DR Medhat MRCP

Method:
Percutaneous coronary
intervention (PCI)
= Percutaneous transluminal
coronary angioplasty (PTCA)
- Ballon dilatation of the
obstructed coronary &
rupturing of atheromatus
plaque with resorption of the
resulting depris and then
stenting to prevent
restenosis
Coronary artery bypass graft
(CABG)
- A section of vein (commonly
saphenous vein) is anastomosed
proximally to aorta & distally to the
obstructed coronary distal to the
obstruction.
- Anastomosis of internal mammary or
radial artery to the obstructed
coronary distal to the obstruction.
Indication
1-2 vessels symptomatic
stenosis more than 70%
without LVF.
Patient is unfit for CABG.
Complications Stent thrombosis(1-2%)
- Due to platelet aggregation
- Within 1 month
- Causes acute MI
Restenosis (5-20%)
- Due to tissue proliferation
- Within 3-6 months
- Recurrence of angina .
Types
- In DM , RF,stent of CABG.
Bare-metal stent (BMS)
Drug-eluting stents (DES):
- Paclitaxel or Rapamycin
- Inhibits restenosis.
Bio-absorbable stents
Lt main coronary stenosis > 50%.
Proximal LAD stenosis > 70 %.
3 vessels stenosis > 50%.
2 vessels stenosis > 70 % with LVF
High cost.
Possibility of graft closure & hence
repeat of the procedure.
Morbidity & mortality of major
surgery
Saphenous vein
Internal mammary , radial artery.
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