Reestenosis binaria post-ACTP con balón de corte previo a la colocación de stent / Binary restenosis post-cutting balloon ptca before stenting

The goal of the study is to describe our experience in percutaneous transluminal coronary angioplasty with cutting balloon, evaluating the immediate and mid-term outcomes. The cutting balloon is a device used as a strategy to promote plaque rupture and to allow for its distribution. METHODS: This is a descriptive study to evaluate the clinical and angiographic restenosis rate (Binary restenosis). Patients with incomplete clinical data were excluded. From January 2003 to June 2004, 1,300 PTCA with stent were made; we selected a group of 39 patients in whom the cutting balloon was used (3.3%). Average age was 60.4+/-9.2 years. There were 32 men (80%) and 8 women (20%). Diabetes Mellitus in 10 (25%), dyslipidemia in 18 (45%), systemic hypertension in 22 (55%), smoking in 22 (55%). The indication for coronary angiography was stable angina in 21 (52.5%), unstable angina in 15 (37.5%), acute myocardial infarction without ST segment elevation in 3 (7.5%). RESULTS: We treated 45 lesions: 4 (8.8%) main left, 24 (53.3%) anterior descending, 7 (15.5%) circumflex obtuse, 2 (4.4%) marginal, 8 (17.7%) right coronary. The average lesion severity before treatment was 88.8%+/-11. Lesions encountered corresponded to type B1 in 1 (2.2%), B2 in 22 (48.8%), and C in 22 (48.8%). The average lesion length was 19 mm+/-5.8 mm. The average vessel diameter was 3.6 mm +/-0.46 mm. We achieved a clinical follow-up of 100%. We performed angiographic control in 32 patients (71.1%) to evaluate instent restenosis, with an average follow-up of 7.6+/-3 months. Clinical and angiographic restenosis corresponded to 25 and 31.25% respectively. COMPLICATIONS: Two (6.2%) patients presented complications; one died because of coronary perforation of the right coronary artery with pericardial effusion and tamponade. CONCLUSIONS: The cutting balloon is a useful device for the management of complex lesions (B2 and C) but the restenosis rate with this device is similar to the one obtained with PTCA and stenting. So we do not recommend it for rutine use.

Resultados inmediatos y a mediano plazo postimplante de stents coronarios en pacientes diabÚticos / Immediate and mid-term results following coronary stent implantation in diabetic patients

INTRODUCTION: We analyzed the clinical and angiographic outcome, including follow-up, in diabetic, patients treated with percutaneous transluminal coronary angioplasty (PTCA) and stenting. MATERIAL AND METHODS: Between January 1995 and December 1999, 770 patients were treated with PTCA, 137 of them with diabetes (DM), 17.7 received 160 stents, average 1.16 stent/patient. Mean age was 58.70 +/- 8.44 years (range 35 to 80 years) and there were 92 men and 45 women. According to the clinical presentation, there were 54 with severe angina based on criteria from the Canadian Cardiovascular Society (CCS). Sixty two percent of patients had prior myocardial infarction and 68 had multivessel disease. Mean vascular obstruction was 90 +/- 6.3 and the ejection fraction was 45.3 +/- 8.7. RESULTS: The immediate angiographic success was 94.4 in patients with DM. There were complications in 8.4 (acute myocardial infarction, and thrombosis). The average follow-up was 10 mouths (range 6 to 36) in 94 of the cases. The mortality was 4.3. CONCLUSIONS: These results show that PTCA and stenting in patients with DM is a successful procedure, with few clinical and angiographics complications.