Propaganda slogan of cardiovascular ultrasound

Severe stenosis of cardiac blood vessels requires cardiac stent.

After cardiac angiography, a patient had 75% stenosis on one side, which was severe stenosis and needed cardiac stent.

Rumors:

Some patients found that the stenosis rate was 75% after cardiac angiography, and they thought that stents must be placed for severe stenosis. In fact, stents are used to improve symptoms. Not every serious stenosis needs stents, and stents can't prevent further aggravation of blood vessels. Only symptomatic drugs and a healthy lifestyle can prevent the deterioration of blood vessels.

How is 75% of vascular stenosis calculated?

In most cases, the doctor will give a percentage judgment by comparing the results from different angles and combining the treatment experience.

Primary lesion: the stenosis is less than 25%, which may not be stenosis, but plaque.

Secondary lesions: 25~49%. We call this stenosis "coronary atherosclerosis".

Grade Ⅲ lesions: 50-74%. Stents or bypass surgery are generally not needed for this proportion of stenosis, because this blood flow is sufficient for the heart and generally does not cause symptoms.

Grade ⅳ lesion: 75~ 100%. According to conventional standards, this degree of stenosis mostly requires bypass or stent. If it is 99- 100%, it is myocardial infarction or vascular occlusion, so it must be treated and rescued in time.

Not 75% of cardiovascular stenoses require stents.

There is generally no dispute about the treatment of the degree of stenosis that is easy to distinguish. For example, if the stenosis is less than 50%, stents are definitely not needed. 90% of severe stenosis definitely needs surgery. But in the face of 75% narrowness, it may be controversial, so how to judge it specifically?

First of all, the undisputed 75% is narrow:

1, left main artery stenosis 75%, must be treated. Because the blood of the heart is supplied through the left trunk, when the trunk narrows by 50%, the blood flow of other blood vessels will be significantly reduced. Treatment must be done at this time, but stents, stents or bypass are not necessary.

2. The stenosis of small blood vessels is more than 75%, and stents are not needed. On the one hand, small blood vessels are relatively less dangerous, on the other hand, too small blood vessels can not be operated, so no special treatment is needed, only drug treatment is needed.

Simply put: the root of the tree is broken and must be treated. If left untreated, the tree may die. There is something wrong with the twig on the treetop, so you can leave it alone. Even if it dies, the tree will be fine.

Second, the controversial 75% stenosis:

1, if the condition is relatively stable, don't put the stent: if the patient's symptoms are atypical, or angina pectoris is relatively stable, or the lesion can be seen to be relatively stable, then you can take medicine first, because there are borderline lesions in clinic, and the effect is very good through a healthy lifestyle combined with certain drugs.

2. If the evidence of unstable angina pectoris is sufficient, the electrocardiogram has dynamic ischemic changes, or the lesions look like unstable plaques, then stents should be placed.

Bottom line: No matter whether the stent is placed or not, the patient's condition should be put first.

An objective criterion to measure whether stents are needed.

In addition to the doctor's judgment, intravascular ultrasound and FFR can also be used to measure whether 75% stenosis has myocardial ischemia and whether stents are needed.

Simply put, it is a miniature ultrasonic wave. Send this ultrasonic wave to the place where the blood vessel is narrow, calculate the degree of stenosis, analyze the nature of plaque, and give out whether there is myocardial ischemia in this diseased blood vessel by computer.

If stenosis is severe and ischemia is severe, stent placement is more objective, and vice versa.

Some people may ask, if you encounter borderline lesions, why not do intravascular ultrasound?

In fact, intravascular ultrasound is not popular at present, and most of them are not covered by medical insurance. Intravascular ultrasound is equivalent to putting a stent. summary

The degree of cardiovascular stenosis is 75%, indicating that coronary heart disease has reached a certain level. Regardless of whether stents are placed or not, patients must adhere to a healthy lifestyle and regular medication.

Generally speaking, don't let go if you can!

Can be infused without instruments;

You can take medicine without infusion;

Take less medicine and not eat more;

You can live healthily without taking medicine!

Rumor expert: Deputy Chief Physician, Cardiovascular Center, Wang Xing 3A Hospital

Evaluation expert: He Yao, former director and researcher of Institute of Geriatrics, General Hospital of Chinese People's Liberation Army.