Flores FJ, Zaragoza RG, Cruz DA, Jiménez VA, Sánchez PJL, Vargas CA, Blanco CM

Language: Spanish
References: 24
Page: 3-7
PDF size: 67.76 Kb.

ABSTRACT

Coronary artery disease its one of the most common disease in adults in Mexico. At Centro Medico Nacional “20 de Noviembre” of the ISSSTE in Mexico City we perform almost 1,500 diagnostic procedures in coronary angiography per year, of this near of 40% of patients undergo percutaneous coronary revascularization. Direct coronary stenting is performed without predilation. This method has potential advantages over conventional technique which uses a balloon predilation. Methods: We studied 90 patients with stable and unstable angina with 105 de novo coronary lesions susceptible to percutaneous intervention between December 1999 and August 2001.Variables were expressed as mean and standard deviations. Results: A total of 105 lesions were treated. Direct coronary stenting was attempted in all cases and was successfully performed in a 100 lesions (95.23%). We found one vessel disease in 82% of cases. The most common type of lesion was B2 in 52% of patients. (ACC/AHA) 23%. Left anterior descending artery was the most affected vessel in 47% of patients. No major cardiac event were present during hospital stay; five patients had postprocedural angina; one patient had a Non Q wave myocardial infarction without hemodynamic disturbance. Conclusion: Direct coronary stenting it’s a safe and effective method for treating de novo coronary lesions in a selected group of patients, with fewer complications and without an increase of clinical events during hospital stay.

REFERENCES

1. Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction: description of a new technique and a preliminary report of its application. Circulation 1964; 30: 654-668.

2. Gruentzig A, Kumpe DA. Technique of percutaneuos transluminal angioplasty with the Gruentzig balloon catheter. AJR Am J Roentgenol 1979; 132: 547-561.

3. Gruentzig AR, Senning A, Siegenthaler WE. Non-operative dilatation of coronary artery stenosis-percutaneous transluminal coronary angioplasty. N Engl J Med 1979; 301: 61-68.

4. Baim D, Grossman W. Coronary Angioplasty. In: Gross-man’s Cardiac Catheterization, Angiography and Intervention. Philadelphia, PA. Sixth edition. Lippincot Williams and Wilkins. 2000: 547-599.

5. Taylor A, Broughton A, Federman J, Walton A, Keighley C, Haikerwal D et al. Efficacy and Safety of Direct Stenting in Coronary Angioplasty. J Invas Cardiol 2000; 12: 560-565.

6. Myler R. Angioplastia coronaria y periférica: Perspectiva histórica. En: Topol Cardiología Intervencionista. Philadelphia Pennsylvania. McGraw-Hill. 2000: 151-171.

7. Escudero X, Lablanche JM, Hamon M. Percutaneous coronary angioscopy: 200 observations in 100 candidates for angioplasty. Arch Inst Cardiol Mex 1995; 65: 307-314.

8. Bates ER, McGillem MJ, Beals TF, De Boe SF, Mikelson JR, Mancini GB et al. Effect of angioplasty induced endothelial denudation compared with medial injury on regional coronary blood flow. Circulation 1987; 76: 710-16.

9. Freed M, Grines C, Safian R. The New Manual of Interventional Cardiology. Birmingham, Michigan. USA Physicians Press. 1999.

10. Chan AW, Carere R, Solankhi N, Dodek A, Webb JG. Coronary stenting without predilatation in broad spectrum of clinical and angiographic situations. J Invas Cardiol 2000; 12: 75-79.

11. Rodriguez A, Ayala F, Bernardi V, Santaera O, Marchad E, Pardiñas C et al. Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS): Immediate and long-term follow-up results. J Am Coll Cardiol 1998; 32: 1351-1357.

12. Figulla HR, Mudra H, Reifart N, Werner GS. Direct coronary stenting without predilatation: A new therapeutic approach with a special balloon catheter design. Cathet Cardiovasc Diagn 1998; 43: 245-252.

13. Herz I, Assail A, Adler Y. Coronary Stent Deployment without predilatation: Prevention of complications of venous graft angioplasty. Angiology 1998; 49: 613-617.

14. Wilson SH, Berger MD, Matew V, Bell MR, Garratt KN, Rihl CS et al. Immediate and late outcome after direct stent implantation without balloon predilation. J Am Coll Cardiol 2000; 35: 937-943.

15. Briguiori C, DiMario C, Colombo A, Sheiban I, DiGregorio I, Anzuini A et al. Direct coronary stenting without predilation. J Am Coll Cardiol 1999; 34: 1910-1915.

16. Fischell TA, Derby G, Stadius ML. Coronary Artery Vasoconstriction routinely occurs after Percutaneous Transluminal Coronary Angioplasty. Circulation 1988; 78: 1323-1333.

17. DeFeyter PJ, Serruys PW, Van Den Brand M, Balakumaran B, Mochtar B, Soward AL et al. Emergency angioplasty in refractory unstable angina. N Engl J Med 1985; 313: 342-346.

18. Carrié D, Khalifé K, Citron B, Izaaz K, Hamon M, Juliard JM et al. Comparison of Direct Coronary Stenting UIT and Without Balloon Predilatation in Patients With Stable Angina Pectoris. (BET Study) Am J Cardiol 2001; 87: 693-698.

19. Bittl JA. Advances in coronary angioplasty. N Engl J Med 1996; 335: 1290-1312.

20. Grines CL, Browne KF, Marco J, Rothbaum D, Stone GD, O’Keefe J et al. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1993; 328: 673-679.

21. Wallentin L, Ohlsson J, Swahn E. Low-molecular-weight heparin during instability in coronary artery disease. Lancet 1996; 347: 561-568.

22. Topol EJ, Moliterno J, David J, Herrmann M, Howard C, Powers E et al. Comparison of Two Platelet Glycoprotein IIb/IIIa Inhibitors, Tirofiban and Abciximab, for the Prevention of Ischemic Events with Percutaneous Coronary Revascularization. TARGET investigators. N Engl J Med 2001; 344: 1888-1896.

23. Montalescot G, Barragan P, Wittenberg O, Elhadad S, Villain P, Boulenc JM et al. ADMIRAL INVESTIGATORS: Abciximab before direct angioplasty and stenting in Myocardial infarction regarding Acute and long term follow up. N Engl J Med 2001; 344(25): 1939-1942.

24. Bertrand ME. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting. Circulation 2000; 102: 624-629.