For most patients with coronary heart disease, drug therapy alone is not enough, and cardiac surgeons need coronary intervention or coronary artery bypass grafting. If coronary artery disease is limited to local branch vessels, the scope is not long, and it does not involve the openings of other branches, such patients can be treated by coronary intervention by doctors. Using a special catheter, puncture through femoral artery, like coronary angiography, retrograde into the narrow coronary artery. Then the balloon is used to dilate the narrow part, and then the coronary stent is placed to dilate the narrow coronary artery cavity and let the blood flow through, thus achieving the effect of restoring myocardial perfusion.
Percutaneous coronary intervention has the advantages of less trauma, quick recovery and easy acceptance by patients. However, its indications are narrow, and it is difficult to deal with complex coronary artery lesions such as left main artery lesions, multi-vessel lesions, long-segment lesions, complete occlusion of blood vessels, small vessels and distal stenosis. At the same time, it can not be ignored that restenosis after stent implantation will lead to the failure of interventional therapy because of the retention of foreign bodies. The restenosis rate after early drug intervention was significantly higher than that after bypass surgery, and the survival rate and quality of life did not improve significantly. Its short-term and medium-term effect can even be comparable to that of coronary artery bypass grafting, but its delayed thrombosis and restenosis can not be ignored, and the long-term effect is inconclusive.
Coronary artery bypass grafting, commonly known as coronary artery bypass grafting. The most common vascular materials used for "bridging" are autogenous internal mammary artery, great saphenous vein and radial artery, in addition to the right gastroepiploic artery and brachiocephalic vein. It is suitable for patients with complex coronary artery disease such as left main artery disease, multi-vessel disease, long-segment disease, complete occlusion of blood vessels, small branches, distal coronary artery stenosis, calcification of vessel wall, restenosis after stent implantation, complications of interventional therapy, diabetes and other metabolic diseases.
Generally speaking, all patients who can't receive medical intervention or fail to receive it for various reasons can be solved by coronary artery bypass grafting. With the continuous maturity of CABG technology, the rapid development of off-pump bypass technology, the development of minimally invasive surgery, the application of endoscopic technology, the improvement of preoperative evaluation and preparation, the improvement of intraoperative myocardial perfusion protection technology, the emphasis on the protection and maintenance of bridge vessels during and after operation, and the improvement of postoperative monitoring level, the mortality rate of CABG surgery has been greatly reduced. Many studies have shown that coronary artery bypass grafting has obvious advantages in relieving symptoms. For patients with coronary heart disease, it is very important to restore myocardial blood perfusion, which we call "revascularization". Coronary artery bypass grafting has considerable advantages in blood supply reconstruction. The left internal mammary artery of CABG anastomoses with the left anterior descending branch, and the patency rate of 1 year is 95.7%, and the patency rate of1year is over 90%, which has been recognized all over the world. The long-term patency rate of radial artery as a bridge material is high, the patency rate of 1 year is 90%, and the patency rate of 5 years is 84%. Great saphenous vein is the most commonly used blood vessel, which is easy to obtain, with large caliber and appropriate length. 10 year patency rate is about 50~60%.
Prevention can avoid coronary heart disease. First of all, good living habits are very important. The occurrence of coronary heart disease is caused by many bad habits, such as smoking, high-fat and high-calorie diet and lack of exercise. Smoking may induce coronary artery spasm, platelet aggregation, reduce the reserve capacity of coronary artery and collateral circulation, and also cause hypertension. Bad eating habits can cause hyperlipidemia, obesity and diabetes, all of which are risk factors for coronary heart disease. Therefore, smokers are strongly advised to quit smoking, and obese people should strictly control their weight. It is more important to exercise more than to eat less. Arrange meals reasonably. A reasonable diet can reduce the intake of total fat, saturated fat and cholesterol. Overweight people should limit their total calories. If the blood lipid level is obviously abnormal, a blood lipid regulator can be selected. Take part in moderate physical activities and exercise. Secondly, it is necessary to avoid overload operation. When people reach middle age, various organs are obviously degraded. They should learn to adjust the pace of life and relax alternately. Never let the "engine" in your body run at full speed for a long time. Third, for patients with "three highs" (hypertension, hyperlipidemia and hyperglycemia), blood pressure, blood sugar and blood lipid should be controlled at normal levels. For middle-aged and elderly people, it is necessary to have regular physical examinations and strive to be "active but not greasy, strong but not fat". Fourth, if you have coronary heart disease, you should actively seek medical treatment and don't "avoid medical treatment". Early detection, early diagnosis and early treatment can prevent minor illness from becoming serious illness, which not only costs less, but also has more obvious treatment effect. Ma Jing Xijing Hospital of Traditional Chinese Medicine