Stabil Koroner Arter Hastalığında Doğrudan Stentleme ve Ön-dilatasyon Sonrası Stentleme Yöntemlerinin TIMI Kare Sayısı Kullanılarak Karşılaştırılması

Yıl 2015, Cilt: 18 Sayı: 3, 130 - 134, 01.12.2015

Mehmet Eyüboğlu , Bahri Akdeniz Ömer Şenarslan Mehmet Akif Ekinci Abdurrahman Arslan Fatih Aytemiz İlhan Koyuncu Barış Ünal Betül Koyuncu

Öz

Giriş:
Stabil koroner arter hastalığında doğrudan stent ve
perkütan translüminal koroner anjiyoplasti (PTKA) sonrasında stentleme
yöntemlerinin koroner kan akımı üzerine etkisini karşılaştıran yeterli veri
yoktur. Çalışmamızda, doğrudan stent ve PTKA sonrası stentleme yöntemlerinin
koroner kan akımı üzerine etkisi TIMI kare sayısı (TKS) kullanılarak
karşılaştırıldı.

Hastalar
ve Yöntem: 2008-2012 yılları arasında
perkütan koroner girişim (PKG) yapılan hastalar taranarak, doğrudan stentleme
uygulanmış 55 hasta ve PTKA sonrası stentleme uygulanmış 42 hasta çalışmaya
alındı. Hastaların PKG kayıtları izlendi. Her hasta için işlem öncesi ve
sonrası TKS hesaplandı. İki tedavi grubu işlem öncesi ve sonrası TKS açısından
karşılaştırıldı.

Bulgular:
Doğrudan stent grubunda ortalama TKS işlem
öncesinde 18.72 kare/saniye, işlem sonrasında 16.12 kare (fark 2.6 kare/saniye)
bulundu; PTKA sonrası stent grubunda ise bu değerler sırasıyla 18.13
kare/saniye ve 16.63 kare/saniye (fark 1.5 kare/saniye) idi. İşlem sonrası
TKS’deki azalma açısından iki grup arasındaki fark anlamlı idi (p< 0.001).

Sonuç: Bulgularımız, stabil koroner arter
hastalığında doğrudan stentleme yönteminin koroner kan akımını iyileştirmede
PTKA sonrası stentlemeye göre daha başarılı olduğunu gösterdi. Bu bulgu,
doğrudan stentleme ile daha iyi mikrovasküler dolaşım sağlandığını düşündürmektedir.

Anahtar Kelimeler

Perkütan koroner girişim, anjiyoplasti, doğrudan stentleme

Comparision between Direct Stenting and Stenting after Pre-dilatation Using TIMI Frame Count in Stable Coronary Artery Disease

Öz

Introduction:
There are limited data comparing the effects of
direct stenting and stenting after balloon percutaneous transluminal coronary
angioplasty (PTCA) on coronary flow in patients with stable coronary artery disease
(CAD). This study was designed to evaluate the effects of direct stenting and
stenting after balloon PTCA on coronary flow using TIMI frame count (TFC) in
patients with stable CAD.

Patients
and Methods: After a retrospective review of patients who underwent
percutaneous coronary intervention (PCI) from 2008 to 2012, we identified and
included 55 patients who underwent direct stenting and 42 patients who received
stenting after balloon PTCA. PCI records of the two study groups were reviewed
to re-calculate pre- and post-PCI TFCs for comparison.

Results:
The average pre- and post-procedural TFC values
were 18.72 frames per second (fps) and 16.12 fps (difference 2.6 fps),
respectively, in the direct stenting group. The corresponding TFC values were
18.13 fps and 16.63 fps (difference 1.5 fps) in the stenting after balloon PTCA
group. The two groups differed significantly with respect to post-procedural
decreases in TFC (p< 0.001).

Conclusion:
Our findings show that, compared to stenting after
balloon PTCA, direct stenting is more successful in terms of improved antegrade
coronary blood flow in stable CAD patients, which suggests that direct stenting
may contribute to better microvascular circulation.

Anahtar Kelimeler

Percutaneous coronary intervention, angioplasty, direct stenting

Kaynakça

• 1. Martinez-Elbal L, Ruiz-Nodar JM, Zueco J, López-Minguez JR, Moreu J, Calvo I, et al. Direct coronary stenting versus stenting with balloon pre-dilation: immediate and follow-up results of a multicentre, prospective, randomized study. The DISCO trial. Direct stenting of coronary arteries. Eur Heart J 2002;23:633-40.
• 2. Weber F, Schneider H, Warzok F, Petzsch M, von Knorre GH, Nienaber CA. Randomized comparison of direct and provisional stenting in de novo coronary artery lesions: the RADICAL study. Z Kardiol 2003;92:173-81.
• 3. Özdemir R, Sezgin AT, Barutcu I, Topal E, Güllü H, Açıkgöz N. Comparison of direct stenting versus conventional stent implantation on blood flow in patients with ST-segment elevation myocardial infarction. Angiology 2006;57:453-8.
• 4. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93:879-88.
• 5. Rogers C, Karnovsky MJ, Edelman ER. Inhibition of experimental neointimal hyperplasia and thrombosis depends on the type of vascular injury and the site of drug administration. Circulation 1993;88:1215-21.
• 6. Schwartz RS, Huber KC, Murphy JG, Edwards WD, Camrud AR, Vlietstra RE, et al. Restenosis and the proportional neointimal response to coronary artery injury: results in a porcine model. J Am Coll Cardiol 1992;19:267-74.
• 7. Alidoosti M, Salarifar M, Kassaian SE, Zeinali AM, Fathollahi MS, Dehkordi MR. In-hospital and mid-term adverse clinical outcomes of a direct stenting strategy versus stenting after predilatation for the treatment of coronary artery lesions. Cardiovasc J Afr 2008;19:297-302.
• 8. Baim DS, Flatley M, Caputo R, O’Shaughnessy C, Low R, Fanelli C, et al. Comparison of PRE-dilatation vs direct stenting in coronary treatment using the Medtronic AVE S670 Coronary Stent System (The PREDICT trial). Am J Cardiol 2001;88:1364-9.
• 9. Danzi GB, Capuano C, Fiocca L, Dallavalle F, Pirelli S, Mauri L, et al. Stent implantation without predilation in patients with a single, noncalcified coronary artery lesion. Am J Cardiol 1999;84:1250-3.
• 10. Le Breton H, Boschat J, Commeau P, Brunel P, Gilard M, Breut C, et al. Randomized comparison of coronary stenting with and without balloon predilatation in selected patients. Heart 2001;86:302-8.
• 11. Balachandran KP, Singh B, Sandilands A, Popusoi G, Rubino P, Baumbach A. Functional result following direct coronary artery stenting with drug eluting stents in chronic stable angina is similar to stenting after balloon predilatation. Int J Cardiol 2008;128:374-7.
• 12. Balducelli M, Varani E, Vecchi G, Paloscia L, Manari A, Santarelli A, et al. Direct coronary stenting versus stenting with balloon pre-dilation: incidence of enzyme release and follow-up results of a multicentre, prospective, randomized study. The CK and Troponin I Estimation in direct STenting (CK TEST) trial. Minerva Cardioangiol 2007;55:281-9.