ABSTRACT
Introducción. La proliferación neointimal es la causa de la reestenosis coronaria intra stent (RIS). Recientemente, el implante de stents liberadores de drogas (DES) ha emergido como una alternativa efectiva de tratamiento endovascular. Material y método. Seleccionamos pacientes con RIS de stents no recubiertos tratados con DES en forma consecutiva en 3 centros chilenos. Luego del alta los pacientes fueron seguidos por al menos 12 meses. Resultados. De 21 pacientes (19 por ciento mujeres) entre 47 y 91 años tratados por al menos una lesión coronaria con RIS, 33,3 por ciento eran diabéticos y 14,3 por ciento tenían cirugía coronaria previa. Se presentaron de preferencia con síndromes coronarios agudos y la mayoría tenía enfermedad de 1 vaso (71,4 por ciento). Se trató sólo 1 lesión con RIS, implantándose en 15 pacientes DES recubierto con Sirolimus y en 6 con Paclitaxel. El largo promedio de stent implantado fue de27,7 mm (13-51 mm). Se obtuvo éxito en todos los casos y no hubo complicaciones isquémicas intrahospitalarias. Durante el seguimiento, sólo 2 pacientes presentaron reestenosis intrastent y uno de ellos, un anciano, falleció en forma súbita en el seguimiento. El 90 por ciento se mantuvo libre de eventos isquémicos en el seguimiento. Conclusión. El implante de DES aparece como una alternativa efectiva en el tratamiento de la RIS.
Background. Neointimal proliferation causes coronary intrastent restenosis (ISR). Recently, drug eluting stents(DES) have emerged as an effective therapeutic approach to treat ISRMethods. Consecutive patients from 3 centers with in stent restenosis after bare metal stent implantation were treated with DES. Patients were followed for 12 months after discharge.Results. Of 21 patients (19 percent females), 47 to 91 years old, with one or more intrastent restenosis, diabetes was present in 33 percent and previous coronary artery surgery in 14 percent. Most patients presented with acute coronary syndromes and 71 percent had single vessel disease. Only one lesion in each patient was treated with DES implantation, 15 with paclitaxel and 6 with sirolimus stents. Mean stent length was 27.7 mm (13-51). The procedure was successful in all patients and no ischemic complications were observed prior to discharge. During follow up 2 patients developed new intra stent restenosis and one of them died suddenly. 90 percent of patients were free from ischemic events at the end of follow up. Conclusion. DES appears to be an effective therapy to treat intra stent restenosis.
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Angioplasty, Balloon, Coronary , Paclitaxel/administration & dosage , Coronary Restenosis/therapy , Stents , Sirolimus/administration & dosage , Chile , Follow-Up StudiesABSTRACT
Background:Re-stenosis after percutaneous Coronary Angioplasty (PTCA) is related to clinical and angiographic features. Aim: To describe the clinical and angiographic characteristic of our patients with coronary cardiopathy subjected to PTCA and the predictor factors for re-stenosis. Material and methods: We gathered the clinical and angiographic characteristics of all patients who underwent a successful PTCA of a native coronary artery. All patients had a clinical assessment one year after the procedure. Patients were classified in Group 1, if they did not have angina or coronary events after the angioplasty or Group 2, if they had angina or a coronary event after the procedure. Only Group 2 patients were subjected to a coronary angiogram. Results: We collected 383 PTCA procedures. Follow up information was obtained in 92.2 percent. Three hundred forty two patients (89.3 percent) were assessed one year the procedure. Nine patients (2.3 percent) died of a cardiovascular cause. Ninety patients (26.3 percent) were classified in Group 2. In 65 patients, angiographic re-stenosis was demonstrated (19 percent). Re-stenosis occurred in 36 and 13 percent of patients with an without Diabetes Mellitus, respectively (p <0.01). The other clinical predictor variables were a history of myocardial infarction (p =0.007), obesity (p =0.041) and hypercholesterolemia (p =0.050). None of the angiographic characteristics predicted restenosis. Stents were protective factors against restenosis (15.6 percent in stented lesions vs 25.4 percent in nonstented; p =0.01). Conclusions: Re-stenosis after angioplasty occured in 19 percent of our patients with angina or coronary events. The clinical variables associated with a higher risk of re-stenosis were diabetes (the main risk factor), previous myocardial infarction, obesity and hypercholesterolemia. Angiographic variables were not associated with re-stenosis. The use of stents decreases the incidence of re-stenosis in all groups).
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Coronary Stenosis/therapy , Stents , Coronary Restenosis/prevention & control , Coronary Restenosis , Coronary Stenosis , Follow-Up Studies , Risk Factors , Severity of Illness IndexABSTRACT
BACKGROUND: Re-stenosis after percutaneous coronary angioplasty (PTCA) is related to clinical and angiographic features. AIM: To describe the clinical and angiographic characteristic of our patients with coronary cardiopathy subjected to PTCA and the predictor factors for re-stenosis. MATERIAL AND METHODS: We gathered the clinical and angiographic characteristics of all patients who underwent a successful PTCA of a native coronary artery. All patients had a clinical assessment one year after the procedure. Patients were classified in Group 1, if they did not have angina or coronary events after the angioplasty or Group 2, if they had angina or a coronary event after the procedure. Only Group 2 patients were subjected to a coronary angiogram. RESULTS: We collected 383 PTCA procedures. Follow up information was obtained in 92.2%. Three hundred forty two patients (89.3%) were assessed one year the procedure. Nine patients (2.3%) died of a cardiovascular cause. Ninety patients (26.3%) were classified in Group 2. In 65 patients, angiographic re-stenosis was demonstrated (19%). Re-stenosis occurred in 36 and 13% of patients with an without Diabetes Mellitus, respectively (p <0.01). The other clinical predictor variables were a history of myocardial infarction (p =0.007), obesity (p =0.041) and hypercholesterolemia (p =0.050). None of the angiographic characteristics predicted restenosis. Stents were protective factors against restenosis (15.6% in stented lesions vs 25.4% in nonstented; p =0.01). CONCLUSIONS: Re-stenosis after angioplasty occurred in 19% of our patients with angina or coronary events. The clinical variables associated with a higher risk of re-stenosis were diabetes (the main risk factor), previous myocardial infarction, obesity and hypercholesterolemia. Angiographic variables were not associated with re-stenosis. The use of stents decreases the incidence of re-stenosis in all groups).
