RESUMO
This study aimed to compare the outcomes of different revascularization strategies among patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing primary percutaneous coronary intervention (PCI). MVD is present in about one-half of patients presenting with STEMI. Despite several randomized controlled trials (RCTs) comparing complete revascularization (CR) and culprit-only revascularization (COR), the optimal PCI strategy for STEMI patients with MVD remains unsettled. Moreover, it is unclear whether angiography-guided CR or fractional flow reserve (FFR)-guided CR is associated with better outcomes. PubMed, Scopus, and Cochrane Library were searched for RCTs comparing CR strategies with COR strategy in patients with STEMI between January 1, 2000 and September 30, 2021 were identified. A frequentist network meta-analyses were performed for three PCI strategies: (1) COR; (2) angiography-guided CR; and (3) FFR-guided CR. Ten RCTs including 7979 patients were included. A strategy of angiography-guided CR or FFR-guided CR was associated with a significantly lower rate of major adverse cardiac events (MACE) and unplanned revascularization compared with COR. Although there were no statistical significant difference between angiography-guided CR and FFR-guided CR, P score analysis showed that angiography-guided CR was ranked as the best strategy for reducing MACE, all-cause mortality, cardiovascular death, recurrent myocardial infarction, and unplanned revascularization. In patients presenting with STEMI and MVD undergoing primary PCI, angiography-guided CR or FFR-guided CR improve outcomes compared with COR. Furthermore, the strategy of angiography-guided CR ranked as the best revascularization strategy in those patients.
Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Reserva Fracionada de Fluxo Miocárdico , Humanos , Metanálise em Rede , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Resultado do TratamentoRESUMO
OBJECTIVES: Although successful recanalization of coronary chronic total occlusion (CTO) can induce subsequent positive vascular remodeling in the distal segment, the predictors are not fully understood. The aim of this study was to investigate the extent and predictors related to luminal gain after successful CTO recanalization. METHODS: A total of 134 patients who underwent intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for CTO and follow-up angiography were included. Angiographic parameters were assessed qualitatively and quantitatively at baseline and follow-up. Gray-scale IVUS images during the PCI procedure were also analyzed. Lumen diameter (LD) at distal reference on the post-PCI angiogram was compared with corresponding LD at follow-up coronary angiography. RESULTS: At the mean follow-up of 10.0 ± 2.7 months, LD at distal reference was significantly increased by 15.9% from baseline to follow-up (2.06 ± 0.62 vs. 2.30 ± 0.55 mm, p < 0.001). Univariable analysis indicated that the left anterior descending artery (LAD), no moderate or severe calcification, presence of peri-medial high-echoic band on IVUS, and impairment of final coronary flow and small distal reference diameter at baseline were associated with greater late lumen enlargement. Multivariable analysis showed the LAD, no moderate or severe calcification, and small LD at distal reference as independent predictors of greater late lumen enlargement. CONCLUSION: The segment distal to recanalized CTO showed significant late lumen enlargement, especially in the cases with small distal reference, in the LAD, and without moderate or severe calcification.
Assuntos
Oclusão Coronária/terapia , Vasos Coronários/fisiopatologia , Intervenção Coronária Percutânea , Remodelação Vascular , Idoso , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: The difference in intraluminal intensity of blood speckle (IBS) on integrated backscatter-intravascular ultrasound (IB-IVUS) across the coronary artery stenosis (i.e., ΔIBS) has been reported to negatively correlate with fractional flow reserve. Fractional flow reserve after coronary stenting is known as a predictor of target vessel revascularization (TVR). However, the relation between ΔIBS and TVR is unclear. METHODS: Seven hundred and three vessels which underwent percutaneous coronary intervention with stents were screened. Vessels without IVUS-guidance and follow-up information were excluded. Intraluminal IBS values were measured using IB-IVUS in cross-sections at the ostium of the target vessel and at the distal reference of implanted stent. ΔIBS was calculated as (distal IBS) - (ostium IBS). RESULTS: A total of 393 vessels were included. Mean ΔIBS at postprocedure was 6.22 ± 5.65. During the follow-up period (11.2 ± 3.1 months), 24 cases (6.1%) had TVR. ΔIBS was significantly greater in the vessels with TVR than in those without (11.10 ± 5.93 vs. 5.90 ± 5.49, P <0.001). In receiver operating characteristic curve analysis, ΔIBS significantly predicted TVR (AUC 0.74, best cut-off value 8.24, P < 0.001). Multiple logistic regression analysis showed use of drug eluting stent and ΔIBS ≥ 8.24 as independent predictors of TVR. CONCLUSIONS: ΔIBS at postprocedure was significantly associated with TVR. IVUS may be able to predict TVR by physiological assessment with measurement of ΔIBS.
