RESUMO
The study included 148 patients with different combinations of multifocal atherosclerosis. The inclusion criteria were clinical manifestations of chronic cerebrovascular insufficiency concomitant with diseases of other arterial basins. The treatment strategies were chosen based on the results of examination by non-invasive methods for vascular visualization. Contrast agents were used only for curative purposes. The patients were divided into 2 groups depending on surgical strategy. Patients of group 1 underwent one-step reconstruction of several affected basins, those in group 2 step-by-step revascularization of different arterial basins with the use of X-ray endovascular interventions. The former approach was applied at the initial stage of the work. It creating a high risk of complications, the latter approach was preferred in the subsequent period. The incidence of complications in group 2 was 4.05% and the lethality rate 1.49%. These values were significantly higher in patients of group 1.
Assuntos
Angioplastia/métodos , Angioscopia/métodos , Aterectomia/métodos , Artérias Cerebrais/cirurgia , Transtornos Cerebrovasculares/cirurgia , Arteriosclerose Intracraniana/cirurgia , Idoso , Angioplastia/efeitos adversos , Angioplastia/normas , Angioscopia/efeitos adversos , Angioscopia/normas , Aterectomia/efeitos adversos , Aterectomia/normas , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/fisiopatologia , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico , Arteriosclerose Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia , Risco Ajustado , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Angioplastia Coronária com Balão/educação , Cateterismo Cardíaco/normas , Cardiologia/educação , Credenciamento/normas , Radiologia Intervencionista/educação , Angioplastia Coronária com Balão/normas , Aterectomia/educação , Aterectomia/normas , Cardiologia/normas , Competência Clínica , Educação de Pós-Graduação em Medicina , Humanos , Radiologia Intervencionista/normas , Sociedades Médicas , Stents/normas , Estados UnidosRESUMO
Coronary angioplasty has changed dramatically in the past three years with major reductions in suboptimal results and restenosis rates, and improvements in safety, efficacy and cost-effectiveness. Intracoronary stent implantation with optimisation of strut expansion and the abandonment of anticoagulants after deployment, have led to less entry-site complications, facilitated early hospital discharge, virtually abolished subacute stent thrombosis and resulted in a 50% reduction in target vessel revascularisation. Adjuvant medical treatment with anti-platelet agents, including glycoprotein IIb/IIIa receptor inhibitors, improves the safety of angioplasty and may further reduce the restenosis rate. Selective use of debulking devices has extended the indications for angioplasty. High resolution fluoroscopy, quantitative coronary angiography and intracoronary ultrasound leading to improved diagnosis, equipment selection and treatment have contributed to better outcomes. Further clinical trials will compare angioplasty and stent implantation with coronary bypass surgery in patients with multivessel coronary disease, and may extend the indications for percutaneous transluminal coronary angioplasty (PTCA) to selected patients with three vessel disease.
