{"id":5869540,"date":"2022-12-30T07:34:43","date_gmt":"2022-12-30T06:34:43","guid":{"rendered":"https:\/\/kapitalis.com\/tunisie\/?p=5869540"},"modified":"2022-12-30T07:34:46","modified_gmt":"2022-12-30T06:34:46","slug":"les-potins-du-cardiologue-en-dehors-de-la-plaque","status":"publish","type":"post","link":"https:\/\/kapitalis.com\/tunisie\/2022\/12\/30\/les-potins-du-cardiologue-en-dehors-de-la-plaque\/","title":{"rendered":"Les potins du cardiologue : en dehors de la plaque!"},"content":{"rendered":"\n

Un cardiologue interventionnel pratiquant couramment l\u2019angioplastie coronaire n\u2019est pas un cascadeur. Aussi ne doit-il pas prendre des risques inutiles, avec des cons\u00e9quences parfois fatales pour le malade. M\u00e9decine et narcissisme ne font pas bon m\u00e9nage\u2026<\/em><\/strong><\/p>\n\n\n\n

Par Dr Mounir Hanablia<\/strong> * \u00a0\u00a0<\/p>\n\n\n\n\n\n\n\n

Il existe des faits qui en cardiologie aussi peuvent d\u00e9fier l\u2019entendement. Ainsi en est-il de la technique de la tunnelisation dans le traitement des obstructions totales chroniques des art\u00e8res coronaires. Celle-ci est constitu\u00e9e par la fermeture de l\u2019art\u00e8re par un caillot issu de la rupture d\u2019une plaque de cholest\u00e9rol. Au d\u00e9part mou et friable, facilement mobilisable, il s\u2019est transform\u00e9 au fil du temps en un bouchon fibreux r\u00e9sistant, et quand apr\u00e8s plusieurs mois du calcaire s\u2019y d\u00e9pose, il devient aussi dur que la paroi d\u2019un mur. Autrement dit, quand il s\u2019agit de le traverser avec un guide en titane ou en polym\u00e8re, dans une dilatation coronaire, le r\u00e9sultat n\u2019est jamais garanti d\u2019avance, et plus que cela, le guide embroche parfois la paroi de l\u2019art\u00e8re, occasionnant une h\u00e9morragie dans le p\u00e9ricarde, plus ou moins grave selon son abondance. C\u2019est pourquoi le taux d\u2019\u00e9checs dans le traitement de ce genre de l\u00e9sions est \u00e9lev\u00e9.<\/p>\n\n\n\n

Contourner l\u2019obstacle<\/h2>\n\n\n\n

Cela \u00e9tant, les cardiologues interventionnels, qui veulent toujours repousser plus loin les limites de la technique, ont trouv\u00e9 une solution pour franchir ces caillots empierr\u00e9s. Au lieu de creuser \u00e0 travers le mur comme ils avaient l\u2019habitude de le faire, ils contournent d\u00e9sormais l\u2019obstacle (la plaque calcaire) en passant le guide par un trou dans la paroi de l\u2019art\u00e8re.<\/p>\n\n\n\n

En r\u00e9alit\u00e9, abstraction faite des ann\u00e9es d\u2019exp\u00e9rience dans la pratique de l\u2019angioplastie coronaire, le simple bon sens suffit \u00e0 laisser dubitatif.<\/p>\n\n\n\n

Quand on sait que la lumi\u00e8re d\u2019une art\u00e8re coronaire ne d\u00e9passe g\u00e9n\u00e9ralement pas 3 millim\u00e8tres, que sa paroi ne d\u00e9passe pas 1 millim\u00e8tre d\u2019\u00e9paisseur, et que le diam\u00e8tre d\u2019un guide ne fait pas plus de quelques dixi\u00e8mes de millim\u00e8tres, on situe d\u00e9j\u00e0 l\u2019\u00e9chelle de grandeur \u00e0 travers laquelle le m\u00e9decin op\u00e8re.<\/p>\n\n\n\n

