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Oclusión coronaria tardía después de braquiterapia intracoronaria
M A Costa1, M Sabaté, W J van der Giessen
1Thoraxcenter, Dijkzigt University Hospital, Rotterdam, The Netherlands.
Circulation
|August 24, 1999
Resumen
La radioterapia intracoronaria después de la angioplastia puede causar trombosis tardía. Este estudio encontró una incidencia del 6,6% de eventos trombóticos inusuales que ocurren meses después del tratamiento, lo que sugiere que la radiación retrasa la curación.
Área de la Ciencia:
- Cardiología Intervencionista Cardiología intervencionista.
- Investigación cardiovascular Investigación cardiovascular Investigación cardiovascular Investigación cardiovascular Investigación cardiovascular
Sus antecedentes:
- La braquiterapia intracoronaria es un nuevo enfoque para prevenir la restenosis después de la angioplastia coronaria transluminal percutánea (PTCA).
- Existen datos limitados sobre la seguridad a largo plazo de esta modalidad terapéutica, particularmente con respecto a los eventos trombóticos tardíos.
Objetivo del estudio:
- Para investigar la incidencia de trombosis tardía (>1 mes) después de PTCA y radioterapia intracoronaria.
- Para identificar los mecanismos potenciales para estos eventos trombóticos tardíos.
Principales métodos:
- Una cohorte de 108 pacientes se sometió a PTCA seguido de radiación beta intracoronaria entre abril de 1997 y marzo de 1999.
- Noventa y un pacientes con al menos 2 meses de seguimiento fueron analizados para eventos trombóticos.
Principales resultados:
- El 6,6% de los pacientes (6 de 91) experimentaron eventos trombóticos repentinos de 2 a 15 meses después de la intervención.
- Estos eventos ocurrieron después de la angioplastia con globo y los procedimientos de stenting.
- Los desencadenantes potenciales incluyeron stents superpuestos y disecciones no curadas, pero el tiempo tardío sugirió un efecto inducido por la radiación.
Conclusiones:
- La trombosis tardía y repentina es un fenómeno recientemente observado después de la PTCA combinada con radioterapia intracoronaria.
- Los hallazgos sugieren que la radioterapia puede retrasar la cicatrización arterial, lo que lleva a una superficie trombogénica persistente y a eventos trombóticos tardíos inusuales.
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