Assuntos
Neoplasias Cardíacas , Leiomiomatose , Embolia Pulmonar , Neoplasias Uterinas , Humanos , Feminino , Leiomiomatose/diagnóstico por imagem , Valor Preditivo dos Testes , Coração , Embolia Pulmonar/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Uterinas/diagnóstico por imagem , Veia Cava Inferior , Átrios do Coração/diagnóstico por imagemRESUMO
Post-coronary artery bypass graft surgery (CABG) angina has been attributed unligated thoracic side branches competing with LIMA-LAD flow. Case reports suggest thoracic branch occlusion can relieve angina. Phasic arterial blood flow and direct measurements argue against the existence of LIMA steal.
Assuntos
Doença da Artéria Coronariana , Artéria Torácica Interna , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/cirurgia , Roubo , Resultado do TratamentoAssuntos
Cateterismo Cardíaco , Ensaios Clínicos como Assunto/métodos , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Projetos de Pesquisa , Adenosina/administração & dosagem , Consenso , Doença da Artéria Coronariana/fisiopatologia , Humanos , Hiperemia/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Vasodilatadores/administração & dosagemRESUMO
Fractional flow reserve (FFR) is a well-validated tool for determining the functional significance of a coronary artery stenosis, facilitating clinical decisions regarding the need for revascularization. FFR-guided revascularization improves clinical and economic outcomes. However, its application remains challenging in certain complex anatomic subsets, including left main coronary artery stenosis, bifurcation disease, and saphenous vein graft disease. This article reviews recent data supporting the use of FFR in these complex anatomic subsets.
Assuntos
Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Reestenose Coronária/fisiopatologia , Reestenose Coronária/cirurgia , Reserva Fracionada de Fluxo Miocárdico , Revascularização Miocárdica/métodos , Veia Safena/transplante , Velocidade do Fluxo Sanguíneo , Ponte de Artéria Coronária , Tomada de Decisões , Oclusão de Enxerto Vascular/fisiopatologia , HumanosAssuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Revascularização Miocárdica/métodos , Tomografia de Coerência Óptica , Ultrassonografia de Intervenção , Angiografia Coronária , Ponte de Artéria Coronária , Reserva Fracionada de Fluxo Miocárdico , Humanos , StentsRESUMO
PCI to SVG is considered a higher risk intervention requiring clinical judgment, especially in the elderly who may have the oldest and most degenerated SVG conduits. In a cohort of patients with a median age of 75 years who received PCI to SVG with DES, all-cause mortality was lower compared to those receiving BMS, and no difference in MI or urgent revascularization was observed to 3 years. PCI to SVG using DES may be a viable and perhaps superior treatment option for elderly patients.
Assuntos
Stents Farmacológicos , Oclusão de Enxerto Vascular/cirurgia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Veia Safena/transplante , Angiografia Coronária , Oclusão de Enxerto Vascular/diagnóstico , Humanos , ReoperaçãoRESUMO
Coronary hemodynamic measurements provide a critical tool to assess the ischemic potential of coronary stenoses. Fractional flow reserve (FFR) is a reliable method to relate translesional coronary pressures to hyperemic myocardial blood flow. Although a basic understanding in FFR can be quickly achieved, many of the nuances and potential pitfalls require special attention. The authors discuss the practical setup of coronary pressure measurement, the most common pitfalls in technique and ways to avoid them, and the limitations of available pharmacologic hyperemic methods.
RESUMO
Bridging for antiplatelet therapy remains a subject of debate with data favoring GP blockers but at a risk of bleeding. This Conversation in Cardiology addresses a key and often asked question about use of alternatives to P2Y12 agents in patients requiring surgery within 6 months after drug eluting stent implantation.
Assuntos
Trombose Coronária/prevenção & controle , Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária/administração & dosagem , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Procedimentos Cirúrgicos Operatórios , Trombose Coronária/economia , Trombose Coronária/etiologia , Análise Custo-Benefício , Esquema de Medicação , Custos de Medicamentos , Hemorragia/induzido quimicamente , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Assistência Perioperatória , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Agregação Plaquetária/economia , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/economia , Procedimentos Cirúrgicos Operatórios/economia , Fatores de Tempo , Resultado do TratamentoAssuntos
Cateterismo Cardíaco/normas , Estenose Coronária/diagnóstico , Reserva Fracionada de Fluxo Miocárdico , Tomografia de Coerência Óptica/normas , Ultrassonografia de Intervenção/normas , Consenso , Ponte de Artéria Coronária/normas , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/patologia , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Hemodinâmica , Humanos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/normas , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Stents/normas , Resultado do TratamentoRESUMO
BACKGROUND: Continuous intravenous adenosine infusion reportedly produces stable and maximal hyperemia to allow for fractional flow reserve (FFR) measurement; however, several observers have noted variation of the coronary/aortic (Pd/Pa) pressure ratio during the course of an adenosine infusion. METHODS: Pd/Pa pressure recordings during continuous peripheral intravenous adenosine infusion were examined in 51 patients (68 measurements) with data collected for at least 150 sec and for at least 30 sec after the lowest Pd/Pa reading. The lowest recorded Pd/Pa ratio was used as the true FFR value at maximal hyperemia. The highest subsequent Pd/Pa during the remaining period of adenosine infusion was recorded. A separate cohort of 12 patients had Pd/Pa values measured with both peripheral and central infusion. RESULTS: The average FFR value was 0.82 ± 0.10 and was recorded 99 ± 33 sec into the infusion. The Pd/Pa value showed a subsequent average increase of 0.08 ± 0.07 at 135 ± 32 sec. From the lowest measurement, Pd/Pa changed from a ratio ≤0.80 to >0.80 in 28% of recordings. In the cohort with matched recordings, central infusion reduced the severity (mean change of 0.08 vs. 0.11, P = 0.09) but not the incidence of Pd/Pa variability compared with peripheral infusion. CONCLUSION: Instability of Pd/Pa measurements is common over the course of a continuous intravenous adenosine infusion. FFR remains valid as the lowest value of Pd/Pa observed, however, Pd/Pa variability may subsequently occur and complicate pullback measurements for serial or multiple lesions.
