Résultats immédiats, à moyens et à long terme de l’angioplastie du tronc commun de la coronaire gauche

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Publiée Dec 23, 2015
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Vol. 93 No 10 (2015): Revue oct. 2015

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Rym Gribaa
Mehdi Slim
Kacem Slim
Helmi Ben Salem
Elyes Neffati
Sana Ouali
Fehmi Remadi
Essia Boughzela

Résumé

RESUME
Prérequis: Les lésions significatives du tronc commun coronaire gauche (TCCG) sont retrouvées chez 4 à 6 % des patients subissant une coronarographie diagnostique. La chirurgie par pontage aorto-coronaire (PAC) constitue le traitement de référence. Actuellement, l’angioplastie prend une place de plus en plus large dans le traitement des lésions significatives du TCCG.
Méthodes : Etude rétrospective et descriptive comportant 32 patients porteurs de sténoses significatives du TCCG et traités par angioplastie coronaire dans le service de cardiologie de l’hôpital Sahloul colligé entre 2005 et mars 2011.
Résultats : L’Age moyen était de 59.7±10.9 ans. Un sexe ratio de 3.57. Le taux de succès angiographique était de 97%. L’évolution à la phase hospitalière était favorable dans 94% des cas. Un seul patient était décédé dans un tableau d’état de choc (EDC) réfractaire compliquant un infarctus du myocarde antérieur étendu vu tardivement. Après un suivi moyen de 18.5 mois±15.4, le taux de resténose global était de 16.12 %. Le taux global des évènements cardiaques majeurs (MACE) était de 29 %. Les facteurs prédictifs de MACE retrouvés dans notre série étaient : l’EDC cardiogénique à l’admission(p=0.022), les procédures urgentes d’angioplastie du TCCG (p=0.033), un Euroscore > 6 (p=0.001), Parsonnet score > 20 (p=0.036), un taux de C réactive protein (CRP) élevé
àl’admission (p=0.007), le taux de créatinine (p=0.008), un diamètre de référence du TCCG < 3.5 mm (p =0.036) et l’utilisation de stents nus (p=0.036). Les facteurs significatifs prédictifs de resténose intrastent retrouvés dans notre série : l’utilisation des stents nus (p=0.004) et le type de stents actifs (p=0.037).
Conclusion : L’angioplastie du TCCG est une procédure sûre et comporte peu de risque. Cependant, elle reste une option thérapeutique réservée à certains cas bien sélectionnés et limitée à certains centres.

Mots-clés :

Tronc commun coronaire gauche, traitement, angioplastie transluminale

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