RESUMO
A white male patient, 59 years old, with two prior surgical myocardial revascularization and unstable angina, was submitted to coronary arteriography that showed: all the saphenous vein grafts patent and obstruction of 75% in the saphenous vein graft to the second marginal branch of left circumflex artery. Left internal mammary artery (LIMA) was angiographically normal and 80% stenosis was detected in the distal segment of the left anterior descending coronary artery (LAD). The patient was submitted to directional coronary atherectomy for saphenous vein graft and coronary angioplasty for distal-LAD. Both procedures were successfully performed.
Assuntos
Angioplastia Coronária com Balão , Aterectomia Coronária/métodos , Doença das Coronárias/terapia , Revascularização Miocárdica , Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , ReoperaçãoRESUMO
PURPOSE: To evaluate the results of coronary angioplasty in patients at the age of 40 years old or under. METHODS: From July 1987 to July 1990, 878 coronary angioplasty procedures were performed. Sixty six patients (7.5%) were 40 years old or under. The coronary obstruction was considered significant when 70% or more of the arterial diameter was involved and the post angioplasty results were considered satisfactory when residual obstruction was less than the 50%. RESULTS: Fifty four patients (81.8%) were male with an average age of 37 years (ranging from 29 to 40). Forty four patients (67%) had stable angina, 18 (27%) unstable angina, 3 (4%) acute myocardial infarction (AMI) and one (1.5%) AMI after streptokinase treatment. Eight of these patients had previous report of AMI and 3 (4.5%) had undergone coronary bypass grafting surgery. Fifty five patients (83%) had single vessel disease and 11 (17%) had multivessel disease. Eighty coronary arteries had balloon dilatation. In 32 patients (58%) with single vessel artery, 12 (22%) in the RCA, 10 (18%) in the left circumflex and one (2%) into a saphenous vein bypass grafting. In 12 patients (48%) with multivessel disease it was performed in the LAD coronary artery, 8 (32%) in the RCA and 5 (20%) in the left circumflex. Angioplasty was successfully performed in 53 (96%) patients with single vessel disease and in 10 (01%) with multivessel disease. One of the patients died immediately after the procedure. A follow up of 11.6 months (ranged from 1 to 27 months) was possible in 63 patients. Re-stenosis was depicted in 10 (19%) of the 55 patients with single vessel disease and in 3 of the 11 patients (30%) with multivessel disease. Nine patients had a successful redilatation in the first group and 2 in the second one. The two remaining patients had undergone coronary bypass surgery. The clinical evaluation among patients who had been dilated as the first procedure and those who had redilatation (61 patients) showed: 92% were asymptomatic and 8% had mild angina. CONCLUSION: Coronary angioplasty performed in young patients is an effective procedure with very low rate of early complications and favorable clinical follow-up.
Assuntos
Angioplastia com Balão , Doença da Artéria Coronariana/terapia , Adulto , Fatores Etários , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: To describe a new alternative technique for treating coronary artery disease: the coronary atherectomy with the transluminal endarterectomy-extraction catheter. METHODS: Four patients, 1 female and 3 males age 46 to 65 years (mean 53 +/- 8.5 years), were submitted to coronary atherectomy with the transluminal endarterectomy-extraction catheter. One patient presenting stable angina, one presenting recent angina, one with residual stenosis after acute myocardial infarction treated with intravenous streptokinase and one with two episodes of syncope and ECG alterations. The treated arteries were: left anterior descending in 3 patients and left circumflex in one. Two lesion were concentric and two were segmentary and eccentric. RESULTS: The coronary artery stenosis ranged from 80 to 95% (mean of 90 +/- 7.1%) before the atherectomy and from 20-50% (mean of 32.5 +/- 12.6%) after the atherectomy. Except the first patient, the other 3 were discharged in less than 48 hours after the atherectomy. None presented chest pain during the procedure and in three of them were no recordings of dissection or coronary artery perforation. In one patient the treated artery presented total occlusion (thrombus) 15 minutes after the procedure, but was immediate and successfully reopened with balloon angioplasty. CONCLUSION: Coronary atherectomy with the "transluminal endarterectomy-extraction catheter" has shown to be a safe and feasible procedure and to bring satisfactory immediate results.