Dissertatie Dr. W.A.L. Tonino, interventie-cardioloog (per 1 oktober 2010), Catharina Ziekenhuis, Eindhoven
Uitgegeven: 06-07-2010
 | Dr. W.A.L. Tonino Cardioloog Catharina Ziekenhuis, Eindhoven |
|
» Fractional Flow Reserve to guide Percutaneous Coronary Intervention in Multivessel Coronary Artery Disease (volledige tekst, PDF) Promotores: Prof.dr. N.H.J. Pijls en Prof.dr. F. Zijlstra Copromotor: Dr. B. de Bruyne   Introduction1.1 Atherosclerosis of the coronary circulationIn Western society, atherosclerosis of the coronary arteries is the most prevalent disease and it is responsible for high numbers of death and nonfatal but disabling myocardial infarction every year. The heart is supplied by blood through the coronary arteries. Blood contains oxygen and nutrients which are essential to contraction of the myocardium. From the aorta, a right and a left coronary artery branch off. The latter usually splits into two major branches, the left anterior descending (LAD) and left circumflex (LCX) artery. Therefore, in clinical practice nomenclature of the coronary arteries is based on the presence of 3 arteries. Significant atherosclerotic disease in only one of these arteries is called single vessel disease and significant disease in 2 or 3 arteries is named multivessel disease. The anatomy and function of the coronary circulation are described in more detail in chapter 2. Atherosclerosis leads to diffuse disease and/or local narrowing in these arteries, which in turn impairs blood flow and therefore oxygen supply to the myocardium. Such an imbalance between oxygen supply and oxygen demand induces myocardial ischemia, resulting in chest discomfort known as angina pectoris. The presence of inducible myocardial ischemia not only causes symptoms, but also has significant and unfavorable prognostic implications.[1-4] Treatment options for coronary artery narrowings consist of medical therapy or revascularization by either percutaneous coronary intervention (PCI) or coronary bypass surgery (CABG). As will be explained in the next paragraph, the choice of treatment largely depends on the severity of the patient’s complaints and the presence and extent of reversible myocardial ischemia. Non-ischemic (hemodynamically or functionally non-significant) coronary lesions do not cause angina pectoris by definition and are relatively benign with a chance of causing death or myocardial infarction of less than 1% per year, if treated by appropriate medical therapy. Ischemic (hemodynamically or functionally significant) lesions generally cause chest pain and negatively affect longevity. Therefore, for proper clinical-decision making it is of critical importance to establish whether a coronary artery stenosis is related to myocardial ischemia, or in other words functionally significant. Although in many patients with single vessel disease, non-invasive testing and standard angiography are suitable methods to determine the potentially ischemic nature of a stenosis, in multivessel disease it is often very difficult to judge which out of several lesions are functionally significant and should be revascularized; and vice versa which stenoses could better be left alone and treated medically. » Lees de volledige tekst Laatste congresverslagen van auteur(s) |