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 GENERAL INFORMATION
The coronary angioplastia transluminal percutánea (ACTP) is a skill indicated in the revascularización of the coronary arteries (those that make a detour and nourish to the cardiac muscle), when they are much pressed hard by a badge of ateroma and/or a thrombus.
The ACTP can be realized of urgent form, or of programmed form.
Immediate or urgent ACTP. The patients with myocardium infarction in development or established they must be treated by ACTP, when it is possible, instead of with other more conservative treatments. The immediate ACTP can be top and more profitable like initial treatment of the infarction of myocardium that the treatment trombolítico (or, the injection of substances as the uroquinasa that try to dissolve the causative coronary thrombus of the infarction). Nevertheless, many centers limit his use to the patients in whom the treatment trombolítico is contra-indicated. Elective or programmed ACTP. It can be realized in patients who have suffered a myocardium infarction, when later they have pain of breast (angina) appellant, after high hospitable.
SKILL
By means of an injection in the artery femoral or in the artery humeral right, there makes go over up to up to the suitable coronary orifice a catheter (flexible pipe) with a ball hichable in the end more distal (to See "CARDIAC CATETERISMO AND CORONARIOGRAFIA"). The ball in the top of the catheter is placed along with the taken in area of the coronary artery, and next the ball gets conceited to dilate the glass. At the end of the intervention there repeats herself the angiografía (the X-ray study of the interior of the coronary arteries with a contrast) to document any change.
During the angioplastia and after the same one there are used special anticoagulants (abciximab or Reopro ®) to diminish the thrombosis frequency in the point of the vascular dilation. After the angioplastia it will be necessary to take, for the same motive, medications antiagregantes of thrombocytes, and perhaps other medications to criterion of the cardiologist.
The reestenosis frequency (that the extensive coronary artery becomes closer again) is maximum in the first 6 months after the angioplastia, with indexes even of 35 %.
The called coronary "stents" or spirals are a species of wharves of noble metal that obstruída introduce in the coronary artery, preventing from being re-obstructed as soon as the angioplastia was carried out. The coronary spirals are used increasingly to reduce the need for repeated interventions of short-term revascularización. The use of spirals in another type of injuries is still in investigation, especially due to his high price (In the year 1999, 280.000 pesetas imposed include you, to add up to the entire cost of the intervention; and the sanitary private insurances usually do not cover the cost of the stents).
CONTRAINDICATIONS OF THE ACTP
Too important obstruction of the left principal coronary artery, without the cardiac irrigation c be guaranteed by another glass during the ACTP. The States of coagulopatía (low coagulation of the blood) or hypercoagulation (too many coagulation of the blood). - Coronary glasses widely sick without expanding focal illness.
COMPLICATIONS
Reestenosis (that the extensive coronary artery becomes closer again), already commented. Maximum frequency in the first 6 months after the angioplastia, with indexes even of 35 %. In most of the patients with reestenosis it is necessary to repeat the angioplastia; some of them will need an operation to heart opened to place a bridge (or "by-pass") aorto-coronary, intervention this one much more complicated and dangerous. The reestenosis index diminishes drastically with the use of a stent or coronary spiral. Sudden closing of an ACTP. It can take place even in 4 % of the patients; for spasm or for formation of a thrombus. The treatment consists of medicines, spirals or, of the worst circumstances, bombs intraaórticas of ball or surgery of coronary arterial derivation ("by-pass) of urgency. Complications of the cateterismo. The ACTP, for being a skill that he needs of cateterismo, it has risk of death, infarction of myocardium and cerebral infarction, risks that in case of the ACTP are major than in that of any diagnostic cateterismo.
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