Utilización del stent pospérdida tardía en la angioplastia con balón en pacientes con cardiolatía isquemica crónica spostar / Stent utilization for late loss following balloon angioplasty in patients with chronic ischemic heart disease

La cardiopatía isquémica de origen ateroesclerótico tiene indicación de tratamiento farmacológico, de angioplastia con balón y colocación de stent coronario o la cirugía de revascularización. Evaluar la necesidad de stent coronario pospérdida tardía en la angioplastia con balón en pacientes con cardiopatía isquémica crónica. Se determinó la pérdida tardía posangioplastia con balón, en diferentes tiempos, con el ultrasonido coronario (IVUS) y angiográfico. Se estudiaron prospectivamente 21 pacientes con cardiopatía isquémica crónica ateroesclerótica (B2, C), en ASCARDIO, de febrero 2002 a julio 2008. Se realizó angiografía coronaria y IVUS. Se utilizó programa SPSS versión 15.0; para el análisis de datos: frecuencias, porcentajes, promedios, desviación estándar; t de Student, prueba de Wilcoxon (z), con 0,05 de significación estadística. Hubo predominio de género masculino, con 49 a 58 años. Como factores de riesgo: hipertensión arterial sistémica (85,7%), dislipidemia (80,9%), consumo de tabaco (47,6%), diabetes mellitus tipo 2 (38,1%). La arteria descendente anterior fue la más tratada. Se encontró lesión arterial coronaria B2 (47,6%), C (52,4%) con alta producción de disecciones posangioplastia con balón clase A (19,0%),B (33,3%), C (19,0%). Con incidencia de retroceso elástico de 29,5%. Todos requirieron Stent. El severo grado ateroesclerótico de las lesiones coronarias de 21 pacientes explicaría el alto grado de complicaciones posterior a la angioplastia con balón y el alto porcentaje de retroceso elástico hallado. Se evidencia la utilidad del uso del IVUS para la obtención de un mejor diagnóstico y cuantificación de la lesión, escogencia del tamaño del stent e impactación adecuada en el vaso coronario.

Ischemic heart disease of atherosclerotic origin is an indication for drug treatment, balloon angioplasty and coronary stenting or bypass surgery. To evaluate the need forcoronary stent use for late loss following balloon angioplasty in patients with chronic ischemic heart disease. Llate loss was determined post-balloon angioplasty, at different times, with coronary ultrasound(IVUS) and angiography. We prospectively studied 21 patients with chronic atherosclerotic coronary artery disease (B2,C), ASCARDIO, from February 2002 to July 2008. We performed coronary angiography and IVUS. We used SPSS version 15.0, fordata analysis: frequencies, percentages, averages, standard deviation,Student t test, Wilcoxon test (z), with 0.05 statistical significance.There was a male predominance, from 49 to 58 years ofage. Risk factors: systemic hypertension (85.7%), dyslipidaemia(80.9%), tobacco use (47.6%), and Type 2 diabetes (38.1 %). The anterior descending artery was treated the most. The following coronary arterial lesions were found: B2 (47.6%), C (52.4%) witha high occurrence of dissections post-balloon angioplasty class A(19,0%), B (33.3%), C (19.0%). The incidence of elastic recoilwas 29.5%. All required stents. The degree of severe atherosclerotic coronary lesions in 21 patients explains the high rate of complications after balloon angioplasty and the high percentage of elastic recoil found. This study demonstrates the utility of using IVUS to obtain a better diagnosis, quantification of the injury, choice of stent size and proper implantation in the coronary vessel.

Hibernation Myocardium in Chronic Coronary Artery Disease

BACKGROUND: Reversibly dysfunctional myocardium caused by chronic reduction of coronary perfusion was named as hibernating myocardium. The clinical characteristics, however, was not well studied. METHOD: To observed the effects of revascularization on regional wall motion(RWM) abnormalities in patients with chronic ischemic heart disease, letf ventriculogram and dipyridamole stress Tl reinjection scan with reinjection imagine were done in 60 patients with angina or old myocardial infarction before and after PTCA. Subjects were divided into two groups, group A(21 patients, improved RWM after PTCA) and group B(39 patients, no change or aggravated RWM after PTCA). RESULTS: There were no significant differences in age and sex distribution between two group. Single vessel disease was more prevalent in group A (7/21, 33.3%) than in group B(1/39, 2.6%, p<0.05), and old myocardial infarction was more prevalent in group B(24/39, 61.5%) compared to group A(7/21, 33.3%, p<0.05). Reversible perfusion defects on Tl scan were found in 19 patients, 15 of whom(78.9%) showed improved RWM after PTCA. CONCLUSION: Hibernating myocardium was more prevalent in single vessel disease and angina patients. Sensitivity of Tl reinjection scan for detection of viable myocardium was 78.9%.