La enfermedad coronaria en los diabéticos se presenta de forma muy agresiva, con una tasa de reestenosis elevada y una excesiva progresión de la ateroesclerosis. En este capítulo revisamos las distintas modalidades de tratamiento percutáneo y sus resultados en la población diabética desde la época de la angioplastia con balón hasta la era actual de los stents farmacoactivos. En tanto que la reestenosis podría considerarse virtualmente erradicada en un futuro próximo, la seguridad de este tipo de stent puede quedar como el principal escollo para la generalización de esta técnica. Asimismo, la cirugía de revascularización coronaria ha sido considerada el patrón de referencia del tratamiento de los diabéticos con enfermedad multivaso. Los estudios aleatorizados (cirugía frente a stent farmacoactivo) que se están llevando a cabo en la actualidad ayudarán a discernir el potencial papel de cada técnica en el tratamiento revascularizador del paciente diabético. Finalmente, con el fin de prevenir la progresión de la enfermedad ateroesclerótica, cabe exigir una modificación de los hábitos higiénico-dietéticos y un mejor control metabólico del paciente diabético.
Palabras clave
Diabetes mellitus
Revascularización coronaria
Stent farmacoactivo
Cirugía coronaria
Reestenosis
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