摘要:

The initiation, localization, growth, composition, and rupture of intracoronary atheromatous plaque–factors that define the natural history of coronary artery disease–are all dependent on inhomogenieties and irregularities of intracoronary local blood flow and endothelial shear stress. Restenosis of mechanically recanalized coronary arteries may be related in part to similar abnormalities of disturbed local flood flow and shear stress. Low or reversed shear stress leads to plaque development and progression. High shear stress contributes significantly to plaque rupture. Regions of hemodynamic stasis caused by major luminal irregularities may lead to thrombosis and myocardial infarction without plaque rupture. This review outlines the mechanisms that link hemodynamic factors to plaque development and rupture and describes in some detail recently developed techniques that, for the first time, make it possible to determine these factorsin vivoin patients during routine cardiac catheterization procedures.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The medical treatment of acute coronary syndromes with thrombolytic, antithrombin, and antiplatelet agents is a major area of research and a vast topic for clinical review. This review summarizes important recent findings on the background of existing pathological and clinical knowledge to provide an understanding of the basis of current therapy and the new therapies that are likely to be introduced in the near future. Current controversies regarding the management of these conditions and the choice between medical, interventional, and combined strategies in different situations are also discussed.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Coronary artery bypass grafting and percutaneous transluminal coronary angioplasty are now well established methods of myocardial revascularization. The choice of a method of revascularization depends on several clinical and angiographic parameters. Patients who derive the greatest benefit from coronary artery bypass grafting are those with left main coronary artery disease or those with three-vessel disease with left ventricular impairment. Patients with single-vessel disease achieve more symptomatic relief with coronary angioplasty than with medical therapy alone, but with no improvement in long-term mortality. In nondiabetic patients with multiple-vessel disease, angioplasty and bypass grafting likely yield similar results, and the choice of revascularization technique rests on weighing the more invasive nature of bypass grafting against the need for additional future revascularizations with angioplasty. Diabetic patients with multiple-vessel disease seem to achieve better outcomes with bypass grafting. Minimally invasive bypass surgery is an evolving technique. It is less invasive in nature but its applications are limited, and its advantages over traditional bypass grafting have not yet been shown. Stenting now plays a major role in percutaneous revascularization and is performed in more than two thirds of all interventional procedures. It improves both the short-term and the long-term outcomes of coronary angioplasty. Other novel percutaneous techniques such as directional or rotational atherectomy, laser angioplasty, or thrombectomy devices have not shown convincing superiority over coronary angioplasty alone. Transmyocardial laser revascularization can be performed surgically or percutaneously and may be beneficial in patients with angina refractory to traditional revascularization procedures.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID