At the 24th National Cardiovascular Annual Meeting of the Chinese Medical Association, Academician Ge Junbo of Fudan University’s Zhongshan Hospital Ge Junbo looked forward to new developments in cardiovascular interventional diagnosis and treatment in the next 10 years.
First of all, Academician Ge proposed a pan-vascular concept innovation.
In the previous treatment concepts, there was always the practice of treating headaches with the head, and pain with the feet. In fact, human blood vessels are a whole, whether they are cardiovascular, cerebrovascular, peripheral blood vessels, etc., they are all blood vessels. With the increase of age and the presence of various cardiovascular risk factors, atherosclerosis will gradually appear. Under this common pathological feature, corresponding damage occurs in different parts such as the heart, brain, kidney, and periphery.
Pan-vascular in a broad sense also refers to small blood vessels, capillaries, veins and tumors, diabetes and immunity etc.
When the pan-vasculature encounters risk factors such as high blood pressure , diabetes, hyperlipidemia, smoking, infection, genetics, obesity, and immune factors, corresponding lesions will appear.
Therefore, as a whole human being, we need to pay attention to pan-vascular issues. Treat all blood vessel-related diseases as a whole to prevent and treat them. It is necessary to prevent the occurrence and development of atherosclerosis and prevent the occurrence of vascular diseases.
For example, starting from a young age, when human blood vessels are still elastic and relatively healthy, lipid streaks, fibrous plaque formation, and atherosclerotic plaques gradually appear, until plaque rupture, fissure, or thrombosis occurs. This series of evolutionary processes are closely related to cardiovascular risk factors. A comprehensive assessment must be done.
Second, pay attention to residual risk control.
Although some patients are taking medicine according to the doctor's requirements, the effect is not good. After cardiac stent treatment, it did not take long for the heart to become clogged again. What's the reason? Some people say it is a "plaque constitution", just like some people have a "stone constitution".
Actually, there are deep-seated reasons for not controlling it well. It means that the treatment you received did not meet the doctor's requirements. Whether it is not taking enough medicine, improper drug selection, or poor lifestyle control, in short, if the target is not met, there will be residual risks. There are 2 residual risks that
is currently aware of. One is the risk of residual cholesterol , that is, the low-density lipoprotein cholesterol is not controlled below 1.8mmol/L. The other is the risk of residual inflammation. The high-sensitivity C-reactive protein detected by the laboratory test is greater than or equal to 2mg/L.
For the first residual cholesterol risk, the lower the LDL cholesterol is required, the better. If the target cannot be reached, the risk can be further reduced by combining the cholesterol absorption inhibitor ezetimibe, or using the PCSK-9 inhibitor of the "blood lipid vaccine".
The risk of residual inflammation can be achieved by actively controlling the inflammatory response, choosing powerful statin drugs , strictly controlling smoking, etc. to reduce the inflammatory response of the vascular endothelium.
Third, coronary interventional therapy has entered the "implantation-free era."
This is the fourth revolution in coronary interventional therapy. Mainly due to the development of two technologies: fully degradable drug-resistant stents (BRS) and drug-coated balloons (DCB).
Although there are still many areas for improvement in fully degradable drug stents in past studies, they can represent the future trend. At present, the first fully degradable drug stent was followed up for 5 years and it was found that the stent had completely degraded and the patient's prognosis was good . Of course, the existing problems of
will also be gradually improved: mainly including the support force of the stent, the passability of the stent and , the visibility of the stent, the breakage of the stent, the scope of use of the lesion, etc.
The application of drug-coated balloons is also becoming more and more mature. The incidence of adverse reactions is getting lower and lower.
Fourth, coronary interventional treatment has entered an era of precision.
In the past, stent implantation was mainly based on the imaging data of blood vessel stenosis, and whether to implant a stent was decided based on the degree of simple blood vessel stenosis. However, with the rise and development of intracoronary functional technology, the field of coronary intervention is moving towards an era of precision.
Through the development of intravascular ultrasound technology, fractional blood flow reserve (FFR) and other technologies, it can help clinicians more accurately identify which lesions require intervention.
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-