RESUMO
Background: Radial access (RA) may offer advantages in peripheral interventions, but previous studies on this approach have been limited to retrospective or single-center studies. Our aim was to prospectively evaluate the safety and feasibility of RA for complex endovascular lower extremity interventions. Methods: In this prospective, multicenter, and observational study, eligible patients with peripheral artery disease scheduled for intervention through RA were enrolled. Primary efficacy end point was procedural success, defined as successful completion of the intended procedure without conversion to femoral access and without RA complications periprocedure. Primary safety end point included evaluation of RA-related complications at 30 days. Results: From June 2020 to June 2021, 120 patients at 8 US centers were enrolled. Mean age was 68.7 years, and 31.7% were women. The 224 lesions treated were in iliac (12.9%), femoropopliteal (55.3%), isolated popliteal (11.9%), and tibial (19.5%) vessels. The primary efficacy end point was achieved in 112 (93.3%) patients. One patient (<1%) required femoral access conversion to complete the procedure. Thirty (25.0%) patients required 1 or more additional access to facilitate crossing and/or to complete the planned treatment (5 femoral, 10 tibial, and 17 pedal accesses). No serious adverse events were adjudicated to the procedure. Mean procedure time and time to ambulation was 74 minutes and 3 hours 30 minutes; respectively, with 93.3% same-day discharge. At 30 days, 97.2% of patients recorded ultrasound-confirmed RA patency. Conclusions: This is the first prospective and multicenter registry to show the safety and efficacy of RA approach for complex endovascular lesions and multilevel disease. RA allowed early ambulation and same-day discharge with no serious adverse events. Future randomized trials should examine the clinical and cost effectiveness of this approach compared with those of femoral access for patients with peripheral artery disease.
RESUMO
OBJECTIVES: The multicenter, prospective, single arm CLOUT registry assesses the safety and effectiveness of the ClotTriever System (Inari Medical, Irvine, CA) for the treatment of acute and nonacute lower extremity deep vein thrombosis (DVT) in all-comer patients. Reported here are the outcomes of the first 250 patients. METHODS: All-comer patients with lower extremity DVT were enrolled, including those with bilateral DVT, those with previously failed DVT treatment, and regardless of symptom duration. The primary effectiveness end point is complete or near-complete (≥75%) thrombus removal determined by independent core laboratory-adjudicated Marder scores. Safety outcomes include serious adverse events through 30 days and clinical outcomes include post-thrombotic syndrome severity, symptoms, pain, and quality of life through 6 months. RESULTS: The median age was 62 years and 40% of patients had contraindications to thrombolytics. A range of thrombus chronicity (33% acute, 35% subacute, 32% chronic) was observed. No patients received thrombolytics and 99.6% were treated in a single session. The median thrombectomy time was 28 minutes. The primary effectiveness end point was achieved in 86% of limbs. Through 30 days, one device-related serious adverse event occurred. At 6 months, 24% of patients had post-thrombotic syndrome. Significant and sustained improvements were observed in all clinical outcomes, including the Revised Venous Clinical Severity Score, the numeric pain rating scale, and the EuroQol Group 5-Dimension Self-Report Questionnaire. CONCLUSIONS: The 6-month outcomes from the all-comer CLOUT registry with a range of thrombus chronicities demonstrate favorable effectiveness, safety, and sustained clinical improvements.
Assuntos
Síndrome Pós-Flebítica , Síndrome Pós-Trombótica , Trombose Venosa , Fibrinolíticos , Humanos , Veia Ilíaca , Pessoa de Meia-Idade , Dor/etiologia , Síndrome Pós-Flebítica/etiologia , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/etiologia , Estudos Prospectivos , Qualidade de Vida , Sistema de Registros , Estudos Retrospectivos , Trombectomia/efeitos adversos , Trombectomia/métodos , Terapia Trombolítica , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/cirurgiaRESUMO
BACKGROUND/PURPOSE: The transradial approach has been proposed as an alternative to traditional transfemoral access for diagnostic and therapeutic purposes in several catheterization procedures. Historically, extended length devices for lower limb endovascular interventions have been limited. The aim of this study was to investigate the acute clinical outcomes of orbital atherectomy (OA) via transradial access (TRA) for the treatment of lower extremity peripheral artery disease (PAD). METHODS/MATERIALS: REACH PVI was a multicenter, prospective, observational study (NCT03943160) including subjects with PAD and target lesion morphology appropriate for OA. All patients were followed post-procedure through the first standard of care follow-up visit. RESULTS: A total of 50 patients were enrolled. In most cases the indication for intervention was disabling claudication (74.0%). Overall, 50 target lesions were treated, 92.0% of lesions were femoropopliteal and 8.0% were infrapopliteal. The average lesion length was 98.3 ± 87.5 mm and 78.0% of the lesions were severely calcified. Balloon angioplasty was performed in 98.0% of target lesions, while a stent was deployed in 16.0%. Treatment success was 98.0%; in only one case the result was sub-optimal (>30% stenosis with stent placement) and a significant dissection was reported. No serious distal embolization, serious thrombus formation or serious acute vessel closure were observed intra- or post-procedurally. CONCLUSIONS: Transradial OA followed by percutaneous transluminal angioplasty for lower extremity PAD is feasible and demonstrates a favorable safety profile. Extended length devices such as the Extended Length Orbital Atherectomy System could further facilitate transradial endovascular procedures by increasing its spectrum of application.
