[Coronary angioplasty of multiple vessels and lesions in unstable functional class-IV angina]. / Angioplastía coronaria de vasos y lesiones múltiples en angina inestable clase functional IV.

A select group of 26, class IV unstable angina patients that had multiple lesions or multivessel disease were treated with percutaneous transluminal coronary angioplasty (PTCA). Complete revascularization was the endpoint in all patients. Seventy lesions were dilated (mean = 2.6 lesions per patient). In the tandem multi-lesion group (13 patients) 2.23 lesions per patient were approached (Range 2-3) and in the multivessel disease group (13 patients) a mean of 3.15 lesions per patient were attempted (Range 2-6). An overall success rate of 96% per patient (25/26 patients) and 95.7% primary success per lesion were achieved with no mortality. We report the results of a select group of unstable angina patients with multi-lesion or multivessel disease who underwent PTCA. A careful performance was associated with high primary success in the high risk group achieving clinical and angiographic improvement.

[Coronary and renal percutaneous angioplasty performed in the same procedure. A report on 5 consecutive cases]. / Angioplastía percutánea coronaria y renal realizadas en el mismo procedimiento. Reporte de 5 casos consecutivos.

Percutaneous transluminal coronary and renal angioplasty (PTA and Renal PTA) were performed during the same procedure in five of 100 patients who underwent PTCA between August 1989 and June 1990. All patients were male, with systemic hypertension (HT) with angina grade I to IV. The median age was 62 years (range 53 to 74). Three patients had controlled HT with 2 to 4 drugs and 2 were uncontrolled even after multiple antihypertensive treatment. Two patients were diabetic and the serum creatinine levels were normal except in one patient (1.9 mg/dL). Lesions more than 70% obstruction of luminal diameter were approached. Multivessel PTCA was done in one patient, multi-lesion in 2 and single lesion in other two. A total of 11 lesions were dilated, 4 in LAD, 5 in Cx and 2 in RCA (type A = 2, type B = 9). Complete revascularization was achieved in all cases. Five renal lesions were approached, 4 in the proximal third and one on the middle third. In 2 patients the blood pressure (BP) fell within normal limits without medication. In other 2 there was an improvement and were easily controlled with just one drug. One patient had no improvement and required multiple therapy to control it. The only complication observed was in a diabetic with previous abnormal serum creatinine who developed non-oliguric renal failure and returned to basal creatinine level at the third day post PTCA. In selected cases PTCA and renal PTA can be safely performed during the same procedure, with the advantage of cost reduction.

[Cardiogenic shock in acute myocardial infarct. Its coronary angioplasty treatment]. / Choque cardiogénico en el infarto agudo del miocardio. Tratamiento con angioplastía coronaria.

Ventricular dysfunction is the most common cause of in-hospital death in patients with acute myocardial infarction. When cardiogenic shock is manifested the mortality is very high. Seven patients with cardiogenic shock complicating acute myocardial infarction were treated with emergency coronary angioplasty. Four patients required cardiopulmonary resuscitation (CPR), 2 intraaortic balloon pump support and one femoro-femoral bypass pump support during the coronary angioplasty. The angiography success rate was 86%. Two patients died, one in the catheterization laboratory and the other one 24 hours later. The hospital mortality was 29%. Of the patients who survived 4 are in functional class I and one in functional class II (NYHA). Coronary angioplasty therapy in patients with cardiogenic shock complicating acute myocardial infarction plays a decisive role in the reduction of mortality.