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| Angiogram
of occluded coronary artery |
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Percutaneous Coronary Intervention (PCI)
Technological advances, coupled with high success
rates and low complication rates have increased
the use of PCI, especially in patients with acute
coronary syndromes, including unstable angina, non-ST-segment
elevation MI and acute myocardial Infarction.1
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Despite the lack of randomized controlled studies
comparing Percutaneous Transluminal Coronary Angioplasty
(PTCA or balloon angioplasty) versus no reperfusion,
this procedure has achieved a high level of acceptance
among physicians, based on the findings that show
that PTCA restored antegrade flow in the occluded
infarct-related artery in a range of 88% to 95%
of patients and was associated with a one-year survival
rate of 90% to 96%. Further, patients who received
PTCA are less likely to require coronary revascularization
for recurrent ischemia over a 6-month follow-up
period than those treated with a thrombolytic agent.2
As with thrombolytics, patients who receive angioplasty
within 2 hours of symptom onset show an impressive
reduction in 30-day mortality compared to those
who receive angioplasty > 2 to 6 hours after
symptom onset. However, up to 5% of patients referred
for PTCA will require emergency Coronary Artery
Bypass Graft (CABG) surgery. This is usually related
to a failed angioplasty, or the artery was not suitable
for PTCA.2
Currently, the majority of PCI procedures involve
PTCA and coronary stenting. The use of stents with
PTCA has become popular because studies have shown
that primary stenting can be safe and effective,
resulting in lower incidence of recurrent infarction
and a significant reduction in the need for target
vessel revascularization when compared with balloon
angioplasty alone.1
It is also important to recognize that PCI also
refers to atheroablative technologies such as atherectomy/thrombectomy
via mechanical and laser methodologies. In the absence
of an active thrombus, rotational atherectomy is
useful to debulk arteries that contain large amounts
of atheromatous burdens and to modify plaques in
preparation for more definitive treatment with adjunctive
balloon angioplasty and/or stenting.2
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| References |
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