Assuntos
Angioplastia Coronária com Balão , Doença Arterial Periférica , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Resultado do TratamentoRESUMO
Tako-tsubo cardiomyopathy was first described in Japan in 1990. The clinical presentation of Tako-tsubo cardiomyopathy (TCM) is similar to an acute myocardial infarction with patients having chest pain, ST segment elevations on EKG and elevated cardiac biomarkers. In TCM, however, the elevation in cardiac enzymes is usually mild. We report a case of TCM where the patient had Troponin I elevation up to 42.3 ng/ml. To the best of our knowledge, this is the first case in which such high troponins have been reported in a patient with Tako-tsubo cardiomyopathy.
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Cardiomiopatia de Takotsubo/sangue , Troponina I/sangue , Biomarcadores/sangue , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The Platypnea-Orthodeoxia syndrome is characterised by dyspnoea and deoxygenation accompanying a change from the recumbent to the upright position. An 81-year-old woman had an elective paraesophageal hernia repair. She developed dyspnoea and hypoxemia post-operatively that was worse when upright. An agitated saline echocardiogram revealed a right-to-left shunt through a patent foramen ovale that increased when the patient was upright. Over 3 weeks the patients' shunt, dyspnoea and hypoxemia improved and she was discharged home.
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Dispneia/etiologia , Forame Oval Patente/complicações , Hipóxia/etiologia , Complicações Pós-Operatórias , Postura , Idoso de 80 Anos ou mais , Doenças do Esôfago/cirurgia , Feminino , Forame Oval Patente/diagnóstico por imagem , Herniorrafia , Humanos , Oxigênio/sangue , Síndrome , UltrassonografiaRESUMO
Tako-tsubo cardiomyopathy is a relatively recently recognized clinical entity, which presents similar to an acute myocardial infarction but there is no evidence of obstructive coronary artery disease on cardiac catheterization. It mostly affects postmenopausal women and an episode of acute illness or stress can often be identified preceding the presentation. Tako-tsubo cardiomyopathy (TCM) usually has a favorable outcome and an excellent prognosis but, in rare instances, it can be associated with life threatening complications. We report a unique case of TCM where the patient presented with a transient complete heart block.
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Eletrocardiografia , Bloqueio Cardíaco/etiologia , Cardiomiopatia de Takotsubo/complicações , Cateterismo Cardíaco , Estimulação Cardíaca Artificial , Diagnóstico Diferencial , Feminino , Seguimentos , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/terapia , Humanos , Pessoa de Meia-Idade , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologiaAssuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Aórtica/etiologia , Ecocardiografia Doppler em Cores , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/fisiopatologia , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Volume Sistólico , Função Ventricular EsquerdaAssuntos
Aneurisma/diagnóstico , Seio Aórtico/patologia , Taquicardia Ventricular/diagnóstico , Idoso de 80 Anos ou mais , Aneurisma/patologia , Diagnóstico por Imagem/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Humanos , Hipertensão/complicações , Masculino , Taquicardia Ventricular/patologiaRESUMO
A 27-year-old man was diagnosed with infective endocarditis due to Streptococcus agalactiae. Large vegetations were seen on the anterior mitral valve leaflet and also on the right ventricular side of a membranous ventricular septal defect. Streptococcus agalactiae is a rare cause of endocarditis, and it is very rare to find large vegetations around ventricular septal defect. The authors present this interesting case of unusual endocarditis with vegetations in both the right and left heart. This case is the first reported case of infective endocarditis involving the left and the right sides of the heart at the same time in a nonintravenous drug user.
Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Streptococcus agalactiae , Adulto , Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Masculino , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae/isolamento & purificação , UltrassonografiaRESUMO
We present a case of a rare complication of atrial septal defect (ASD) device closure causing cor triatriatum dextro iatrogenica. A 29-year-old female presented with sudden onset dysarthria and ataxia and was found to have basilar and thalamic infarcts. Further evaluation using transthoracic echocardiography revealed an ASD which was repaired using the Gore HELEX septal occluder. Transesophageal echocardiography done after 2 months of ASD closure revealed an interesting finding termed cor triatriatum dextro iatrogenica. We briefly describe the case and discuss the relevant literature.
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Coração Triatriado/diagnóstico por imagem , Coração Triatriado/etiologia , Comunicação Interatrial/cirurgia , Doença Iatrogênica , Dispositivo para Oclusão Septal/efeitos adversos , Adulto , Ecocardiografia Transesofagiana/métodos , Falha de Equipamento , Feminino , Seguimentos , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologiaRESUMO
Bacterial pericarditis is a well-known although rare complication of Staphylococcus aureus infection in modern practice. We present a rare case of Staphylococcus pericarditis caused by an infected trichilemmal cyst present on patient's scalp. Our case emphasizes that all cases of bacterial pericarditis should be thoroughly investigated for a source of infection. Constrictive changes can be seen in the pericardium postinfection, as in our patient, and should be treated aggressively. To our knowledge, a case of an infected cyst causing bacterial pericarditis has never been reported previously in the literature.
