Résumé
BACKGROUND: Ischemia, left ventricular dysfunction, endothelial damage and hemodynamic changes during percutaneous coronary intervention can lead to neurohumoral activation. This may partly explain the frequent episodes of coronary spasm, hypotension and bradycardia which occur during the procedure. Rotastenting, by employing the two basic mechanisms for coronary interventions-debulking and dilatation-epitomizes percutaneous coronary interventions in general. We sought to investigate the neurohumoral changes during and immediately following coronary rotastenting. METHODS AND RESULTS: Eighteen patients undergoing elective rotablator atherectomy followed by balloon predilatation and stenting for chronic stable angina were studied. Four femoral vein blood samples were drawn from each patient at the start of the intervention (baseline), and 2 (postdebulking-2), 10 (postdebulking-10) and 60 (postdebulking-60) minutes. respectively, after the first complete passage of the rotablation burr across the whole length of lesion. Levels of 10 neurohormones, namely, endothelin-1, bradykinin, arginine vasopressin, norepinephrine, dopamine, epinephrine, angiotensin II, serum angiotensin-converting enzyme activity. atrial natriuretic peptide and kininogen were estimated in each sample. Endothelin-1 and bradykinin attained their peak levels in the postdebulking-2 samples. and the rise from 0.34+/-0.07 pmol/ml and 235.8+/-17.7 pg/ml to 0.42+/-0.06 pmol/ml and 337.2+/-41.0 pg/ml, respectively, was statistically significant (p<0.05). The level of arginine vasopressin showed a significant (p<0.05) rise from baseline (108.5+/-31.8 pg/ml) to postdebulking-60 samples (136.5+/-39.4 pg/ml). The other neurohormones did not show significant changes. CONCLUSIONS: The results suggest a definite but differential neurohumoral activation during and immediately following rotastenting. These neurohumoral changes may have a role in untoward intra- and postprocedural vasomotor and hemodynamic effects. This study establishes the concept of neurohumoral activation during percutaneous coronary interventions.
Sujets)
Sujet âgé , Sujet âgé de 80 ans ou plus , Angine de poitrine/sang , Angioplastie par ballonnet , Athérectomie coronarienne/effets indésirables , Bradykinine/sang , Endothéline-1/sang , Humains , Mâle , Adulte d'âge moyen , Agents neuromédiateurs/sang , EndoprothèsesSujets)
Angioplastie par ballonnet/effets indésirables , Angioplastie coronaire par ballonnet/effets indésirables , Athérectomie coronarienne/effets indésirables , Pontage aortocoronarien , Maladie coronarienne/radiothérapie , Femelle , Fibrinolytiques/usage thérapeutique , Dérivation cardiaque gauche/méthodes , Humains , Mâle , Radiothérapie adjuvante , Récidive , Endoprothèses/effets indésirables , Facteurs temps , Échographie interventionnelleSujets)
Sujet âgé , Angioplastie par ballonnet/effets indésirables , Athérectomie coronarienne/effets indésirables , Coronarographie , Maladie des artères coronaires/imagerie diagnostique , Études de faisabilité , Femelle , Humains , Mâle , Adulte d'âge moyen , Infarctus du myocarde/complications , Projets pilotes , Études prospectives , Récidive , Endoprothèses , Résultat thérapeutique , Échographie interventionnelle , Degré de perméabilité vasculaire/physiologieSujets)
Angioplastie/méthodes , Angioplastie par ballonnet/effets indésirables , Angioplastie transluminale percutanée assistée par laser/effets indésirables , Angioplastie coronaire par ballonnet/effets indésirables , Athérectomie coronarienne/effets indésirables , Pontage aortocoronarien/effets indésirables , Maladie coronarienne/thérapie , Prévision , Occlusion du greffon vasculaire/prévention et contrôle , Humains , Revascularisation myocardique/méthodes , Endoprothèses/statistiques et données numériquesSujets)
Angioplastie transluminale percutanée assistée par laser/méthodes , Athérectomie coronarienne/effets indésirables , Coronarographie , Maladie coronarienne/imagerie diagnostique , Vaisseaux coronaires/traumatismes , Études de suivi , Humains , Mâle , Adulte d'âge moyen , Défaillance de prothèse , Récidive , Réintervention , Rupture , EndoprothèsesRésumé
The authors describe a rare case of circumflex coronary artery perforation during rotational coronary atherectomy complicated with cardiac tamponade and good outcome. The possible causes of perforation are discussed and the burr oversize (burr/artery ratio was 0.58) was refused. Shortening and artery plicature (accordeon effect) might have been the cause of this event. Quantitative measurement was made in order to strengthen this hypothesis. It is emphasized the importance of selecting lesions that should be submitted to rotational coronary atherectomy
É relatado caso raro de perfuração da artéria circunflexa durante aterectomia rotacional (AR), complicado com tamponamento cardíaco, que evoluiu favoravelmente. São discutidas as prováveis causas, afastando a possibilidade da ocorrência de um superdimensionamento da oliva utilizada (relação de diâmetro oliva-artéria foi de 0,58), e é sugerido o encurtamento e plicatura da artéria (efeito sanfona) como provável causa dessa perfuração. São feitas medidas quantitativas para reforçar essa hipótese, e ressaltam-se os cuidados necessários na escolha das lesões a serem submetidas à ablação com AR