\u00c9videmment, le calcaire \u00e9tant naturellement opaque aux rayons X, il permet un bon rep\u00e9rage de l\u2019obstacle par rapport au guide, lui-m\u00eame visible. Mais \u00e0 supposer qu\u2019on ait r\u00e9ussi \u00e0 contourner l\u2019obstacle en cheminant dans la paroi, il faut encore trouer de nouveau pour revenir dans la lumi\u00e8re de l\u2019art\u00e8re. Or rien n\u2019est plus difficile que de faire prendre \u00e0 un guide pr\u00e9form\u00e9 un trajet autre que celui qu\u2019il emprunte, et si celui-ci est rectiligne, il n\u2019y a aucune raison qu\u2019il devienne brusquement courbe. Et il faut aussi partir de l\u2019hypoth\u00e8se que le guide ne prenne pas un autre trajet, celui, f\u00e2cheux, vers l\u2019ext\u00e9rieur de l\u2019art\u00e8re, qui provoquerait un saignement souvent fatal.<\/p>\n\n\n\n

Sans vouloir nier que de telles proc\u00e9dures soient parfois possibles, peut-\u00eatre en usant d\u2019un mat\u00e9riel de radiologie avec des guides beaucoup plus fins de la taille d\u2019un cheveu, des trackers, et un amplificateur de brillance (tube \u00e0 rayons X) ad\u00e9quat, elles sont conditionn\u00e9es certainement par des contraintes techniques et anatomiques rigoureuses.<\/p>\n\n\n\n

Ne pas se jeter par la fen\u00eatre<\/h2>\n\n\n\n

Il faut donc \u00eatre tr\u00e8s prudent lorsque dans les congr\u00e8s m\u00e9dicaux, y compris internationaux, si tant est qu\u2019on se trouve dans les bonnes gr\u00e2ces des laboratoires pour y acc\u00e9der, des sommit\u00e9s voulant convaincre de leur caract\u00e8re surhumain, pr\u00e9tendent voler en se jetant par la fen\u00eatre, et fournissent les statistiques n\u00e9cessaires pour le prouver.<\/p>\n\n\n\n

Un \u00e9minent coll\u00e8gue, ex-pr\u00e9sident de la soci\u00e9t\u00e9 savante, affirmait un jour le plus s\u00e9rieusement du monde la possibilit\u00e9 de glisser un stent serti sur son ballon, entre la paroi d\u2019un stent d\u00e9ploy\u00e9 et celle d\u2019une art\u00e8re; cela est \u00e9videmment possible si on pense faire passer un d\u00e9 \u00e0 coudre  dans un trou d\u2019aiguille. <\/p>\n\n\n\n

La confr\u00e9rie des cardiologues n\u2019est pas d\u00e9pourvue de narcissiques (ils se glorifient de leurs proc\u00e9dures en en publiant parfois les vid\u00e9os sur facebook), qui pr\u00e9tendent en faire plus et mieux que le commun des mortels et qui n\u2019h\u00e9sitent pas \u00e0 prendre des risques inutiles, avec des cons\u00e9quences parfois fatales pour le malade, qu\u2019on aura \u00e9videmment beau jeu de passer par pertes et profits. <\/p>\n\n\n\n

En r\u00e9alit\u00e9, une occlusion chronique d\u2019une art\u00e8re ne tue pas, mais elle peut devenir\u00a0l\u00e9tale\u00a0lorsqu\u2019on \u00e9choue \u00e0 la reperm\u00e9abiliser.\u00a0Il faudrait donc peut-\u00eatre prendre l\u2019habitude, dans les congr\u00e8s m\u00e9dicaux, de s\u2019opposer aux cascadeurs.<\/p>\n\n\n\n

* M\u00e9decin de pratique libre.<\/em> <\/p>\n","protected":false},"excerpt":{"rendered":"

M\u00e9decine et narcissisme ne font pas bon m\u00e9nage\u2026<\/p>\n","protected":false},"author":8,"featured_media":5869544,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[992,998,1000,2433],"tags":[104988,105438,2783,103335,105439,87558,810,104990,62643],"class_list":["post-5869540","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-a-la-une","category-societe","category-tribune","category-tunisie","tag-angioplastie-coronaire","tag-arteres-coronaires","tag-cardiologie","tag-cholesterol","tag-dilatation-coronaire","tag-dr-mounir-hanablia","tag-sante","tag-stents","tag-tunisie"],"yoast_head":"\nLes potins du cardiologue : en dehors de la plaque! - Kapitalis<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/kapitalis.com\/tunisie\/2022\/12\/30\/les-potins-du-cardiologue-en-dehors-de-la-plaque\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Les potins du cardiologue : en dehors de la plaque! 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