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2018, vol. 49, br. 2, str. 137-140
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Prednosti perkutane koronarne intervencije u odnosu na medikamentoznu terapiju kod pacijenata sa stabilnom anginom pektoris (trosudovna koronarna bolest)
Advantages of percutaneous coronary intervention in relation to medication therapy in patients with stable angina pectoris ( three-wessel coronary disease)
aPHI 'Sv Vračevi' Bijeljina, Internal Department, Department of Interventional Cardiology, Bijeljina, BiH bKlinički centar Srbije, Klinika za kardiologiju, Beograd cClinic Center Kragujevac, Cardiology Clinic, Kragujevac dPHI 'Sv Vračevi' Bijeljina, BiH
e-adresa: nemil03@gmail.com
Sažetak
Uvod: Cilj ovog rada je prikazati postupak perkutane koronarne intervencije kod pacijenata sa stabilnom anginom pektoris i njene prednosti, s obzirom da se ne preporučuje rutinska PCI kod pacijenata sa stabilnom anginom prema važećim preporukama, dobijenih na osnovu velikih radomizovanih studija, koje će kroz rad biti opisane. Prikaz slučaja: U Pacijent, muškarac, životne dobi od 66 godina, primljen je na Interno odelenje, odsek za Interventnu kardiologiju zbog bolova u grudima po tipu stabilne angine pektoris. CCS II. U ambulantnim uslovima mu je učinjena neinzvazivna dijagnostika, te nakon pozitivnog ergometrijskog testa, donešena je odluka da se uradi invazivna dijagnostika i eventualna PCI. PCI SYNTAX Score II: 23,0; PCI četvorogodišnji mortalitet 3,8%. CABG SYNTAX Score II: 25,3; CABG četvorogodišnji mortalitet 4,6%. Koronarografja: LCA: LM: pravilnog odstupa, pravca, lumena, bez stenoza, račva se na LAD i LCx. LAD: pravilnog odstupa, pravca, proksimalno u dužem segmentu sužena tubularnom stenozom oko 95%, distalno stenoza oko 50%. LCx: pravilnog odstupa, pravca, daje OM1 granu koja je bez suženja, OM2 granu koja je proksimalno sužena oko 60-70% (tandem lezija) i OM3 (PD) grana je proksimalno subokludirana 99%. RCA: bez stenoza, minorna. PCI LAD: Implantiran stent DES Orsiro 3,0x35mm insuflacijom do 14 atm. Proksimalno implantiran stent ower lap tehnikom BMS Integrity 3,5x15mm insuflacijom do 16atm. Nakon toga, urađen POT tehnika, balonom od BMS stenta insuflacijom do 18atm i postdilatacija ower lap-a insuflacijom do 18atm. PCI OM3: Replasiran guidwire BMW u pravcu PD grane i Direct tehnikom implantiran stent BMS Integrity 2,5x18mm insuflacijom do 18atm. PCI OM2: Plasiran guidwire Runtrough floppy u pravcu OM2 grane i Direct tehnikom implaniran stent DES Resolute integrity 2,5x22mm insuflacijom do 16atm. (LCA-leva koronarna arterija, LAD-prednja descendentna arterija, LCx-cirkumfleksna arterija, OM- optuzna marginalna arterija, PD- zadnja descedentna arterija, RCA-desna koronarna arterija). Zaključak: Procedura mora biti postupna, pažljivo planirana i da tek nakon inicijalne i dobre neinvazivne dijagnostike, se treba pristupiti odluci o perkutanoj koronarnoj intervenciji. Značajan stepen stenoza na koronarnim arterijama i tegobe koje pacijent ima su presudne u odluci o izvođenju PCI. Ako se pažljivo izvodi, PCI se i dalje može smatrati dragocenom tehnikom kod odabranih pacijenata u odnosu na samu medikamentoznu terapiju.
Abstract
Patient, a man, age of 66 years, was admitted to the Internal Department, Interventional Cardiology Department for chest pains by type of stable angina pectoris. CCS II. In ambulatory conditions he was made non-invasive diagnostics, and after a positive ergometric test, a decision was made that the patient be admitted to the catheterization hall for invasive diagnosis and possible percutaneous coronary intervention.
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