RESUMEN
Acute coronary occlusion as a consequence of dissection or thrombosis occurs in 2 to 11% of patients treated with percutaneous transluminal coronary angioplasty (PTCA), and continues to be the principal cause of early morbidity and mortality. In this study the experience of one center is presented with the application of two types of stents, Wiktor (Medtronic Inc.) or Gianturco-Roubin (Cook Inc.) for bailout of acute or threatening coronary occlusion that persisted after treatment with prolonged balloon inflation. All patients received a complete anticoagulation scheme with heparin, dextran, dipyridamole, aspirin and coumadin. From January to November 1993, 26 patients with 27 prosthesis were included. There were 21 men and 5 women with mean age of 58 years (range 36 to 73). The indications for stenting were: total occlusion in five (19%) threatening occlusion in 13 (50%) and severe persistent dissection in eight (31%). Initial implantation success was 93% (25/27). Procedure related clinical complications were death in one patient, bypass surgery in two (8%) and myocardial infarction in four (15%). Acute stent thrombosis occurred in three cases and subacute in one (11 and 4% respectively). Three patients, had non-fatal bleeding complications. Final clinical success without myocardial infarction, bypass surgery or death was 77%. In conclusion, coronary stenting for bailout of acute or threatening coronary occlusion after PTCA is a good alternative to emergency surgery. New antithrombotic strategies and better anticoagulation schemes may improve further this procedure.
Asunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Enfermedad Coronaria/terapia , Vasos Coronarios , Stents , Enfermedad Aguda , Adulto , Anciano , Angioplastia Coronaria con Balón/métodos , Terapia Combinada , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/etiología , Urgencias Médicas , Femenino , Francia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Due to the recent technological advances, it is possible to perform percutaneous coronary angioscopy in a straightforward fashion in most patients. To know the safety and usefulness of this technique we present 200 observations in 100 patients candidates for coronary intervention. We used a coronary angioscope (Baxter, Edwards LIS Division), that can be placed using the conventional technique for percutaneous coronary angioplasty. The system incorporates a proximal occluding balloon, and distally a movable optical fiber. Case selection considered non-ostial coronary segments relatively straight. It was possible to obtain adequate images in 86 percent of cases. The technique is safe in experienced hands: there were two cases of ventricular fibrillation, and two cases of local dissection occurred, none of these associated with clinical consequences. No myocardial infarction, surgery or death, related to this procedure occurred. Valuable diagnostic information is derived from angioscopy as the method provides some histopathological correlation. Stable plaques are usually uniformly white or yellow. Unstable plaques are yellow and ulcerated. Thrombus can be easily recognized in acute coronary syndromes. Also in percutaneously treated segments, the final result and the presence of dissection or hemorrhage can be visualized. Coronary percutaneous angioscopy is safe and brings useful clinical information. Its applications in the clinical practice are still to be determined.