Occlusion of the middle segment of the anterior descending artery. Stenting of chronic total occlusions of coronary arteries in patients with ischemic heart disease

In medicine, at the time of diagnosis of serious diseases, the term "occlusion" is often used. What it is? What pathological changes are behind it and by what signs can the presence of occlusion be determined? We will talk about this in today's article. Let's dwell on vascular occlusion, its symptoms and methods of establishing an accurate diagnosis.

Separately about the concept of occlusion in dentistry

"Occlusion" is a broad term. In dentistry, for example, it refers to any contact between the teeth of the upper and lower jaw. Thus, central occlusion (the arrangement of teeth with the maximum number of interdental contacts, in which the line passing between the incisors of the upper and lower jaw coincides with the conditional middle of the face) is practically the same as the concept of bite. That is, a bite is considered to be one or another ratio of teeth, which is determined in the central occlusion.

In dentistry, there are many types of occlusion. So, very common cases, for example, provoked by underdevelopment or, conversely, its overdevelopment - this is distal occlusion. You have probably observed such a bite: the front upper teeth with it cover the lower row of teeth.

Why is vascular occlusion dangerous?

Physicians, speaking of occlusion, mean the state of any hollow anatomical formation: lymphatic or subarachnoid (subarachnoid) space, etc. - which turns out to be closed as a result of damage to its walls or the appearance of neoplasms that clogged its lumen.

Vascular occlusion is a very dangerous phenomenon, since, for example, a decrease in their patency can lead to a malfunction of many human organs. This type of pathology in medicine rightly belongs to the most dangerous cardiovascular diseases, which, unfortunately, have risen in our time to the leading place among health problems leading to death or severe disability.

Cause of vascular occlusion

First of all, it is necessary to clarify what exactly vascular occlusion is caused by: what this disease provokes and what its symptoms look like. This information is very necessary, since most often the time allotted for the provision of urgent assistance to such patients is calculated literally in hours, or even minutes.

The reasons for occlusion include violations of the integrity of the vascular walls, blood clotting and varicose veins. Often such deviations in blood circulation are associated with the consequences of infectious diseases or their complications, as well as with atrial fibrillation.

As a result of a rhythm failure in certain areas of the heart, small blood clots are formed, which at the time of a sharp rise in blood pressure, stress or physical exertion are thrown out of the atrium and block the vessels that feed the lungs or lower extremities.

The patient, as a rule, feels a sharp sudden pain, since the thrombus presses on the vessel wall, and, expanding it, respectively, on the nerve endings. The pain can cover a fairly large area, and the patient is sometimes not even able to indicate exactly where it is located.

Types of occlusion

Remember, speaking of a pathology called occlusion, that this circulatory disorder in its localization is divided into venous and arterial, affecting the great vessels that feed the human organs, his central nervous system and limbs. And depending on the time and nature of the course of the disease - in acute and chronic forms.

When obstruction of the vessel by any dense formation moving along the bloodstream prevents patency, we are talking about embolism. It causes poor circulation. And thereby provokes a new thrombus formation. This condition is characterized as urgent, requiring urgent intervention. It is reversible only in the first 6 hours, and then leads to tissue necrosis.

Symptoms of Acute Embolism

As you understand, all tissues that end up in the pool of a vessel that have lost their patency undergo necrosis. In order to have time to provide assistance, it is important to know the symptoms that characterize the appearance of a pathological condition:

• acute sudden onset;
• sharp severe pain;
• the skin at the site of the blockage becomes pale and cold to the touch, here after a while cyanosis with a marble pattern appears;
• there is no vascular pulsation at the site of occlusion;
• the skin loses sensitivity;
• the functions of the organ affected by occlusion are disrupted.

What are the reasons for the violation of the patency of blood vessels

To accurately determine the cause of the occlusion of the artery, there are several definitions.

• So, for example, an embolism is a blockage caused by a blood clot (blood clot) moving through the vessel. And most often, heart disease is at the heart of this phenomenon. They also cause blood clots in the cavities of the heart.
• And thrombosis is a blockage formed by blood clots that have appeared on the walls of blood vessels as a result of blood stagnation.
• Obliteration is the closure of the lumen with an atherosclerotic plaque in atherosclerosis or its narrowing as a result of changes in the vessel walls that occur when
• An aneurysm is a sharp expansion or protrusion of the walls of a vessel that appears as a result of thrombus formation and often leads to embolism.

