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Transcript
Coronary Stents RDSC 326 Basic Anatomy of the Coronary System • Right coronary artery (RCA) • Originates above right cusp of the aortic valve, travels down right atrioventricular groove, towards the crux of the heart • Right marginal artery • Supplies blood to the right side of the heart • Posterior descending artery (PDA) • Supplies blood to the apex of the heart and the posterior ventricular walls Basic Anatomy of the Coronary System • Left coronary artery (LCA) • Arises from aorta above left cusp of the aortic valve • Left anterior descending (LAD) artery • Supplies blood to the anterior walls of both ventricles • Left circumflex artery (LCX) • Supplies blood to the left atrium and the posterior walls of the left ventricle Basic Anatomy of the Coronary System Coronary Artery Disease • Arteries that supply blood and oxygen to the heart muscle become clogged by plaque. • Plaque is the build-up of fat, cholesterol and other substances in the artery walls • Plaque build-up over time: atherosclerosis Coronary Stenosis • A narrowing or constriction of the diameter of a bodily passage or orifice. Coronary Artery Disease • Who is at Risk? • • • • • • • • • • Both men and women High cholesterol levels High blood pressure Diabetes A diet too high in saturated fat Obesity Too much stress Lack of exercise Cigarette smoke intake Family history of coronary artery disease Coronary Artery Disease • Effects • Angina (chest pain) • Dyspnea (shortness of breath) • Coronary Heart Disease (CHD) • Ischemia (decreased blood flow to the heart muscle) • Arrhythmia (irregular heart beat) • Myocardial Infarction (heart attack) Coronary Stents • A tiny coil or mesh tube that is inserted into the clogged coronary artery to form a rigid support which holds the artery open. Coronary Stents • Types of Stents • Mechanism of expansion • Composition • Design Coronary Stents • Mechanism of expansion •Balloon expandable • Stainless steel coil tube •Mounted on balloon catheter •Positioned at the stenosis site •Stent expands with balloon Coronary Stents Coronary Stents •Self-expandable •Placed over a guide wire •Positioned at the stenosis site •Cover is retracted •Self-expands and locks into place Coronary Stents • Composition • Stainless steel • Nitinol • Cobalt-based alloy • Tantalum Coronary Stents • Stainless Steel • Advantages • Small size of the whole system (guidewire, stent, and balloon) • Ability to fit into twisting vessels • Disadvantages • Difficulty in seeing them while positioning • Difficulty in determining their final length upon expansion Coronary Stents • Nitinol (Nickel Titanium Naval Ordinance Laboratory) • A family of intermetallic materials that contain a nearly equal mixture of nickel and titanium • High degree of elasticity • Shape memory Coronary Stents • Design • Coil design • Flexible • Tubular design • More support Express² Stent System Alterative Procedures and Devices • Angioplasty • A medical procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart • Unevenly expands balloon against the sides of the artery lumen • Produces a rough, irregular channel and a rough surface Alterative Procedures and Devices Alterative Procedures and Devices • Coronary Artery Bypass Graft (CABG) • Creates new routes around narrowed and blocked arteries • Saphenous vein, sewn to the coronary artery beyond the narrowing or blockage, other end is attached to aorta • Advantage: • Multiple narrowings in multiple coronary artery branches • People who are not good candidates for balloon angioplasty • Disadvantage: Very invasive procedure Alterative Procedures and Devices How to Prevent Stenting • Exercise • Healthy Diet