[Intracoronary stents in the treatment of angioplasty complications].
Acute or subacute occlusion of the dilated artery is the main cause of complication after percutaneous transluminal coronary angioplasty. The occlusion incidence ranges between 2 and 10% of the procedures and the mechanisms include dissection, subintimal hemorrhage, thrombosis, vasospasm and elastic recoil. Intracoronary stent is a metallic support which may seal dissection due to angioplasty, resists elastic recoil and geometric remodeling and prevents other occlusion mechanisms. Data from recent studies demonstrate the benefit of stenting acute occlusive coronary dissection in a large artery with extensive myocardium at risk. The election of the type of stent in the treatment of the acute coronary occlusion depends on the clinical status, the coronary anatomy and the stent characteristics. The major limitation of stent is the apparition of subacute thrombosis. The mechanisms of stent thrombosis are not well known. However, some factors related to complicated angioplasty, such as the presence of important dissection, intracoronary thrombus and vessels of small diameter have been involved. For this reason, the major incidence of subacute thrombosis is observed in bail-out situations. New techniques using intravascular ultrasound and high pressure dilatation after stent placement and new approaches in antiplatelet treatment have been recently described in order to reduce the incidence of subacute occlusion and the hemorrhagic events associated to previous anticoagulant therapy.
Cequier
A
A
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital de Bellvitge, Universidad de Barcelona.
Mauri
J
J
Gómez-Hospital
J A
JA
Sabaté
M
M
Jara
F
F
Esplugas
E
E
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003331:Coronary Vessels / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D012008:Recurrence; D015607:Stents