Los stents liberadores de drogas con su doble efecto mecánico y farmacológico son muy eficaces en prevenir la reestenosis, hecho ya conocido en lesiones favorables y que este año ha quedado confirmado también en lesions de alto riesgo. El número de angioplastias coronaries sigue aumentando (10% anual) como consecuencia del tratamiento invasivo de los síndromes coronarios agudos, la implantación de programas de angioplastia primaria y el tratamiento de pacientes más complejos. El diagnóstico y eventual tratamiento de las placas vulnerables es ahora un nuevo reto.
La medicina regenerativa ha levantado grandes expectativas, y la investigación clínica ha precedido a la experimentación animal. De hecho, aspectos tan básicos como el tipo celular, su preparación, la vía de administración, el momento de aplicación o la medicación coadyuvante no están todavía aclarados; todavía están en discusión si las células aplicadas anidan o no en el tejido miocárdico. Con todo, la terapia celular se está aplicando ya y empiezan a aparecer los resultados de los primeros estudios.
Las prótesis aórticas percutáneas están en fase avanzada de investigación clínica. En cuanto a los dispositivos de reducción de la regurgitación mitral, acaban de iniciar su fase de aplicación en humanos por lo que tardarán más en incorporarse a la clínica. Los dispositivos de cierre están ya bien desarrollados técnicamente, pero falta perfilar su indicación en determinadas entidades y su efectividad en otras.
En el presente artículo se revisan estos y otros aspectos relevantes que durante este año han supuesto aportaciones de interés en el campo de la cardiología intervencionista.
Palabras clave
Intervencionismo coronario
Stents
Stent con fármacos
Terapia regenerativa
Intervenciones valvulares
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2005. Sociedad Española de Cardiología