Lesion of the vessels of the lower extremities

Occlusion of the lower extremities should rightfully be placed in a separate section, since medical statistics record that half of all known cases of blockage occur in the femoral or This pathology is divided into acute and chronic.

Symptoms of the acute form have been studied in detail, described and reduced to five main signs, the manifestation of at least one of which requires urgent diagnosis and treatment. They are all listed in the section on signs of acute embolism. Failure to diagnose and take action can lead to irreversible tissue changes and loss of a limb.

This acute pathology is treated surgically. At the onset of the disease, therapy is aimed at restoring blood circulation, and in situations of gangrene development, limb amputation is required.

Chronic occlusion - what is it?

In the case of a chronic form of the disease, at the initial stage, patients complain of quickly onset fatigue when walking, pain that appears in the calf muscles, a feeling of freezing of the limbs, as well as a change in skin color on them.

In the future, a characteristic symptom of the disease becomes. It is caused by pain that appears in the calves and makes it stop. The patient waits for it to subside and can walk again. Constant pain, by the way, is a sign of progressive or significant limb occlusion.

Examination of the patient shows a change in tissues: the skin is atrophied, pale, there is no hair on it, the nails are thickened and crumble. Necrotic changes are manifested at first by a spotted blue discoloration, mainly in the area of ​​the sole and toes. The addition of an infection, as a rule, leads to gangrene. In the initial stages, pathology is treated conservatively in a hospital setting and is aimed at restoring blood circulation and improving metabolic processes.

Chronically occluded coronary arteries make up a significant part of coronary lesions detected in patients with coronary artery disease (IHD) during diagnostic coronary angiography (CAG) and, in a certain clinical situation, requiring myocardial revascularization.

Thus, occluded coronary arteries are detected in about 40% of patients, and coronary angioplasty on chronically occluded coronary arteries accounts for 10-20% of all interventional procedures.

Many authors refer to the fact that in angioplasty of chronic coronary artery occlusions, the percentage of successful interventions is lower, while the irradiation time is longer and the cost of the procedure is higher than in angioplasty in patients with stenotic lesions.

In the Scientific and Practical Center for Interventional Cardioangiology (SPCIC), during the planned diagnostic CAG, complete chronic occlusions of 1-2 or more coronary arteries are also quite often found. In this connection, we conducted a study aimed at assessing the effectiveness of endovascular treatment of chronically occluded coronary arteries.

In the NPTSIK in the period from October 1997 to December 2002. 380 attempts were made to mechanical recanalization of chronically occluded coronary arteries in 375 patients. At the same time, the procedures were recognized as successful in 253 patients (67.5%), in whom 258 segments were recanalized. In 122 cases (32.5%), the recanalization procedure was ineffective.

Guiding recanalization and coronary angioplasty of the occluded artery were performed in 107 patients in 107 segments; recanalization, transluminal balloon angioplasty (PTCA) and stenting - in 146 patients who were recanalized in 151 segments.

In our study, 2 cases (0.53%) had complications - rupture of the coronary artery of the anterior interventricular branch of the left coronary artery (LAD) and right coronary artery (RCA), which required surgical intervention - embolization and suturing of the artery, respectively. Both patients are alive and discharged from the clinic.

This study presents the results of examination and treatment of 185 people with coronary artery disease who underwent the procedure of recanalization of a chronically occluded coronary artery and who underwent a follow-up examination, including coronary angiography.

The patients were divided into 2 groups: 146 patients underwent stenting of 151 segments after recanalization of a chronically occluded coronary artery, and 107 patients underwent PTCA. The study did not include patients who had the procedure in the acute stage of myocardial infarction (MI), as well as patients who had undergone previous procedures on coronary vessels.

