Dr. Borisov, what is new in the treatment of coronary narrowings?
- State-of-the-art polymer stents are used in the treatment of coronary narrowings. Their main advantage is that after 3 years the stents are completely resorbed and disappear. The patency of the treated artery is not only preserved after the "melting" of the stent, but its lumen even increases, because the absence of a stent allows the artery to continue to grow.
You said that after the stent disintegrates, the artery continues to grow. Does this mean she will recover and not need a new stent?
- This means that she has recovered - her functionality is fully restored. This is actually the purpose of this treatment.
What material are the new stents made of?
- The new type of stents are made of a specific polymer - polylactate. Placed in the artery, for 3 years the polymer breaks down to lactic acid and is resorbed by the patient's body. Conventional stents are metal, most often made of chromium-cob alt or platinum-chromium. They remain in the body forever, which in some ways brings negatives. The best that can happen to a stent is for it to do its job and then be gone.
Which patients are suitable for the “disappearing” stents?
- The new stents can be applied to all patients where the anatomy of the arteries allows it - that is, before we have done the coronary angiography we cannot say which patient is suitable and which is not. But I expect that in a fairly large proportion of cases treated in the invasive cardiology department of the hospital, the new resorbable stents will be used.
Are there any contraindications for placing them?
- These stents are "gentler", they are made of polylactates. And from this point of view, they are not quite suitable when there is a lot of calcium on the arteries, when in preparation for implantation the artery itself cannot open well. There are also limitations when there are branches of the artery. Usually, such severely altered arteries are mostly in older people, and in younger people this type of stent is more suitable.
In older people, do you then put another type of stent?
- Yes, a drug-eluting stent is more suitable for them, for
to reduce the risk of re-narrowing of the artery
In addition, the side of the stent facing the artery is coated with antibodies for progenitor endothelial cells.
What does this mean?
- This means that it traps these endothelial cells (these are cells that transform into endothelium) in the circulation and they stay anchored in the center. And already from them a normal endothelium develops in the very center. Within just 1 month with this type of stents, we have a completely he althy segment of the artery again at the site of its placement.
This significantly limits the risk of new strictures, stent occlusion and many other benefits for patients.
You recently conducted arrhythmia treatment for the first time in a hospital outside the capital. How is your patient feeling now?
- State-of-the-art American equipment allows us to treat arrhythmias without blood. Indeed, such an operation is being carried out for the first time outside the capital. We applied electrophysiological neutralization of life-threatening cardiac arrhythmia. The device allows us to bloodlessly reach the damaged area of the heart muscle that causes the arrhythmia and literally burn it by releasing radio frequency energy. The site of the arrhythmia is reached via the venous route by precisely introducing special catheters through the veins of the patient's lower limbs. Our first patient is a 76-year-old man from Kazanlashko, suffering for years from cardiac arrhythmia, which was unsuccessfully treated with medication. After the operation, the arrhythmia was completely eliminated, and the patient recovered quickly and his heart is now working very well. The intervention itself was performed by my fellow cardiologists - Dr. Mihail Protich and Dr. Milko Stoyanov.
How have you treated arrhythmias so far?
- Until now, these arrhythmias were treated only with medication, which did not always give results.
There are benign arrhythmias as well as malignant ones,
which are life-threatening. There are also arrhythmias that can be defined as intermediate - they are unfavorable in the long term and lead to deterioration of the patient's condition, to repeated visits to emergency medical centers and often to hospitalization. The availability of this equipment now allows us to definitively treat cardiac arrhythmias in almost 100% of cases.
Bulgaria holds the unenviable first place in mortality from myocardial infarction. Will new treatment methods help control high-risk heart disease?
- Invasive cardiology allows a very precise diagnosis of heart problems and diseases of the vessels of the heart, of the aorta and of the peripheral arteries, of blood supply to the limbs and the brain. Invasive methodology allows problems not only to be diagnosed, but also successfully treated with interventional and operative methods.
Thanks to invasive cardiology, in recent years we have seen a significant reduction in mortality from acute myocardial infarction, unstable angina and other risky heart diseases. If the mortality rate used to be on the order of 18-20%, now it has been reduced several times and is on the order of 3-4%, largely thanks to the invasive methods of treatment.