Background The percutaneous transluminal coronary angioplasty (PTCA) is a therapeutic technique based on the use of devices (balloon catheters (POBA), bare-metal stents (BMS) and drug-eluting stents (DES)) which permit the treatment of coronary artery stenosis. Introduced at the end of the 70s’, the PTCA has had a rapid and intense development both in terms of number of procedures/year and in terms of technological evolution. In little more than 30 years we have moved from the treatment of coronary lesions with only the expansion by POBA, to the system of BMS, and since the 2000s, the system of DES.
Purpose The aim of this work is to evaluate how the evolution of devices affects the work of the haemodynamic unit, with particular reference to the “San Paolo” hospital in Bari.
Materials and methods The analysis was conducted retrospectively on the data of the aforementioned department in the years 2011–2012. Results: Until the mid-90s’, the treatment of coronary artery stenosis by percutaneous way was limited to the use of POBA with high incidence of procedural complications (coronary dissection and use of interventions of aortic-coronary bypass) and post-procedural (high incidence of restenosis evaluated between 40% and 50%). With the introduction of BMS both complications were significantly reduced. In particular, the incidence of restenosis was halved and the necessity of recurring to urgent by-pass intervention was lowered to almost zero. The use of DES and their technological development has resulted in a further reduction in the incidence of restenosis, now less than 7–8%. In 2011, in the haemodynamic unit of “San Paolo” hospital, were carried out 339 PTCA by treating 430 vessels; 271 DES and 190 BMS were implanted. 19 procedures were completed with the use of POBA. In 2012, 479 PTCA were performed by treating 600 vessels; 462 DES, 209 BMS and 28 POBA were implanted. In the two years analysed, only one case was resorted to by-pass surgery emergency (for ineffectiveness of PTCA) and the incidence of restenosis was approximately 4%.
Conclusions The analysis shows that the use of DES, characterised by the release of drugs with cytostatic and antiproliferative activity, is prevalent (58.3% in 2011 and 68.9% in 2012) due to their efficacy and safety. With regards to the analysis of costs, the advantage of using DES is the lower incidence of restenosis and therefore re-hospitalisation and additional procedures reduction. Disadvantages are: major procedural costs and the need to continue the dual antiplatelet therapy for one year.
No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.