Diagnosis of ischemic heart disease and its forms was carried out on the basis of a thorough history taking, electrocardiography (ECG) data, Holter ECG monitoring, echocardiographic study (EchoCG), veloergometric test (VEM), clinical and biochemical blood tests (CPK, CPK-MB, AST, LDG, cholesterol and blood lipid spectrum). All patients underwent selective coronary angiography and left ventriculography (VV) to assess the state and degree of coronary artery disease, contractile and functional ability of the left ventricular (LV) myocardium.

The indications for the endovascular procedure were attacks of angina pectoris, signs of myocardial ischemia, according to 24-hour ECG monitoring, as well as positive results of stress tests.

The clinical characteristics of patients are presented in ... In the overwhelming majority of cases, functional class III (FC) of exertional angina was observed - 60.0 and 72.0% in 2 groups, respectively. Exertional angina of FC I was not observed in both groups of patients in the study. Painless myocardial ischemia was detected in 3 (4%) patients from the PTCA group.

80% of people from the first group and 86.7% of patients from the second group had previously suffered myocardial infarction, hypertension of various stages and duration was detected, respectively, in 60.9 and 69.3% of patients.

Type 2 diabetes mellitus suffered from 7.3% of patients in the stenting group and 5.3% of patients in the PTCA group. In all cases, there was an average severity of the course of the disease. Type 1 diabetes mellitus did not occur in our study in any case.

The estimated duration (“age”) of occlusion was defined as the period of time from a previous myocardial infarction in the area supplied by the occluded artery, or from an episode of angina pectoris of greater than usual intensity. Duration of occlusion up to 3 months. was observed in 46.4% of patients from the first group and in 46.7% - from the second group. The "age" of occlusion is from 3 to 6 months. was detected in 30.9% of patients in the first group and in 25.3% of patients in the second group, from 6 to 12 months. - 14.5 and 17.3%, respectively, over 12 months. - 8.2 and 10.7% of patients, respectively.

To clarify the nature of coronary lesions and assess LV function, all patients underwent selective CAG and left VH. Lesions stenosing the lumen of the coronary artery by more than 50% were considered hemodynamically significant.

The total number of hemodynamically significant atherosclerotic lesions (more than 50% of the arterial lumen) was 248 in 110 patients in the stenting group and 152 in 75 patients in the PTCA group. Most of the lesions were localized in the LAD and RCA.

Most often, the procedure was performed on permanent residence - 50.45 and 56.0%, in the first and second groups, respectively. On RCA, 25.67% of procedures were performed in the stenting group and 21.30% in the PTCA group. On the circumflex branch of the left coronary artery (OV LCA) - 19.47 and 17.30% of procedures, respectively.

All patients received symptomatic therapy, which included the appointment of nitrates (nitrosorbide, cardiket, mono mac), β-blockers (atenolol, concor, egilok, betalok-ZOK, dilatrend), calcium antagonists (amlovas, norvasc, normodipine, lacidipine), ACE inhibitors (enalapril, prestarium, fosinopril) and statins (zokor, liprimar, simgal).

The immediate angiographic success of the procedure in patients after stenting and balloon angioplasty was quite high, residual stenosis did not exceed 30%, and antegrade blood flow in all patients was defined as TIMI III. In the overwhelming majority of cases, the diameter of the stented segment practically did not differ from the adjacent intact segments of the coronary artery.

Various stents were used for implantation, however, the following stents were most often used: BX Velocity (Cordis, Johnson & Johnson) - 26 (23.0%), BX Sonic (Cordis, Johnson & Johnson) - 15 (13.3%), CrossFlex (Cordis, Johnson & Johnson ) - 14 (12.4%), Biodivysio (Biocompatible) - 12 (10.6%), Angiostent (Angio Dynamics, NJ) - 10 (8.9%), Multilink (Guidant, Santa Clara, CA) - 7 (6.2%). The average stent length was 17.96 ± 4.79 mm, the average stent diameter was 2.98 ± 0.27 mm.

In 9 (8.2%) patients, 2 coronary stents were installed in the main artery. In 1 (0.9%) patient, 3 stents were implanted into the main artery.

No acute or subacute stent thrombosis was observed during stenting. Coronary artery spasm after stenting was detected in 2 (1.8%) cases, which required only medical correction. In 3 (2.7%) patients, occlusion of the lateral branch was noted, in no case was it accompanied by significant clinical symptoms or the development of myocardial infarction.

