RESUMO
Robotic-assisted percutaneous coronary intervention can reduce the exposure of interventional cardiologists to radiation and minimize the risk of occupational orthopedic injuries from wearing heavy protective aprons. The PRECISE (Percutaneous Robotically-Enhanced Coronary Intervention) study showed the efficacy and safety of robotic-assisted procedures for relatively low-risk lesions in single coronary arteries. Several reports have described robotic-assisted treatment of complex high-risk lesions, mostly through the transfemoral approach. We report 4 cases of patients in whom we used the transradial approach to treat complex lesions in the left anterior descending coronary artery with bifurcation balloon angioplasty reconstruction (2 cases), in the ostium of the first diagonal branch, and in the right coronary artery.
Assuntos
Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Intervenção Coronária Percutânea/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Robotic-assisted coronary angioplasty has been utilized to decrease radiation exposure to cardiologists, and to diminish risk of orthopedic and ergonomic injuries caused by wearing heavy lead during long procedures. The efficacy and safety of robotic-assisted percutaneous coronary intervention for relatively low-risk lesions was demonstrated in the PRECISE study. Successful percutaneous coronary interventions using robotic system for treatment of complex high-risk lesions have been reported in few case series so far. We describe a successful robotic-assisted coronary angioplasty for a complex lesion of saphenous vein graft using a FilterWire EZ embolic protection. This case illustrates the feasibility to use robotic-assisted angioplasty for complex cases.
Assuntos
Angioplastia Coronária com Balão/métodos , Oclusão de Enxerto Vascular/cirurgia , Intervenção Coronária Percutânea/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Veia Safena/transplante , Constrição Patológica/cirurgia , Angiografia Coronária , Estudos de Viabilidade , Humanos , Resultado do TratamentoRESUMO
Papillary muscle rupture is a rare, life-threatening post myocardial infarction mechanical complication. Without surgical intervention, prognosis is very poor. Clinicians need to recognize this complication early, as prompt therapy is crucial. We present a case of inferior ST elevation myocardial infarction complicated by posteromedial papillary muscle rupture resulting in severe acute mitral regurgitation (flail anterior mitral leaflet), acute pulmonary edema and cardiogenic shock. In our patient, a new mitral regurgitation murmur suggested this mechanical complication. Complete disruption of papillary muscle was visualized by transesophageal echocardiography. This case illustrates the importance of good physical examination for early diagnosis of papillary muscle rupture, so that life-saving treatment can be administered without delay.
Assuntos
Bioprótese , Ponte de Artéria Coronária/métodos , Ruptura Cardíaca Pós-Infarto , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Infarto Miocárdico de Parede Inferior , Insuficiência da Valva Mitral , Músculos Papilares , Idoso , Angiografia Coronária/métodos , Diagnóstico Precoce , Ecocardiografia Transesofagiana/métodos , Ruptura Cardíaca Pós-Infarto/complicações , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/fisiopatologia , Humanos , Infarto Miocárdico de Parede Inferior/complicações , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto Miocárdico de Parede Inferior/fisiopatologia , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/lesões , Exame Físico/métodos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Coronary artery stent fracture is a well described complication during percutaneous intervention, with rates ranging from 0.84 to 8.4 percent in first generation drug eluting stents. Complications of stent fractures usually present with symptoms of acute coronary syndrome or progressive angina days, months to years after initial implantation. We present a case of an acute stent fracture during post balloon dilation of an everolimus eluting stent at a critical stenosis junction of a saphenous vein graft to the first diagonal of the left anterior descending artery. A shorter oversized drug eluting stent was placed to cover the stent fracture with good angiographic results. To our knowledge, this is the first incidence in literature of an acute stent fracture in a saphenous vein graft.
Assuntos
Angina Instável , Angioplastia Coronária com Balão , Infarto Miocárdico de Parede Anterior/cirurgia , Ponte de Artéria Coronária , Stents Farmacológicos/efeitos adversos , Complicações Pós-Operatórias , Falha de Prótese , Reoperação/métodos , Idoso , Angina Instável/diagnóstico , Angina Instável/etiologia , Angina Instável/fisiopatologia , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Angiografia Coronária/métodos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/instrumentação , Ponte de Artéria Coronária/métodos , Everolimo/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Falha de Prótese/efeitos adversos , Falha de Prótese/etiologia , Veia Safena/transplante , Resultado do TratamentoRESUMO
Aspirin, the first antiplatelet agent, has been around since the 19th century, and is one of the most established drugs in history. With the improvement of coronary interventions in the past few decades, there has been more reliance on oral antiplatelet agents to reduce complications of in-stent restenosis/thrombosis. Clopidogrel was initially introduced in 1997, and within the past seven years, two additional oral antiplatelet agents have been approved by the U.S. Food and Drug Administration. With more potent antiplatelet agents comes increased risks of adverse effects. Physicians of all fields should be aware of the common antiplatelet agents used today, and the basic landmark trials that allowed them to be on the market today. The focus of this review article is to evaluate each oral antiplatelet drug, its brief history, relevant trials, indications and management of complications through evidence based guidelines.