The cardiovascular diseases

THE MYOCARDIAL INFARCTION - HEART ATTACK

- Definition
- A few explanations
- The Symptoms
- How to make the diagnosis?
- Gravity diagnosis and prognosis
- The Causes
- Evolution and complications
- Medical treatment
- The Coronarography
- Treatment by angioplasty or "Stent"
- The surgical treatment
- Monitoring
- Conclusion

TREATMENT BY ANGIOPLASTY or "STENT"

The physician can achieve a simple angioplasty, which means he crushes the lesion present in the heart artery (atheroma plaque) with a small balloon he inflates using a very high pressure. This method is simple but its disadvantage is that the coronary artery can plug after a few weeks or a few months.

Thus, the second possibility consists in achieving the implantation of a spring named “stent” during the angioplasty, which permits to keep the coronary artery open.

These techniques can be achieved in emergency or after the medical treatment (a few days as a rule).

1 - Description of the technique

The technical procedure of the angioplasty is the same as the one of the coronarography apart from its possible achievement in emergency, as the infarct occurs, and the penetration of the pipebeyond the origin of the coronary artery, but up to the level of the obstacle responsible for the infarct.

- Simple angioplasty with the help of a small balloon:

Once facing the obstacle, a small balloon is implanted under radiological control, and then inflatedunder very high pressure (8 bars as a rule), during 5 to 10 seconds. It is then deflated, and a radiological control is made to insure that the obstacle has disappeared.

If the obstacle has not disappeared, a second procedure can be then achieved.

Description of the simple angioplasty technique with an
inflated balloon facing the stenosed area.

- Angioplasty with implantation of a spring (“stent”):

In more and more cases, a prosthesis (or a spring) is implanted into the coronary artery (endoprosthesis or “stent”). This metallic prosthesis looks like a spring and is placed according to the same procedure as the angioplasty.

The spring is slipped at the end of the probe, and then introduced into the coronary artery, in front of the obstacle, then applied onto the artery walls. This procedure is precise and demands a long experience from the cardiologist’s part.

2 - Immediate results of the simple angioplasty with a small balloon

Implanting the balloon:

Coronary arteries made opaque, then implantation of the guide (a small metallic thread) into the circumflex artery and positioning of the small balloon.

Visualization of the balloon implanted in the coronary artery.

Result just after the withdrawal of the coronary artery balloon.

3 - Immediate results of the angioplasty with implantation of an endoprosthesis or "stent"

Implanting the “stent”:

Implanting the stent into the coronary artery.

Results after implantation of the “stent”.
The circumflex coronary artery is open again.

4 - Long-term results (after a few weeks or months) of the simple angioplasty or “stent” angioplasty

a - Simple angioplasty:

In about 50% of the cases, the artery that has been dilated by the small balloon plugs again, within a 6 months mean delay.

When the artery plugs again, the symptoms of the angina pectoris are frequently observed, but sometimes no symptom exists; this is why the physician has an exercise test carried out by his patient.

A new coronarography then confirms the existence of a resurgence of the obstacle in the coronary artery. In this case, a new angioplasty is achieved, associated this time to the implantation of a spring (endoprosthesis or “stent”) keeping the coronary artery open.

b - Angioplasty with implantation of a “stent” (endoprosthesis)

Seldom, the spring (or “stent”) plugs, just after its implantation in the artery.

This phenomenon is due to the existence of a blood clot formed in the prosthesis because of an abnormality of the coronary artery wall responsible for the making of products encouraging the formation of the clots. This blood clot is thus going to plug the coronary artery.

Nevertheless, it can be quickly unplugged thanks to the administration of an anticoagulant treatment. In some cases, if the physician has doubts about the coronary artery permeability, a new coronarography is achieved to check the good position of the spring (“stent”) and to administer an anticoagulant treatment possibly in its direct contact.

As a rule, the short-, middle- and long-term result is very good, as the patient has no longer any symptom of angina pectoris.

These techniques have been trulyrevolutionizing the management of the heart arteries illnesses for a few years.

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File last modified on july 24, 2006