RESUMEN
Coronary artery bypass surgery has been the accepted treatment for left main coronary artery disease for over 50â¯years. Balloon angioplasty was later used then abandoned because of deaths likely due to restenosis or thrombotic occlusion. However, rapid innovations in drug-eluting stent designs leading to more biocompatible thin strut platforms with optimal drug elution profiles and further advances in modern pharmacotherapy involving potent P2Y12 inhibitors combined with utilization of intracoronary imaging and physiologic assessment for procedural planning and optimization have transformed percutaneous interventions into successful alternatives to coronary artery bypass graft surgery (CABG) in selected LM anatomic territories. Herein, we provide an evidence-based practical guide on how to approach and perform LM percutaneous interventions (PCI).
Asunto(s)
Enfermedad de la Arteria Coronaria , Intervención Coronaria Percutánea , Puente de Arteria Coronaria , Stents Liberadores de Fármacos , Humanos , Resultado del TratamientoAsunto(s)
Puente de Arteria Coronaria/métodos , Oclusión Coronaria/cirugía , Intervención Coronaria Percutánea , Procedimientos Quirúrgicos Robotizados , Enfermedad Crónica , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/mortalidad , Humanos , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIMS: To investigate the extent and the circumferential distribution of the neointima tissue developed following an Absorb bioresorbable vascular scaffold (BVS) implantation. METHODS AND RESULTS: Twenty-three patients who were treated with the Absorb BVS and had optical coherence tomographic examination after scaffold implantation, at six-month and at two-year follow-up, were included in the current analysis. The lumen and the scaffold borders were detected and the circumferential thickness of the neointima was measured at one degree intervals. The symmetry of the neointima was defined as: minimum/maximum thickness. The lumen area was decreased at six months compared to baseline but it did not change between six-month and two-year follow-up (baseline: 7.49 [6.13-8.00] mm², six months: 6.31 (4.75-7.06) mm², two years: 6.01 [4.67-7.11] mm², p=0.373). However, the mean neointima thickness (six months: 189 [173-229] m, two years: 258 [222-283] m, p<0.0001) and the symmetry index of the neointima (six months: 0.06 [0.02-0.09], two years: 0.27 [0.24-0.36], p<0.0001) were increased at two years. Full circumferential coverage of the vessel wall by neointima tissue was seen in 91% of the studied frames at two years. CONCLUSIONS: This study demonstrates that after an Absorb BVS implantation neointima tissue develops that covers almost the whole circumference of the vessel wall. In contrast to the metallic stents, the neointima tissue does not compromise the luminal dimensions. Further research is required to evaluate the neointimal characteristics and assess the potential value of the device in passivating high-risk plaques.
Asunto(s)
Implantes Absorbibles , Antineoplásicos/uso terapéutico , Estenosis Coronaria/cirugía , Stents Liberadores de Fármacos , Neointima/diagnóstico , Sirolimus/uso terapéutico , Andamios del Tejido , Adulto , Anciano , Estudios de Cohortes , Estenosis Coronaria/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neointima/patología , Intervención Coronaria Percutánea/instrumentación , Estudios Prospectivos , Tomografía de Coherencia ÓpticaAsunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/terapia , Técnicas de Apoyo para la Decisión , Diagnóstico por Imagen , Revascularización Miocárdica , Cateterismo Cardíaco , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/mortalidad , Diagnóstico por Imagen/métodos , Humanos , Revascularización Miocárdica/efectos adversos , Revascularización Miocárdica/mortalidad , Selección de Paciente , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tomografía de Coherencia Óptica , Tomografía Computarizada por Rayos X , Ultrasonografía IntervencionalRESUMEN
Transcatheter aortic valve implantation (TAVI) has nowadays replaced open heart surgery as an alternative therapeutic tool in selected patients. Thirty-five percent of patients with severe degenerative aortic valve stenosis (AS) remain untreated because of the existing comorbidities that increase their perioperative risk. TAVI is a relatively new technique that has "come to stay" in the everyday clinical practice considering, that is the only alternative to surgery and appears to have excellent long term results. Herein, we describe a vascular complication immediately after the implantation of the Edwards SAPIEN (Edwards Lifesciences, Irvine, CA) prosthesis, followed by ad hoc percutaneous coronary intervention.
Asunto(s)
Estenosis de la Válvula Aórtica/terapia , Cateterismo Cardíaco/efectos adversos , Oclusión Coronaria/etiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Enfermedad Aguda , Angioplastia Coronaria con Balón/instrumentación , Cateterismo Cardíaco/instrumentación , Angiografía Coronaria , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/terapia , Femenino , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Persona de Mediana Edad , Diseño de Prótesis , Stents , Resultado del TratamientoRESUMEN
Tumours of the heart are rare, and in the vast majority of cases are myxomas that have a benign profile. According to their location, their clinical manifestations differ but there are cases that are completely asymptomatic [M. Yuce, S. Dagdelen, M. Ergelen, N. Eren, N. Caglar, A huge obstructive myxoma located in the right heart without causing any symptom. Int J Cardiol 2007;114:405-406.], found only post-mortem. Herein we describe the case of a 45-year-old female patient previously asymptomatic who presented with syncope due to a large right atrial myxoma with extracardiac localization as embolic phenomenon in the pulmonary artery tree.