Cateterismo cardíaco, diagnóstico (angiografia) e terapêutico (angioplastia) na doença arterial coronária dos pacientes diabéticos

Abstract

Screening, diagnosis and revascularization of coronary artery disease (CAD) in type 2 diabetes mellitus are major challenges for current clinical practice. Diagnostic (angiography) and therapeutic (angioplasty) cardiac catheterization are important resources for the clinical assessment and management of coronary atherosclerosis. Anatomic peculiarities of CAD in diabetics can be well characterized by angiography, associated or not by intravascular ultrasound. The worse outcome following coronary revascularization procedures, either angioplasty or surgery, in diabetic is one of the main fields of clinical research. In spite of controversies, about one quarter of angioplasty and one third of surgical revascularization procedures are performed in diabetics. Two ongoing, large, randomized, multicentric trials are investigating the best management of CAD in diabetics. The BARI 2D trial is randomizing asymptomatic or mildly symptomatic patients with CAD for either medical therapy or revascularization (angioplasty or surgery, according to the best clinical judgment). The FREEDOM trial is randomizing stable patients with multivessel CAD for either angioplasty with drug eluting stents or surgery, with or without extracorporeal circulation. While the evidences are not available, in order to decide on the best revascularization procedure for individual patients, medical practice has been balanced according to a number of variables. Conditions that favor angioplasty: short lesions, lesions in large vessels, absence of left anterior descending artery disease, previous coronary bypass surgery and high surgical risk due to co-morbidities. Conditions that favor surgery: long lesions, lesions in small vessels, presence of left anterior descending artery disease and need for associated valve surgery.

Most common anatomic anomalies of coronary arteries

“…When this anomaly is excluded, the prevalence of CA found in our study decreases to 1.27%, showing that, when such anomaly is considered, the result of the study can change. Given the 4 range of values for the prevalence of this anomaly in all studies analyzed, including ours, it was not possible to estimate whether the results corresponded to the prevalence in the general population. This indicates the importance of using a single CA classification by all researchers.…”

“…Coronary angiography can assess the anatomicmorphologic features of coronary arteries to ascertain the presence of severe obstructive lesions (>50% of stenosis) and the degree of CAD (number of affected vessels), and to assess systolic ventricle function. 4 The right coronary artery usually originates from the right coronary sinus. The left main coronary artery originates from the left coronary sinus, crosses the pulmonary trunk posteriorly, and bifurcates into left anterior descending and left circumflex arteries.…”

Estudo preliminar dos custos envolvidos na utilização potencial de ligas de titânio em stents coronarianos / Preliminary evaluation of the costs involved in the potential use of titanium alloys in coronary stents

“…Estes implantes são colocados no organismo através do procedimento cirúrgico chamado de angioplastia coronariana, que permite a desobstrução de uma artéria bloqueada pelo acúmulo de gordura (LIMA, 2007). Com base nas características de implantação, os stents são classificados em dois tipos: expansível com balão e auto-expansível.…”