Simultaneously with the main procedure, 31 patients underwent an endovascular procedure on another lesion of the coronary bed. At the same time, one additional procedure was performed in 24 (21.8%) patients, and 2 procedures in 7 (6.4%) patients.

As a result of endovascular treatment, complete myocardial revascularization, i.e., elimination of all hemodynamically significant stenoses, was performed in more than 60% of patients in both groups.

At the hospital stage, the absence of exacerbations after the intervention was noted in 100% of patients in the stenting group and in 98.7% in the PTCA group, i.e., in all patients, endovascular procedures stabilized the state and stopped angina attacks. The development of acute myocardial infarction, the need for surgical treatment was not noted in any case. Hospital mortality was also not observed in our study.

The currently obtained data from randomized trials indicate that late opening of occluded coronary arteries has a positive effect on the incidence of adverse cardiac events in the long term (reduction in mortality, the frequency of recurrent MI), improves LV function, and affects its remodeling after MI.

It was noted that the survival rate of patients 2 years after coronary angioplasty is 98%, and the absence of heart attacks during the same period was noted in 94% of patients.

According to a study conducted by P. A. Sirnes, patients after recanalization, PTCA and stenting of chronically occluded coronary arteries in the long-term period showed a significant improvement in the clinical condition compared to the initial one. Before PTCA, 83% of patients were taking b-blockers and 55% were taking nitrates. In the long-term period, the corresponding figures were 53 and 9% (p< 0,001), хотя не было значительных изменений в приеме антагонистов кальция, диуретиков, ингибиторов АПФ или дигиталиса .

According to the data of our study, in most of the patients before the endovascular procedure, exertional angina of FC III was noted: 60 and 72% in patients of both groups, respectively. In the long-term period, the majority of patients showed a significant improvement in their clinical condition. The absence of angina pectoris was noted in 43.6 and 53.3% of patients in both groups, respectively; angina pectoris I-II FC - in 35.4% in the stenting group and 36.0% in the PTCA group.

An exercise test was used to determine the reserve capacity of coronary blood flow and the effect of myocardial revascularization procedure on it.

Before endovascular intervention, the patients underwent an exercise stress test. A positive result was obtained in 72 (79.1%) patients, negative - in 7 (7.7%) patients. The average exercise tolerance was 65.7 ± 24.1 W. In the second group, during VEM, a positive result was noted in 49 (77.8%) patients, negative in 6 (9.5%). The average exercise tolerance was 75.6 ± 19.9 W.

In the long-term period, in the first group of patients, when performing VEM, a negative result was obtained in 49 (50.5%) cases, a positive result - in 34 (35.1%) cases. The average exercise tolerance was 79.4 ± 24.5 W. In the second group, in the long-term period, the VEM test was negative in 37 (58.7%) patients, in 17 (27.0%) - positive. Average exercise tolerance - 91.4 ± 26.8 W.

Restenosis is a major long-term problem after successful coronary angioplasty.

The frequency of restenosis discussed in the literature for this group of patients varies, apparently, not only because of the difference in the severity of the condition and morphology of the lesion of the operated patients. In modern practice, there are several angiographic definitions of the concept of "restenosis", the measurement methodology for some authors also differs.

The rate of restenosis of PTCA, according to numerous studies carried out in various countries, ranges from 17 to 50%.

According to P. A. Sirnes et al., After balloon angioplasty of chronically occluded coronary arteries, the frequency of distant restenosis is 53%, after stenting of coronary arteries - 40%.

Analysis of our own data (NPTSIK) shows that in the long term after stenting, a good angiographic result of the procedure was preserved in 68 (60.2%) arteries (Fig. 1-3). Stent restenosis was detected in 28.3%, reocclusion - in 11.5% of cases.

Less comforting results were obtained after coronary angioplasty in similar situations: a good result of the procedure was detected only in 41.3% of cases, restenosis at the site of angioplasty was observed in 38.7% of cases, and reocclusion - in 20% of patients.

Thus, in terms of maintaining good results of angioplasty, stenting of chronically occluded coronary arteries has significant advantages over balloon angioplasty.

