December 4, 2022

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Heart Stent: Good or Bad?

Heart Stent: Good or Bad?



 

Heart Stent: Good or Bad? in the field of cardiovascular disease treatment, heart stents have a mixed reputation.  

 

Although the price of Chinese heart stent reduced to about US$105 in China ( details here), people still worry if taking such surgery.

 

Some  opinions that the heart stent is to make the heart blood supply unblocked and let life continue; there are also opinions that this technology is overused, behind it is an unknown chain of interests.

In addition, in 2015, Professor Zhong Nanshan, a well-known Chinese respiratory medicine expert, questioned the abuse of heart stent surgery, and there have been rumors that “the United States has eliminated heart stent surgery”… For a while, heart stents have been pushed to the cusp of public opinion.

As a result, many patients are hesitant about heart stent surgery.

 

Heart Stent: Good or Bad?

 

 

Rumor: Americans no longer have heart stent surgery?

Internet rumors say that heart stents are something that the United States has eliminated. Americans no longer have heart stent surgery. Therefore, many people have heard that they regret having this kind of surgery.

 

Is this really the case? If you ask an American doctor, they will probably laugh.

According to statistics, at present, the United States, with a population of only 300 million, has more than 1 million heart stent operations per year;  and China, with a population of 4-5 times that of the United States, performed 750,000 heart stent operations in 2017.

Moreover, many celebrities including former President Clinton and George W. Bush have successfully undergone heart stent surgery. One such rumor is not true.

 

 

 

The heart stent controversy

So why are there such rumors? The fact is this: In the United States, there have been controversies about heart stent surgery since 2007, and the focus of the debate is mainly whether the stent is appropriate for patients with chronic heart disease without obvious symptoms. Many people think that this treatment is overused.

But for patients with clear indications for placement, this treatment technique is still being used extensively. Therefore, the claim that Americans no longer have heart stent surgery is actually taking out of context, exaggerating the facts, and spreading falsehoods.

 

 

 

The history of heart stent implantation

Just as impurities in the water turn into scales that can block pipelines, coronary arteries can also become blocked due to plaque rupture and thrombus formation.

The consequences may be insufficient blood supply to the heart, myocardial infarction, or even sudden death.

The purpose of placing a stent is to open the narrowed or occluded blood vessels, restore the blood flow of the coronary arteries, and restore the blood supply to the heart.

 

At present, heart stent implantation is still one of the main ways for cardiologists to treat coronary heart disease worldwide. Before it, there were only two options for coronary heart disease, either medication or thoracotomy; either the effect was not good, or the risk and trauma were too great.

 

 

First generation heart stent

In 1977, the world’s first percutaneous coronary balloon dilatation and angioplasty (PTCA) was born as the first generation of cardiac stents.

Since then, the curtain of coronary intervention has been opened. Its advantage is that it can be removed after the blood vessel is dilated and can be placed repeatedly. , No foreign body reaction. However, its fatal disadvantage is that it has little effect.

 

Second generation heart stent

The second-generation bare metal stent (BMS) of the heart stent was born.

Although it reduces emergency bypass and acute myocardial infarction, it still does not eliminate the risk of restenosis; and once the stent is implanted, it will be with the patient for life.

 

The third generation heart stent

The third-generation heart stent is a drug-eluting stent (DES). This stent is coated with a layer of organic polymer coating on the metal surface, and the coating is loaded with drugs that can regulate local inflammation and cell proliferation, which greatly reduces restenosis. Rate, but also need to be placed for life.

 

Fourth generation heart stent

The fourth-generation heart stent is called a biosoluble stent (BVS). As the name suggests, it can dissolve in the body and be absorbed by the body. This solves the dilemma that traditional stents must always exist in the patient’s body as a “foreign body”.

The biosoluble stent is also the first heart stent approved by the FDA. However, despite its excellent performance in early clinical trials, long-term results have shown that it may increase the probability of thrombosis. Due to the low demand, the biosoluble stent eventually withdrew from the market.

 

Fifth generation heart stent

The fifth-generation heart stent magnesium alloy soluble heart stent is made of magnesium alloy, which takes into account the solubility of the fourth-generation stent and the supporting capacity of the metal stent, and has potential advantages in restoring coronary vascular motion.

However, the above advantages have not been confirmed by long-term, large-scale clinical trials. What is its fate, we will wait and see.

 

How to treat heart stent surgery?

The heart stent is not an almighty god, but it should never be demonized.

 

First of all, patients with acute myocardial infarction should race against time for interventional surgery.

We know that coronary heart disease is divided into two types, one is called acute coronary heart disease, which mainly includes acute myocardial infarction and sudden death; the other is called chronic coronary heart disease.

The acute onset of acute coronary heart disease is mainly due to the acute occlusion of blood vessels and the loss of blood supply to the heart, causing the heart to stop beating. For acute coronary heart disease, there are two traditional treatment methods: one is thrombolysis, and the other is emergency stent.

