[The clinical and angiographic evolution of dilated lesions in the proximal segment of the anterior descending coronary artery: stent versus balloon]. / Evolución clínica y angiográfica de las lesiones dilatadas en el segmento proximal de la arteria coronaria descendente anterior: stent frente a balón.

INTRODUCTION AND OBJECTIVES: The restenosis rate after coronary balloon angioplasty of lesions located in the proximal segment of the left anterior descending coronary artery is high, having been recommended elective stent implantation in order to improve the outcomes. The aim of this study was to analyze clinical, anatomic and angiographic factors related to the short-term outcome after angioplasty of severe lesions in the proximal segment of the left anterior descending artery, with and without stent implantation. MATERIAL AND METHODS: We study 87 patients with severe stenosis (> or = 70%) of the proximal segment of left anterior descending artery treated successfully with angioplasty. In 54 patients (62%) a conventional balloon was used (group A) and in 33 (38%) a stent was implanted (group B). RESULTS: Mean age of patients was 61.9 +/- 12 years old, 74% were male and angioplasty was performed because of unstable angina in 72%. At the end of the follow-up (mean 6.3 +/- 1.5 months), 21% of patients in group B had angina vs 54% in group A (p = 0.03). Group B patients experienced a lower restenosis rate (30% vs. 50%; p = 0.07) and less repeat angioplasty procedures (33% vs 21%; p = NS) than group A. These results were maintained independently of the vessel diameter (< 3 mm or > or = 3 mm) or when an optimal result (< 25%) after balloon angioplasty was obtained. CONCLUSIONS: In our experience, stenting of lesions located in the proximal segment of the left anterior descending artery appears imply a better short-term clinical, angiographic outcome and a lower restenosis rate than lesions treated with conventional balloon angioplasty, even despite an optimal result after balloon angioplasty or independently of the vessel diameter. Future studies will be necessary to confirm these results.

[Encapsulated coronary rupture following stent implantation]. / Rotura coronaria encapsulada tras implantación de stent.

We report a case of coronary encapsulated rupture following stent implantation in the distal anastomosis of a saphenous by-pass graft to the left anterior descending coronary artery that evolved well with conservative treatment. The patient did not require pericardiocentesis and was treated with prolonged inflations with low pressure autoperfusion balloon at the rupture point. Pericardial adherences related to a previous coronary surgery probably limited the bleeding process avoiding hemodynamic collapse.