PERCUTANEOUS CORONARY ANGIOPLASTY Adolfo Lpez Campanher, MD - - PowerPoint PPT Presentation

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PERCUTANEOUS CORONARY ANGIOPLASTY Adolfo Lpez Campanher, MD - - PowerPoint PPT Presentation

Jan 05, 2024 826 likes •978 views

DIABETES MELLITUS AND PERCUTANEOUS CORONARY ANGIOPLASTY Adolfo Lpez Campanher, MD Disclosure Statement of Financial Interest I, Adolfo Lpez Campanher DO NOT have a financial interest/arrangement or affiliation with one or more

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DIABETES MELLITUS AND PERCUTANEOUS CORONARY ANGIOPLASTY

Adolfo López Campanher, MD

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I, Adolfo López Campanher DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

Disclosure Statement of Financial Interest

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INTRODUCTION

  • Coronary artery disease is the main cause of

morbidity and mortality in diabetics.

  • CAD in diabetics has an earlier presentation and

worse outcomes, than in non diabetics.

  • Diabetic patients have more complex multiple

vessel disease, often with long and more diffuse

  • lesions. Also, the restenosis rate is higher than in

non diabetics.

Circ Cardiovasc Interv 2011;4:72-79

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CASE DESCRIPTION

  • 63

y.o. male. History

  • f

hypertension, dyslipidemia and type II Diabetes, insulin dependent since 2011.

  • Sept. 2013:

Unstable angina functional class II-III but did not seek medical attention.

  • Dec. 2013: Unstable angina functional class IV.
  • Hospitalization. Echocardiogram: Preserved EF. No

wall motion abnormalities.

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CASE DESCRIPTION

  • Coronary angiography:

1- Left Anterior Descending artery: severe diffuse proximal lesion. 2- Left Circunflex: severe diffuse proximal lesion of the Obtuse Marginal artery. 3- Right Coronary artery: Severe lesion in middle third.

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CASE DESCRIPTION

TARGET LESIONS

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  • Jan. 2014: PCI was

performed.

  • A

6 french Extra Backup guiding catheter was advanced to the Left coronary artery

  • stium.

CASE DESCRIPTION

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Left Obtuse Marginal artery was treated first. Stenosis was crossed with a 0.014” Hi Torque Floppy II guidewire (Abbott Vascular). A 3.0-28 mm, drug eluting stent, was implanted in proximal segment of the vessel at 16 atm.

CASE DESCRIPTION

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Post stent implantation angiography.

CASE DESCRIPTION

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CASE DESCRIPTION

Then Left Anterior Descending artery was

  • treated. Stenosis was crossed with a 0.014”

Hi Torque Floppy II guidewire (Abbott Vascular). Predilatation was performed with a 2.5x20 mm Maverick 2 balloon (Boston Scientific Corporation).

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CASE DESCRIPTION

A 3.0-32 mm drug eluting stent was implanted in proximal segment

  • f

the Left Anterior Descending artery at 16 atm.

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CASE DESCRIPTION

Finally, a 6 french Judkings Right guiding catheter was advanced to the rigth coronary ostium. A 0.014” Hi Torque Floppy II guidewire (Abbott Vascular) was used to cross the stenosis. A 3.5-16 mm drug eluting stent was implanted in middle segment of the Right Coronary artery at 16 atm.

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CONCLUSION

  • Diabetic

patients suffering ischemic heart disease with multiple vessel disease, lead to a difficult decision about which revascularization technique is best.

  • Patients with diabetes presenting with “simple”

anatomy might fare just as well with percutaneous coronary intervention as bypass surgery.

  • Ellis. JACC 2014;63(20):2119-2120
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  • Can we identify patients with diabetes with

simple lesions who are at reasonably low risk for death or MI and still need revascularization?

  • Simple MVD in diabetic patients should also be

send for CABG?

CONCLUSION

  • Ellis. JACC 2014;63(20):2119-2120