Common types of coronary stents used in Vietnam

Posted by Doctor Nguyen Van Phong - Cardiology Center, Vinmec Times City International Hospital

There are many types of coronary stents used in Vietnam such as bare metal stents, drug-eluting stents, self-absorbable stents, etc. They have different advantages and disadvantages. Depending on the patient's condition and ability to pay, the patient can choose the appropriate type of stent.

Percutaneous coronary intervention is a technique that uses a small catheter (catheter) to insert a small balloon into the lumen of a blocked coronary artery, then dilate and place a stent to re-open the blood flow. Unlike coronary bypass surgery, which requires opening the chest, coronary intervention can be performed by simply opening a small hole in the skin to insert a catheter into an artery in the thigh or wrist. The patient will be numbed at the puncture site, so in general, this procedure is not more painful than a blood test. The patient remains awake throughout the procedure. During a coronary angiogram, your doctor will show you the narrowed/obstructed coronary artery, the location of the blockage, and the extent of the damage that requires angioplasty and stenting. The procedure is usually done within 1 hour and most patients can go home 1-2 days after the procedure is over.
In stenting, a stent is placed outside a balloon that is attached to a special guide wire. When the balloon is inflated, the stent opens and presses against the wall of the coronary artery. When the balloon-carrying wire is removed, the stent will remain in the lumen, acting as a support to prevent the lumen from narrowing.

With each method of balloon angioplasty or different types of stents used in coronary intervention, there are different advantages and disadvantages.

As the first method, ushering in the era of interventional cardiology. Depending on the damage to the coronary artery, the doctor may use a special small balloon to dilate the narrow blockage in the coronary artery. This balloon helps open the blockage by forcefully pressing the plaque against the vessel wall, opening up the artery. A few subsequent dilations may be necessary with larger balloon sizes or with higher pressure to reduce the degree of obstruction. Usually, balloon angioplasty can reduce the degree of stenosis by 20-30% and then a stent is needed to prevent restenosis.
Advantages: Widen blood vessels, relieve angina. Disadvantages: Rapid coronary artery contraction, high restenosis, rapid symptom recurrence and rapid coronary events.

Second revolution. A stent with a metal frame acts as a support for the lumen, which is placed into the lumen after the narrowing is dilated with a balloon. However, many studies have demonstrated that bare stents have a high rate of restenosis. Currently, few intervention centers still use this type of stent.
Advantages: Less vasoconstriction, low early re-stenosis rate. Cons: Permanent metal frame in coronary artery, endothelium proliferation, late re-stenosis.

Third revolution. Drug-eluting stents are coated with a special drug, which is gradually released into the vessel lumen after stenting, preventing the progression of scar tissue. Thereby helping to keep the coronary artery smooth and the coronary artery not narrow. The rate of coronary re-stenosis was significantly lower with drug-eluting stents than with conventional stents. This is the most commonly used stent today.
Advantages: There are anti-proliferative drugs => Reduce restenosis. Cons: Incomplete endothelium, vasculitis response, increased risk of thrombosis.

New generation stents. The stent is self-dissolving after a while, the lumen returns to its natural character. In addition, the rack is also covered with a layer of medicine to prevent re-stenosis. However, studies have shown that the rate of events occurring after the intervention using this type of stent as well as the limited indications on some lesions makes the use of this stent not yet popular, still in the process of being used. further research and development.
Advantages: reduce thrombosis, reduce the duration of dual antiplatelet therapy. Cons: High cost, limited indications on some lesions.

Currently, drug-eluting stents are the most commonly used stents, performed in most cases requiring coronary stenting. Stents coated with coronary artery drugs cost about 45-50 million VND/stent. In addition to the cost of buying stents, patients need to pay additional costs: bed, test, angiography - intervention, consumables during the procedure, medication, treatment, etc. .. The average cost of a stenting intervention at Vinmec International General Hospital is from 150 to 200 million VND. The cost of coronary stents is also partially covered by health insurance.

Attention on activities and exercises: Patients should exercise gently, travel within short distances, and limit climbing stairs for the first 3 days. Avoid lifting heavy objects, exerting strength,... Avoid participating in sports that require a lot of strength such as soccer, jogging, playing badminton, tennis... for the first few weeks. About diet: It is necessary to maintain a healthy diet for patients with coronary artery disease; Limit foods high in fat, salt, and sugar and increase green vegetables, soluble fiber from unrefined grains. Adherence to drug use: Use anticoagulants and other therapeutic drugs strictly as prescribed by the doctor. Absolutely do not stop or quit smoking without the prescription of the interventional cardiologist. Patients should be periodically re-examined to monitor their cardiovascular status after stenting, or re-examine immediately if abnormal symptoms are found. Coronary stenting is a technique that requires a high level of experience of the doctor and the perfect coordination of the team. At Vinmec International General Hospital, with a team of specialists with many years of experience in specialized fields, and complete and modern specialized equipment. Cathlab room with state-of-the-art equipment such as DSA angiography machine, meets the requirements of coronary angiography and intervention with the most modern minimally invasive techniques.
Inpatient area with a completely separate disease prevention system, full of supporting equipment and facilities. The clinic is also equipped with state-of-the-art cardiac diagnostic equipment such as 2D and 3D echocardiography machines with full features of transesophageal and chest wall ultrasound, electrocardiogram machine, Holter blood pressure machine, Holter electrocardiogram machine. chart, electrocardiogram stress machine, ... bring optimal treatment results for customers.

Reference source: updatetodate.com; vnha.org.vn