Assuntos
Adenosina , Circulação Coronária , Microcirculação , Resistência Vascular , Humanos , Adenosina/administração & dosagem , Vasos Coronários/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Masculino , Reserva Fracionada de Fluxo Miocárdico , Pessoa de Meia-Idade , Vasodilatadores/administração & dosagem , Angiografia CoronáriaRESUMO
Proximal optimization technique and final kissing balloon inflations with noncompliant balloons facilitate success with coronary bifurcation intervention. The use of bioresorbable vascular scaffolds has been postulated to reduce the risk of in-stent restenosis, a particular problem with bifurcation intervention. We present a case of bifurcation intervention in a 49-year-old woman, using for the first time, proximal optimization and kissing balloon inflation within bioresorbable vascular scaffolds, using optical coherence tomography guidance.
Assuntos
Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/métodos , Stents , Alicerces Teciduais , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Desenho de Prótese , Tomografia de Coerência ÓpticaAssuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Intervenção Coronária Percutânea/métodos , Tomografia de Coerência Óptica , Ultrassonografia de Intervenção , Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Stents Farmacológicos , Everolimo , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Valor Preditivo dos Testes , Desenho de Prótese , Sirolimo/administração & dosagem , Sirolimo/análogos & derivados , Resultado do TratamentoRESUMO
The coronary pressure wire is used for physiological assessment of the coronary vasculature increasingly frequently in clinical practice. Fractional flow reserve (FFR) can now be used to assess lesion severity in a variety of anatomical situations. Increasingly, the coronary pressure wire is being used to interrogate the coronary microvasculature. Coronary flow reserve (CFR) and Index of microcirculatory resistance (IMR) require hyperaemia to accurately assess thermodilution-derived mean transit times, and pressure derived collateral flow index (CFIp) is calculated from coronary wedge pressure and aortic pressure at hyperaemia. In addition, coronary flow velocity as assessed by a coronary Doppler flow wire needs appropriate induction of hyperaemia. However, the majority of this article will however focus on hyperaemia induction for pressure wire studies particularly FFR. Significant clinical decisions are made as a result of FFR readings, therefore it is imperative that they are carried out correctly. Maximal coronary hyperaemia is essential in producing accurate, reproducible measurements. This article focuses on the pharmacological agents that can be used for this purpose, discusses which agents can be used in specific situations, and briefly addresses the future of pharmacological stress in the catheter laboratory.