We believe that with the development of the material and technical base of medical institutions, the accumulation of experience in conducting interventions, as well as a more accurate selection of patients, the proportion of successfully performed procedures will grow.

Based on the foregoing, the following conclusions can be drawn.

• If patients with chronically occluded coronary arteries have clinics of angina pectoris or other signs of transient myocardial hypoxia, especially in the basin of the occluded artery, it seems appropriate to carry out the procedure for recanalizing the occluded artery.
• Stenting after successful recanalization of the coronary artery significantly improves the long-term results of coronary angioplasty.
• Successfully performed recanalization and angioplasty of chronically occluded coronary arteries in the overwhelming majority of cases have a positive effect on the clinical course of the disease.

For literature questions, please contact the editorial office.

D. G. Ioseliani, Doctor of Medical Sciences, Professor
M. V. Yanitskaya, Candidate of Medical Sciences
A. V. Kononov, O. V. Zakharova, P. Yu. Lopotovsky
Scientific and Practical Center for Interventional Cardioangiology, Moscow

31.07.2016

The term occlusion (translated from Latin "concealment") is used in medicine to refer to a wide process of violation of the patency of arteries. Blockage of blood vessels and arteries interferes with the proper functioning of human organs. This pathology leads to serious diseases in the cardiovascular system, leading in the number of people with disabilities and mortality.

Basically, thrombus formation affects the arteries of the lower extremities, cerebral vessels and the retina of the eyes. Vascular lesions of the upper extremities are less common.

Occlusion is associated with spasm or external damaging effects that provoke the formation of a blood clot that clogs the lumen.

As a result, the speed of blood movement decreases, coagulability is impaired, and pathologies arise in the walls of the arteries. These processes lead to oxygen starvation of tissues and acidosis.

Causes

1. Embolism is a blockage of the vessel lumen by the formation of a dense consistency. The cause of embolism is often associated with several factors:

• Arrhythmia. In case of rhythm disturbances, small blood clots appear in some areas of the heart, which, during an increase in pressure, are thrown into the bloodstream and block the vessels.
• The entry of air into the bloodstream as a result of injury or disruption of injection technology.
• Wrong metabolism. Small fatty particles accumulate in one place and lead to the formation of a fatty clot.
• Infections. Inflammatory processes provoke the accumulation of pus or microbes in the lumen of the vessels.

1. Thrombosis is a gradual increase in a blood clot attached to the vessel wall. Thrombosis often occurs with atherosclerosis and creates conditions for the development of embolism.
2. Vascular aneurysm - abnormalities in the structure of the walls of arteries and veins, leading to their protrusion. Aneurysm can be either congenital or acquired.
3. Injuries. When muscle and bone tissue is damaged, large blood vessels become compressed and obstruct blood flow, leading to aneurysm and later occlusion.

A common disease of vascular atherosclerosis can also cause occlusion of varying degrees. It narrows the lumen of veins and arteries, and is also able to move from a mild form to a more severe one, that is, to develop.

Varieties of the disease

Depending on the location of the stenosis, the occlusion can be divided into several types:

Lower limbs

The most common type of pathology. More than 50% of detected cases of vascular obstruction occur in the popliteal and femoral arteries.

It is necessary to take immediate measures for therapeutic treatment if at least one of 5 signs is found:

• Extensive and persistent pain in the lower limb. When rearranging the leg, the painful sensations intensify many times over.
• In the area where the arteries pass, no pulse is felt. This is a sign of occlusion formation.
• The affected area is characterized by bloodless and cold skin.
• Feelings of numbness in the legs, goose bumps, slight tingling are signs of an incipient vascular lesion. After some time, numbness of the limb may be observed.
• Paresis, inability to abduct or lift the leg.

If these signs appear, an urgent need to consult a specialist. With advanced occlusion processes, tissue necrosis may begin, and subsequently - amputation of the limb.

CNS and brain

This type of pathology ranks three times in distribution. The lack of oxygen in the cells of the brain and central nervous system is caused by a blockage of the carotid artery from the inside.

These factors cause:

• Dizziness;
• Memory losses;
• Fuzzy consciousness;
• Numbness of the limbs and paralysis of the muscles of the face;
• Development of dementia;
• Stroke.

