Percutaneous transluminal coronary angioplasty: Difference between revisions

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'''Percutaneous transluminal coronary angioplasty''' (PTCA), also called '''percutaneous coronary intervention''' (PCI), is "dilatation of an occluded coronary artery (or arteries) by means of a balloon  catheter to restore myocardial blood supply."<ref>{{MeSH}}</ref>
{{TOC|right}}
In [[medicine]], '''percutaneous transluminal coronary angioplasty''' (PTCA), also called '''percutaneous coronary intervention''' (PCI), is a form of [[myocardial revascularization]] in which occurs "dilatation of an occluded coronary artery (or arteries) by means of a balloon  catheter to restore myocardial blood supply."<ref>{{MeSH}}</ref>


PTCA may be a treatment for [[myocardial infarction]] and an intravascular stent may or may not be left at the site of the stenosis in order to prevent restenosis.<ref name="pmid17202455">{{cite journal |author=Keeley EC, Hillis LD |title=Primary PCI for myocardial infarction with ST-segment elevation |journal=N. Engl. J. Med. |volume=356 |issue=1 |pages=47-54 |year=2007 |pmid=17202455 |doi=10.1056/NEJMct063503}}</ref>
{| class="wikitable"
|+ PCI and risk of  target-lesion failure at one year.<ref name="pmid8041414">{{cite journal| author=Fischman DL, Leon MB,  Baim DS, Schatz RA, Savage MP, Penn I et al.| title=A randomized  comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study  Investigators. | journal=N Engl J Med | year= 1994 | volume= 331 |  issue= 8 | pages= 496-501 | pmid=8041414
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=8041414  }} </ref><ref name="pmid14523139">{{cite journal| author=Moses JW, Leon MB,  Popma JJ, Fitzgerald PJ, Holmes DR, O'Shaughnessy C et al.|  title=Sirolimus-eluting stents versus standard stents in patients with  stenosis in a native coronary artery. | journal=N Engl J Med | year=  2003 | volume= 349 | issue= 14 | pages= 1315-23 | pmid=14523139
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=14523139  | doi=10.1056/NEJMoa035071 }}  </ref><ref name="pmid16971716">{{cite journal| author=Spaulding C, Henry P, Teiger E, Beatt K, Bramucci E, Carrié D et  al.| title=Sirolimus-eluting versus uncoated stents in acute myocardial infarction. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 11 | pages= 1093-104 | pmid=16971716
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=16971716  | doi=10.1056/NEJMoa062006 }}  </ref><ref  name="pmid20445180">{{cite journal|  author=Stone GW, Rizvi A, Newman W, Mastali K, Wang JC, Caputo R et  al.| title=Everolimus-eluting versus paclitaxel-eluting stents in  coronary artery disease. | journal=N Engl J Med | year= 2010 | volume=  362 | issue= 18 | pages= 1663-74 | pmid=20445180
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20445180  | doi=10.1056/NEJMoa0910496 }} </ref>
!  Trial(s)!!Intervention !! Outcome
|-
| STRESS<ref  name="pmid8041414"/><br/>(1994)||PCI without stent|| 20% (6 months)<ref name="pmid8041414"/>
|-
| STRESS<ref  name="pmid8041414"/><br/>(1994)<br/>SIRIUS<ref name="pmid14523139"/><br/>(2003)<br/>TYPHOON<ref  name="pmid16971716"/><br/>(2006)||PCI with bare-metal [[stent]]s|| 14%<ref name="pmid16971716"/>to 14% (6  months)<ref  name="pmid8041414"/> to  21% (270 days)<ref  name="pmid14523139"/>
|-
| SIRIUS<ref name="pmid14523139"/><br/>(2003)<br/>TYPHOON<ref  name="pmid16971716"/><br/>(2006)<br/>SPIRIT IV<ref name="pmid20445180"/><br/>(2010)||PCI with first generation [[Stent|DES]]|| 7%<ref name="pmid16971716"/><ref name="pmid20445180"/> to 9% (270  days)<ref  name="pmid14523139"/>
|-
| SPIRIT IV<ref name="pmid20445180"/><br/>(2010)||PCI with second generation [[Stent|DES]]|| 4%<ref name="pmid20445180"/>
|}


