[Interventional therapy in unstable angina pectoris].
The presence of unstable angina points to the severity of the culprit lesion, but it does not necessarily inform about the extent of coronary artery disease. Coronary angiography should be performed as soon as possible, with the exception of very old patients. If the lesion identified as the cause of unstable angina is amenable to coronary angioplasty (PTCA), the latter can be performed immediately. However, in patients with unstable angina due to an unstable plaque (fissured atheroma with partial thrombosis), acute occlusions occur more often than with routine PTCA, leading to higher perinterventional infarction and death rates and increased need for emergency bypass surgery. In cases with large intracoronary thrombi that are not completely occlusive, preliminary therapy with heparin for a few days or a fibrinolytic agent for a few hours may be wise to diminish the risk of acute vessel closure after PTCA. Sufficient clearing of the thrombus by these measures obviating the need for further interventions may occur occasionally. The point in time of coronary angiography and PTCA in unstable angina is controversial. Medical stabilization may be tried, and it appears that pretreatment with heparin and aspirin may decrease the high complication rate typical for PTCA in the acute phase. On the other hand, PTCA should not be postponed for too long, because of the risk of intercurrent infarction.
Meier
B
B
Departement Medizin, Universitätsklinik Bern.
D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D015912:Thrombolytic Therapy
Interventionelle Therapie bei instabiler Angina pectoris.