Conceptos Categóricos

LA FUNCION DE LOS DADORES DE OXIDO NITRICO EN LA PREVENCION DE LA REESTENOSIS LUEGO DE LA INTERVENCION CORONARIA PERCUTANEA

LA FUNCION DE LOS DADORES DE OXIDO NITRICO EN LA PREVENCION DE LA REESTENOSIS LUEGO DE LA INTERVENCION CORONARIA PERCUTANEA

(especial para SIIC © Derechos reservados)
Actualización acerca de la función del óxido nítrico y de los dadores de óxido nítrico con respecto a la evolución luego de la angioplastia transluminal coronaria y en relación con la incidencia de reestenosis coronaria.
wohrle9.jpg Autor:
Jochen Wöhrle
Columnista Experto de SIIC

Institución:
Department of Internal Medicine II, University of Ulm


Artículos publicados por Jochen Wöhrle
Coautor
Thorsten Nusser, MD* 
University of Ulm*
Recepción del artículo
5 de Septiembre, 2005
Aprobación
8 de Septiembre, 2005
Primera edición
27 de Abril, 2006
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La aparición de reestenosis es la principal limitación de las intervenciones coronarias percutáneas que reducen el éxito a largo plazo. El proceso de reestenosis es un mecanismo multifactorial que incluye el tono vascular, la hemostasis, el metabolismo lipídico, las células, el crecimiento celular, la migración celular, las reacciones inflamatorias y las interacciones con las plaquetas. Los dadores de óxido nítrico (ON) influyen sobre esos mecanismos y claramente demostraron propiedades antirreestenóticas en varios experimentos con animales. En estudios clínicos, la administración oral de compuestos liberadores de ON que no inducen el fenómeno de tolerancia, como la molsidomina, no redujo la frecuencia de reestenosis luego de la angioplastia coronaria. La falta de eficacia se debe a las concentraciones plasmáticas sistémicas alcanzables de ON, las cuales claramente estuvieron por debajo de los niveles efectivos en pruebas con animales. Algunas preparaciones recientes, como nuevas drogas liberadoras de ON en mayores concentraciones, la liberación local de ON por stents coronarios recubiertos o la combinación con sustancias de efectividad probada como el paclitaxel parecen ser muy prometedores.

Palabras clave
óxido nítrico, reestenosis, angioplastia coronaria, stent, Molsidomina, molsidomina


Artículo completo

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Extensión:  +/-8.49 páginas impresas en papel A4
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Abstract
The occurrence of restenosis is the main limitation of percutanoues coronary interventions limiting the long-term success. The restenotic process is a multifactorial mechanism including vascular tone, hemostasis, lipid metabolism, cells, cell growth, cell migration, inflammatory reactions and interactions with platelets. Nitric oxide donors influence these mechanisms and have clearly shown antirestenotic properties in several animal experiments. In clinical studies, the oral administration of NO-releasing compounds such as molsidomine not inducing the tolerance phenomenon did not reduce the restenosis rate after coronary angioplasty. The lack of efficacy was based on the systemic achievable plasma concentrations of NO, which were clearly below the levels being effective in animal tests. Recent developments, such as new drugs releasing NO in higher concentrations, local NO delivery by coated coronary stents or the combination with proven effective restenotic substances like paclitaxel seem to be very promising.

Key words
Molsidomine, nitric oxide, restenosis, coronary angioplasty, stent


Full text
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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cardiología
Relacionadas: Bioquímica, Cirugía, Farmacología, Medicina Interna



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Bibliografía del artículo
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