Stenting reduces the rate of restenosis, but should not be done if the patient cannot take [[clopidogrel]], has extensive stenoses, the stenosis is in a very small coronary artery, or if bypass surgery is planned within a few days.<ref name="pmid17202455"/>
PTCA may be a treatment for [[myocardial infarction]] and an intravascular [[stent]] may or may not be left at the site of the stenosis in order to prevent restenosis.<ref name="pmid17202455">{{cite journal |author=Keeley EC, Hillis LD |title=Primary PCI for myocardial infarction with ST-segment elevation |journal=N. Engl. J. Med. |volume=356 |issue=1 |pages=47-54 |year=2007 |pmid=17202455 |doi=10.1056/NEJMct063503}}</ref>


Drug-eluting stents further reduce restenosis compared with bare-metal stents, but drug-eluting stents may increase the rate delayed restensos. Delayed restenosis may be prevented by taking  [[aspirin]] combined with and [[clopidogrel]].<ref name="pmid17202455"/>
The relief from angina, as compared to relief from medical therapy, may  be reduced when evidence-based medications are used.<ref  name="pmid20231568">{{cite journal| author=Wijeysundera HC,  Nallamothu BK, Krumholz HM, Tu JV, Ko DT| title=Meta-analysis: effects  of percutaneous coronary intervention versus medical therapy on angina  relief. | journal=Ann Intern Med | year= 2010 | volume= 152 | issue= 6 |  pages= 370-9 | pmid=20231568
|  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20231568  | doi=10.1059/0003-4819-152-6-201003160-00007 }} </ref>
 
==Stenting==
{{main|Stent}}
{{Image|Coronary stent.jpg|right|350px|Insertion of the stent on the delivery catheter, expansion of the stent, and lastly appearance after withdrawal of the delivery catheter.}}
 
[[Stent]]ing reduces the rate of restenosis, but should not be done if the patient has extensive stenoses, the stenosis is in a very small coronary artery, or if bypass surgery is planned within a few days.<ref name="pmid17202455"/>
 
Drug eluting stents can reduce restenosis rate<ref name="pmid16971716"/>, but should not be used if the patient cannot take [[clopidogrel]].
 
==Effectiveness==
[[Clinical practice guideline]]s address management and selection of patients.<ref name="pmid22064601">{{cite journal| author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al.| title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. | journal=Circulation | year= 2011 | volume=  | issue=  | pages=  | pmid=22064601 | doi=10.1161/CIR.0b013e31823ba622 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064601  }} </ref>
 
==Complications==
Ventricular dysrhythmia during PTCA for [[myocardial infarction]] indicates an increased risk for mortality at 3 months.<ref>{{Cite journal
| doi = 10.1001/jama.2009.600
| volume = 301
| issue = 17
| pages = 1779-1789
| last = Mehta
| first = Rajendra H.
| coauthors = Aijing Z. Starr, Renato D. Lopes, Judith S. Hochman, Petr Widimsky, Karen S. Pieper, Paul W. Armstrong, Christopher B. Granger, for the APEX AMI Investigators
| title = Incidence of and Outcomes Associated With Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention
| journal = JAMA
| accessdate = 2009-05-06
| date = 2009-05-06
| url = http://jama.ama-assn.org/cgi/content/abstract/301/17/1779
}}</ref>


==References==
==References==
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[[Category:Suggestion Bot Tag]]

Latest revision as of 10:30, 28 October 2024

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In medicine, percutaneous transluminal coronary angioplasty (PTCA), also called percutaneous coronary intervention (PCI), is a form of myocardial revascularization in which occurs "dilatation of an occluded coronary artery (or arteries) by means of a balloon catheter to restore myocardial blood supply."[1]

