Vascular angioplasty and stent placement are minimally invasive cardiac procedures used to treat vascular obstructions. This treatment primarily targets stenosis or blockages caused by atherosclerosis, employing catheter techniques to insert metal stents into the blood vessels to restore blood flow and reduce the risk of myocardial infarction. The procedure is typically performed in a catheterization lab, utilizing imaging guidance to ensure precise operation.
The main goal is to relieve obstructions in the coronary arteries, carotid arteries, or peripheral arteries, thereby improving tissue oxygenation. Compared to traditional open-chest surgery, this non-surgical approach offers advantages such as minimal trauma and quick recovery, making it a first-line treatment option for cardiovascular diseases.
Vascular angioplasty is divided into plain balloon dilation and stent placement. Stent placement can be further categorized as:
The metal structure of the stent remains permanently within the vessel, supporting the vessel wall and maintaining lumen patency. Drug-eluting stents release anti-inflammatory drugs such as TNF inhibitors to inhibit smooth muscle cell proliferation, reducing restenosis rates to 5-10% within two years.
This procedure is mainly indicated for stable angina, acute myocardial infarction, and other coronary artery diseases, especially when the blockage exceeds 70%. It is also used for carotid artery stenosis (blockage >60%) to prevent stroke, or for peripheral artery disease causing intermittent claudication.
Patients with vascular obstructions unresponsive to medication or with vascular anatomy suitable for percutaneous intervention are candidates. However, overall patient condition, such as renal function and bleeding risk, must be evaluated.
The procedure is performed under local anesthesia with the patient conscious. A catheter is punctured through the femoral or radial artery, guiding to the lesion site. After dilating the stenosis with a balloon, a stent is implanted. Typically, 1-3 stents are placed in a single session, adjusted according to the length of the blockage.
The operation lasts approximately 30 minutes to 2 hours, with hospitalization for 1-3 days. Postoperatively, dual antiplatelet therapy is recommended for 6-12 months, with regular follow-up via angiography or vascular ultrasound.
Main advantages include:
Treatment outcomes for diabetic patients or those with complex lesions (such as bifurcation stenosis) are also significantly improved, making it the standard treatment in most cardiac centers.
Possible complications include:
Emergency Precautions: If chest pain, severe puncture site pain, or limb ischemia occurs postoperatively, immediate medical attention is required. Overuse of anticoagulants may cause bleeding; regular monitoring of platelet function is necessary.
Preoperative requirements include stopping anticoagulants (such as warfarin) 3-5 days prior and undergoing complete blood count, renal function, and vascular imaging. Contraindications include:
Diabetic patients should strictly control blood glucose levels, as hyperglycemia increases the risk of in-stent thrombosis. Avoid strenuous activity within 3 months post-surgery to prevent stent displacement.
When combined with antiplatelet drugs (such as aspirin + clopidogrel), dosage adjustments are necessary to prevent bleeding. Patients undergoing radiation therapy should inform their physicians, as contrast agents may affect renal function.
When combined with oral anticoagulants (such as NOACs), INR monitoring is required. Cancer patients undergoing chemotherapy should evaluate platelet counts to prevent bleeding complications during surgery.
Clinical studies show that drug-eluting stents reduce restenosis rates from 30% to 5-10% within one year. For acute myocardial infarction, performing the procedure within 90 minutes can improve myocardial salvage by 30%.
Follow-up data indicate that the incidence of major cardiovascular events after stent placement is reduced by 40% compared to balloon angioplasty alone over 5 years. The latest bioresorbable scaffolds (BVS) are absorbed by tissue after 2-3 years, though long-term data are still under observation.
Alternative options include:
CABG is suitable for diabetic patients with three-vessel disease but requires open surgery and longer recovery. Medication therapy is suitable for low-risk patients or those unable to undergo invasive procedures, but restenosis rates are higher.
Is it normal to experience leg swelling or tenderness after the procedure? How should it be handled?
Minor swelling or tenderness at the puncture site after surgery is common and usually resolves within a few days. Patients are advised to rest in a supine position, avoid bending the punctured limb, and apply ice packs (15-20 minutes each time). If pain persists beyond 48 hours or redness, swelling, or fever occurs, immediate medical consultation is necessary to evaluate for hematoma or infection.
Do I need to adjust my diet or exercise habits after stent placement?
It is recommended to follow a low-salt, low-fat diet to maintain stable blood pressure and lipid levels, avoiding greasy foods that may induce restenosis. Regarding exercise, once the puncture site has healed (about 1-2 weeks), gradually resume light activity. However, avoid lifting heavy objects or vigorous torso twisting for at least one month to prevent displacement of the stent.
What are the risks and necessity of long-term antiplatelet medication after stent placement?
Patients should continue dual antiplatelet therapy (such as aspirin and clopidogrel) for at least 6-12 months to prevent in-stent thrombosis. Although this increases bleeding risk, studies show that combined medication reduces thrombosis by over 70%. The physician will assess individual coagulation function and history of complications to determine dosage and duration.
When should follow-up vascular imaging be performed? How is the interval determined?
Generally, follow-up with angiography or CTA is recommended at 6 to 12 months post-procedure to evaluate stent expansion and vessel status. For high-risk patients such as those with diabetes, hyperlipidemia, or immediate post-placement incomplete expansion, the interval may be shortened to 3-6 months. The specific schedule should be personalized by the treating physician.
What precautions should be taken before undergoing other surgeries or dental treatments?
Inform healthcare providers about the presence of vascular stents before any invasive procedures, especially if general anesthesia or dental surgery is planned, as anticoagulants may increase bleeding risk. The physician may recommend temporarily stopping antiplatelet drugs before surgery, but this should be carefully coordinated by cardiologists and surgeons to balance thrombosis and bleeding risks.
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