New Year, New Weather, come and focus on one of our most important organs, the heart.
Drug-coated balloons and stents are both methods of coronary intervention.
Bracket, everyone knows better. What is that drug-coated balloon?
The drug-coated balloon (referred to as the drug balloon) is a new interventional treatment technology. In recent years, the use of drug balloons has increased significantly, and there seems to be a tendency to replace stents.
Many patients have this doubt: drug balloon or stent, which is better?
Bracket, that's right
Loaded into the body
The most widely used stent is the drug-eluting stent, which consists of three parts: a metal stent platform, a polymer carrier, and an antiproliferative drug. Antiproliferative drugs mainly include rapamycin and paclitaxel.
When the stent is installed, the doctor places the drug stent into the coronary artery in a minimally invasive manner. After placement, the stent is like a small umbrella, supporting the narrow blood vessels and restoring the blood supply to the coronary arteries. At the same time, the antiproliferative drug carried by the polymer carrier wrapped in the surface of the metal stent, controlled release in the local diseased tissue of the coronary artery.
Although the rate of intrastentary restenosis of drug-eluted stents decreased significantly compared with traditional bare metal stents, with the increase in the use of stents, the problem of intrastitional restenosis became increasingly prominent, and re-implantation of stents may trigger re-stent stenosis and other risks; and after stent implantation, it also remains in vivo as a foreign body.
Drug balloon,
The concept of treatment is completely different
The drug balloon is a normal dilated balloon coated with antiproliferative drugs (currently mainly paclitaxel) and then delivered to the coronary stenosis of the drug balloon. When the balloon is dilated, it adheres to the inner wall of the blood vessel for 30 to 60 seconds, at which time the drug will penetrate into the subothelial tissue cells of the blood vessels, playing a role in preventing the restenosis of the blood vessels. The drug balloon is immediately withdrawn from the blood vessel after the release of the drug, and no foreign body remains in the body, avoiding the re-implantation of the stent, as if implanting an "invisible stent" for the patient.
Drug balloons
Can replace the bracket
The answer is no.
At present, stent implantation is still the mainstream of interventional treatment of coronary heart disease. After the state's centralized procurement of stents, whether it is a domestic stent or an imported stent, the price is more reasonable and cost-effective. At present, the drug balloon is only suitable for a small number of people, and the price is about 10 times the price of stents, which is still relatively limited in clinical practice. However, with the continuous expansion of the indications for the application of drug balloons and the further decline in prices after centralized procurement by the state, drug balloons will increasingly become the mainstream of interventional optimization treatment for coronary heart disease.
Stents and drug balloons
Each has its own suitable group of people
Cardiac stents are mainly suitable for people
Cardiac stents are mainly suitable for patients with moderate to severe stability of angina with more than 75% narrowing of coronary blood vessels on transcorrectal angiography, or unstable angina patients with poor drug therapy, and also for patients with acute myocardial infarction. For patients with acute myocardial infarction, time is of the essence. The use of stents to quickly open occluded blood vessels has a better effect on the recovery of cardiac function than thrombolysis and drug therapy.
Of course, whether the patient is suitable for stent treatment depends on the type of coronary artery lesion. If it is a simple lesion (1 to 2 stenosis), it is suitable for stent implantation; if it is a severe lesion, such as left main trunk lesion, diffuse lesion, or severe calcification lesion, it is better to undergo coronary artery bypass surgery.
Drug balloons are mainly used in people
1
Re-narrowing in the stent
Drug balloons were first approved for use in patients with intrastent restenosis. Compared with drug stents, drug balloons have no polymer matrix and no metal stent residues, thereby reducing the response to inflammation of the endovascular lining, greatly reducing the risk of thrombosis, and shortening the time of dual antiplatelet therapy (drug stents often require double antiplatelet therapy for 12 months after drug stents, while only 1 to 3 months after drug balloon surgery). In simple terms, stent sleeve stents are more likely to re-block, so drug balloons are the best choice for patients with restenosis in stents.
2
Small vascular lesions
The thinnest stent on the market is currently 2.25 mm in diameter, and there is no stent available for vessels smaller than this diameter. Drug balloons can fill the gap in the interventional treatment of small blood vessel lesions.
3
Bifurcation lesions
The technical operation of the double stent of bifurcated lesions is complex, takes a long time, and is easy to form a metal overlap of the stent and insufficient expansion of the stent at the branch mouth, which is easy to cause recent thrombosis in the stent and re-narrowing at the branch. Drug balloons greatly simplify the management of bifurcated lesions and have a better long-term prognosis.
4
For patients at risk of bleeding
Patients with long-term use of aspirin or contraindications to clopidogrel are more suitable for the drug balloon. Patients at high risk of bleeding include those with mechanical artificial heart valves, atrial fibrillation, and pulmonary artery embolism who have been treated with oral anticoagulants (warfarin, etc.) for a long time.
Summary focus: drug balloons and stents,
So choose
Is it the bracket or the balloon? It mainly depends on the indications. As mentioned earlier, it is better to choose a drug balloon in patients with stent restenosis, bifurcation lesions, small blood vessel lesions, and high risk of bleeding.
In addition, the drug balloon promotes the concept of intervention without implantation, and no foreign body remains in the body after surgery, which can reduce the psychological burden of patients. The drug balloon is also suitable for some patients who are psychologically resistant to mounting the stent: although the inner stent is rejected outside the door, there is still a window of the drug balloon.
In addition, the drug balloon also leaves more room for subsequent treatment of patients, and once re-narrowing occurs, it can be re-implanted into the stent, or reserve the foothold of the bridge blood vessel for coronary artery bypass.
Then again, most patients with coronary heart disease who need intervention may not have to face this choice. Because, the indications for stents are wider and the price is cheaper. Patients who do not have the above special circumstances can choose stents with confidence.
Drug balloons are also not without drawbacks. For example, the use of drug balloons in the main branch blood vessels or in the dominant blood vessels should be used with special caution. The use of drug balloons in the main or dominant vessel requires more experience, so that the probability of unexpected situations is lower.
No single treatment is perfect. This is true of drug stents, and drug balloons are no exception. With the continuous research and development of new technologies for coronary interventional therapy, patients with coronary heart disease must have more choices and a better tomorrow.
Source | The Journal of Popular Health
Author | Department of Cardiovascular Medicine, Second Hospital of Shandong University Gong Yaoyao
Audit | expert of the National Health Science Popularization Expert Database
Department of Cardiology, Beijing Hospital, Wang Fang
Planned by | Wu Weihong tan jia
Edited by | Luan Zhaolin