 

Both European and American guidelines and Chinese guidelines consistently recommend that if the clinical judgment is acute vascular occlusion, stents or thrombolysis should be done as soon as possible within 12 hours.

There is no dispute about this! The reality in our country is that about 70% of people died before admission because they did not have the opportunity to be treated.

 

Even if admitted to the hospital, the family members have to go through a long process of thinking and entanglement during the signing process.

The ideal time to open the blood vessel is within 120 minutes after the onset of the disease. For every minute of delay, a large number of cardiomyocytes will die.

 

Therefore, for patients with acute myocardial infarction, time is life. The earlier the blood vessel is opened, the better the treatment effect.

Inserting a stent to open blood vessels is the most effective method. Heart stents have saved the lives of many patients in the acute phase.

 

Secondly, there is a dedicated team to monitor the proper implementation of heart surgery.

For example, in the United States, the medical quality control team will track and supervise the implementation of each medical behavior in safety and compliance, including risk reduction, infection control, and monitoring of complications.

The entire medical process is transparent, controllable, and Traceability can be regarded as the second protection of evidence-based medicine.

 

Third, the current controversy about stents is mainly concentrated in the field of chronic coronary heart disease.

For these patients, there are clear indications for whether to place a stent. At the same time, the doctor must comprehensively evaluate the actual situation of the patient to determine, that is, “the stent is not what you want to put, you can put it if you want.”

 

In response, Feng Jianwei, vice president of the American Southwestern Memorial Hospital, director of the heart and blood vessel center of the hospital, and expert of the JF Southwest Heart Disease Treatment Center in Houston, said,

“In the United States, the degree of blockage is more than 70%, accompanied by chest tightness, chest pain, or exercise-type angina, exercise-type palpitation, shortness of breath, etc., and exercise-type treadmill tests have confirmed the existence of exercise-type ECG changes or transcardiac nucleus Only when the prime scan confirms the existence of reversible cardiac ischemia will the patient be recommended to place a stent. In other words, patients with chronic heart disease with a degree of blockage of 70% must have clear corresponding symptoms before the doctor will perform surgical intervention. At all levels of hospitals in the United States, doctors will strictly abide by this principle. Specific to each patient, doctors must conduct a comprehensive assessment based on all aspects of the situation.”

 

It can be seen that the placement principle of the heart stent is very strict and strict.

 

 

 

Is heart stent surgery once and for all?

Sorry, no! With regard to health issues, there has never been a once-and-for-all statement, because the body and disease are changing dynamically and require continuous monitoring and attention.

 

Heart stent surgery mainly plays a role in relieving symptoms and stabilizing the condition. It does not mean that the heart problem will be completely resolved after the stent is placed.

 

First of all, the coronary arteries of patients with coronary heart disease have already appeared lesions.

Therefore, stents can only eliminate the risk of the most dangerous part of myocardial infarction. For other lesions whose severity has not reached the level of stent placement, the current safety may be Evolve into hidden dangers in the future, which must be prevented; secondly, there are many problems after stent implantation, such as restenosis in the stent and thrombosis in the stent.

 

Therefore, in order to achieve good results, postoperative medication and care cannot be ignored.

The commonly used drugs after stent surgery mainly include:

  • Anti-platelet aggregation drugs, one is aspirin, the other is ADP inhibitors, such as clopidogrel or ticagrelor
  • Statins, such as atorvastatin, rosuvastatin, etc.
  • Heart rate control drugs, such as Betaloc, Kangxin, etc.
  • Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as Pristine and Sartan drugs
  • Nitrate drugs, such as isosorbide mononitrate, isosorbide, etc.
  • Drugs for the treatment of chronic diseases such as high blood pressure and diabetes must be taken for a long time

Of course, the situation of each patient is different. The above is only a general principle of medication. Specific to the treatment of each patient, a more refined and personalized treatment plan is required.

 

In addition, in addition to insisting on taking medication, patients should also actively improve their lifestyles, such as doing postoperative rehabilitation exercises, scientifically arranging diet and work and rest, quitting smoking and drinking, and regular physical examinations.

Dr. Feng Jianwei highly praises lifestyle medicine. He believes that lifestyle improvement is crucial to the prognosis of patients with heart disease.

Research has shown that a good lifestyle can prevent, slow down or even reverse blood vessel blockage to a certain extent. , Promote the reduction of plaques.

The same is true for patients who have undergone stent placement surgery, because these patients face a major practical problem, which is to prevent restenosis and reblocking of blood vessels.

 

In summary, heart stent surgery should be viewed with a rational attitude, and it should neither be regarded as an “artifact” for curing heart disease, nor should it be demonized. For patients, the first important point of disease treatment is to receive the most suitable treatment at the most suitable time.

 

 

Heart Stent: Good or Bad?

(source: internet, reference only)

 


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