Galeano-Ricaño HA

Idioma: Español
Referencias bibliográficas: 29
Paginas: 20-26
Archivo PDF: 123.16 Kb.

RESUMEN

Es bien conocido el hecho de que la angioplastia coronaria transluminal percutánea (ACTP) y el implante de stent provocan daño endotelial. En ocasiones es tan severo que se manifiesta por vasoconstricción coronaria persistente, condicionando isquemia miocárdica (clínica, eléctrica y/o enzimática). Sin embargo, es posible que se manifieste de otra forma: espasmo coronario dinámico. Se presentan dos casos con varias similitudes entre sí: evolución tórpida con sospecha de oclusión del stent; intervencionismo con agresión endotelial (ultrasonido intracoronario e implante de stent); imagen angiográfica de espasmo arterial coronario dinámico, confundido con puente muscular. El espasmo coronario dinámico se puede definir como la vasoconstricción oclusiva dinámica de un segmento coronario epicárdico, en una arteria que ha sido sometida a intervencionismo. Habría que diferenciarlo del no reflujo, provocado por la oclusión total de la arteria intervenida del espasmo inducido por catéter, pero sobre todo, del puente muscular. En ambos casos se reportó como puente muscular, sin embargo, en el estudio diagnóstico no se observaba esta imagen. El motivo del presente trabajo es llamar la atención a la comunidad médica, específicamente al médico intervencionista, sobre una imagen que puede ser un factor pronóstico y terapéutico (tratamiento con calcio-antagonistas y nitratos, uso de marcadores séricos o seguimiento más estrecho), en la evolución de los pacientes sometidos a intervencionismo coronario.

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