What is coronary intervention? Who is it for?

  Interventional treatment of coronary artery disease is based on catheterization (also known as coronary angiography) and the use of interventional means, such as balloons and stents, to dilate narrowed or (and) occluded coronary arteries in patients with pathological changes, for the purpose of treating coronary artery disease. Among them, percutaneous coronary angioplasty is the most commonly used and it is the basic technique of coronary intervention.  Percutaneous transluminal coronary angioplasty, commonly known as PTCA, is derived from its acronym in English. This technique is performed under local anesthesia using percutaneous puncture by inserting a thin catheter called a guiding catheter into the artery from the root of the wrist or thigh and sending it upward to the opening of the left or right coronary artery, and then injecting a contrast agent through the guiding catheter. After the site of the stenosis and the lesion are accurately determined, a thin guidewire is sent into the coronary artery and a way is made to cross the stenosis or occlusion of the coronary vessel to the distal end of the vessel. The doctor selects the appropriate type of balloon according to the caliber of the vessel, delivers it along the guidewire to the lesion site, and inflates the balloon with a pressure pump to enlarge the lumen of the narrowed or occluded lesion for the purpose of treating coronary artery disease. During the pressurization process, as the balloon temporarily blocks the blood flow, it will cause myocardial ischemia and some patients may experience chest tightness or chest pain, then, the patient should not panic and tell the doctor, who will promptly deflate the balloon and the symptoms will disappear.  PTCA is generally used in patients with coronary heart disease who still have symptoms after medication, including  Patients with acute myocardial infarction can open the blocked coronary artery with a balloon in time to save the ischemic myocardium and reduce the area of myocardial infarction if they are seen in time and the onset of symptoms is within 6 hours. The importance of time should be emphasized here because there is a very clear relationship between the time of onset and the amount of surviving myocardium. The shorter the time between onset and consultation, the more myocardium can be saved through treatment, the better the preservation of cardiac function, and the better the prognosis. Therefore, prompt medical attention should be sought after the onset of the disease. PTCA can also be performed in patients who have had a recent acute myocardial infarction and will be helpful in improving myocardial ischemia and long-term prognosis. Such patients should preferably undergo PTCA 1-3 months after the onset of myocardial infarction, because the earlier it is performed, the easier it is to succeed; on the contrary, if the lesion is completely blocked for more than 6 months, the success rate will be significantly reduced.  2. Patients with recurrence of chest pain after coronary artery bypass grafting.  Patients with coronary artery disease will have significantly increased risk and mortality when performing bypass surgery again. After clarifying the lesion, interventional treatment can be performed on their own coronary artery bypass vascular lesions to improve the patient’s symptoms and quality of life.  Another type of interventional treatment is stent implantation, which is performed after the balloon is pre-dilated and the doctor carefully delivers the balloon catheter containing the stent to the lesion, and after accurately positioning the stent in the proper position under a fluoroscope, the balloon is pressurized and dilated through a pressurization device connected to the balloon catheter. As the balloon expands, the stent unfolds, and the stent complements the inner wall of the vessel until it matches the size and shape of your vessel. The balloon is then deflated, the balloon catheter is withdrawn, and the stent is left in place and supported on the vessel wall.  Stents are generally suitable for: 1. Conditions that are prone to complications after PTCA. Such as significant entrapment after balloon dilatation, severe intimal tears or acute occlusion of the coronary artery.  2. Lesions prone to restenosis. Such as lesions of the proximal middle segment of the anterior descending branch, completely occluded lesions bypass vascular lesions, etc.  3. Vascular lesions that have been treated with PTCA and underwent postoperative restenosis. It should be noted that not every patient and not every vessel must be implanted with a stent, for example, if the vessel is too small or if there is a contraindication to anticoagulation, a stent cannot be implanted. In addition, it is not necessary to implant a stent if a balloon dilation results in the same outcome as a stent implantation, because the long-term prognosis of patients who achieve such an outcome is similar to that of stent implantation.  In recent years, other interventional techniques have been applied in the clinic, including coronary plaque spinning, plaque spinning and grinding, and laser angioplasty. At present, interventional techniques have become indispensable for the diagnosis and treatment of coronary heart disease.