RESUMO
En la actualidad, la técnica óptima para el tratamiento del infarto de miocardio es la angioplastia primaria. Hasta el 30% de los casos evoluciona, tras la angioplastia primaria «exitosa», hacia un importante remodelado miocárdico, un mayor tamaño del infarto y una mayor mortalidad. El factor común en todos éstos es la alteración de la perfusión miocárdica. Aunque la etiopatogénesis de esta situación es multifactorial, la causa principal está en la embolización del material trombótico hacia la microcirculación. El tratamiento se centra en la prevención, desde que las distintas opciones farmacológicas estudiadas en la disfunción microvascular establecida no cambian sustancialmente el pronóstico. La publicación de recientes nuevos datos que avalan una estrategia de trombectomía coronaria habitual en los pacientes con infarto de miocardio con el fin de proteger la microcirculación ha motivado la presente revisión y actualización de este importante problema clínico (AU)
Currently, the preferred treatment of persistent ST-segment elevation acute myocardial infarction is primary angioplasty. After successful primary angioplasty, up to 30% of patients develop left ventricular dilation and heart failure, as a result of incomplete microvascular reperfusion. The pathophysiology of the microvascular dysfunction in the setting of primary angioplasty is complex and not completely known. Distal embolization of necrotic and thrombotic material acts as a mayor factor. No treatment has so far demonstrated proven efficacy in this scenario. However, several prophylactic measures have been identified. Among them, the rheolytic trombectomy offers interesting benefits both in surrogate and clinical outcome variables (AU)
Assuntos
Humanos , Infarto do Miocárdio/cirurgia , Trombectomia/métodos , Infarto do Miocárdio/terapia , Angioplastia Coronária com Balão/métodosRESUMO
Currently, the preferred treatment of persistent ST-segment elevation acute myocardial infarction is primary angioplasty. After successful primary angioplasty, up to 30% of patients develop left ventricular dilation and heart failure, as a result of incomplete microvascular reperfusion. The pathophysiology of the microvascular dysfunction in the setting of primary angioplasty is complex and not completely known. Distal embolization of necrotic and thrombotic material acts as a mayor factor. No treatment has so far demonstrated proven efficacy in this scenario. However, several prophylactic measures have been identified. Among them, the rheolytic trombectomy offers interesting benefits both in surrogate and clinical outcome variables.
