Intervention in coronary artery disease.
نویسندگان
چکیده
ercutaneous transluminal coronary angioplasty (PTCA) was introduced into clinical practice more than 20 years ago. 1 The breathtaking growth of percutaneous coronary interventions (PCI) during the 1990s in Europe (fig 1) reflects their widespread acceptance for coronary revascularisation, challenging coronary artery bypass grafting (CABG). This review provides an overview of current coronary interventional techniques with emphasis on adjunctive pharmacologic treatments and indications of PCI in patients with chronic coronary artery disease. Percutaneous coronary interventions Balloon angioplasty The balloon catheter is central not only to balloon angioplasty, but serves also as a complementary instrument for other intracoronary interventions such as delivery of stents or radiation sources. There are three types of bal-lon catheter (based on the relation between the guidewire and balloon)— fixed wire, over the wire, and Monorail balloon catheters—the latter being the most popular in Europe. There are five possible mechanism by which balloon angioplasty improves coronary haemodynam-ics w1 : (1) plaque compression; (2) plaque fracture; (3) stretching of the plaque free wall segment in eccentric lesions; (4) stretching of the vessel wall without plaque compression; and (5) medial dissection (fig 2). The most important mechanisms for improved blood flow appears to be the rupture and dehiscence of the atherosclerotic plaque, resulting in numerous fissures and sprouting of blood filled channels. The individual procedural outcome is a combination of diVerent degrees of the above mechanisms, and the final luminal geometry following balloon angioplasty is determined by the ensuing remodelling of the vessel wall. w2–4 Despite this crude mechanism of arterial dilatation the initial success rate of balloon angioplasty is > 90% in single lesions. w5-7 The chief limitations to event free survival following balloon angioplasty have been abrupt vessel closure in the short term and restenosis in the long term. 2 w8 Abrupt vessel closure, defined as the sudden occlusion of the target vessel during or after angioplasty, has been reported in 4–8% of cases. w9 w10 The pathophysiologic mechanisms underlying abrupt vessel closure are dis-section (80% of cases), thrombus formation (20% of cases), and coronary artery spasm. w11 Abrupt vessel closure becomes apparent in 75% of cases while still in the catheterisation laboratory, the remainder occurring within 24 hours of the procedure. Abrupt vessel closure has been associated with death in 0–8% and myocardial infarction (MI) in 11–54% of cases. In the past > 20% of patients suVering abrupt vessel closure were referred for emergency CABG. w12 In …
منابع مشابه
Effect of illness perception improvement on risk factors of coronary artery disease
Abstract Background: Illness perception can affect health-related behaviors and disease outcomes. Objectives: To determine the effect of an educational intervention of improving illness perception on some modifiable risk factors of coronary artery disease. Methods: In this clinical trial, 100 patients undergoing coronary angiography that met the inclusion criteri...
متن کاملAcute and Long Term Outcomes of Coronary Intervention in Unprotected Left Main Lesions
Introduction : Significant left main coronary artery stenosis jeopardizes the entire myocardium of the left ventricle and has the worst prognosis of any form of coronary artery disease. Coronary-artery bypass grafting (CABG) has been considered as the standard therapeutic approach for such patients. There are limited data on the safety and effectiveness of percutaneous coronary intervention (PC...
متن کاملThe Effect of Mindfulness-Based Stress Reduction on Anxiety and Stress in Patients with Coronary Heart Disease after Coronary Artery Bypass Graft Surgery: A Single-Subject Study
Background and objectives: Coronary artery disease (CAD) is associated with negative emotions of anger and stress, which are one of the nonclinical risk factors of the disease. Therefore, evaluation of the effective therapeutic models alleviating the patients’ negative emotions is of paramount importance. This study aimed to examine the effect of mindfulness-based stress reduction (MBSR) on ang...
متن کاملThe Effectiveness of Rehabilitation-Education Program on Risk Factors in Patients with Coronary Artery Disease
Introduction: Cardiac rehabilitation programs refer to interventions aimed at stopping the recurrence of coronary artery disease in patients. The purpose of this study was to determine the effect of rehabilitation-education program on risk factors in patients with coronary artery disease. Methods: In this clinical trial study 70 CAD patients who were admitted to coronary care units of Ali-Ebne ...
متن کاملThe Relation of Serum Bilirubin Level with the Severity and Complexity of Coronary Artery Disease and Long-term Outcomes in the Patients Undergoing Primary Percutaneous Coronary Intervention
Background and Aims: Bilirubin has been considered an antioxidant that protects against atherosclerosis. The aim of this study was to evaluate the relationship of serum bilirubin level with the severity and complexity of coronary artery disease (CAD) and long-term outcome in the patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: This prospective coho...
متن کاملاثر PercutaneousCoronary Intervention Elective بر بهبودی نارسایی ایسکمیک میترال
Introdution: Ischemic mitral regurgitation (IMR) remains one of the most complex and unresolved aspects of ischemic heart disease that the impact of percutaneous coronary intervention (PCI) on improvement of intensity of ischemic mitral regurgitation is not well clarified. Patients with coronary artery diseases and ischemic mitral regurgitation have a worse prognosis than the patients with coro...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Heart
دوره 83 4 شماره
صفحات -
تاریخ انتشار 2000