Subclavian and vertebral arteries

The narrowing of these large vessels leads to damage to the occipital region of the brain. As a result, the patient develops speech disorders, loss of consciousness, temporary memory lapses and periodic paralysis of the legs.

Retinal vascular occlusion

This type of vascular lesion is the rarest. It is dangerous with an asymptomatic course with a sharp loss of vision. Usually occurs between the ages of 45-50.

Any kind of occlusion of the left or right artery is dangerous, can lead to irreversible consequences for a person.

Symptoms

The fact that the disease has manifested itself is evidenced by a number of signs. Symptoms of occlusion depend on the location of the blockage in the vessel.

Vessels of the heart. Occlusion of the coronary vessels supplying blood to the heart muscle is the most dangerous manifestation of pathology resulting from ischemia or atherosclerosis.

The chronic course of the disease can cause myocardial infarction and death. Signs of blockage of the heart vessels are persistent chest pain (even at rest after taking medications).

Peripheral vessels. Signs of blockage of the vessels of the lower extremities is divided into several stages, which differ from each other.

• Stage 1. The skin is pale, the limbs are cold. With prolonged walking, severe fatigue is felt in the calf muscles.
• Stage 2. In the process of walking, increasing pain occurs, which does not allow moving for longer distances. Lameness appears.
• Stage 3. Incessant sharp pain, even at rest.
• Stage 4. Ulcers and gangrene-like changes form on the skin.

For suspicion of occlusion, it is enough to have at least one of the listed signs.

Cerebral vessels. Insufficient nutrition of brain cells is fraught with strokes, paralysis, dementia and sudden death. Blockage of the carotid arteries is accompanied by impaired coordination, nausea or vomiting, slurred speech, and decreased vision. Ischemic attacks are clear precursors of stroke.

Obstruction arising in the cervical spine is indicated by:

• Gradually increasing pain at the site of the growth of a blood clot;
• There is no pulse in a blocked vessel;
• Lack of nutrition leads to pallor and peeling of the skin, wrinkles;
• Feeling of numbness, goosebumps, paralysis may develop later.

Depending on the side of the occlusion development (left or right), the vision of one or the other eye may be impaired.

Diagnostic research

Occlusion of any shape and stage requires careful examination. Signs of the disease that has arisen are diagnosed, specific studies are assigned. Diagnostics is carried out in stationary conditions.

• The vascular surgeon examines the site of suspected vascular occlusion. Visually, you can distinguish swelling, dryness, peeling and thinning of the skin.
• A thorough scan of the arteries reveals specific sites for the localization of blood clots.
• The blood flow in all vessels is examined.
• In case of insufficient history, X-ray methods and the introduction of a contrast agent are used.

In addition to hardware diagnostics, it is mandatory to study the patient's blood tests, including cholesterol.

Diagnostics allows you to identify the location and degree of obstruction, to anticipate complications.

How to treat

It is possible to treat limb occlusion only after establishing an accurate diagnosis and stage of the disease.

Stage 1 - conservative treatment with drugs: fibrinolytic, antispasmodic and thrombolytic drugs.

Physical procedures (magnetotherapy, barotherapy) are also prescribed, which entail positive dynamics.

Stage 2 is based on surgery. The patient undergoes thromboembolism, shunting, which allows to restore the correct blood flow in the venous arteries.

Stage 3 - immediate surgical treatment: excision of a thrombus with bypass bypass grafting, prosthetics of a part of the affected vessel, sometimes partial amputation.

Stage 4 - the beginning tissue death requires immediate amputation of the limb, since a sparing operation can provoke the death of the patient.

After operations, follow-up therapy plays an important role in the positive effect, preventing re-embolism.

It is important to start treatment in the first hours of the development of the occlusion, otherwise the process of gangrene development will begin, which will lead to further disability with the loss of a limb.

Prophylaxis

A number of measures are used to prevent vascular occlusion:

• Proper nutrition, enriched with vitamins and vegetable fiber with the exclusion of fatty and fried foods;
• Weight loss;
• Constant monitoring of blood pressure;
• Treatment of arterial hypertension;
• Avoiding stress;
• Minimal consumption of alcohol and tobacco;
• Light physical activity.

