Coronary Intervention Q&A

First, what is the intervention of coronary heart disease usually referred to as the intervention of coronary heart disease, in the medical profession called “percutaneous coronary intervention (PCI)”, hereinafter referred to as coronary intervention. This includes techniques such as percutaneous transluminal coronary angioplasty (PTCA), coronary stenting, coronary plaque rotational grinding, and laser angioplasty. Internationally, percutaneous transluminal coronary arterioplasty (PTCA) was first applied to the clinic in 1977. In 1984, the first case of PTCA was performed in China, and over the past 20 years, the development of coronary interventional therapy in China has been rapid, and coronary interventional therapy has become a treatment technique that the majority of patients with coronary heart disease are willing to accept due to the advantages of simplicity, safety, no pain, and short hospitalization time. PTCA is the basic technique of coronary intervention. This refers to the use of percutaneous puncture method (puncture the thigh fossa of the femoral artery or the wrist of the radial artery), with a balloon dilatation tube inserted into the coronary artery stenosis site, and then inflated and pressurized, so that the balloon dilatation, through the coronary artery wall of the atherosclerotic plaques on the mechanical extrusion and the role of the tensile, so that stenosis of the lumen of the vessel expansion, reduce the degree of stenosis, increase the coronary artery blood flow, to improve the local cardiac blood supply, thus making the heart ischemia caused by ischemia, and thus the heart ischemia, the coronary artery blood supply. Thus, various symptoms caused by myocardial ischemia, such as chest pain and/or chest tightness, can be reduced or disappeared to achieve the therapeutic purpose. In a small number of patients after PTCA, the dilated coronary vessels may be narrowed again (restenosis) due to various reasons (vascular elasticity, endothelial hyperplasia, thrombosis, etc.), which may lead to chest pain and/or chest tightness again. In order to minimize the occurrence of restenosis and other complications after PTCA, a stent is placed at the site of the dilated vessel after the stenotic vessel has been dilated. The stent is made of alloy and has a very fine mesh-like column shape. The size of the stent is determined by the diameter of the stenotic segment and the length of the stenotic lesion. Over the years, due to the increasing improvement of coronary interventional therapy equipment conditions, good performance of the new equipment (such as stents) and a large number of new devices and doctors continue to improve the level of operating technology, some coronary stenosis lesions in the permitted circumstances, may not be pre-expansion of stenotic lesions section of the blood vessel, and directly placed into the stenosis of the blood vessel site, that is, the so-called “direct stent” placement technology. This is the so-called “direct stenting” technique. It should be noted that after stent implantation, restenosis (in-stent stenosis) still occurs in a small number of patients at the site of stent implantation. For this reason, a so-called “drug-coated stent” has been developed in recent years to reduce the incidence of restenosis after stenting. These stents are coated with a special drug that prevents or minimizes the occurrence of in-stent restenosis. “Although drug-coated stents are more expensive, patients are willing to accept them because of the satisfactory clinical results and the simplicity and safety of the method. Second, which patients are suitable for coronary heart disease interventional therapy in coronary heart disease interventional therapy, often involves “acute coronary syndrome” (ACS) this concept. Clinically, unstable angina, no Q-wave myocardial infarction and Q-wave myocardial infarction are collectively referred to as “acute coronary syndrome”. This is because they share the same acute onset, critical condition, and the same pathologic basis (rupture of unstable plaque and thrombosis in the coronary artery). In short, “acute coronary syndrome” is an indication for coronary intervention. However, as each patient’s specific situation is different, there is a need to differentiate and select. Now on the common clinical indications for coronary intervention for a brief introduction: 1, various types of unstable angina patients: these patients clinically have moderate or severe angina attacks, work and life restrictions, especially in a quiet state or at night also often attack, the effect of drug therapy is not good. 2, acute myocardial infarction patients: acute myocardial infarction is a kind of acute onset of disease, the condition of many changes and the need for timely and correct treatment of the emergency. Whether acute myocardial infarction requires interventional therapy depends on the patient’s condition, but also according to the onset of time, the equipment conditions of the hospital and the development of coronary heart disease interventional therapy technology level and decide. The following situations can be used as reference for interventional therapy. (1) Patients with acute myocardial infarction within 6 to 12 hours after the onset of chest pain. This “time window” is very important, it is