PCI and risk of target-lesion failure at one year.[2][3][4][5]
Trial(s) Intervention Outcome
STRESS[2]
(1994)		 PCI without stent 20% (6 months)[2]
STRESS[2]
(1994)
SIRIUS[3]
(2003)
TYPHOON[4]
(2006)		 PCI with bare-metal stents 14%[4]to 14% (6 months)[2] to 21% (270 days)[3]
SIRIUS[3]
(2003)
TYPHOON[4]
(2006)
SPIRIT IV[5]
(2010)		 PCI with first generation DES 7%[4][5] to 9% (270 days)[3]
SPIRIT IV[5]
(2010)		 PCI with second generation DES 4%[5]

PTCA may be a treatment for myocardial infarction and an intravascular stent may or may not be left at the site of the stenosis in order to prevent restenosis.[6]

The relief from angina, as compared to relief from medical therapy, may be reduced when evidence-based medications are used.[7]

Stenting

For more information, see: Stent.
Insertion of the stent on the delivery catheter, expansion of the stent, and lastly appearance after withdrawal of the delivery catheter.

Stenting reduces the rate of restenosis, but should not be done if the patient has extensive stenoses, the stenosis is in a very small coronary artery, or if bypass surgery is planned within a few days.[6]

Drug eluting stents can reduce restenosis rate[4], but should not be used if the patient cannot take clopidogrel.

Effectiveness

Clinical practice guidelines address management and selection of patients.[8]

Complications

Ventricular dysrhythmia during PTCA for myocardial infarction indicates an increased risk for mortality at 3 months.[9]

References

  1. ↑ Anonymous (2024), Percutaneous transluminal coronary angioplasty (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I et al. (1994). "A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators.". N Engl J Med 331 (8): 496-501. PMID 8041414.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O'Shaughnessy C et al. (2003). "Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery.". N Engl J Med 349 (14): 1315-23. DOI:10.1056/NEJMoa035071. PMID 14523139. Research Blogging.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Spaulding C, Henry P, Teiger E, Beatt K, Bramucci E, Carrié D et al. (2006). "Sirolimus-eluting versus uncoated stents in acute myocardial infarction.". N Engl J Med 355 (11): 1093-104. DOI:10.1056/NEJMoa062006. PMID 16971716. Research Blogging.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Stone GW, Rizvi A, Newman W, Mastali K, Wang JC, Caputo R et al. (2010). "Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease.". N Engl J Med 362 (18): 1663-74. DOI:10.1056/NEJMoa0910496. PMID 20445180. Research Blogging.
  6. ↑ 6.0 6.1 Keeley EC, Hillis LD (2007). "Primary PCI for myocardial infarction with ST-segment elevation". N. Engl. J. Med. 356 (1): 47-54. DOI:10.1056/NEJMct063503. PMID 17202455. Research Blogging.
  7. ↑ Wijeysundera HC, Nallamothu BK, Krumholz HM, Tu JV, Ko DT (2010). "Meta-analysis: effects of percutaneous coronary intervention versus medical therapy on angina relief.". Ann Intern Med 152 (6): 370-9. DOI:10.1059/0003-4819-152-6-201003160-00007. PMID 20231568. Research Blogging.
  8. ↑ Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al. (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.". Circulation. DOI:10.1161/CIR.0b013e31823ba622. PMID 22064601. Research Blogging.
  9. ↑ Mehta, Rajendra H.; Aijing Z. Starr, Renato D. Lopes, Judith S. Hochman, Petr Widimsky, Karen S. Pieper, Paul W. Armstrong, Christopher B. Granger, for the APEX AMI Investigators (2009-05-06). "Incidence of and Outcomes Associated With Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention". JAMA 301 (17): 1779-1789. DOI:10.1001/jama.2009.600. Retrieved on 2009-05-06. Research Blogging.

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