Coronary artery stents and surgery; the basis of sound perioperative management

Abstract

The introduction of drug-eluting stents (DES) to interventional cardiology heralded a limited time of increased anaesthetic and surgical complications in patients implanted with these devices. The horns of the dilemma, in the anaesthetic and surgical management of patients in the first 3 -6 months after the 1 st generation DES insertion, were between the risk of bleeding from continued clopidogrel treatment and the risk of instent thrombosis and myocardial infarction following discontinuation of dual antiplatelet therapy, clopidogrel and aspirin. Initial accounts of early catastrophic cardiac and haemorrhagic complications, at the time of elective or emergency surgery, following DES insertion, were followed by equally worrying reports of in-stent thrombosis many months after DES insertion. Initial recommendations for the conduct of safe operations were propagated in the literature before formal guidelines were produced. This article summarises the issues identified in the development of interventional cardiology particularly DES and the requirement for ongoing antiplatelet therapy. The article reviews the treatment protocols that are still applicable for the different devices that have been deployed in clinical practice.

Fizinė Ir Psichoemocinė Pacientų Būklė Po Kardiochirurginių Intervencijų Reabilitacijos Laikotarpiu

“…Dažniausiai PKI metu atliekamas stentavimas, po kurio MI dažnis sumažėja 30 proc., mirštamumas -20 -40 proc. Didžiausia komplikacijų rizika išlieka 35 dienas po stentavimo [3]. KI sėkmingai atliekamos visame pasaulyje, taip pat ir Lietuvoje, tačiau reabilitacija (R) ir jos reikšmė pointervenciniu laikotarpiu mažai tyrinėta sritis.…”

“…Justina Laurinskaitė 2 , Laimutė Kazlauskienė 1,2 , Geriuldas Žiliukas 1,2 , Dovilė Majauskytė 31 Klaipėdos universitetas, 2 Klaipėdos jūrininkų ligoninė,3 Vilniaus universitetas…”