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La angiografía coronaria ha sido la técnica estándar para valorar la enfermedad coronaria y sus cambios con el tratamiento. Esta técnica visualiza el lumen y las estenosis coronarias, pero no la pared arterial. Otras limitaciones son su agresividad, su alto coste y su aplicabilidad restringida a pacientes con enfermedad coronaria establecida. Las nuevas técnicas de detección por la imagen de la aterosclerosis preclínica (ecografía carotídea, tomografía computarizada para la detección de calcio coronario y resonancia magnética vascular) permiten evaluar de manera incruenta la carga aterosclerótica y sus cambios con el tratamiento en individuos con o sin enfermedad coronaria. Otra técnica reciente, la ecografía intravascular, también es agresiva, pero resulta útil porque evalúa tanto el lumen como la pared arterial. Aunque todavía no está estandarizada, la medición ecográfica del grosor íntima-media carotídeo es la técnica más asequible y la única recomendada para estudios de regresión de la aterosclerosis. Varios estudios clínicos han demostrado detención de la progresión o regresión de la aterosclerosis carotídea tras el tratamiento con estatinas durante 1-4 años. Los estudios angiográficos para la valoración de la eficacia terapéutica del tratamiento hipolipemiante no son realmente necesarios.
Palabras clave:
Aterosclerosis
Tratamiento hipolipemiante
Estudios de regresión
Ecografía carotídea
Grosor íntima-media
Ecografía intravascular
Calcio coronario
Resonancia magnética vascular
Coronary angiography has been the standard technique to evaluate coronary disease and its changes with treatment. This technique can visualize the coronary lumen and stenosis but not the arterial wall. Other limitations are that it is an aggressive and expensive procedure and its use is restricted to patients with established coronary disease. New imaging techniques for the protection of preclinical atherosclerosis (carotid ultrasonography, computed tomography for the detection of coronary calcium and vascular magnetic resonance imaging) allow atherosclerotic load and its changes with treatment to be evaluated noninvasively in individuals with or without coronary disease. Another recent technique, intravascular ultrasonography, is also aggressive, but is useful because it evaluates both the lumen and the arterial wall. Although still not standardized, ultrasonographic measurement of carotid intima-media thickness is the most accessible technique and is the only procedure recommended for studies of atherosclerosis regression. Various clinical studies have demonstrated that progression of carotid atherosclerosis is halted or that there is regression after 1-4 years of treatment with statins. Angiographic studies to evaluate the therapeutic efficacy of lipid lowering drugs are not really required.
Key words:
Atherosclerosis
Lipid-lowering therapy
Regression studies
Carotid ultrasonography
Intima-media thickness
Intravascular ultrasonography
Coronary calcium
Vascular magnetic resonance imaging
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