A very small metal spring coil, through the catheter, from the groin aorta sent in, magnified screen, it through the flow of blood, through the chest cavity, circuitous to the heart, in a because of the blockage of just "chiseled through" the blood vessel, stop, the balloon inside the spring coil will be open metal coil, into a hollow "life.
"Is the hospital are putting stents, cardiovascular stent implantation has blossomed everywhere," said a chief physician of a tertiary hospital in Guangzhou worried, should not use the stent with a stent, put 1 can put more than one, general imported stents do not have to be used to use drug-coated stents. Secretary-General of the Guangdong Provincial Medical Association said yesterday in an interview with the author, in order to standardize cardiovascular interventional therapy, all over the country in reference to the national standard for the development of the province's approach, the Guangdong Provincial Medical Association organized a lot of experts, is in full swing to revise the cardiovascular interventional therapy access methods, is expected to be implemented in the second half of the year.
Regarding the phenomenon of cardiac stent abuse, the following are the examples recorded by the author from the cardiovascular industry on July 18th - 20th.
1. The stent was put in the wrong place, and a specialist was called in to "save the day."
There was a patient with less than 30% stenosis of coronary arteries, and the doctor put a stent in his heart, and the stent was installed and stenosed again 5 months later. Like this stenosis 20%, 30% on the installation of stents, in small hospitals to do intervention after coronary artery blockage, and to large hospitals to treat the patient is not in many. Guangdong Provincial People's Hospital Medical Research Center director said that the indications for coronary intervention is that the coronary artery stenosis in about 75%, at least 50%, stenosis of 30% is certainly not advocated.
Generally speaking, after the stent is put in, the blockage of the blood vessel is passed, 3 months to half a year or so, the incidence of blood vessel restenosis is 30--50%. The first thing you need to do is to get your hands on some of the most popular products that you can find on the market, and then you can get your hands on some of the most popular products that you can find on the market.
There is a patient: angina, myocardial ischemia, large blood vessels and distal small blood vessels are blocked, the doctor put a stent in his small blood vessels, blocked blood vessels can not pass, the stent can not be put in, the patient's condition is critical, had to urgently ask for a large hospital cardiac intervention experts "save the scene". Doctors said that the first small blood vessels in the stent is definitely not right. If the blockage area is large, there is a large blood vessel blockage, should be the first in the large blood vessels to put a stent, small blood vessels to put a stent is not useful, if the distal small blood vessels are still blocked, within six hours, the available medication thrombolysis; in addition, can also be an emergency surgery, cardiac bypass.
2. a stent with multiple guidewires two balloons
There is also 1 patient: the doctor put a stent in his heart, but with many guidewires, with two balloon expansion. "This is something I heard from my peers, it's just ridiculous, 1 guidewire more than 1000 yuan, 1 balloon more than 5000 yuan, you can even. Experienced doctors, 1 guide wire is enough, some patients simply do not need balloon dilatation", said another tertiary hospital cardiologist in Guangzhou.
Another patient, listening to the doctor's advice, put 2 expensive imported drug-coated stents, not long after, she died of acute heart attack. Doctors were controversial about this patient's treatment plan and the appropriateness of putting in two drug-coated stents.
3. Reasons for abuse
Is stenting profitable?
In the interview, many cardiovascular doctors mentioned that the incidence of cardiovascular disease is getting higher and higher, and the application of coronary stents has saved countless patients with landmark significance. However, in some medical institutions, under some people, but some changed flavor.
4. Individual doctors do the number of cases and commission linked
It is understood that the imported stents are high-value materials, put a more than 10,000 yuan, imported drug-coated stents are more expensive, the market used more respectively, each 29,500 yuan, 18,500 yuan, which does not include the cost of the balloon, wire, catheter.
Profit-driven medical institutions that do not have the technology, personnel, and equipment are also rushing into the process. According to statistics, more than 40 hospitals in Guangdong have catheterization rooms, and the hospitals that have catheterization rooms are carrying out cardiac interventions, but a few hospitals and doctors do not have the qualifications, and the therapeutic effect is not passable.
A professor from Guangdong Provincial People's Hospital said that some small hospitals misuse stents, which does not exclude the economic interests that drive them. Imported stents are high-value materials, profits will be relatively high, individual hospital catheterization room doctors do the number of cases and catheter commission linked to a patient put 3 stents, that is, 40,000 or 50,000 yuan, to do a patient is equivalent to do 2 or 3.
5. Unqualified technology and equipment induced abuse
"Stent abuse, perhaps also reflected in the experience of technology and equipment," said the Guangdong Provincial People's Hospital cardiac interventionist, coronary intervention, the first thing you need to do is to do coronary arteriography, coronary artery angiography machine is good and bad, big hospitals may use 1000 More than one million dollars a machine, smaller hospitals may use more than 200 million dollars a machine. The angle of view is not so big, the image is not so clear, if the doctor is not experienced enough, some patients with deviated lesions, from this angle, the stenosis is 30%, from that angle, maybe the stenosis is 80%. In the big hospitals, there is no indication at all, but in the substandard hospitals, the stenosis may be more than 70%, which can also lead to stent abuse.
There are also subtle factors at play. The incidence of coronary artery disease is young, just in the prime of life on the coronary artery stenosis, of course, will be worried about fear, once heard of the benefits of stenting how how to not put the stent will have what consequences, the patient will mostly choose to put the stent, and this will also relax the indications.
6. Consequences of abuse
Abuse of stents can easily lead to a variety of complications
"Patients put stents when the blood vessels tear, or blood vessels suddenly blocked death," a doctor who did not want to disclose his name, said that, according to foreign statistics, stent implantation complications is 1%, we have some technical equipment does not meet the standards of the Hospitals, due to the lack of experience of doctors, encountered an emergency, the hospital does not have a strong cardiac surgical support, it is easy to lead to stent abuse a variety of complications.
According to a professor at the Provincial People's Hospital, the full name of the stenting procedure is "percutaneous intracoronary balloon dilatation + stenting", the stent can make the atherosclerotic plaque rupture and make the narrowed blood vessels to expand, so as to improve the symptoms. However, due to the self-repairing ability of human tissues, the endothelium of the blood vessel will naturally proliferate, and the proliferating tissues will crawl along the stent and slowly block the stent's hollow network, resulting in restenosis. If you put a stent on a patient who doesn't need it, and the blood vessels are narrowed again one day, it will be more difficult to treat them, and you will have to do a surgical bypass, and the patient will have to spend money and suffer for nothing.
Guangzhou, a tertiary hospital, a deputy chief physician mentioned, before a small hospital to do cardiac interventional surgery, please ask the big hospital doctors "go to the hole", from July 1, the State Ministry of Health regulations, doctors are not allowed to "go to the hole", the new problem is also A new problem has arisen: if a small hospital still performs stent surgery, it is operated by its own doctors, no matter how much experience they have. This is a very important part of the process, and it is a very important part of the process, and it is a very important part of the process, and it is a very important part of the process, and it is a very important part of the process, and it is a very important part of the process, and it is a very important part of the process, and it is a very important part of the process.
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