Preface

Wide range of lesions: involving two or more coronary arteries, and the length of each vessel is long, not a limited "single point blockage".

Poor vascular conditions: often accompanied by vascular calcification, twisting, and fine branch involvement, the stent is difficult to completely cover all lesion sites, and the risk of restenosis after surgery is high.

Symptoms are more stubborn: patients often present with chest tightness, chest pain, shortness of breath after repeated activities, and in severe cases, angina pectoris will also occur at rest, and even gradually develop complications such as heart failure and arrhythmia.

For this complex lesion, the core principle of clinical treatment is "individualized comprehensive intervention", and it is often difficult to achieve the desired effect by a single method, and a combination of methods is required:

1. Coronary artery bypass grafting (bypass surgery) – the preferred surgical option

This is one of the most established and effective means of treating diffuse lesions, especially for patients with severe multivessel involvement.

Principle: Take the patient's own blood vessels (such as the internal breast artery of the chest and the saphenous vein of the legs) and build multiple "vascular bridges" to allow blood to bypass the diffusely blocked blood vessel segments and directly supply blood to the ischemic myocardium.

Advantages: It can solve the blood supply problem of multiple blood vessels at one time, and the long-term patency rate is high, which can significantly relieve angina symptoms, improve heart function, and reduce the risk of myocardial infarction and death.

2. Conservative treatment with intensive drugs – basic treatment for all patients

Regardless of whether surgery is performed or not, drugs are the key to controlling the progression of the disease, and for patients who are intolerant to surgery, standardized medication is the core means. It is necessary to follow the principle of "sufficient dose, sufficient treatment, individualization":

Antiplatelet aggregation: dual antiplatelet drugs (such as aspirin + clopidogrel) to prevent thrombosis and avoid aggravation of blood vessel blockage;

Lipid regulation and plaque stabilization: high-intensity statins reduce blood lipid levels, stabilize plaques, and prevent plaque rupture and acute myocardial infarction;

Improve myocardial ischemia: β receptor blockers, nitrate drugs, etc., to reduce cardiac oxygen consumption and relieve angina symptoms;

Control of underlying diseases: Strictly control blood pressure and blood sugar, and use targeted drugs to maintain indicators within the ideal range to reduce further damage to blood vessels.

3. Emerging minimally invasive treatment methods - new solutions for difficult coronary artery blockages

With the development of interventional techniques, minimally invasive methods can also be tried for diffuse lesions, providing new directions for patients who are intolerant to bypass surgery:

Drug-coated balloon: no need to implant a stent, the balloon with antiproliferative drugs will expand the diseased blood vessels, and the drugs will be attached to the blood vessel wall to inhibit intimal hyperplasia, which is suitable for diffuse lesions with small blood vessels and stent restenosis;

Precise intervention under the guidance of intravascular ultrasound (IVUS): through ultrasound, the lesions of the blood vessel wall can be clearly seen, and the treatment site can be accurately selected, reducing blind operation and improving the treatment effect;

Combined treatment of plaque rotation + drug-coated balloon: first grind the hard calcified plaque in the blood vessel, and then treat the lesion segment with a drug balloon, which is suitable for diffuse lesions with severe calcification.

4. Strict lifestyle interventions – the "cornerstone" of delaying the disease

Diet: low salt, low fat and low sugar, eat more vegetables, whole grains, high-quality protein, avoid fatty meat, animal offal, and pickled foods;

Exercise: After the doctor's assessment, do gentle exercises such as walking and tai chi to avoid strenuous activities; stop immediately if you feel uncomfortable during exercise;

Quit smoking and limit alcohol: Completely quit smoking (including second-hand smoke) and strictly limit alcohol intake;

Emotional management: avoid overwork and emotional agitation, ensure adequate sleep, and reduce the burden on the heart.

With the development of medical technology, some new minimally invasive methods can also deal with some special blood vessel blockage problems.

Drug-coated balloon: The balloon with the drug is sent to the blocked blood vessel, and the drug will adhere to the blood vessel wall after dilation, inhibiting the proliferation of the endometrial of blood vessels and avoiding restenosis, which is suitable for patients with restenosis and small vessel lesions after stenting.

Plaque atherectomy: The hard calcified plaque in the blood vessel is ground with a high-speed rotating "grinding head" to create conditions for subsequent treatment, suitable for patients with severe vascular calcification that cannot be dilated by balloon.