Percutaneous coronary interventional therapy (PCI), commonly known as cardiac interventional therapy or heart stent implantation, has experienced more than 40 years of rapid development since its inception in 1977 and has become one of the most commonly used and mature technologies for treating coronary heart disease . It is a treatment method to clear the narrow or obstructed coronary artery through specially made catheters, guidewires, balloons and stents under the guidance of an angiography device. Improvements in operating devices, especially the emergence of drug stents, have greatly improved the prognosis and quality of life of patients. The main surgical steps of PCI are as follows:
1. Puncture
After local skin anesthesia, the arterial puncture is performed. The most common thing in the past was transfemoral artery puncture. With the improvement of technical level and the development of equipment, transradial artery puncture is generally chosen, and transradial artery puncture causes less damage and inconvenience to patients.
2. Insert the guidewire and catheter
After the artery is successfully punctured, an arterial sheath will be placed at the puncture point to facilitate the passage of the guidewire and the contrast catheter. The surgeon pushes the guidewire and the angiography catheter forward along the radial artery or femoral artery , all the way to the root of the aorta, which is the site where the coronary artery is emitted. The angiography catheter is placed into the coronary artery opening and then withdraws the guidewire.
3. Coronary angiography
Inject contrast agent from the external end of the contrast catheter, and the contrast agent enters the coronary artery along the catheter. At the same time, the contrast agent can be displayed under X-ray fluoroscopy, that is, it can be seen whether the coronary artery is stenosis or occlusion, the location and extent of the stenosis or occlusion. Through the contrast results, we can determine whether most coronary artery blood vessels need to be placed in stents. If the stenosis of the left main trunk exceeds 50%, or the stenosis of the three main vasculature exceeds 70%, then the stent needs to be placed in stents. For critical lesions, further intravascular ultrasound/coronary flow reserve fraction/optical coherence tomography (OCT) and other examinations are needed to help judge.
4. Stent
For patients who need to put stent , the surgeon will send the stent along the guide tube to the lesion position, and use an inflatable balloon to spread the stent. The opened balloon and stent can clear the narrow area, restore blood flow to smoothly, thereby improving myocardial ischemia .
5. Exit the catheter and bandage
After the stent is placed, the guide wire, catheter, and sheath are successively removed, and the pinholes of the radial artery or femoral artery are pressurized and bandaged.
6. Postoperative precautions
Radial artery bandage is generally used to use radial artery compressors. After the operation, the punctured arm should be kept elevated; the compressor should be decompressed once every 2 hours and removed after 8 hours; the hand should not be exerted within 1 week after the operation to prevent the wound from collapsing. The compression of femoral artery is done using a bandage "8-character bandage". After the operation, the horizontal braking is required for 16 to 24 hours. After the operation, drink more water, 1000 to 2000 ml of water within 6 to 8 hours to speed up the excretion of contrast agents and reduce damage to the kidneys. It is advisable to eat a light and easy-to-digestible diet on the day after the operation.
Source : Xu Yawei, Fan Lihong and others edited the text, written by Li Shuang, Liu Weijing, Shen Jianying, Zhang Hengbin, Chen Yingqun, Yao Jianhua, Sun Yifan, Sun Yujing, Hong Liqiong, Jiang Rong, Xu Yuanhong, Zhu Yidong, He Li, Zang Yingjun, Sun Xiao and others.
illustration production : Dai Huacheng.
