Coronary angioplasty with the implantation of medicated stents
When is this procedure indicated?
The angioplasty procedure is indicated if critical stenoses are found on coronary arteryography.
How is it performed?
The procedure generally takes place in the same session as the diagnostic coronarography, and, like the latter, is performed under local anesthesia using a radial arterial access or femoral arterial access, through which a guiding catheter is inserted with which the coronary artery to be treated is cannulated. Heparin is administered during angioplasty to prevent thrombotic phenomena.
The coronary narrowing is crossed using a guide wire, over which a balloon is run and placed at the level of the stenosis and inflated to crush the plaque against the vessel walls. After predilatation, the coronary stent is implanted, a metallic device capable of adhering to the vessel walls and ensuring the patency of the coronary artery.
The stents currently implanted are "medicated" stents, which release an antiproliferative drug at the level of the vessel walls in order to reduce the incidence of new narrowing (restenosis).
In case of particularly calcified lesions, our Hemodynamics Laboratory uses the Rotablator, an instrument capable of milling coronary calcium or intracoronary lithotripsy (shockwave) capable of splitting the calcium by shock waves, allowing an adequate expansion of the stent subsequently implanted.
On the other hand, if there is a narrowing of a previously implanted stent (intrastent restenosis), it is possible to perform a new angioplasty with a special type of balloon that releases an antiproliferative drug to prevent future narrowing (medicated balloon) or place a new stent.
Our Hemodynamics Laboratory also offers treatment of particularly complex coronary lesions, such as chronic total occlusions (100% coronary narrowing). This type of surgery, like a traditional angioplasty, is performed under local anesthesia, but in this case generally two arterial accesses are required to simultaneously visualize the occluded coronary artery and any collaterals. The coronary artery is reopened using dedicated guides and microcatheters either anterograde (starting from the occluded coronary artery) or retrograde (through the collateral circles). Once the vessel is reopened, coronary angioplasty is performed, which involves dilating the lesions and implanting medicated stents.
Patients are generally discharged the day after angioplasty, with the indication for a double antiplatelet therapy (in order to prevent stent thrombosis) that should be continued for a period of at least 6 months.