In a timely manner started therapy with the development of any type of occlusion is the key to recovery. In almost 90% of cases, earlier treatment and surgery restores the correct blood flow in the arteries.

Late start of treatment threatens limb amputation or sudden death. The death of a person can provoke the onset of sepsis or renal failure.

The materials are published for information purposes only, and are not a prescription for treatment! We recommend that you consult a hematologist at your hospital!

Diseases of the cardiovascular system occupy a leading position in the list of causes of death. Pathology of coronary arteries due to atherosclerotic lesions is the scourge of our time. Many methods of dealing with vascular stenosis have been developed, but one thing has not been taken into account - this is only pathogenetic treatment. Until now, no one knows the cause of atherosclerosis.

Coronary arteries ( they are the coronary arteries) - vessels feeding the structures of the heart. They are the only routes for the delivery of arterial blood and essential substances to the heart tissues.

The importance of the coronary arteries is also proved by the fact that they begin their branch directly from the aorta, above the aortic valve.

The location of the arteries of the heart and their anatomical features

With a normal variant of the anatomical structure and location of blood vessels, the heart is supplied with blood only by 2 (!) Coronary arteries: left and right. Sometimes, in a small percentage of cases, a third artery appears - the posterior coronary artery. It happens that the supply of blood occurs entirely through one artery (usually the left one), while the right coronary artery remains underdeveloped or completely absent.

Important! Since blood supply to the heart muscle and endocardium only passes through 2 arteries with poorly developed collaterals, any spasm or occlusion can be critical.

The lumen of the arteries of the heart is approximately 8 mm in diameter. Narrowing of the coronary arteries by more than 2/3 (i.e., 75%) leads to serious ischemic changes in the myocardium and the onset of clinical manifestations, namely angina pectoris in its various forms.

You can also familiarize yourself with the structure in the article on our website.

Pathogenesis of disorders due to diseases of the coronary system

Due to blockage of the coronary artery, ischemic processes begin in the myocardium. Due to the lack of oxygen and nutrients, the heart tissue is forced to "use" an economical type of energy production - anaerobic glycolysis. There are many acidic breakdown products that stimulate pain receptors. In addition, the received glucose is still not enough to meet the needs of the myocardium. The heart is forced to work less - there are symptoms of heart failure.

This video describes the stenting operation

In medicine, there is such a concept as “ acute coronary syndrome"(Abbreviated - ACS) is an acute (urgent) condition, which implies 3 diseases: unstable angina pectoris, myocardial infarction with elevation (elevation) of the ST segment and without such elevation.

Important! ACS is a preliminary diagnosis of ambulance doctors, when the exact pathology of the heart is not diagnosed at this stage, but it is safe to take the patient to a cardiological hospital or cardiac intensive care unit.

Diagnosis of coronary stenosis

Arteries can be examined in several ways. Moreover, one does not exclude, but complements the other:

• clinical picture (patient complaints, anamnesis - who was sick in the family, when the pain began, etc.);
• ischemic changes on the ECG;
• diagnosis of coronary arteries has a "gold" standard - coronary angiography. This is a study of the arteries of the heart with a contrast agent under X-ray control.

Remedies

The main methods of surgical restoration of vascular patency are angioplasty and stenting of the coronary arteries. The first method was popular at the end of the twentieth century, and the second began to be actively introduced at the beginning of the twenty-first century.

Another method used was atherectomy - removal of the atherosclerotic plaque itself. But this procedure is not effective, because does not solve one of the main problems of the pathogenetic mechanism of atherosclerosis - damage to the vessel wall. The plaque was removed, but platelets and aggregating substances again “sat down” on the pathologically altered wall, which increased the risk of repeated thrombosis and subsequent ischemia several times. Now atherectomy is rarely used or only as an adjunct to other procedures.

Until the "zero" years of this century, angioplasty was more popular. The essence of the method was to replace the narrowed ("damaged") part of the artery with an artificial one - a prosthesis made of neutral hypoallergenic material. However, the effect was not as positive as expected. First, at least 2 circular sutures were placed on the artery. The vessel wall was damaged, which promoted even greater adhesion (adhesion) of platelets at the sites of stitching. Secondly, atherosclerotic plaques formed on the material of the vascular prosthesis with the same success as before.