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Cistos/complicações , Cistos/microbiologia , Folículo Piloso/patologia , Pericardite Constritiva/etiologia , Couro Cabeludo/patologia , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Adulto , Antibacterianos/farmacologia , Cistos/patologia , Ecocardiografia , Humanos , Masculino , Meticilina/farmacologia , Pericardite Constritiva/diagnóstico por imagem , Pericardite Constritiva/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacosRESUMO
Hypereosinophilic syndrome is a rare condition characterized by idiopathic eosinophilia with organ system involvement. Cardiac involvement portends a less favorable prognosis as it can be complicated by development of heart failure, valvular dysfunction, and restrictive cardiomyopathy. We present a rare case of hypereosinophilic syndrome with FIP1L1/PDGFRA fusion in a 50-year-old male associated with thrombus in left and right ventricle.
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Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Síndrome Hipereosinofílica/diagnóstico por imagem , Trombose/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Immunoglobulin A nephropathy is the most common primary glomerulonephritis worldwide. The pathogenesis is still unknown and newer treatments are being researched. Rarely, it can be associated with other disorders. Its association with hereditary lymphedema has been reported on one occasion but never with lymphedema-distichiasis syndrome. We report a patient with hereditary lymphedema-distichiasis syndrome and immunoglobulin A nephropathy occurring simultaneously.
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Pestanas/anormalidades , Glomerulonefrite por IGA/diagnóstico , Linfedema/diagnóstico , Doenças Raras/diagnóstico , Anormalidades do Olho/complicações , Anormalidades do Olho/diagnóstico , Anormalidades do Olho/genética , Feminino , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/genética , Humanos , Linfedema/complicações , Linfedema/genética , Pessoa de Meia-Idade , Doenças Raras/complicações , Doenças Raras/genética , SíndromeRESUMO
We describe a case of an elderly man admitted to our hospital with syncope and a slow pulse rate. An echocardiogram showed both diastolic as well as systolic aortic regurgitation. Careful analysis of the clinical data, electrocardiogram and echocardiogram revealed that systolic aortic regurgitation was related to syncope in a very interesting fashion.
Assuntos
Insuficiência da Valva Aórtica/diagnóstico , Falência Renal Crônica/complicações , Síncope/diagnóstico , Sístole , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/etiologia , Bradicardia/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Frequência Cardíaca , Humanos , Masculino , Doenças Raras , Síncope/etiologiaRESUMO
We present an interesting case of a patient with thyrotoxicosis who developed both arterial and venous thrombosis. Although there have been reports of thrombosis in such patients, there has been no case reporting arterial and venous thrombosis in the same patient. We describe the case and discuss the medical literature. We feel that any patient with unexplained hypercoagulability should be thoroughly evaluated for thyroid dysfunction.
Assuntos
Infarto da Artéria Cerebral Média/etiologia , Embolia Pulmonar/etiologia , Tireotoxicose/complicações , Trombose Venosa/etiologia , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Antitireóideos/administração & dosagem , Antitireóideos/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Humanos , Infarto da Artéria Cerebral Média/sangue , Infarto da Artéria Cerebral Média/tratamento farmacológico , Masculino , Metimazol/administração & dosagem , Metimazol/uso terapêutico , Pessoa de Meia-Idade , Propranolol/administração & dosagem , Propranolol/uso terapêutico , Embolia Pulmonar/sangue , Embolia Pulmonar/tratamento farmacológico , Tireotoxicose/sangue , Tireotoxicose/diagnóstico , Tireotoxicose/tratamento farmacológico , Resultado do Tratamento , Trombose Venosa/sangue , Trombose Venosa/tratamento farmacológicoRESUMO
Celiac disease is an intestinal disorder caused by an immunologic response to gluten, which results in diffuse damage to the proximal small intestinal mucosa with malabsorption of nutrients. An association between celiac disease and nonischemic dilated cardiomyopathy has been noted. Cardiomyopathy has been shown to improve in some patients on a gluten-free diet. We report a case of progressively worsening dilated cardiomyopathy in a patient with documented celiac disease.
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Cardiomiopatia Dilatada/complicações , Doença Celíaca/complicações , Anemia/etiologia , Anemia/terapia , Cateterismo Cardíaco , Cardiomiopatia Dilatada/diagnóstico , Doença Celíaca/diagnóstico , Doença Celíaca/dietoterapia , Dieta Livre de Glúten , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Volume SistólicoRESUMO
Intracardiac blood cysts are thin-walled cysts, lined by flattened, cobblestone-shaped epithelium, and filled with nonorganized blood. During autopsy, they are found on cardiac valves in approximately 50% of infants below the age of 2 months and are rarely found after the age of 2 years. We report a rare case of blood cyst attached to the mitral valve and a possible cause of an embolic stroke.