Utilidad de la angiografía intracoronaria con microcatéter para evitar fenómeno de no reflujo en la angioplastia primaria
2018
Introduction: The acute coronary
occlusion associated with a high valuation of
morbimortalidad in the acute infarction of the myocardium
with elevation of the ST segment (STEMI), represents a
challenge for the interventionist, due the unknown amount
of thrombus load and its characteristics beyond the
occlusion (microvascular obstruction (MVO), distal
stenosis), which leads to complicate the primary
angioplasty (PTCA) and to the no refl ow phenomenon (NFP),
which has an overall incidence reported from 20 to 40%.
Objectives: To evaluate the effi cacy of the distal
coronary angiography with microcatheter, that leads to an
individualized therapeutic strategy, with the purpose of
prevent the NFP in the accute coronary occlusion in STEMI
treated with PTCA. Material and methods: 70 patients were
included with STEMI. We performed coronary angiography with
microcatheter distal to the obstruction, and the
therapeutic strategy was chosen in accordance with fi
ndings: stenosis, thrombus amount or MVO. After the PTCA
were performed, we evaluated the NFP incidence. Results:
Report of 70 patients, the majority men (80%), class Killip
Kimbal I (95 %), with disease of the right coronary artery
in 57%, and anterior descending coronary artery in 37%.
Distal thrombus was present in 47% of the studied patients.
An obstruction length of more than 30 mm was observed in
21% of the cases, also we observed dissection of the
arteries in a 21%, MVO was presented in 41%, and distal
stenosis in 25%. Used therapeutic strategies: It was
applied medicated stent in 81% of the patients, long
balloon in 93%, and thrombolytic therapy in 30%. We
observed a NFP incidence of 18.6 %. Conclusions: The
diagnostic and therapeutic approach for STEMI that this
study recommends, diminishes the NFP in comparison with
reported. An obstruction > 30 mm is an independent
factor for NFP, therefore in these cases we recommend use
the described diagnostic approach and long
balloon.
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