Our heart works non-stop throughout our lives, pumping blood to all our organs. The heart muscle does not get tired, but it constantly needs clean, oxygen-rich blood. In order for the heart to work this way, it must be constantly supplied with clean blood. We call the vessels that feed the heart muscle Coronary Arteries. Atherosclerosis (arteriosclerosis) is an abnormal process that occurs with the accumulation of fatty particles in the vessel wall and blocks the space of the vessels, preventing normal blood flow. The disease caused by atherosclerosis in the coronary arteries is called Coronary Artery Disease. Personal and environmental factors play a role in the development of atherosclerosis, and personal factors include first-degree relatives with Coronary Artery Disease, Hypertension, High Cholesterol, Diabetes, age and unclarified genetic factors. Environmental or acquired risk factors are smoking, high cholesterol diet, stressful and passive lifestyle. Fat accumulations that develop in the heart vessels over time prevent the blood flow in the vessels, disrupt the nutrition of the heart muscle, and initiate the patient's complaints. The most common complaint is chest pain. Apart from this, it may also cause tightness, tightness and burning in the chest. If the narrowing of the coronary artery occurs suddenly and blood flow cannot be provided from another place, a heart attack (myocardial infarction) occurs. The accompanying rhythm disorder and the pump power of the heart may decrease significantly or even stop completely, and the patient may die if not intervened. The diagnostic tool that best shows the structure of the coronary vessels is coronary angiography. After coronary angiography, drug treatment can be decided without any further action. To open appropriate stenosis or obstruction, balloon angioplasty and/or stent (steel cage) may be applied or coronary bypass surgery may be recommended.
PERCUTANEOUS CORONARY INTERVENTION is a treatment attempt to open a narrowed or blocked vessel in the same session. Balloon dilation is performed in the cardiac catheterization laboratory using catheters designed for this procedure, which are similar in structure to the catheters (thin, long, soft plastic tubes) used in angiography. Specially designed in the stenosis area within the vein Stenosis is eliminated by controlled inflation of the balloon. When the balloon is inflated, it pushes the plaque against the artery wall. After the balloon is removed, blood flow is restored from the blocked area. The procedure usually takes less than half an hour. Nowadays, stenting is generally performed on patients who have undergone balloon surgery. Rarely, in some patients, only the balloon procedure is sufficient. Coronary Stent: Coronary stents have been developed to eliminate some of the difficulties encountered in balloon treatment and to provide better blood flow in the opened vessel and have been widely used since the 90s. Coronary Stent (steel wire cage) is a system that is mounted directly on the inner wall of the vessel after balloon treatment in the coronary vessels or sometimes without balloon treatment. One or more stents may be required depending on the length of the narrowed area. Within weeks, these stents are covered with an endothelial layer and the stent remains in the vessel wall for life. With the development of technologically better quality stents over the years, this initiative has somewhat reduced the need for By-Pass surgery. The success rate of balloon and stent application is between 90-95%. There is a 5-20% chance of narrowing (restenosis) again within a six-month period. If there is narrowing within the stent, a balloon or stent can be applied again. After stent placement, the patient may be taken to the coronary intensive care unit, depending on his condition. The hospital stay is usually 1-2 days. It is very important to keep the treated leg straight for the first 6 -12 hours after the procedure. Other Interventions There are some special wig-based coronary interventions. These; Procedures performed on long-term occluded (CTO, chronic total occlusion), bifurcation and bypass vessels are longer, more complex and require more specialized devices. There are other types of interventions that can be used in cases where the stenosis area in the vein is curved, has irregular walls, is long, chalky, and rough in structure, and adequate patency cannot be provided with a balloon/stent. These are: Laser, which opens the stenosis by burning it away; rotablator, which rotates at a very high speed and opens the stenosis with crystal protrusions placed on a small ball at its end; Atherectomy is the procedure that cuts and cleans the rough structures in the stenosis.
Every invasive procedure There is a certain amount of risk. The risk of complications (undesirable events or consequences) of balloon angioplasty and stent procedure is low. Sudden vascular occlusion (acute occlusion) occurs with blockage in the vessel in which the stent is inserted during the procedure and within the first 24 hours after the procedure. Although this risk of occlusion gradually decreases, it continues until the 28th day (Subacute occlusion). In order to minimize this risk, it is mandatory to use Coraspin and other blood thinners (one of Clopidogrel, Ticagrelor or Prasugrel) together as recommended by the physician, in people who have stents. The duration of use of aspirin and other blood thinners is generally 12 months, but your doctor will decide this period according to your clinical condition. You should NEVER stop taking aspirin or any other blood thinner without asking your doctor. Most other complications result from sudden vascular occlusion: Heart attack (1-2%), Sudden death (less than 1%), Need for emergency bypass surgery (less than 1%).
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Allergic reaction to local anesthetic or contrast material (medical dye used in the procedure)
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Contrast Substance-related renal dysfunction >
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A stroke that occurs when a clot breaks off from the heart or vessels and travels to the brain.
It is serious enough to require intervention. If the stenosis is left untreated, sudden death, heart attack and subsequent heart failure may occur.
If you have a heart attack (Acute Coronary Syndrome), the treatment is PKI or bypass as a result of your doctor's evaluation. However, in cases of stable coronary artery disease, drug treatment can be used for a while without balloon/stenting. However, this drug treatment is not a definitive treatment for vascular stenosis and the risk of heart attack cannot be completely prevented despite drug treatment. If there is stenosis in the left anterior descending artery (LAD), bypass (open heart surgery) method can be applied as an alternative. Open heart surgery may have surgery-related complications such as heart attack, stroke, and death. However, if there is no problem in the LAD vein, bypass is not recommended and the treatment is PCI.
Call your doctor immediately if you experience the following situations after being discharged from the hospital.
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Newly developing chest pain and increasing pain.
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Fever
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Shortness of breath
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Bleeding from the puncture site or bruising with large swelling on the leg or arm where the procedure was performed.
The lifestyle changes you need to make after percutaneous coronary intervention will be explained by your doctor when you are discharged. These generally include avoiding fatty foods, physical exercise, weight control and quitting smoking.
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