What is an angioplasty?
Mini medicine lesson. The arteries that circulate blood in our body are like "pipes" formed of several layers: the outer layer is called the adventitia, the inner layer is called the endothelium and between them is the media.
However, between the endothelium and the media, deposits (of cholesterol, limestone or even foam cells, that is to say immune cells loaded with fat) can accumulate: this is called atheroma plaque. It should be noted that an atheroma plaque can form in an artery of the heart, brain, leg or even the arm.
By dint of thickening, the atherosclerotic plaque ends up obstructing the good circulation of blood: this is atherosclerosis. Worse still: in the event of an "atheroma plaque rupture", the content of the plaque spills into the blood, which leads to an aggregation of blood platelets – we can then see a blood clot, potentially responsible for an accident. cerebrovascular disease (stroke) or myocardial infarction (heart attack).
Who is affected by atheroma plaque? Rather, we observe the development of atheroma plaques in men after 50 years or in women after 60 years. In addition, there are risk factors:
Theangioplasty is an intervention which consists in unblocking an artery narrowed by an atheroma plaque. Concretely, it involves bringing a deflated balloon to the level of the atheroma plate (by inserting it into an artery of the wrist or groin, using a small metal guide) and then inflate so as to "crush" the atheroma plate to reduce its thickness.
Why can't we remove the atheroma plaque? " Current techniques do not completely eliminate an atheroma plaque, explains Dr. Mathieu Bernard-Le Bourvellec, cardiologist. The risk is that the plaque breaks up and ends up in the bloodstream, which can lead to blockage of the artery … and potentially serious consequences. "
Stent: what is it and how does the intervention take place?
Problem: the angioplasty is not definitive and, over time, the atheroma plaque can reform. This is where the stent : this small spring (which has the shape of a flexible pipe: it measures a few centimeters long and a few millimeters in diameter) keeps the diameter of the artery open and prevents the (re) formation of the atheroma plate .
To know. The stent (also known as a stent) is an alternative to bypass surgery – particularly in the coronary arteries. It is a shorter and less cumbersome intervention: it is now preferred.
Stent placement: how does it work? In case of atheroma plaque at the level of a coronary artery, the stent is placed by the cardiologist. First, the doctor will perform a coronary angiography, that is to say an arteriography of the coronary arteries.
The goal ? Observe the arteries and pinpoint the "pinch" where the blood circulation is obstructed. " For this, iodine is injected directly into the arteries of the patient: it is therefore an invasive examination that is only performed if there is a real suspicion of atheroma, explains Dr. Mathieu Bernard-Le Bourvellec. Otherwise, the cardiologist can perform an MRI, a myocardial scintigraphy, a ultrasound or a CT scan of the coronary arteries. "
The stent placement takes place under local anesthesia. " Most often, a night in the hospital is necessary, specifies the cardiologist. But the intervention is done more and more on an outpatient basis: it takes place in the morning and the patient can return home at the end of the day. Observation time of 6-8 hours in the hospital remains necessary. "
The cardiologist injects iodine into the patient to visualize the arteries, then slides a balloon (around which the stent is located) into the bloodstream from the groin or wrist to the affected artery. Arrived at the level of the atheroma plate, the balloon is inflated with a strong pressure: this makes it possible to deploy the stent which is found "pressed" against the walls of the artery. Last step: the balloon is deflated and then removed.
" With a new injection of iodine, the cardiologist checks that the stent is in place and that no additional stent is necessary: indeed, one can put several stent in the same artery if necessary "adds the specialist.
What are the treatments after stenting?
To know. Once installed, the stent no longer moves. " In about 6 months, the body covers the stent with a layer of endothelial cells "specifies the cardiologist.
There are actually 2 types of stent:
- The naked stent: it is "simply" a spring composed of an alloy of metals,
- Active stent: this metal spring releases an immunosuppressive drug in the body for 6 months-1 year. The objective: avoid the proliferation of endothelial cells around the device … which could lead to a reduction in the diameter of the artery!
" After the placement of a stent, drug treatment is essential: patients must take 2 antiplatelet agents (most often:aspirin and clopidogrel / Plavix®) to prevent the formation of a blood clot in the affected artery ", explains Dr. Mathieu Bernard-Le Bourvellec.
" In the case of a bare stent, this treatment lasts about 1 month; in the case of an active stent, it lasts between 6 months and 1 year because the active stent may be responsible for a chemical reaction leading to the formation of a clot. "It is essential to take your treatment seriously:" do not stop it without asking the advice of your cardiologist! "adds the specialist.
Thanks to Dr. Mathieu Bernard-Le Bourvellec, cardiologist at the Institut Cœur Paris Center (ICPC) and author of The heart our other brain (ed. Larousse).
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⋙ Cardiovascular diseases: the essential precautions to take care of your heart
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