Assuntos
Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/instrumentação , Stents , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Hospitais , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoAssuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemólise , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Resultado do TratamentoRESUMO
The diagnosis of vasospastic angina (VSA) according to Japanese guidelines involves an initial intracoronary acetylcholine (ACh) provocation test in the left coronary artery (LCA) followed by testing in the right coronary artery (RCA). However, global variations in test protocols often lead to the omission of ACh provocation in the RCA, potentially resulting in the underdiagnosis of VSA. This study assessed the validity of the LCA-only ACh provocation approach for the VSA diagnosis and whether vasoreactivity in the LCA aids in determining further provocation in the RCA. A total of 273 patients who underwent sequential intracoronary ACh provocation testing in the LCA and RCA were included. Patients with a positive ACh provocation test in the LCA were excluded. Relations between vasoreactivity in the LCA and ACh test outcomes (positivity and adverse events) in the RCA were evaluated. In patients with negative ACh test results in the LCA, subsequent ACh testing was positive in the RCA in 23 of 273 (8.4%) patients. In patients with minimal LCA vasoconstriction (<25%), only 3.0% had a positive ACh test in the RCA, whereas the ACh test in the RCA was positive in 13.5% of those with LCA constriction of 25% to 90% (p = 0.002). No major adverse events occurred during ACh testing in the RCA. In conclusion, for the VSA diagnosis, the omission of ACh provocation in the RCA may be clinically acceptable, particularly when vasoconstriction induced by ACh injection was minimal in the LCA. Further studies are needed to define ACh provocation protocols worldwide.
Assuntos
Acetilcolina , Vasoespasmo Coronário , Vasos Coronários , Vasoconstrição , Humanos , Acetilcolina/administração & dosagem , Acetilcolina/farmacologia , Feminino , Masculino , Vasoespasmo Coronário/diagnóstico , Vasoespasmo Coronário/fisiopatologia , Vasoespasmo Coronário/induzido quimicamente , Vasos Coronários/fisiopatologia , Vasos Coronários/efeitos dos fármacos , Idoso , Pessoa de Meia-Idade , Vasoconstrição/fisiologia , Vasoconstrição/efeitos dos fármacos , Angiografia Coronária , Vasodilatadores/administração & dosagem , Estudos Retrospectivos , Angina Pectoris/fisiopatologia , Angina Pectoris/diagnósticoRESUMO
BACKGROUND: Although guidelines recommend intracoronary administration of acetylcholine (ACh) with incremental doses of 20, 50, and 100⯵g into the left coronary artery (LCA) during spasm provocation test for diagnosing vasospastic angina, 50⯵g of ACh rarely induced significant coronary vasospasm when no vasoconstriction was observed with 20⯵g of ACh in a previous report. The aim of this study was to evaluate the safety and feasibility of omitting 50⯵g according to the vasoreactivity by 20⯵g of ACh in the LCA. METHODS: A total of 556 patients undergoing ACh provocation test with 20⯵g followed by 50 and/or 100⯵g were retrospectively included. Injection of 50⯵g of ACh was primarily omitted when vasoconstriction <25â¯% was observed with 20⯵g, which was left to operator's discretion. Adverse events were defined as a composite of ventricular fibrillation, sustained ventricular tachycardia, and cardiogenic shock during ACh test in the LCA. RESULTS: Positive ACh test in the LCA was observed in 245 (44.1â¯%) patients. Overall, patients with LCA constriction <25â¯% by 20⯵g of ACh had a lower rate of positive ACh test than their counterpart (24.0â¯% vs. 88.4â¯%, pâ¯<â¯0.001). In patients with LCA constriction ≥25â¯% by 20⯵g, the incidence of adverse events was significantly higher than in those with LCA constriction <25â¯% during the provocation test at doses of 50 and 100⯵g (2.3â¯% vs. 0â¯%, pâ¯=â¯0.009). CONCLUSIONS: Omitting 50⯵g of ACh in the LCA may be safe and feasible when little vasoconstriction was observed with preceding injection of 20⯵g of ACh during spasm provocation test for diagnosing vasospastic angina. However, we believe that 50⯵g of ACh should not be omitted when 20⯵g of ACh induced LCA constriction ≥25â¯%.
