People suffering from cardiovascular problems can increasingly hear from doctors the suggestion of stenting. Sometimes it is difficult to decide on this step, because it is not known what this procedure means and how it will affect the future life. In this regard, people ask the following questions: stenting - what is it, why is it necessary and how much does this treatment method cost? Therefore, we will consider these and other nuances regarding this procedure.
What is the essence of the operation?
To begin with, it is worth noting that this type of treatment is one of the most effective methods for certain cardiovascular diseases. So, what if the doctor recommended that you have a stent? What is it and how is it performed? This procedure is a surgical procedure. If there is an atherosclerotic plaque in the vessel, it must be expanded to improve the patency of the blood flow. To do this, a special stent is inserted, which will not allow narrowing of the lumen in the affected vessel.
Before starting stenting, a personundergoes coronary angiography to determine the location of atherosclerotic plaques and how narrowed the coronary vessels of the heart. After that, you can proceed to the operation, which is done under local anesthesia. In the process, more than one stent can be installed, but several. It all depends on the number of affected vessels. The procedure itself is safe. On average, the operation takes up to an hour. And the recovery period is very short.
When is vascular stenting indicated?
Recommendations for vascular stenting are given by a cardiac surgeon individually for each patient. He can offer this operation to those people who have a narrowed lumen in the coronary arteries caused by atherosclerotic plaques. Vasodilatation in this case is necessary, since the blood flow is markedly reduced. This, in turn, leads to a reduction in the amount of oxygen that must be supplied to the heart. It is this deficiency that provokes the occurrence of angina attacks.
Operation cost
Since we found out how stenting is performed, what it is and what it is for, the next important question is the cost of this operation. The final amount depends on many factors. They are affected by:
- Stent type. It comes with and without coating. The doctor should decide which stent to install, since a lot depends on the condition of the vessel and some individual characteristics of the patient. Naturally, an uncoated stent is less expensive.
- Number of affected vessels.
- The place where the stenting is performed. The cost of the operation largely depends on the clinic in which it is performed. For example, the procedure can be done in Germany in a cardiology center. In addition to the operation, comfortable rooms are offered there for the period of rehabilitation. The cost of treatment can vary from 5,000 to 14,000 euros. Stenting in Moscow will cost approximately 100,000 to 200,000 rubles. But in any case, the cost largely depends on the first two factors.
Preparation for stenting
Before proceeding with the operation, measures are taken to prepare for successful stenting. The first step is coronary angiography. It gives the cardiac surgeon a complete picture of vascular disease. It becomes clear how damaged they are, how many plaques there are and in which arteries they are. Also, if the patient has concomitant diseases, additional studies are carried out.
A few hours before surgery, the person stops eating and taking medications (taken to correct sugar in diabetes) because the stent is performed on an empty stomach. Acceptance or refusal of other medicines - at the discretion of the doctor. Also, in order for the vasodilation to be successful, a special drug called Clopidogrel is prescribed for three days. It does not allow the formation of blood clots. Sometimes the doctor decides to prescribe it immediately before the operation, while increasing the dose. But this approach is undesirable becausestomach problems may occur.
Execution method
The whole procedure is performed under local anesthesia. At the beginning of the operation, a large artery is punctured, which passes through the arm or leg. The choice of the puncture site depends on the surgeon and the patient himself. But most often access to the coronary vessels of the heart is obtained through the leg. A puncture in the groin area is simpler and more reliable. Next, an introducer is inserted into the artery (this is a small plastic tube), it serves as a kind of gate through which the rest of the instruments will be inserted. A catheter is inserted into the introducer, which reaches the damaged artery and is installed in it. The stent is already delivered through the catheter. It is put on a deflated balloon. In order to fix the stent in the right place and not make a mistake, modern X-ray equipment is used. After a control check of the exact location of the instruments, the balloon is inflated, straightening the stent, which is pressed into the walls of the vessel damaged by the plaque. After installation, all tools are taken. Only the stent remains in the vessel forever (in very rare cases it has to be removed). The operation itself usually lasts no more than an hour, but sometimes longer. Much depends on the condition of the vessels and the specific case.
Possible Complications
Like every operation, this one can also have further complications. The most common include:
- Obstruction of an artery that has been exposed tooperations.
- Allergy to a substance that inflates the balloon (the degree of severity varies, sometimes kidney function is impaired).
- The appearance of a hematoma or bleeding in the place where the artery was punctured.
- New vascular diseases, in particular damage to their walls.
- The most dangerous complication is stent thrombosis. It can manifest itself both after a few years, and in a shorter period. It is accompanied by an acute pain attack and requires immediate response and treatment. Otherwise, myocardial infarction may occur.
Also, it's worth noting that because blood flows throughout the body, complications can occur in other arteries that are not directly related to the operation. In addition, it is important to adhere to the diet and drug therapy prescribed by the cardiologist.
Varieties of stenting
But the operation of stenting can be performed not only on the vessels of the heart. If necessary, this type of treatment is performed on the renal arteries and vessels of the lower extremities. Therefore, it is worth considering in more detail these two types of stenting and the cases in which they are prescribed.
Renal stenting
The need for this type of surgical intervention may arise when atherosclerotic plaques appear in the renal arteries. This condition is commonly referred to as vasorenal hypertension. With this disease, plaques form at the mouth of the renal artery. If such a disease is detected, the doctor recommendskidney stenting, since even high-quality drug therapy may not give the desired results. Such an intervention is a sparing therapy, since it is possible to avoid an open operation. The procedure is performed on the principle of stenting the coronary vessels of the heart. Balloon expandable stents are also used here. Before the operation, the kidneys are examined using X-ray equipment with a preliminary injection of a contrast agent. This is necessary in order to determine the anatomy of the pathology.
After stenting, a sick person stays in the intensive care unit for several hours. After this time, he is sent to a regular ward. If the operation was performed through the arm, the patient can get up and walk on the same day. In the case of a femoral stent, the patient does not rise until the next day.
Atherosclerosis and stenting of vessels of the lower extremities
Peripheral arteries are responsible for delivering blood to the legs. But they can also form atherosclerotic plaques, which cause impaired blood flow. There are several signs of a malfunction in the circulation of the lower extremities, but the main one is the appearance of pain in the legs while walking. At rest, these sensations recede. Sometimes there may not be such pain, but cramps, weakness or a feeling of heaviness in the legs are not excluded. These symptoms can occur over the entire surface of the limbs: in the feet, legs, thighs, knees, buttocks. When this problem is foundthe doctor may recommend stenting. This method is considered one of the most effective in this disease. The whole procedure is carried out according to the same principle as during stenting of the coronary vessels of the heart.
We looked at some questions that explain how stenting is performed, what it is, in what cases it is necessary and what complications can be. But in order to decide on such an operation or refuse it, it is important to talk with a cardiac surgeon who can explain in more detail all the pros and cons of this procedure.
