Monday 01 May 2017
Modern treatment of cardiovascular diseases: interventional cardiology

Cardiovascular diseases are the leading cause of death worldwide based on data from the World Health Organization. (1) The problem of cardiovascular disease is particularly evident in developed Western societies, where it now belongs to Greece, where nearly half of deaths annually due to cardiovascular diseases. Also an important factor, which often escape from informing the general public, is that now the world's deaths from cardiovascular disease in women have exceeded those of men. So the myth that women are protected in relation to cardiovascular disease apparently shot down, and after the deaths of women who are due to cardiovascular disease (heart attacks, stroke) is first in frequency than any other condition as a benchmark is almost ten times the deaths due to breast cancer.

The last forty years have been many epidemiological studies have demonstrated the importance of different risk factors in the development of cardiovascular disease. Speaking on cardiovascular disease should be clear that the lion's share belongs to atheromatous disease, the progressive deposition of fat content in the arterial wall with narrowing of blood vessels and reduce blood flow of the respective instruments. (2) atherosclerosis is a universal disease that most patients do not only focus on one area but may present clinical findings from various areas of our arterial tree. The most common views are in the carotid system with subsequent stroke, of course, the coronary arteries with subsequent coronary heart disease and myocardial infarction and of course in other peripheral arteries in the form of peripheral vascular disease with intermittent claudication.

The main risk factors are responsible for the development of atherosclerotic disease are five:

 The family history of cardiovascular disease at a young age in first degree relatives (parents and siblings)
 Smoking is both active and passive
 Increased blood cholesterol
 Diabetes mellitus
 Hypertension

Recent years have emerged and several secondary factors such as obesity, physical inactivity, psychological disorders such as anxiety disorders and depression, and more recently the relationship between periodontal disease to cardiovascular diseases. Most studies have shown that most impressive and significant results in reducing cardiovascular deaths are due to measures that are the concern of prevention. Although nowadays there is significant potential for the medication with many excellent medications that reduce cardiac mortality and several invasive or surgical interventions, the fact remains that approximately 70% of deaths prolifthenton achieved by medical intervention due to preventive measures. The central pillars of prevention include the correct diagnosis and treatment of hypertension and diabetes, the regulation of elevated cholesterol levels, smoking cessation and physical exercise. In future, we hope we can have genetic interventions to help and those who have inherited a predisposition for cardiovascular disease.

But once the patients come to us after the occurrence of atherosclerotic disease, no longer talking about prevention, but for detailed diagnosis and proper treatment. The modification of risk factors remain important, but often compounded medication depending on the features and characteristics of each patient's specific circumstances is necessary and the interventional or surgical intervention for the treatment of advanced atherosclerotic disease. Globally, when we talk about interventions epanaimatoseos, that facilitate the passage of blood through stenosed arteries, can now be thoroughly conclude that surgical treatment has assumed a leading position in treating patients with coronary heart disease in relation to cardiac treatment. Specifically, within the last ten years, the initial equivalence of 1 to 1 of angioplasty with coronary artery bypass (by pass) in the U.S. has now definitively overturned and now about 75% of patients with coronary artery disease treated with surgical operations and only 25% driven in cardiac treatment. (3) Similar rates are found in Europe, while in Greece angioplasty procedures have increased considerably in recent years.

The history of ceramics began in 1977 with the first such intervention takes place in Zurich a young man 37 years by the late Andreas Gruentzig. Since then, the route of the specialty of interventional cardiology has been accompanied by numerous and significant technological advances in the most excellent clinical results. Over time, perhaps the most important disadvantage of an angioplasty intervention was that at the expansion of stenoseos ensue after a relatively short period of restenosis and need for the patient to undergo a second surgery. That is also the reason why the view circulating in the general population that the benefits of angioplasty are temporary. Perhaps the best answer to that long-term effects in some patients were very even the first days of angioplasty provides the clinical course of the first patient 30 years after anterior descending angioplasty remains an excellent result as shown by recent coronary angiography.

The next very important development which marked a new era in the field of interventional cardiology has been the discovery of the stent. These metal rings or endostefaniaies intentions are permanently placed during angioplasty and achieve much higher rates of immediate success, significant reduction of complications, and significant reduction in restenosis rates to approximately 15% of patients. Almost immediately after their appearance, dominated by the stent against the simple angioplasty in the treatment of coronary artery disease and contributed significantly to the popularity of interventional treatment of coronary artery disease. The most recent technological developments is that the combination of stent coated with medicines that are released locally leading to a further significant reduction in rates epanastenoseos. Long-term results of four to five years with these new "smart stent» show restenosis rates to single figures and many studies are usually around 5%. (4.5) In conclusion, angioplasty procedures have been developed and improved both the immediate effectiveness and safety with success rates of surgery over 95% and reduced the severity of acute complications of less than 1%, but in the long term effectiveness as the need for new surgery for restenosis is limited to rates below 5%.

Finally, perhaps the biggest advantage and the main reason that most patients prefer treatment over invasive surgery is the minimum total charge that accompanies the surgery. Usually then, a patient undergoing angioplasty at the hospital stays only 24 hours within one week may return to normal activities. Moreover, it is particularly important for patients to comply with the appropriate accompanying medication, particularly the adoption of dual antiplatelet therapy to prevent late complications of stent placement namely thrombosis.

Newer techniques are also available to us and is useful at a rate of approximately 5% of interventions, including systems and athirektomis thromvektomis (devices that can remove part of the plaque or thrombus). Specific examples are directed athirektomi and rotary athirektomi and reolytiki thromvrktomi. The use of these devices should be used to shape and anatomical whitewashed rough bottlenecks so as to allow the placement of stent. Also at our disposal for difficult cases and there endostefaniaios ultrasound (IVUS), who through a catheter passing in coronary arteries, gives ultrasound sections of the vascular wall, allowing more accurate measurements of the rate stenoseos, and components a plate. So, nowadays with the help of all these advanced techniques can go to specific niche operations depending on the circumstances of each patient and each failure, thereby ensuring excellent results for most patients. (6)

Interventional cardiology has also been extended to correct congenital heart disease without the need for open cardiac surgery. The most important example and perhaps the most successful intervention is the valvuloplasty of pulmonary valve and the mitral valve in which the majority of patients have excellent long-term results without the need for reintervention. The last years have also created several systems convergence (common name: umbrellas), which help address the majority of mesokolpikon communications specific kinds ventricular septal defect, as well as convergence of the foramen ovale in patients who have undergone clinical events. In some patients, remain an open foramen ovale contributes to unexplained ischemic events (myocardial infarction, stroke, etc.) and in selected patients, the convergence of the foramen ovale may lead to prevention of new ischemic episodes.

Lastly, modern and quite new development is a percutaneous (interventional) replacement heart valves. This technique is in its infancy in our days for patients who can not undergo the classical cardiac surgery due to high risk. There is great research activity in this area and it is probable that a significant proportion of cardiac valvular heart disease in the future be treated invasive. (7)

In conclusion, the most effective method of reducing cardiovascular disease remains prevention. Despite technological advances and discoveries of new drugs in the greatest benefit to the general population and patients with cardiovascular disease remains the modification of risk factors mentioned above. Also, the attendant medication as appropriate depending on the characteristics of each patient and where appropriate served or invasive Cardiac surgery, can also significantly improve the life expectancy of patients with cardiovascular disease. With regard to intervention, the interventional cardiology through technological developments and new innovative techniques fairly claim to dominance in the treatment of patients with atheromatous disease and gradually extended in later entries.

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