Subject(s)
Humans , Male , Adolescent , Echinococcosis, Pulmonary/complications , Echinococcosis, Pulmonary , Chest Pain/complications , Chest Pain/etiology , Echinococcosis/complications , Echinococcosis/surgery , Diagnosis, Differential , Albendazole/therapeutic use , Echinococcosis, Pulmonary/physiopathology , Echinococcosis, Pulmonary/therapy , Multiple Pulmonary Nodules/complications , Coronary Disease/complications , Coronary Disease/surgery , Cysts/complications , Cysts/diagnosis , Cysts/surgery , Tomography, Emission-Computed/methods , Electrocardiography/methodsABSTRACT
En los últimos años, la evolución del intervencionismo coronario, hasido muy importante. La tasa de éxito primario al comienzo de ladécada de los noventa era del 86-88% con una incidencia derestenosis del 30-40%. En la actualidad estas cifras de éxito primariohan aumentado a amas del 95% y la tasa de restenosis se hareducido a menos del 10% incluidos muchos tipos de lesionesclínicamente consideradas complejas. La principal limitación delintervencionismo coronario actual son lesiones en las que resultaimposible acceder debido a una oclusión antigua tortuosidad ocalcifacion extrema de los segmentos proximales. Los avances tanrápidos de estos años han permitido ampliar las indicaciones de estamodalidad de revascularizacion. Se describen los últimos avancestécnicos
In the last few years, the evolution of coronary interventionism has been very important. The primary success rates in the early 1990s were 86-88% with a re-stenosis rate of 30%-40%. Current primary success rates have risen to over 95% with a re-stenosis rate of under 10% even for many types of lesions classically considered complex. Currently the main limitations in interventional cardiology remain coronary segments that cannot be accessed due to chronic total occlusion, or severe proximal tortuosity or calcification. Rapid improvements have led to broader clinical indications for percutaneous revascularization procedures. We describe the latest improvements in techniques (AU)
Subject(s)
Humans , Coronary Disease , Angioplasty, Balloon, Coronary , Clinical Trials as Topic , Coronary Angiography , Coronary Disease/surgery , Coronary Disease , Stents , Ultrasonography, InterventionalABSTRACT
In the last few years, the evolution of coronary interventionism has been very important. The primary success rates in the early 1990s were 86-88% with a re-stenosis rate of 30%-40%. Current primary success rates have risen to over 95% with a re-stenosis rate of under 10% even for many types of lesions classically considered complex. Currently the main limitations in interventional cardiology remain coronary segments that cannot be accessed due to chronic total occlusion, or severe proximal tortuosity or calcification. Rapid improvements have led to broader clinical indications for percutaneous revascularization procedures. We describe the latest improvements in techniques.
Subject(s)
Coronary Disease/diagnostic imaging , Angioplasty, Balloon, Coronary , Clinical Trials as Topic , Coronary Angiography , Coronary Disease/surgery , Humans , Stents , Ultrasonography, InterventionalABSTRACT
La radioterapia intravascular coronaria ha demostrado de manera convincente en estudios clínicos y experimentales que produce una disminución favorable del proceso de reestenosis. Hay evidencia suficiente para definir a dicha técnica como la principal terapia actual en el manejo de la reestenosis intra stent. Existe experiencia acumulada de hasta 3 años en pacientes tratados con radiación gamma y múltiples estudios en varios centros demuestran beneficios similares con emisores beta. Como efectos adversos de la braquiterapia se han descrito el desarrollo de nuevas estenosis en los márgenes de la lesión tratada (el efecto borde) y la oclusión trombótica tardía. A pesar de esto, la mayoría de investigadores cree que estos problemas pueden ser evitados y que la radiación intravascular es la terapia de elección en pacientes con alto riesgo de reestenosis tras intervención percutánea de revascularización coronaria. Ahora que se ha pasado de la experimentación animal a la fase clínica, y mientras la investigación continua, la tecnología está siendo optimizada para encontrar nuevas fuentes y vías de administración de la radiación que puedan ser lanzadas al mercado. El presente artículo revisa una serie de sistemas de radioterapia y hace una puesta al día sobre el empleo de la braquiterapia intravascular en pacientes cardiológicos (AU)
Intravascular radiotherapy has convincingly shown in several experimental and clinical studies to result in a marked and favorable control of the restenotic process. The evidence that radiation therapy constitutes a major breakthrough therapy for patients with in-stent restenosis is convincing, and the safety and long-lasting benefit with gamma-radiation at 3 years has been demonstrated. It is known that this benefit comes at the price of an excess of new stenoses at the lesion edge (the edge effect) and late (>1 month) thrombotic occlusion compared with control groups. However, investigators believe these problems can be avoided and that radiation therapy is the first-line treatment in this group of patients. Intravascular radiotherapy has moved from animal experiments via the safety and feasibility testing into the phase of clinical trials of efficacy in large numbers of patients. While ongoing research continues to search for new sources and delivery techniques, currently available technology is being optimized in pursuit advanced intravascular radiotherapy systems and resumes the principal issues of intravascular brachytherapy in the cardiology field (AU)
