After the stent price cut, some doctors abused the drug balloon, the State Council Information Office: there is still room for the price of the balloon
In the past month, 69-year-old Uncle Wang always felt pain in the chest area. He went to the hospital for examination accompanied by his family. He found that the original hypertension, hyperlipidemia and coronary heart disease were all aggravated . Severe blockage, the other two were also slightly blocked , diagnosed with myocardial infarction.
The doctor immediately suggested surgery to open the blood vessels to relieve the symptoms of myocardial ischemia, but Uncle Wang was afraid of the surgery and worried that after the stent was placed on the heart, the heart would stop beating . Although the doctor explained in detail, he still had many doubts, but the myocardial infarction was serious, and the situation would be very bad if he did not undergo surgery. Danger.
Fortunately, Uncle Wang's son came and finally persuaded Uncle Wang to agree to the operation. During the operation, the doctor opened the blood vessel blocked by Uncle Wang and placed a stent. The postoperative myocardial ischemia was quickly relieved.
Implantation of stents is the most common treatment for heart disease. It can relieve angina pectoris, myocardial infarction, protect cardiac function, and reduce mortality. However, many patients still do not understand or even misunderstand cardiac stents.
1. Put on the bracket, and people will be useless?
Many patients worry that their life expectancy will be shortened after stent surgery, and people will be useless. Is this true?
As far as the current medical level is concerned, the possibility of cardiac stent surgery harming the body is unlikely. Although there are risks, most of them can be avoided . Patients live longer.
According to different postoperative conditions, under the guidance of a doctor, you can formulate exercises that suit your intensity, frequency and time, insist on taking medicines and regularly review, and you can live like a normal person .
Does the heart stent have a "service life" and does it need to be replaced every few years? First, this is a false proposition. The stent placed in the body attaches the plaque to the blood vessel wall and is closely combined with the intima of the blood vessel. With the growth of endothelial cells on the intima of the blood vessel, it gradually covers the trabeculae of the stent. Finally, the stent and the blood vessel wall are integrated into one . .
"Change every few years" is also a misunderstanding. In the early years, the cardiac stent was a "bare metal stent" supported by medical stainless steel. After being placed in the blood vessel, it would stimulate the excessive proliferation of the vascular endothelium, and the intima on the surface of the stent would be excessively thickened. rate as high as 50%.
However, these bare metal stents are rarely used now , and are replaced by "drug-eluting stents" , which are coated with drugs that inhibit vascular endothelial proliferation on the surface of bare metal stents, reducing the probability of vascular restenosis to 10% .
It should be noted that although drug-eluting stents reduce the rate of restenosis, they may also cause the vascular endothelium to not cover the stent trabeculae uniformly. There are certain surgical risks and adverse reactions.
2. Why do some people put 1 bracket and some people want 3 brackets?
All patients have coronary heart disease. Why do some patients have less stents, while others have more stents? In fact, the doctor's judgment is mainly related to the following factors:
· Blockage
Different occlusion sites lead to differences in the number of stents. If the main vessel is blocked and the lesion is short, one stent can be placed. If it is blocked at the bifurcation and there are problems with both vessels on the fork, at least two stents may be placed. In addition, when smaller blood vessels with a diameter of less than 2 cm are blocked, there is generally no such small stent that can be placed.
· Plug length
At present, the longest stent is 38 mm (48 mm at the entrance) and the shortest is 12 mm. If the diseased vessel is within 30 mm, only one stent is required, and if the lesion length is 50 mm, at least 2 stents are required.
blood vessel diameter
If the length of the vascular lesion is not long, but the diameter of the same blood vessel is quite different before and after, 2 stents may be needed at this time.
· Number of blockages
If there are two blockages in one blood vessel and they are far from each other, at least two stents should be placed.
3. Is the "invisible stent" drug balloon abused?
Drug-coated balloon is a new interventional treatment technology. After the common dilation balloon is coated with anti-proliferative drugs and sent to the coronary stenosis, the balloonIt expands, sticks to the inner wall of the blood vessel, and releases the drug for 30 to 60 seconds. After the drug is released from the drug balloon, it is withdrawn from the blood vessel , and no foreign matter remains in the body, which is equivalent to an "invisible stent".Especially in recent years, the usage has increased significantly, and there are even rumors that it will replace the bracket.
Previously, CCTV's "News Investigation" reported that after the price reduction of stents, some doctors did not use stents and switched to balloons.
At the beginning of 2021, cardiovascular doctor Hu Dayi predicted the current situation of stent application after "centralized procurement": the reduction of stent prices does not mean the end of excessive medical treatment. On the contrary, many doctors may turn to drug balloons and degradable stents .
At the briefing of the State Council Information Office in March, Chen Jinfu, deputy director of the National Medical Security Administration, responded to reporters' questions. After the stent procurement the previous year, the use of stents has increased, and the use of drug balloons has also increased significantly. However, the drug balloon is not included in the centralized collection, and there is room for price, so there are falsely high components . Last year, the centralized collection of drug balloons was carried out in Jiangdu and other places. This year, it will be expanded to the whole country to block this falsely high space.
As for whether the drug balloon can replace the stent? Not likely at the moment. Stent implantation is still the mainstream of interventional treatment of coronary heart disease. Drug balloons are only suitable for a small number of patients , and the price is about ten times that of stents. There are still limitations in clinical practice.
In addition, stents and drug balloons have strict user groups.
• Cardiac stent is suitable for patients with moderate to severe angina pectoris with poor drug treatment effect and coronary artery stenosis of more than 75%. It is also suitable for acute myocardial infarction.
• The drug balloon is suitable for in-stent restenosis, bifurcation lesions, small vessel lesions and patients with bleeding tendency.
Whether it is a drug stent or a drug balloon, no treatment method is perfect. However, with the continuous development of new technologies for coronary interventional therapy, I believe that in the future, patients with coronary heart disease will definitely have more choices in treatment and a better tomorrow!
References:
[1] "The price of heart stents has been reduced, can you be safe? All the issues you care about are here". Public Health Magazine. 2020-12-15
[2] "Do cardiac stents have a "service life"? Why do I still insist on taking medicine after the heart stent is placed? ". Human Health. 2022-04-07
[3] "Does Heart Stent Surgery Reduce Life? He is still alive 18 years after stenting, and his experience is in two sentences". Chronic Diseases. 2021-03-07
[4] "Drug-coated balloon or stent, which one is better? 》.Healthy China.2022-01-08
[5] The Abused Stent: How to Save You, Heart? ". Sanlian Life Weekly. 2021-06-23
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