The number of cases of the development of cardiovascular diseases is increasing every year, and with it the statistics of deaths related to heart failure, myocardial infarction and other pathologies of the heart are corrected. All the same it is a question of the organ providing a blood supply of all human body, and failures in its work necessarily affect the condition of other organs and systems. But it happens that the heart itself suffers from a lack of nutrients. And the reason for this can be a narrowing of the vessels that feed the organ. Effective methods to restore the blood supply to the heart, improving the patency of the affected vessel, is not so much, and one of them is coronary stenting.
Pathogenesis of arterial stenosis
Heart is not in vain compared with the pump, because thanks to him, the blood gets the opportunity to move along the vessels. Rhythmic contractions of the heart muscle provide the movement of a physiological fluid that contains the substances necessary for the nourishment and respiration of organs and oxygen, and then everything depends on the state of the vessels.
Blood vessels are hollow organs, bounded by a strong and elastic wall. Normally, inside the arteries, veins and small capillaries, nothing should stop the blood from moving at a heart rate. But the narrowing of the lumen of blood vessels, the formation on their walls of blood clots and cholesterol plaques is an obstacle to the movement of physiological fluid.
Such obstacles inhibit the flow of blood, and this affects the organs for the blood supply which corresponded to the stenotic vessel, because they now do not receive enough nutrients and oxygen, necessary for normal life.
Comparing the human heart with the pump, one can understand that to exercise its important function this body also needs energy. And her heart gives blood, providing food and breathing myocardium. Blood to heart, in turn, feeds the coronary artery network, any changes in the state of which, including stenosis of blood vessels, negatively affect blood supply and cardiac efficiency, provoking myocardial ischemia, heart failure, heart attack.
What are the reasons for narrowing the lumen of the coronary arteries? The most common cause of this condition is considered by doctors to be atherosclerosis of the vessels, i.e. Formation on the inner layer of their walls of cholesterol deposits, which gradually increase, leaving less and less free space for blood.
Other common causes include coronary artery thrombosis (thrombosis) or spasm of the heart vessels due to GI diseases, infectious-allergic pathologies, rheumatoid and syphilitic lesions.
Risk factors for such problems are hypodynamia (sedentary lifestyle), overweight (obesity), bad habits (eg, smoking), age over 50 years, frequent stresses, taking certain medications, hereditary predisposition and national characteristics.
The appearance of foci of abnormal vasoconstriction, in the treatment of which coronary stenting is practiced, can cause some diseases, besides the above. These include metabolic diseases, endocrine diseases, blood and vascular diseases (for example, vasculitis), body intoxication, arterial hypertension, anemia, congenital malformations of the heart and blood vessels (for example, slowly progressive heart disease with predominance of stenosis).
Since our heart is divided into two parts, to the ventricles of which the blood vessels are brought, the doctors distinguish stenosis of the left and right coronary artery trunk. In the first case almost whole organ of the person gets under attack, in fact the left cardiac ventricle provides with a blood the big circle of a circulation. The most common cause of stenosis of the left artery of the heart is atherosclerosis, in which a gradual decrease in the lumen of the vessel occurs.
If it is a question of the cavity of the artery occupying less than 30% of the initial lumen, one speaks of a critical stenosis that is fraught with cardiac arrest or the development of a myocardial infarction.
With stenosis of the right heart artery, the organ itself suffers, first of all, because the blood supply of the sinus node is disturbed, which leads to cardiac rhythm failure.
In some cases, doctors diagnose concurrently narrowing the right and left coronary arteries (so-called tandem stenosis). If the compensatory mechanism worked during unilateral stenosis and the main part of the work was taken by an intact ventricle, then with tandem narrowing this is impossible. To save a person's life in this case will only help surgical treatment, a more gentle option of which is considered stenting.
The concept of treating vasoconstriction by expanding the stenotic site of arteries with a special framework was proposed more than half a century ago by the American radiologist Charles Dotter, but the first successful operation was carried out only a year after his death. But the evidence base for the effectiveness of stenting was obtained only 7 years after the first experiment. Now this method helps save the life of many patients without resorting to a traumatic abdominal operation.