Over the past 15-20 years, stenting has actively entered the cardiological practice. The essence of this manipulation is to install a special cellular metal tube (stent) into the lumen of a vessel damaged by atherosclerosis. This is done using a special catheter, which is delivered through the femoral artery to the coronary artery under X-ray control. If the stenosis is severe, the artery can be expanded with a special balloon before stent placement.

The stent is delivered folded to the site of the stenosis, and in the artery itself it expands. In the unfolded state, the stent is a metal elastic mesh that restores the lumen of the vessel and maintains it in this state.

Indications for stent placement:

• unstable angina pectoris, manifested by severe sudden chest pain;
• the first hours (only the first!) of myocardial infarction for reperfusion (restoration of nutrition) of the damaged area;
• ischemic heart disease with a stenosis degree of no more than 85%.

Contraindications to stent placement:

• severe stenosis of the arteries (diameter less than 2 mm);

Note: 2mm when folded is the smallest possible stent size.

• pathological tortuosity and other congenital anomalies of the arteries;
• pronounced postinfarction scars;
• intolerance to anticoagulants (Clopidogrel or Warfarin), which must be taken within six months after stenting.

Important! Even with a successful cardiac surgery, it must be remembered that this treatment is not a panacea, it will not make the damaged vessel 100% healthy and elastic. Coronary artery disease stays with a person forever.

Earlier in Soviet times, another surgical method for restoring cardiac blood flow was used - bypass grafting. There is an even more precise definition - coronary artery bypass grafting (CABG). The bottom line is to install a prosthesis (shunt) bypassing the narrowed site from the aorta to a healthy area or from a healthy area of ​​an artery to a healthy area of ​​an artery, "jumping" over the stenosis.

Blockage of a coronary artery, or coronary artery atherosclerosis, occurs when the blood vessels that supply blood to the heart become clogged or blocked. This type of blockage significantly increases the risk of heart attack, one of the leading causes of death in both men and women. Many cases of coronary artery blockage are the result of coronary artery disease. Signs of coronary artery disease include chest pain or tightness, cold sweats, and shortness of breath. People who experience any of these symptoms should see a doctor immediately for a diagnosis and treatment. Those at risk of coronary heart disease should take care of making lifestyle and dietary changes to reduce the risk of coronary artery blockage.

Coronary arteries are the blood vessels that supply blood to the heart. Three large coronary arteries are distinguished: the left anterior descending artery, the circumflex artery, and the right coronary artery. Each artery carries blood to different parts of the heart. The left anterior artery delivers blood to the anterior part of the heart, the circumflex artery to the posterior part, and the right coronary artery to the lower part. If any of these arteries become blocked, serious complications can occur, including severe chest pain, heart attack, and even death.

As a person ages, fatty deposits can form on the walls of the coronary arteries.

In some people, these deposits are quite significant and contribute to the blockage of the arteries. They cause waste and other cells to adhere to the walls of the arteries. Over time, these deposits can harden. Hardened deposits called cholesterol plaques can interfere with the blood supply to the heart, causing partial blockage of the coronary artery. If the hard shell of the plaque is damaged or cracked, the body begins to repair the crack. To do this, he uses platelets, which stick to the crack and to each other. This is how a blood clot forms.

A blood clot can block a coronary artery completely. Without a proper blood supply, the heart is deprived of oxygen.

Without sufficient oxygen, the heart is at risk. In the event of a partial blockage of a coronary artery, the person may feel tightness or chest pain when doing hard work or a stressful situation. This is because blood does not travel well through the arteries and does not provide the heart with sufficient oxygen. If there is a complete blockage of a coronary artery, blood flow is completely blocked, which can lead to a heart attack.

To prevent blockage of a coronary artery, you should follow a lifestyle that reduces the risk of coronary artery development. The main risk factor is high cholesterol, so eating foods that are low in cholesterol can help avoid this disease. Procedures such as balloon angioplasty can be used to remove body fat. Doctors may also prescribe medication to keep the risk of coronary artery blockage low and recommend physical activity and other lifestyle changes.