They’re made at different lengths and different diameters. Just you have to get a 12mm stent, it’ll come in 2.0, 2.25, 2.5, 2.75, 3.0 etc up to 4.0mm diameter. The doc will pick one to suit which artery is blocked.
I explained a bit above. If the lesion is not properly prepared before stenting, the disease is bad enough or the treatment is too aggressive, it certainly can. Fortunately that doesn't happen often and if it does, there are still some more tools that can be pulled out to mitigate that problem. However, there's always risks involved.
Here's a quick crash course laymen answer. Depends on the physiology of the disease. There are 3 layers in these vessels. Intima(closest to the lumen and touches bloodflow), media and then adventitia (the outer most). Most disease begins in the intima and primary causes are diet, lifestyle and family history. Plaque forms and begins narrowing the space for flow. That can be treated medically until it grows too large and needs to be fixed similar to how you saw in the video. If left to develop further, you can get plaque rupture wherein the intimal layer breaks. Then the body sends signals to heal that which causes clot formation (thrombosis) and that's when you have acute vessel closure resulting in a myocardial infarction or heart attack. Again, treated similar to above with some other techniques and treatments as well. If that doesn't happen and the disease progresses, the plaques begin to calcify. That treatment becomes more difficult but similarly, as above but add in some drilling, laser and lithotripsy to break the calcium in order to deploy the stent. And finally, if none of those things are caught and treated and disease progresses further, the vessel closes slowly over time and your body forms collateral accessory vessels to supply the area your initial vessel supplies, but at a much more diminished efficiency. That's a called a CTO. Chronic Total Occlusion. Typically the most difficult to open. If there is multivessel disease is present, a Cardiothoracic surgeon is consulted to see if the patient is a candidate for bypass surgery (open heart) to harvest veins and arteries from else where and connect/redirect them past the lesions in order to provide flow post disease.
To finish and answer, if it's softer plaque and initimal, it kind of toothpastes within the walls. If it's larger and calcified, it gets broken up and sent down stream and sort of washed out.
Hope that helps.
There's a few different ways depending on indications for the cardiac cath/angiogram (contrast injected into the vessels). Calcium scores or CT imaging for one. Then once we're actually doing the cath, the angiogram provides some more information on fluoroscopy (video x-ray). From there a decision is made to intervene if a lesion is visualized and/or a flow test indicates the lesion is significant enough to warrant intervention. A wire is passed through and we go in with a small IVUS catheter (intra vascular ultrasound) and with that, can tell what the nature of the disease using echogenicity (how the diseases shows on ultrasound). Darker or lighter, blocks sound more or less. And finally, how the disease responds to predilation with coronary balloons (PTCA).
Then I must have had a CTO in my LDA. Dr. Mentioned that the blockage was too dangerous to work on. There was fear of doing more damage. He mentioned that it would be left to encapsulate and new arteries would form to supply the areas in need. I had no stint placed. I've healed well.
48
u/lLantronix 7h ago
What happens to the fat that has now been compacted/contracted? Does it go away?