Ateneo 16 06-10
Transcript of Ateneo 16 06-10
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Ateneo Central
16 de Junio de 2010
Servicio de Diagnostico y Tratamiento Servicio de Diagnostico y Tratamiento EndovascularEndovascular
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Enfermedad actual
• Paciente de 52 años, de sexo masculino, refiere episodios de angor, de umbral variable, de 4 meses de evolución aproximadamente.
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Factores de riesgo
• HTA
• DSL
• DBT 2
• Tabaquista
• Antecedentes Fliares de CI
Antecedentes• Internación por SCA hace 4 meses, sin cambios en
el ECG, Tropo -, Spect prealta sin alteraciones
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Medicación Previa
• AAS
• Carvedilol
• Simvastatina / Ezetimibe
• Metformina
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ECG
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Conducta
• Paciente derivado a Servicio de Diagnóstico y Tratamiento Endovascular para realización de Cinecoronariografía luego de hallazgos en TCMS …
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TC MS• Score de CalcioScore de Calcio: : 00
• ADAADA: : obstrucción severa en tercio medioobstrucción severa en tercio medio. . Obstrucción mayor del 50% de primer ramo Obstrucción mayor del 50% de primer ramo DiagonalDiagonal..
• Primer ROMPrimer ROM: : obstrucción severa en tercio obstrucción severa en tercio medio por placa fibrolipídicamedio por placa fibrolipídica. .
• Segundo ROMSegundo ROM: : placa fibrolipídica que placa fibrolipídica que obstruye su tercio medio en grado moderadoobstruye su tercio medio en grado moderado
• FSVIFSVI: conservada(65%): conservada(65%)
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TC MS
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TC MS
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TC MS
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TC MS
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TC MS
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TC MS
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TC MS
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TC MS
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Cinecoronariografía
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Cinecoronariografía
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Cinecoronariografía
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Cinecoronariografía
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Cinecoronariografía
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Cinecoronariografía
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Cinecoronariografía
• Conclusiones:
• Obstrucción suboclusiva de arteria descendente anterior segmento proximal. Lesión severa (80%) de primer ramo diagonal ( diámetro < 2 mm)
• Obstrucción severa ( 80%) de primer ramo obtuso marginal a nivel del segmento medio( 28mm)
• Obstrucción severa (75%) de segundo ramo obtuso marginal a nivel del segmento medio
• Syntax Score: 15
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CONDUCTA
1. REVASCULARIZACION MIOCARDICA PERCUTANEA
2. REVASCULARIZACION MIOCARDICA QUIRURGICA
• REVASCULARIZACION MIOCARDICA PERCUTANEA
• REVASCULARIZACION MIOCARDICA QUIRURGICA
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Angioplastia
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Angioplastia
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Angioplastia
Stent liberador de Everolimus 3.0x23 mm – 22 Atm
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Angioplastia
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Angioplastia
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Angioplastia
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Angioplastia
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Angioplastia
Stent liberador de Everolimus
2.5x23 mm- 22 Atm
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Angioplastia
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Angioplastia
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Angioplastia
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Angioplastia
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Stent Liberadores de Everolimus
Telescopados – 2.25x15 mm y 2.25x18 mm
Angioplastia
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Angioplastia
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Angioplastia
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Muchas Gracias