Assuntos
Acetilcolina , Vasoespasmo Coronário , Humanos , Acetilcolina/efeitos adversos , Vasoespasmo Coronário/diagnóstico , Vasoespasmo Coronário/induzido quimicamente , Vasos Coronários , Estudos Retrospectivos , Angiografia CoronáriaRESUMO
Traumatic brain injury (TBI) can result in left ventricular dysfunction, which can lead to hypotension and secondary brain injuries. However, the association between left ventricular systolic dysfunction (LVSD) and in-hospital mortality in patients with moderate-to-severe isolated TBI is controversial. Therefore, we conducted a systematic review and meta-analysis to identify the prevalence of LVSD and evaluate whether LVSD following moderate-to-severe isolated TBI increases the in-hospital mortality. We searched PubMed, EMBASE, and the Cochrane Library database from January 1, 2010, through June 30, 2020. Meta-analysis was performed to determine the incidence of LVSD and related mortality in patients with moderate-to-severe isolated TBI. A systematic review identified 5 articles appropriate for meta-analysis. The total number of patients pooled was 256. LVSD was reported in 4 studies, of which the estimated incidence of patients with LVSD was 18.7% (95% confidence interval, 11.9-26.6). Five studies reported on in-hospital mortality, and the estimated in-hospital mortality was 14.1% (95% confidence interval, 5.3-25.6). Finally, 3 studies were eligible for analyzing the association of LVSD and in-hospital mortality. On meta-analysis, in-hospital mortality was significantly higher in patients with LVSD (risk ratio, 6.57; 95% confidence interval, 3.71-11.65; P < 0.001). In conclusion, LVSD after moderate-to-severe TBI is common and may be associated with worse in-hospital outcomes.
Assuntos
Lesões Encefálicas Traumáticas , Disfunção Ventricular Esquerda , Lesões Encefálicas Traumáticas/complicações , Mortalidade Hospitalar , Humanos , Prevalência , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/etiologia , Função Ventricular EsquerdaRESUMO
Successful recanalization of coronary chronic total occlusion (CTO) can induce subsequent positive vascular remodeling. Although myocardial bridge (MB) is known to alter endothelial function and wall shear stress, the impact of MB on late lumen enlargement in the distal segment is unclear. A total of 59 patients who underwent successful percutaneous coronary intervention (PCI) for CTO in the left anterior descending artery (LAD) under intravascular ultrasound (IVUS) guidance and follow-up angiography at 8-12 months were included. Gray-scale IVUS images were analyzed and MB was detected. Lumen diameter (LD) at distal reference at post-PCI was quantitatively compared with corresponding LD at follow-up coronary angiography to assess late lumen enlargement. MB on IVUS was detected in 17 patients (29%). The length from LAD ostium to the entry of CTO was shorter (11.7 ± 13.9 vs. 22.8 ± 13.4 mm, p = 0.006) and LD at distal reference at post-PCI was smaller (1.65 ± 0.54 vs. 1.97 ± 0.56 mm, p = 0.049) in patients with MB than those without. At the mean follow-up of 10.4 ± 2.4 months, LD at distal reference was significantly increased by 25% from baseline to follow-up in the overall population (1.88 ± 0.57 vs. 2.21 ± 0.41 mm, p < 0.001), with a greater increase in patients with MB compared to those without (46 ± 31% vs. 17 ± 29%, p < 0.001). Multivariable analysis indicated MB as an independent predictor of late lumen enlargement. In patients with MB on IVUS, CTO was located in more proximal segment of LAD than those without. Late lumen enlargement at follow-up was greater in patients with MB compared to the counterpart.