generally believed that this “time window” for the so-called “emergency coronary intervention” (can be directly for PCI), can be occluded coronary artery “open”. Coronary artery “open”, restore its ischemia, damage to the blood supply of the myocardium, rescue the ischemic damage to the myocardium on the verge of necrosis, limit the infarcted area, thus stabilizing the condition, reduce complications and improve the prognosis have played a very good role. Many studies have shown that emergency PCI for patients with acute myocardial infarction is significantly more effective than the commonly used “intravenous thrombolytic therapy”. In particular, it should be pointed out that, for some myocardial infarction area is large, especially combined with cardiogenic shock critical patients, in order to save the patient’s life, in order to have a variety of conditions, is also an indication for emergency coronary intervention. (2) Acute myocardial infarction “thrombolytic therapy” failed patients. Because of the failure of “thrombolytic therapy” (or unsuccessful), these patients still have obvious chest pain or recurrent myocardial ischemia (such as electrocardiogram shows that the elevated ST segments do not fall back significantly, and the cardiac status is not good, or even cardiogenic shock, etc.), suggesting that the occluded blood vessels have not been opened, or there is a reinfarction occurred. The so-called “remedial PCI” can be performed in such patients (48-72 hours after the failure of thrombolysis can be performed routinely). (3) Patients with acute myocardial infarction after the acute phase. This type of patients mostly refers to patients within 2 weeks to 1 month or even 3 months after the onset of acute myocardial infarction. If coronary angiography shows occlusion or severe stenosis of the relevant artery in the infarcted area during this period, especially if there are signs related to myocardial ischemia, PCI is useful for preventing dilatation and distension of the infarcted area, ventricular remodeling, and malignant arrhythmias, which is also conducive to the improvement of long-term prognosis of the patients with acute myocardial infarction. (4) For patients who have undergone PCI treatment or coronary artery bypass grafting, if restenotic lesions occur, there will be corresponding clinical manifestations, and such patients can also be treated with PCI. Third, the coronary heart disease intervention should pay attention to what matters 1, for coronary heart disease intervention before, must first do coronary angiography. The so-called “coronary angiography” refers to the application of cardiac catheterization technology, the contrast catheter placed into the coronary artery openings, and then injected directly into the coronary arteries, so as to clearly show (through the film technology) the coronary artery stenosis of the site, degree, nature and other aspects of the situation. Based on these conditions, the treatment method (medication, coronary intervention or surgical coronary bypass grafting) is selected. At present, coronary angiography is a reliable method of diagnosing coronary heart disease, and was previously known as the “gold standard” for the diagnosis of coronary heart disease. 2, for coronary heart disease before intervention, should be in accordance with the requirements of the doctor to take some of the necessary drugs. Such as anti-platelet drugs (commonly used aspirin, clopidogrel, etc.), anti-angina drugs (such as nitrates, beta-blockers and calcium antagonists, etc.), the purpose is to stabilize the condition, reduce or avoid intraoperative and/or postoperative ischemic complications, increase the safety of coronary intervention. 3, after coronary intervention, especially the implantation of coronary stents, should be long-term anti-platelet drugs to prevent the occurrence of restenosis (this is very important, which anti-platelet drugs aspirin, Polivir as long as there is no contraindication to take at least 12 months, the conditions can be considered appropriate to prolong the joint use of time. Aspirin usually needs to be taken for life). In addition, some other drugs such as statin lipid-lowering drugs are also very important and one of the necessary drugs. Also according to the doctor’s request whether or how to take anti-angina drugs. 4, coronary heart disease interventional therapy, strengthen the follow-up work after surgery, is also very important. (1) strengthen the control of coronary heart disease risk factors, including control of blood pressure, treatment of diabetes, smoking cessation, regular exercise, do not overweight, pay special attention to the rational use of lipid-adjusting drugs, strict control of blood lipid levels. Unless the patient can not tolerate, aspirin, statin lipid-regulating drugs and ACEI drugs should be taken for a long time. (2) Regular outpatient follow-up, timely detection and treatment of toxic side effects of drugs and recurrence of myocardial ischemia symptoms. In addition, it is necessary to closely observe the status of arrhythmia and cardiac function. For patients in critical condition with coronary intervention or those with serious abnormal clinical conditions after intervention, coronary angiography is recommended when necessary in order to detect problems and deal with them in a timely manner.