الفهرس 
ResultsOnly 14 pages are availabe for public view
 |  | from | 127 |  |  |
| | | from | 127 | | |
Abstract
PCI with stenting is the standard of care in STEMI because it is associated with a significant reduction in morbidity and mortality as compared to fibrinolysis and balloon angioplasty. To perform stenting, it is mandatory to visualize the length of culprit lesion and the diameter of the downstream artery. However, in a STEMI patient, TIMI flow is most often ≤ 1. Balloon PD is associated with more reperfusion failure and lower probability of final TIMI 3 flow. Pharmacologically facilitated PCI has been associated with significant increase in bleeding and has failed to show any improvements in the clinical outcomes.
DS is currently suggested as the default strategy in primary angioplasty. DS, or stenting without lesion PD, is employed in 30-50% of PCIs in elective as well as non- elective patients undergoing PCI. There is a significant benefit of DS in terms of safety, procedural outcomes, MACE rate and mortality. Superior clinical out comes associated with DS may be driven by reduced wall damage and inflammatory response from balloon PD, greater preservation of residual endothelium, better longitudinal centering of the stent on the lesion with more uniform axial redistribution of plaque, reduced microcirculatory dysfunction and/or distal embolization, significant improvement in myocardial reperfusion, higher probability of TIMI 3 flow, fewer intimal dissections and consequently lesser requirement of number and length of stents. There are also significant downsides to DS including: underestimation of true vessel size, failure to cross, non-dilatable lesions, inadequate stent expansion, geographic miss, late stent malapposition and restenosis.
The present study was comparative study that include 60 patients diagnosed with STEMI and underwent PPCI. group 1 consist of 30 patients underwent deflated balloon facilitated direct stenting DBDS technique.group 2 consist of 30 patients underwent balloon inflation before stenting.
In the deflated balloon group The TIMI flow after the procedure mean ±SD equal 2.77 ± 0.57 while in the balloon inflation the TIMI flow equal 2.43 ± 0.68. That showed significant statistical difference.
The mean myocardial blush grade after DBDS procedure equal 2.63 ± 0.67 while in the balloon inflation the mean myocardial blush grade equal 1.93 ± 0.98. That showed highly significant statistical difference.
The MACE rate during the deflated balloon procedure was significantly lower than MACE rate in balloon inflation group (3.3% Vs 26.7%P value=0.011).
The complication rate was 13.3% in the deflated balloon group while it was 43.3% in the balloon inflation group.
The no reflow rate and distal embolization rate after DBDS procedure was 6.7% while it was 26.7% after balloon inflation procedure.
The heart failure rate occurred only in one patient in the DBDS group while it occurred in 6 patients in the balloon inflation group. The DBDS technique to facilitate DS appears to be simple, feasible and safe. It significantly increases DS and could offer an alternative to PD and thrombectomy.
CONCLUSION AND RECOMMENDATIONS
D
BDS technique has a better clinical outcomes,lower 1 month MACE, lower complications and lower distal embolization and no reflow rate. It appears to be simple, feasible and safe. It helps in maximizing DS and could offer an alternative to balloon pre dilatation (PD) and aspiration thrombectomy in STEMI patients. However, larger studies with longer follow up are required before a wider application of this technique.