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Kirurgisk behandling

Ved stabil angina pectoris av moderat grad viser forskning at resultatene er omtrent like gode ved medikamentell behandling, som beskrevet over, og ved kirurgisk behandling. Ved alvorlige symptomer, eller dersom man ikke får kontroll med sykdommen med livsstilsråd og medisiner alene, er kirurgisk behandling aktuelt. Kirurgisk behandling består enten av utblokking og innlegging av stent via kateter som føres inn til hjertet (PCI) - eller det gjennomføres en såkalt by-pass operasjon.

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Perkutan koronar intervensjon, angioplastikk (PCI)

Dette er det vanligste inngrepet, og det minst omfattende. Inngrepet gjennomføres ved at legene fører inn et lite kateter (en plastslange) i en blodåre ved håndleddet eller i lysken. Denne slangen føres så via hovedpulsåren til hjertet, hvor kateteret føres inn i koronararteriene. Ved hjelp av røntgengjennomlysning og kontrastinnsprøyting finner legene de områdene av koronararteriene som er forsnevret eller blokkert. På kateterspissen befinner det seg en ballong som blåses opp i det trange partiet, og dermed utvides passasjen, og blodstrømmen forbedres. Som regel blir det også satt inn en forsterkning i det tidligere trange partiet i blodåren, en spiralformet netting som på fagspråket kaller en "stent". Stenten øker sjansen for at blodåren forblir åpen. Dette inngrepet kan gjøres i lokalbedøvelse, og med forberedelser og etterbehandling tar inngrepet noen få timer.

Bypass operasjon

Dette er en kirurgisk metode som innebærer at man må åpne brystkassen for å kunne operere på selve hjertet - åpen hjertekirurgi. Inngrepet foretas nesten bare på pasienter med alvorlige forsnevringer av flere koronararterier, eller dersom det teknisk sett ikke ligger til rette for blokking og stentbehandling. Det trange partiet av blodåren erstattes av en ny åre - oftest en vene fra leggen eller en arterie fra baksiden av brystbeinet - som føres forbi (bypass) den trange delen. Dette er en omfattende og krevende operasjon, men den oppfattes som et trygt inngrep. Siden brystkassen må åpnes og det kreves full narkose, tar det atskillig lengre tid å komme til hektene igjen sammenliknet med PCI.

Det er tverrfaglige team hvor hjertekirurger og hjertemedisinske spesialister samarbeider, som gir anbefalinger hos den enkelte pasient for valg av behandlingsmetode, det vil si PCI eller by-passoperasjon. 

Dette dokumentet er basert på det profesjonelle dokumentet Kronisk koronare syndromer . Referanselisten for dette dokumentet vises nedenfor

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