Assuntos
Oclusão Coronária/terapia , Vasos Coronários/fisiopatologia , Ponte Miocárdica/fisiopatologia , Intervenção Coronária Percutânea , Remodelação Vascular , Idoso , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte Miocárdica/diagnóstico por imagem , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
Radiofrequency ablation is an established treatment for atrial fibrillation (AF). However, coronary artery spasm (CAS) is a rare but a potentially lethal complication associated with this procedure. A 54-year-old man with paroxysmal AF underwent pulmonary vein isolation. The procedure was completed and AF could not be induced after burst pacing and the administration of isoproterenol. Suddenly, ST-segment elevation developed in the anterior leads and frequent premature ventricular contractions followed by non-sustained ventricular fibrillation. The diagnosis of CAS was made by urgent coronary angiography. We identified isoproterenol as a potential cause of CAS. Physicians should be aware of this potentially lethal side effect.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Infusões Intravenosas , Isoproterenol/efeitos adversos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Espasmo , Resultado do TratamentoRESUMO
Clinical impact of tissue protrusion (TP) after coronary stenting is still controversial, especially in patients with ST-segment elevation myocardial infarction (STEMI). A total of 104 STEMI patients without previous MI who underwent primary percutaneous coronary intervention (PCI) under intravascular ultrasound (IVUS)-guidance were included. Post-stenting grayscale IVUS analysis was performed, and the patients were classified according to the presence or absence of post-stenting TP on IVUS. Coronary angiography and single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) with 99mTc tetrofosmin were analyzed. Major adverse cardiac events were defined as cardiovascular death, myocardial infarction, heart failure hospitalization, and target vessel revascularization. TP on IVUS was detected in 62 patients (60%). Post-PCI coronary flow was more impaired, and peak creatine kinase-myoglobin binding level was higher in patients with TP compared to those without. SPECT MPI was performed in 77 out of 104 patients (74%) at 35.4 ± 7.7 days after primary PCI. In patients with TP, left ventricular ejection fraction was significantly reduced (47.5 ± 12.0% vs. 57.6 ± 11.2%, p < 0.001), and infarct size was larger [17% (8-25) vs. 4% (0-14), p = 0.002] on SPECT MPI. During a median follow-up of 14 months after primary PCI, Kaplan-Meier analysis demonstrated a significantly higher incidence of major adverse cardiac events in patients with TP compared to those without. TP on IVUS after coronary stenting was associated with poor outcomes in patients with STEMI.
Assuntos
Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Complicações Pós-Operatórias/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Stents , Ultrassonografia de Intervenção , Idoso , Biomarcadores/sangue , Meios de Contraste/administração & dosagem , Angiografia Coronária , Circulação Coronária , Creatina Quinase Forma MB/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Compostos Organofosforados/administração & dosagem , Compostos de Organotecnécio/administração & dosagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Volume Sistólico , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
Elevated serum uric acid (SUA) level is reportedly associated with subsequent cardiovascular events including revascularization in patients with coronary artery disease. However, the impact of SUA level on revascularization in patients with chronic total occlusion (CTO), one of the highest risk subsets in coronary artery disease, is unclear. The aim of this study was to evaluate the impact of SUA level on target lesion revascularization (TLR) in contemporary percutaneous coronary intervention (PCI) for CTO. A total of 165 patients who underwent successful PCI with new-generation drug-eluting stent for CTO under intravascular ultrasound guidance were included. Patients were classified into 3 groups according to the tertiles of SUA level at baseline. Coronary angiography was qualitatively and quantitatively assessed, and gray-scale intravascular ultrasound was also analyzed. The primary end point was TLR. The tertiles of SUA level were as follows: low tertile, ≤5.2 mg/dl; intermediate tertile, 5.3 to 6.4 mg/dl; and high tertile, ≥6.5 mg/dl. During a median follow-up of 34 months, TLR was observed in 5 patients (8.8%) in the low tertile, in 5 (9.4%) in the intermediate tertile, and in 14 (25.5%) in the high tertile (pâ¯=â¯0.02). Kaplan-Meier analysis demonstrated a significantly higher incidence of TLR in patients with high tertile than the low and intermediate groups. Multivariable analysis showed SUA ≥6.5 mg/dl, diabetes mellitus, and longer CTO length as independent predictors of TLR. In conclusion, in patients who underwent PCI with drug-eluting stent, elevated SUA level was associated with TLR after successful recanalization of CTO.
