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Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado

2005, Number 2

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Rev Esp Med Quir 2005; 10 (2)

Lesiones coronarias en bifurcación tratadas con colocación de Stent. Seguimiento a seis meses. Centro Médico Nacional “20 de noviembre” ISSSTE

Arrieta MEM, Jiménez VA, Flores FJ, Zaragoza RG, Jiménez VA, Sánchez PJL, Blanco CM, Ortega CF

Language: Spanish
References: 26
Page: 35-42
PDF size: 233.68 Kb.


ABSTRACT

Objective: Evaluate clinical and angiographic results after six months follow up of patients treated with a stent for coronary lesions in the bifurcation, at “20 Noviembre National Medical Center”. Material and Methods: A retrospective, descriptive and observational study after six months follow up of patients, that were taken to the homodynamic room, for coronary intervention to treat the coronary lesions in the bifurcation with the placement of a stent, during the period of may 1th to November 30 of 2002. Results: A total of 28 patients were included, and in 27 there was a follow up for six months. 85.2% were men and 14.8% women, the range of age was 39 to 78 years. 18.9% had documented previous myocardial infarction. The most common clinical indication for intervention was Stables Angina. 29 lesions were treated; were the most common approach for the main vessel was the anterior descending artery and for the side branch the diagonal arteries. Type I lesion in the Bifurcation, was most common lesion treated. Reference diameter of the vessel in the lesion was 3.12±0.32mm of main artery and 2.41±0.43mm of side branch. In all of the lesions the coronary stent was placed in the main artery. Angiographic and clinical success was in 26 of the treated lesions and nonsuccess; because of side branch total occlusion in 3 (two with non-Q wave infarction). During follow-up, clinical data of restenosis occurred in 7.40% of patients and angiographic restenosis was present in 10.34%. Major adverse cardiac events occurred in 18.5%; non of the patients had myocardial infarction or dead. Two of the three lesions that the lateral branch was occluded, had spontaneous recanalization. Discussion and Conclusions: Our results of treating coronary lesions in the bifurcation with the placement of a stent, has no significant difference with those reported in the literature, with a tendency of lower percentage of immediate success rate, but less restenosis percentage and major adverse cardiac events in long term.


REFERENCES

  1. Pinkerton CA, Slack JD. Complex coronary angioplasty: A Technique for dilatation of bifurcation stenosis. Angiology 1985;543-548.

  2. Renkin J, Wijns W, Hanet C. Angioplasty of coronary bifurcation stenosis. Cathet Cardiovasc Diagn 1991;22:167-173.

  3. George BS, MylerRK, Stertzer SH. Ballon Angioplasty of coronary bifurcations lesions. Cathet Cardiovasc Diagn 1986;12:124-138.

  4. Ciampricutti R, El-Gamol M, Van Golder B. Coronary Angioplasty of bifurcation lesions without protection of large sidebranches. Cathet Cardiovasc Diagn 1992;27:191-196.

  5. Myler RK, Shaw RE, Stertzer SH. Lesion morphology and coronary angioplasty: Current experience and analysis. J Am Coll Cardiol 1992.

  6. Meier B, Gruentzig AR, King SB III. Risk of side branch occlusion during coronary angioplasty. Am J Cardiol 1984;53:10-14.

  7. Zack PM, Ischinger T. Experience with a technique for coronary angioplasty of bifurcational lesions. Cather Cardiovasc Diagn 1984;10:433-43.

  8. Bonzel T, Wollschlager H, Kasper W, Meinertz T, Just H. The sliding rail system (“monorail”): description of a new technique for intravascular instrumentation and its application to coronary angioplasty. Z Kardiol 1987;76:780-9.

  9. Vallbracht C, Kober G, Kaltenbach M. Double long-wire technique for percutaneous transluminal coronary angioplasty for narrowings at major bifurcations. Am J Cardiol 1987;60:907-9.

  10. Iniguez A, Macaya C, Alfonso F. Early angiographic changes of side branches arising from a Palmaz-Schatz stented coronary segment: results and clinical implications. J Am Coll Cardiol 1994;23:911-5.

  11. Mazur W, Grinstead C, Hakim AH. Fate of side branches after intracoronary implantation of the Gianturco-Roubin Flex-Stent for acute or Threatened closure after percutaneous transluminal coronary angioplasty. Am J Cardiol 1994;74:1207-10.

  12. Lefevre T, Louvard Y, Morice MC. Stenting of bifurcation lesions: Seven-month follow-up of a prospective study. Circulation 1998;98(suppl I):I-638.

  13. Al Suwaidi J, Berger P, Rihal C. Immediate and log-term outcome of intracoronary stent implantation for true bifurcation lesion. JACC 2000;35:929-36.

  14. Sheiban I, Albiero R, Marsico F. Immediate and logn-term results of “T” stenting for bifurcation coronary lesions. Am J Cardiol 2000;85:1141-44.

  15. Yamashita T, Nishida T, Adamina M. Bifurcation lesions: two stents versus one stent-immediate and follow-up results. J Am Coll Cardiol 2000;35:1145-51.

  16. Cervinka P, Foley D, Sabaté M, Costa M, Serrano P, Ligthart J, Serruys P. Coronary bifurcation stenting using dedicated bifurcation stents. Cath Cardiovasc Intervent 2000;49:105-111.

  17. Ahmed JM, Mintz S, Weissman NJ, Lanski AJ, Pichard AD, Satler LF, Kent KM. Arterial remodeling after coronary angioplasty: a serial intravascular ultrasound study. Circulation 1996;94:35-43.

  18. Fischman DL, Leon MB, Baim DS: for the Stent Restenosis Study Investigators: A randomized camparison of coronary stent placement and ballon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994;331:496-501.

  19. Serruys PW, de Jaegere P, Kiemeneij F: for the BENESTENT Study Group: A comparison of ballon-expandable-stent implantation with ballon angioplasty in patients with coronary artery disease. BENESTENT Study Group. N Engl J Med 1994;331:489-495.

  20. Teirstein P, Stratienko AA, Schatz RA: Coronary stenting for ostial stenoses: Initial results and six month follow-up. Circulation 1991;84:II-250.

  21. Fischman DL, Savage MP, Leon MB: Fate of lesion related side branches after coronary stenting. J Am Coll Cardiol 1993;22:1641-1646.

  22. Pan M, Medina A, Suarez de Lezo J: Follow-up patency of side branches covered by intracoronary Palmaz-Schatz stent. Am Heart J 1995;129:436-440.

  23. Caputo RP, Chafizadeh ER, Stoler RC: Stent jail: A minimum security prision. Am J Cardiol 1996;77:1226-1230.

  24. Aliabadi D, Tilly FV, Bowers TR: Incidence and angiographic predictors of side branch occlusion following high-pressure intracoronary stenting. Am J Cardiol 1997;80:994-997.

  25. Gambhir DS, Singh S, Sinha SC: Treatment of true bifurcation stenosis by elective stent implantation in parent vessel and non-stent dilatation of side branch: Immediate and follow-up results. Indian Heart J 2000;52:289-296.

  26. Lefévre T, Louvard Y, Morice MC: Stenting of bifurcation lesions: Classification, treatments, and results. Cathet Cardiovasc Intervent 2000;49:274-283.




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