Učestalost lokalnih komplikacija na mjestu punkcije nakon perkutane koronarne intervencije

master's thesis

• Title (english): Incidence of local puncture site complications after percutaneous coronary intervention
• Author: Stjepan Aždajić
• Mentor: Diana Delić-Brkljačić (mentor)
• Committee member: Mislav Vrsalović (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Diana Delić-Brkljačić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Unatoč značajnom napretku u prevenciji, dijagnostici i liječenju ishemijske bolesti srca ona je i dalje vodeći uzrok smrtnosti u svijetu. U posljednjih dvadeset godina razvojem invazivne kardiologije najznačajniju ulogu u liječenju akutnog koronarnog sindroma, kao najtežeg oblika koronarne bolesti srca, dobiva perkutana koronarna intervencija (PCI). Danas je perkutana koronarna intervencija s ugradnjom stenta zlatni standard u liječenju akutnog koronarnog sindroma. Iako učestalost lokalnih komplikacija nije velika ne smijemo ih zanemariti, te je stoga iznimno bitno usavršavati tehnike i težiti što boljem liječenju i bržem oporavku pacijenata.
Radijalni pristup u izvođenju PCI pokazao se jednako učinkovitim i sigurnim u odnosu na femoralni pristup, a sve više velikih istraživanja pokazuje brojne prednosti, osobito kada su u pitanju lokalne komplikacije. Najučestalija lokalna komplikacija na samom mjestu punkcije je krvarenje, odnosno stvaranje hematoma dok su druge poput pseudoaneurizme, AV fistule ili tromboze i embolije znatno rjeđe. Najnovije meta-analize su dokazale statistički značajno smanjenje pojavnosti krvarenja kod perkutanih koronarnih intervencija koje se izvode transradijalnim pristupom. Upravo zbog znatno manje učestalosti lokalnih komplikacija perkutane koronarne intervencije Europsko kardiološko društvo u trenutno vrijedećim smjernicama preporučuje radijalni pristup.

Abstract (english)

Ischemic heart disease is the leading cause of death in the world despite significant progress in the prevention, diagnosis and treatment. Through last twenty years in development of invasive cardiology, percutaneous coronary intervention (PCI) plays an important role in treatment of the hardest form of coronary heart disease - acute coronary syndrome. Nowadays, percutaneous coronary intervention with stent implantation is gold standard in the treatment of acute coronary syndrome. Although the incidence of local complications is not high, we should not ignore them, and therefore it is extremely important to improve the techniques and aspire to a better treatment and faster recovery of patients.
Radial approach in performing PCI proved to be equally effective and safe comparing to the femoral approach. Numerous studies show many advantages of radial approach, especially when it comes to local complications. Bleeding is the most common local complication at the puncture site, while others such as pseudoaneurysm, AV fistula, thrombosis or embolism are less frequent. The latest meta-analyses proved statistically significant reduction in the incidence of bleeding in percutaneous coronary interventions performed by transradial access. Because of significantly lower incidence of local complications while proceeding percutaneous coronary intervention, European Society of Cardiology in latest guidelines recommends the radial approach.

• Keywords: akutni koronarni sindrom; perkutana koronarna intervencija; lokalne komplikacije; radijalni pristup; femoralni pristup
• Keywords (english): acute coronary syndrome; percutaneous coronary intervention; local complications; radial approach; femoral approach
• Language: croatian
• URN:NBN: urn:nbn:hr:105:164621
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-03-14 10:41:06