Revascularização da descendente anterior proximal com stents revestidos por fármacos

Abstract

SummaryObjective: To assess the clinical prognosis of patients with coronary artery diseases undergoing percutaneous revascularization with drug-eluting stent implantation in the proximal left anterior descending coronary artery.Methods: One hundred and seventy consecutive patients with mean age of 65 years, 49 of them females (29%), undergoing implantation of at least one drug-eluting stent in our medical center. The total number of drug-eluting stents implanted was 189, of which 115 (61%) were sirolimus-eluting (CYPHER™) and 74 (39%) were paclitaxel-eluting stents (TAXUS™). In 100 (60%) of the cases, multivessel coronary artery disease was present. In 61 (36%) patients another coronary artery segment was treated in addition to the proximal left anterior descending coronary artery. The mean clinical follow-up period was 11 ± 5 months, and angiographic controls were performed between 6 and 9 months. The final endpoint was a composite of death, acute myocardial infarction and need for reintervention on the anterior descending. The secondary endpoint included the occurrence of restenosis, need for reintervention on the proximal segment of the left anterior descending and stent thrombosis.Results: The procedure achieved immediate angiographic success in all patients. Two deaths, two acute myocardial infarctions, and two percutaneous coronary reinterventions due to stent thrombosis were recorded during in-hospital stay. At the sixth month of follow-up, an additional cardiac death and three myocardial infarctions were observed; three repeat revascularization procedures were required. Up to the end of the followup, three additional deaths, three myocardial infarctions and eight revascularization procedures of the anterior descending, two of them surgical, were verified. Survival free from major adverse cardiac events was 91%. Cardiac mortality was 3%. Binary restenosis in the proximal segment of the left anterior descending coronary artery was 4.1%. Target vessel revascularization-free survival was 94%. No cases of late stent thrombosis were observed.Conclusion: Percutaneous revascularization of the proximal left anterior descending coronary artery with implantation of drug-eluting stents is a safe and very efficient therapeutic strategy in the short and long terms.

Relationship between left coronary artery bifurcation angle and restenosis after stenting of the proximal left anterior descending artery

“…The incidence of stent restenosis after PCI for pLAD artery disease published in the past 10–15 years varies between 4.1 and 24.3% 18 – 24 . It remains the most common complication of PCI and a major clinical challenge.…”

Lesão no segmento proximal da artéria coronária descendente anterior: resultados entre o tratamento cirúrgico (mamária) e o percutâneo (stent com fármaco)

“…Assim, os estudos mais recentes [11][12][13] evidenciam que, nessa circunstância, a revascularização da ACDA proporciona evolução clínica mais favorável, ou seja, não se deve adotar conduta contemplativa. Dessa forma, não é profícuo se adequar à orientação de um estudo recentemente publicado 26 , que analisa os pacientes de maneira generalizada.…”

“…No tocante ao tratamento da ACDA utilizando os SEF, tanto nos pacientes uni como nos multiarteriais, relatos contemporâneos têm demonstrado resultados alentadores, por vezes comparáveis aos achados cirúr-gicos com o uso da MIE [10][11][12][13] .…”

Sirolimus-Versus Zotarolimus-Eluting Stents in Acute Coronary Syndromes With C Type Left Anterior Descending Artery Lesions: A Three-Year Clinical Follow-Up

“…The advent of the bare metal stents (BMS) and the following drug-eluting stents (DES) have improved the efficacy of percutaneous coronary intervention (PCI), and made it the preferred therapy in the treatment of ischemic heart diseases including ACS [1]. Nevertheless, the treatment of obstructive lesions, especially those in the left anterior descending coronary artery (LAD), represents a challenge for interventional cardiologists due to the wide heart area LAD supplies [2]. It has been shown that percutaneous revascularization of the proximal LAD with implantation of DES is a safe and very efficient therapeutic strategy in the short and long terms [2].…”

“…Nevertheless, the treatment of obstructive lesions, especially those in the left anterior descending coronary artery (LAD), represents a challenge for interventional cardiologists due to the wide heart area LAD supplies [2]. It has been shown that percutaneous revascularization of the proximal LAD with implantation of DES is a safe and very efficient therapeutic strategy in the short and long terms [2]. Sawhney et al state that LAD intervention with sirolimus-eluting stents (SES) significantly reduces angiographic restenosis and clinical events compared with BMS [3].…”