Coronary Heart Disease-Cardiac Stent and Bypass Surgery

According to the 2013 edition of the China Cardiovascular Disease Report, Cardiovascular diseases have long surpassed tumors, respiratory diseases, trauma, It has become the leading cause of death from diseases in China. About 3.5 million people die each year from cardiovascular diseases, or 9,590 per day, That is, about one person dies of cardiovascular diseases every 10 seconds. What is more noteworthy is that In the 1990s, Cardiovascular disease is also a affluent disease among high-growth urban dwellers, Now, With the improvement of living standards, In the past five years, the proportion of deaths caused by cardiovascular diseases has been comparable between urban and rural residents. It accounts for about 40% of all deaths among Chinese residents, It is estimated that more than 200 million people suffer from various cardiovascular diseases. Knowledge of cardiovascular diseases is so important. However, according to a large-scale online survey in the first half of this year, The awareness rate of cardiovascular disease-related knowledge is very low even among young and middle-aged people with high school education or above. Even fewer have received CPR training, This is in sharp contrast to the fact that simple rescue equipment can be found everywhere in public places in western developed countries. Therefore, we hope to write a series on cardiovascular diseases and spread more scientific information to the public on the most important issues. A few months ago, an online article full of errors < < Terrible Heart Stent! Let’s Rethink Wicked Surgery > > is widely circulated. Even though many professional organizations and media have refuted the rumor, this article is still circulating in social media. This time we will start with coronary heart disease, cardiac stenting and bypass surgery, and talk about coronary heart disease, a disease with a prevalence rate of 15.9 ‰ in urban areas of China, and its treatment.

First, coronary heart disease-the most deadly blood vessel [traffic problems]

The full name of coronary heart disease is [coronary atherosclerotic heart disease], It can also be called coronary heart disease. The heart is one of the most important organs in the human body. The coronary arteries are exactly supplying blood to the heart. The heart does work day and night. Therefore, the blood supply from coronary arteries to the heart must not stop at all times. We can understand that, The coronary artery is a highway, To deliver the most needed blood to the heart in time, If the road gets narrower, It may not be enough to affect traffic at first, Narrow to a certain extent, Less blood will be transported, It will not be enough, Symptoms such as angina pectoris and corresponding cardiac dysfunction. Once this road is blocked, There is no other path to the corresponding heart part, After a period of time, myocardial necrosis will occur, This is often called myocardial infarction. Coronary artery stenosis is usually caused by plaques formed by lipid, thrombus, fibrous tissue, etc. The coronary artery is usually blocked by local aggregation of thrombus. Of course, The actual situation is far from as simple as metaphor. But we can understand that, For coronary heart disease, The things we need to do are: 1. For those problems that have not yet occurred, We need to avoid this kind of [stenosis]. This is the primary prevention of coronary heart disease. We’ll talk about it later. 2. For those that are already slightly narrow, We need to avoid its further narrowing, And prevention of infarcts. This involves long-term drug treatment such as aspirin and lipid-lowering drugs. As well as a scientific and reasonable lifestyle. 3. For the already severely narrow, In addition to preventing infarcts, Try to relieve the stenosis. The most common is what we often call [stenting]. 4. For those who have already suffered from infarction or chronic occlusion, We have to find a way to open the blood vessels (coronary intervention, Placing the bracket), Or re-establish a blood vessel as a bypass (bypass) to restore the blood supply to the corresponding heart part. In recent years, there has been a great controversy over China’s medical system, especially the cost issue. The [stent] and [bypass] mentioned here are often pushed to the forefront by public opinion. In fact, few people understand what [stent] and [bypass] are. Let’s briefly talk about them here.

Second, interventional therapy for coronary heart disease, minimally invasive surgery that saves millions of people every year

Interventional therapy for coronary heart disease, Most of the time it refers to the implantation of [cardiac stents], It is also commonly known in Cantonese as “Tong Bo Zi”. Doctors pass metal guide wires and catheters through the patient’s radial artery (wrist) or femoral artery (thigh root) and other blood vessels. Put it all the way down the blood vessels into the heart, Into the coronary artery, Passing through a narrow or occluded area, Use an inflatable balloon to expand this place, A special tubular metal mesh is used to support the expanded part. Keep the coronary artery open. This method can be used to improve severe stenosis of coronary arteries. It can also be used for first aid of patients with acute myocardial infarction-within a certain period of time when myocardial infarction occurs, stents are placed to open occluded blood vessels, which can save dying myocardium as much as possible. (Coronary heart disease interventional therapy also includes simple balloon dilation, coronary artery rotary grinding and other technologies, but in most cases stent implantation is accompanied)

So, will the stent be narrowed again? This is the main problem of stenting-restenosis. Early coronary stents are [bare stents], The metal is in direct contact with the blood, It is prone to local inflammatory reaction and thrombosis, Therefore, the restenosis rate is relatively high, Half a year as high as 30%. Then a new type of scaffold was born. The coating on the outside of the stent made of anti-stenosis drugs is called [drug-coated stent], which reduces the restenosis rate to 5-10%. The new restenosis prevention drugs currently being developed and [endothelial progenitor cell capture stent] will push the long-term effect of coronary heart disease interventional therapy to a new level.

