23
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Técnica de pull-back para implante de stent em lesões de bifurcação com envolvimento único do óstio do ramo lateral: avaliação dos resultados iniciais e aos seis meses pós-implante Translated title: Pull-back technique for stent implantation in coronary bifurcation lesions involving isolated ostial side branch: early and 6-month follow-up results

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          INTRODUÇÃO: Lesões coronárias em bifurcação ainda representam um desafio ao tratamento percutâneo, com sucesso do procedimento abaixo do esperado e altas taxas de reestenose. A técnica de pull-back é uma opção no tratamento de lesões coronárias de bifurcações que apresentam acometimento isolado do óstio de ramos laterais, embora seus resultados a médio prazo ainda não sejam conhecidos. O objetivo deste estudo foi avaliar os resultados angiográficos iniciais e aos seis meses com essa técnica em nossa casuística. MÉTODO: A técnica consiste no posicionamento de duas guias, seguido do stent no ramo lateral e do balão no vaso principal encobrindo a origem do ramo. Após a insuflação do balão no vaso principal, o stent é tracionado em direção ao vaso principal até contato com o balão e, então, liberado. RESULTADOS: Foram tratados 37 pacientes consecutivos. Os ramos diagonais foram os mais freqüentemente abordados (70,3%). O diâmetro de referência dos ramos laterais foi de 2,51 ± 0,37 mm e a extensão da lesão, de 11,1 ± 3,7 mm. A pressão de liberação dos stents no ramo lateral foi de 12,8 ± 1,9 atm e a pressão de insuflação do balão no vaso principal, de 7,8 ± 0,9 atm. O sucesso do implante ocorreu em todos os procedimentos. Foram submetidos a coronariografia tardia 22 (59,5%) pacientes, tendo sido observada reestenose no ramo lateral em nove (40,9%) pacientes e desenvolvimento de lesões > 50% no vaso principal em sete (31,8%). CONCLUSÃO: Lesões isoladas localizadas no óstio de ramos laterais tratadas com stent pela técnica de pull-back apresentaram elevadas taxas de sucesso do procedimento. No seguimento a médio prazo, entretanto, observou-se elevada taxa de reestenose no ramo lateral e alto risco de desenvolvimento de uma nova obstrução no vaso principal.

          Translated abstract

          INTRODUCTION: Bifurcated coronary lesions are still a challenge to the percutaneous treatment, with a lower than expected success rate and high rates of restenosis. The pull-back technique is an option for the treatment of coronary lesions in bifurcations that compromises exclusively the ostium of lateral branches, but its middle term results are still not known. The aim of this study is to assess the initial and 6-month angiographic results of this technique in our casuistic. METHOD: The technique consists in the positioning of two guide-wires, followed by the stent in the lateral branch and the balloon in the main vessel, covering the origin of the branch. After insufflating the balloon in the main vessel, the stent is pulled back towards the main vessel until it touches the balloon, and then implanted. RESULTS: Thirty-seven consecutive patients were treated. The diagonal branches were the most commonly treated (70.3%). The reference diameter of the lateral branches was 2.51 ± 0.37 mm and the extension of the lesion 11.1 ± 3.7 mm. The release pressure of the stents within the lateral branch was 12.8 ± 1.9 atm and the insufflation pressure of the balloon in the main vessel was 7.8 ± 0.9 atm. The stent was successfully implanted in all procedures. Twenty-two (59.5%) patients were submitted to late coronariography and restenosis was observed in the lateral branch in 9 (40.9%) patients, and the development of lesions > 50% in the main vessel was observed in 7 (31.8%) patients. CONCLUSION: Isolated lesions found in the ostial of lateral branches treated with the "pull-back" stent implantation technique presented high rates of procedural success. However, in the middle term follow-up, a high restenosis rate in the lateral branch was observed, as well as a high risk of developing a new obstruction in the main vessel.

          Related collections

          Most cited references 15

          • Record: found
          • Abstract: found
          • Article: not found

          Coronary angioplasty of bifurcational lesions without protection of large side branches.

          To assess the risk and clinical relevance of side branch (SB) occlusion during angioplasty (PTCA) we attempted PTCA of major branches (MB) without protection of lesion-associated large (> or = 1.8 mm) SBs in 67 patients (50 men). There were 32 patients with unstable angina and 35 with stable angina. Their mean age was 55 years (range 31-77). There were 69 SBs: 43 with severe ostium stenosis (type A); 6 with severe non ostial stenosis (type B); and 20 with no or slight nonostial stenosis (type C). PTCA of the MB was successful in all but one patient who underwent acute bypass surgery. After MB PTCA occlusion occurred in 10 SBs (7A, 1B, 2C) and was asymptomatic in 5. Recanalization and dilatation was successful in 4 out of 5 symptomatic SB occlusions. A single patient developed a non-q wave myocardial infarction. PTCA was also attempted in 21 diseased SBs and failed in one. 21 SBs remained severely stenotic and 6 occluded. During follow-up symptomatic MB restenosis occurred in 12 patients, associated with restenosis in 4 out of 6 dilated SBs. Four patients underwent bypass surgery and 8 repeat successful PTCA. The SB was redilated in 2 cases and occluded silently in one. Angiography in 16 asymptomatic patients showed moderate MB restenosis in 3 and SB occlusion in 2. At 2.2 years follow-up 60 (89%) patients were asymptomatic with a normal exercise test and/or maintained angiographic result. Angioplasty of bifurcational lesions without SB protection can be effectively performed with a low rate of complications and a favourable long-term outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Frequency of success and complications of coronary angioplasty of a stenosis at the ostium of a branch vessel

              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Angioplasty for dilatation of complex coronary artery bifurcation stenoses

                Bookmark

                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbci
                Revista Brasileira de Cardiologia Invasiva
                Rev. Bras. Cardiol. Invasiva
                Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista - SBHCI (São Paulo )
                2179-8397
                2008
                : 16
                : 1
                : 44-49
                Affiliations
                [1 ] Hospital Stella Maris
                [2 ] Universidade de São Paulo Brazil
                Article
                S2179-83972008000100010
                10.1590/S2179-83972008000100010
                Product
                Product Information: website
                Categories
                CARDIAC & CARDIOVASCULAR SYSTEMS

                Comments

                Comment on this article