CC BY
2INNOVATION: THE JOURNAL OF SOCIAL SCIENCES AND RESEARCHES
ISSN: 2181-3868 SJIF-2023: 3.812 | ISI: 0.539 | VOLUME 1, ISSUE 6, 2023
INTERNATIONAL SCIENTIFIC JOURNAL
STENTING OF THE CORONARY ARTERIES: PROBLEMS AND PROSPECTS
Saidov Shodlik
Urgench branch of TMA, 6th year student Sapaeva Dilfuza Narbayevna
Urgench branch of TMA, PhD, associate professor at the department of English language
Abstract. The results of literary analysis on development stages and establishing of interventional surgery have been given in this paper. Mostfrequent occurring issues at stenting of coronary arteries have been revealed. The perspectives of developing of interventional cardiology are also studied.
Key words: interventional cardiology, coronary stenting, complicans of stenting.
https://doi.ors/10.5281/zenodo.7666981
Introduction. The beginning of endovascular treatment of arterial atherosclerosis was initiated by S.T. Dotter, M.R. Judkins, who in 1964 reported on the experience of treating patients with atherosclerosis of the vessels of the lower extremities using the method of intravascular dilatation using a system of coaxial catheters. To restore the lumen of the artery through the puncture hole in the passable part of the vessel along the installed conductor, bougie catheters with a successively increasing diameter were inserted in turn. However, due to the fact that coaxial catheters were used only in the treatment of peripheral vessels, this method was not widely used. And only on September 16, 1977, A. Gruentzig for the first time used in humans a double-lumen balloon catheter developed by him, which, using guiding catheters and controlled metal conductors, could penetrate to atherosclerotic plaques in the coronary arteries through a puncture hole in the femoral artery. This method has been called "Percutaneous Transluminal Coronary Angioplasty" by the author.
Main Part. To begin with, it is worth noting that this type of treatment is one of the most effective methods for cardiovascular diseases. This procedure is a surgical procedure. If there is an atherosclerotic plaque in the vessel, it must be expanded to improve the patency of the blood flow. To do this, a special stent is introduced, which will not allow narrowing of the lumen in the affected vessel. Before starting a stent, a person undergoes coronary angiography to determine the location of atherosclerotic plaques and how narrowed the coronary vessels of the heart are. After that, you can proceed to the operation, which is done under local anesthesia. In the process, more than one stent can be installed, but several. It all depends on the number of affected vessels. The procedure itself is safe. On average, the operation takes up to an hour. And the recovery period is very short.
Recommendations for vascular stenting are given by a specialist individually for each patient. He can offer this operation to those people who have a narrowed lumen in the coronary arteries caused by atherosclerotic plaques. Vasodilatation in this case is necessary, since the blood flow
INNOVATION: THE JOURNAL OF SOCIAL SCIENCES AND RESEARCHES
ISSN: 2181-3868 SJIF-2023: 3.812 | ISI: 0.539 | VOLUME 1, ISSUE 6, 2023
INTERNATIONAL SCIENTIFIC JOURNAL
is markedly reduced. This, in turn, leads to a reduction in the amount of oxygen that must be supplied to the heart. It is this deficiency that provokes the occurrence of angina attacks.
Restenoses developing after stent placement in the coronary arteries initiated studies aimed at explaining this fact. Along with doctors and research institutes, these studies were initiated by stent manufacturers interested in eliminating the causes of such complications in order to increase consumer demand for their products in a highly competitive environment.
Under the experimental conditions, after stenting of the coronary arteries, their scanning electron microscopy and OCT scanning were performed.
Given the continuous development of technology in interventional cardiology and the constant improvement of stents, these are not easy questions. Currently, the standard in the design and manufacture of stents are the stages, including the choice of material, shape and diameter of the beams, the formation of a sinusoid, the twisting of a sinusoid into a spiral, laser welding at key points, surface electropolishing, corrugation to reduce the profile. For any stent to be considered a standard, it must meet a range of criteria. Such a stent should take a leading position in the market, demonstrate stable efficacy and safety in several large multicenter randomized clinical trials, including not only ordinary patients, but also patients from groups with a high risk of complications (diabetics, extended lesions, small vessels, patients with acute coronary syndrome, etc.). At the same time, the stent should demonstrate a high degree of safety not only based on the results of randomized trials with even difficult, but still selected patients, but also in large registries that reflect the "real" clinical practice of using various stents over several years.
Conclusion. At present, the nature of these changes is not fully explained and requires further study. One of the hypotheses is based on the results of in vivo animal experiments, in which Everolimus triggered a chain of biological reactions that activate genes responsible for autophagy of macrophages, which form one of the bases of atherosclerotic plaque, causing its indirect "self-purification". Another possible mechanism may be the inhibition of lipoprotein-associated phospholipase A2 (Lp-PLA2), which is responsible for the development of atherosclerosis. Whatever the mechanisms of interaction between bioresorbable stents on the vascular wall, this type of therapy is already called "restorative", as opposed to traditional stenting, which opens a new page in interventional cardiology, which will allow it to make another qualitative leap in its development.
List of used literature.
1. Осиев А.Г., Гранкин Д.С., Бирюков А.В., Редькин Д. А. Стентирование коронарных артерий. Медицинская технология. Новосибирск 2008; 27.
2. Dotter C.T., Judkins M.R. Transluminal treatment of arteriosclcrotic obstruction. Circulation 1964; 30: 654-670.
3. Garcia E., Serruys P.W., Dawkins K. et al. BENESTENT-II trial: final results of visit II & III: a 7 month fol. EuropHeart J 1997; 18: 350.
4. Gruentzig A. Transluminal dilatation of coronary artery stenosis (letter to editor). Lancet 1978; 1: 263.
INNOVATION: THE JOURNAL OF SOCIAL SCIENCES AND RESEARCHES
ISSN: 2181-3868 SJIF-2023: 3.812 | ISI: 0.539 | VOLUME 1, ISSUE 6, 2023
INTERNATIONAL SCIENTIFIC JOURNAL
5. Hanke H., Strohschneider Th., Oberhoff M. et al. Time Course of Smooth Muscle Cell Proliferation in the Intima and Media of Arteries Following Experimental Angioplasty. Circ Res 1990; 67 (3): 651-659.
6. Hanratty C., Walsh S. Longitudinal compression: a «new» complication with modern coronary stent platforms--time to think beyond deliverability? EuroIntervention 2011; 7(7): 872-877.
7. http://www.tctmd.com/show.aspx?id=1103769.
