The main reason for stent thrombosis is premature stoppage of the blood clot prevention therapy.

Drug therapy after angioplasty
After implantation of a stent is preventive treatment with Albyl-E (75-325 mg) and clopidogrel (75 mg) - duobehandling - absolutely necessary.

We do not know with certainty how long duobehandlingen should last. Some recommend 1 year. As a minimum, allow 1 month for clean metallstenter, 3 months for sirolimus-releasing stents and 6 months for other drug-releasing stents. Research shows that patients who have established drug-releasing stents should stop treatment with clopidogrel after 1 year. Longer treatment does not improve the prognosis, on the contrary, the worse.

Do not stop duobehandlingen without the advice of a doctor!

Duobehandling carries an increased risk of bleeding - treatment you receive does "blood thinning". If you are due to other disease tend to bleed, for example from the digestive tract, your doctor should consider measures to limit this risk. Also if you ever get in a situation where you need surgery, it is necessary to take into account duobehandlingen. The surgeon and cardiologist will then discuss what is best for you.

After the recommended duration of duobehandlingen is reached, continue with Albyl-E lifetime.

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