Assuntos
Causas de Morte , Oclusão Coronária/terapia , Mortalidade Hospitalar , Hiperuricemia/complicações , Intervenção Coronária Percutânea/métodos , Idoso , Doença Crônica , Estudos de Coortes , Angiografia Coronária/métodos , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/etiologia , Oclusão Coronária/mortalidade , Stents Farmacológicos , Feminino , Seguimentos , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Revascularização Miocárdica/métodos , Revascularização Miocárdica/mortalidade , Intervenção Coronária Percutânea/mortalidade , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Cirurgia Assistida por Computador/métodos , Análise de Sobrevida , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Ácido Úrico/sangueRESUMO
BACKGROUND: Optical coherence tomography (OCT)-derived fractional flow reserve (FFR)-which may be calculated using fluid dynamics-demonstrated an excellent correlation with the wire-based FFR. However, the applicability of the OCT-derived FFR in the assessment of tandem lesions is currently unclear. CASE SUMMARY: We present two cases of tandem lesions in the mid segment of the left anterior descending (LAD) artery which could have assessed accurately by OCT-derived FFR. The first patient underwent wire-based FFR at the far distal site of LAD, showed a value of 0.66. The OCT-derived FFR was calculated, yielding a value of 0.64. In the absence of stenosis at the proximal lesion, the OCT-derived FFR was calculated as 0.79, which was as same as the wire-based FFR obtained after stenting to the proximal lesion. Thus, additional stenting was performed at the distal lesion. The second patient underwent wire-based FFR at the far distal site of LAD, showed a value of 0.76 which was as same vale as OCT-derived FFR. Considering the absence of stenosis in the proximal lesion, the OCT-derived FFR was estimated as 0.88. After coronary stenting in the proximal lesion, the wire-based FFR yielded a value of 0.90. Therefore, additional intervention to the distal lesion was deferred. DISCUSSION: The described reports are the first two cases which performed physiological assessment using OCT in tandem lesions. The OCT-derived FFR might be able to estimate the wire-based FFR and the severity of each individual lesion in patients with tandem lesions.
RESUMO
The difference in the intraluminal intensity of blood speckle (IBS) on integrated backscatter-intravascular ultrasound (IB-IVUS) across a coronary artery stenosis (i.e., ΔIBS) has previously shown a negative correlation with fractional flow reserve, reflecting an impaired coronary blood flow. Periprocedural myocardial injury (PMI) after coronary stenting has also been associated with coronary circulatory dysfunction. The aim of this study was to investigate the relation between ΔIBS after coronary stenting and PMI. A total of 180 patients who underwent elective coronary stenting under IVUS guidance for a single lesion were included. Intraluminal IBS was measured using IB-IVUS in cross sections at the ostium of the target vessel and at the distal reference of the stent. ΔIBS was calculated as (distal IBS value) - (ostium IBS value). PMI was defined as an elevation of troponin I >5 times the 99th percentile upper reference limit (>0.45 ng/ml) within 24 hours after the procedure. The mean ΔIBS after coronary stenting was 6.52 ± 5.71. There was a significantly greater use of the rotational atherectomy, the number of stents, the total stent length, and ΔIBS in patients with PMI than those without. In the receiver operating characteristic curve analysis, ΔIBS significantly predicted PMI (area under the curve 0.64, best cut-off value 7.88, p = 0.001). Multiple logistic regression analysis determined that the total stent length, the use of rotational atherectomy, and ΔIBS were independent predictors of PMI. In conclusion, greater ΔIBS assessed by IB-IVUS was significantly associated with PMI after coronary stenting in patients with a stable coronary artery disease.
Assuntos
Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Stents/efeitos adversos , Ultrassonografia de Intervenção/métodos , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/fisiopatologia , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Masculino , Período Pós-Operatório , Valor Preditivo dos Testes , Curva ROC , Espalhamento de RadiaçãoRESUMO
This case report demonstrated the usefulness of scoring balloon when luminal narrowing occurred after balloon angioplasty in the left circumflex artery due to coronary intramural hematoma. Although a stent was placed, coronary flow was not improved. We intended to make a fenestra between the true lumen and the hematoma using a scoring balloon (Scoreflex® 2.0 × 10 mm, OrbusNeich, Tokyo, Japan) which was dilated in the distal segment of the branch. Angiograms showed restoration of TIMI-3 flow with a long dissection spanning from distal of the stent to the scored area. After 3 months and 1 year, follow-up coronary angiograms demonstrated occluded false lumen and good coronary flow in the treated vessel.