In short, this therapy is effective for most patients with coronary heart disease, It can be said that the results were immediate. And the trauma is minimal. Since its birth in 1977, Saved countless lives. With the spread of technology, Its application is also increasingly common. The number of coronary heart disease interventional therapy cases in China in 2011 exceeded 340,000, and it is estimated that it will approach 450,000 cases in 2013, gradually approaching the level of 600,000 cases per year in the United States. Although the incidence rate of coronary heart disease in China is still increasing year by year, with the popularization and promotion of interventional therapy methods, the mortality rate of coronary heart disease has already reached an inflection point.

Three, heart bypass, classic surgery is still useful

Cardiac bypass grafting is called coronary artery bypass grafting. As the name implies, a different blood vessel is used to build another road beside the [blocked highway] of coronary artery, so that blood can be transported to the heart from the newly repaired road by [bypass]? The idea of this genius, In fact, it was much earlier than the appearance of stents, It was successfully launched in the United States as early as 1960. It is still one of the most common heart surgeries in the United States. Numerous movies, TV plays and literary works have regarded [heart bypass] as a classic of exquisite surgery to help shape characters. Traditional heart bypass surgery is a thoracotomy, After the heart is exposed, it is connected at both ends by a blood vessel. Bypass the stenosis or occlusion of the coronary artery, This bypass graft is usually taken from the internal mammary artery in the patient’s own thoracic cavity or the great saphenous vein on the surface of the lower leg. When these vessels are not working well, There are many other autologous blood vessels and even artificial blood vessels to choose from. These transplanted blood vessels are not the only blood vessels supplying the original site. So there are other blood vessels that can be replaced after removal. Before interventional therapy for coronary heart disease occurs, Cardiac bypass grafting is the only radical cure for coronary heart disease. In the past 20 years, with the great progress of interventional technology and material science, Interventional stent surgery quickly occupied the mainstream of coronary heart disease treatment. Only let patients choose, most people will not hesitate to choose stent therapy with much less trauma and faster recovery. At one time, there was public opinion that perhaps in the near future, the scope of application of bypass grafting will become narrower and narrower and even will be replaced by stents. Is this actually the case? After 2000, Many large-scale clinical studies have been carried out worldwide, As a result, In some complex coronary heart disease, The effect of bypass is significantly better than that of stent, Bypass grafting has lower mortality, myocardial infarction rate, restenosis rate, etc. Therefore, According to the American Heart Association, In patients with severe stenosis of the main trunk, multiple coronary artery lesions, In the case of severe cardiac insufficiency and diabetes, Cardiac bypass surgery should be the first choice. Of course, Large trauma is not the only defect of bypass surgery. For example, However, the new technology of small incision coronary artery bypass grafting, which has gradually begun in recent years, will not be unobstructed. Advances in technology such as optimal selection of vascular bridge materials and stent implantation in vascular bridges have reduced the harm of such problems. The new technology of small incision coronary artery bypass grafting, It has also brought bypass surgery into the era of minimally invasive surgery. The rapid development of medical technology has continuously updated our understanding of diseases and treatment methods. The ultimate result of pursuing a [arms race] with good curative effect, less trauma and high safety among new technologies is to benefit patients. The answer to [which therapy is better] is often [different from person to person] and constantly changes.

4. End

Whenever we, as doctors, talk happily about a new technology for cardiovascular diseases, There will always be people who will leave the comment that [prevention is the root]. Admittedly, Prevention is necessary, Is fundamental. However, The pathogenesis of coronary heart disease is complex, In addition to the controllable pathogenic factors such as smoking, obesity, hyperlipidemia, hypertension and diabetes, There are also uncontrollable factors such as sex, age and genetic background. No matter how good the prevention is, it cannot prevent the occurrence of diseases 100%. In fact, The proportion of coronary heart disease in our population is already very high, Sixteen out of every 1,000 urban residents are sick, and the number is still increasing year by year. In the near future, it may be a common disease around us. Knowing the main treatment methods of coronary heart disease is actually very helpful to our life. In future articles, we will discuss the issues of prevention and drug treatment.