Assuntos
Adenosina/administração & dosagem , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/efeitos dos fármacos , Idoso , Cateterismo Cardíaco , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/efeitos dos fármacos , Feminino , Seguimentos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Humanos , Infusões Intravenosas , Masculino , Estudos Retrospectivos , Vasodilatadores/administração & dosagemRESUMO
Coronary saphenous vein graft (SVG) rupture during diagnostic angiography is a very rare but known complication of the procedure. It has typically been reported to occur at the site of pseudoaneurysms or secondary to an interventional procedure involving the graft. We present a case of SVG mid-body rupture during diagnostic angiography that occurred without evidence of pseudoaneurysmal changes.
Assuntos
Meios de Contraste/efeitos adversos , Angiografia Coronária/efeitos adversos , Ponte de Artéria Coronária , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Veia Safena/transplante , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Ponte de Artéria Coronária/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/terapia , Humanos , Injeções , Masculino , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Grau de Desobstrução VascularRESUMO
OBJECTIVE: The purpose of this study was to determine if there was a relationship between angiographic lesion complexity and the extent of lipid core plaque (LCP) identified by catheter-based near-infrared spectroscopy (NIRS). BACKGROUND: The angiographic complexity of coronary artery disease (CAD) is used to predict outcomes in patients undergoing percutaneous coronary intervention (PCI). The SYNTAX score, an angiographic tool quantifying the complexity of CAD, is associated with PCI outcomes. Recently, a novel catheter-based imaging technique using NIRS can identify LCP, which also is associated with PCI periprocedural myocardial infarction (MI). However, it is unknown whether these events are related to distinct adverse event prone pathobiology, such as a LCP within a complex angiographic lesion. Thus, we hypothesized that LCP identified by NIRS would be associated with high SYNTAX score. METHODS: Seventy-eight patients who underwent coronary angiography and target-vessel NIRS were selected from the Chemometric Observations of Lipid Core Containing Plaques of Interest in Native Coronary Arteries Registry, an industry sponsored registry to collate clinical findings in all patients undergoing NIRS evaluation. A lipid core burden index (LCBI) was obtained from the scan of the proximal 50 mm of the target vessel. Three vessel SYNTAX (total, tSYN) and target single vessel (only NIRS-interrogated vessel) SYNTAX (1vSYN) scores were calculated and compared to LCBI. High LCBI was defined as (>110) and was compared to tertile scores for 1vSYN score (low 0-5, intermediate 6-10, high ≥11) and previously established tertiles for tSYN score (low 0-22, intermediate 23-32, high ≥33). RESULTS: Patients had mean age of 63 years with prevalence of females (10%), diabetes mellitus (28%), hypertension (88%), and smoking history (72%); 1vSYN and tSYN scores correlated poorly with LCBI [(r(2) = 0.25; P = 0.02; n = 78) and (r(2) = 0.24; P = 0.04; n = 78), respectively]. Mean LCBI did not differ significantly across all tertiles of 1vSYN or tSYN scores. CONCLUSIONS: Angiographic SYNTAX score only weakly correlated with LCBI. It is of interest as well that high LCBI was also present in cases of low SYNTAX scores. The disparity between the degree of angiographic complexity and the amount of LCP supports postulated mechanisms of the adverse event propensity even in patients who demonstrate low angiographic complexity. Future studies are necessary to address the clinical significance of high LCBI in patients with low-to-intermediate angiographic complexity and their potential for PCI-related complications.
Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/química , Lipídeos/análise , Placa Aterosclerótica/química , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Cateterismo Cardíaco , Doença da Artéria Coronariana/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , PrognósticoRESUMO
Transradial cardiac catheterization in patients with previous coronary artery bypass graft surgery can be technically challenging. The presence of a left internal mammary artery (LIMA) graft was previously considered a relative contraindication for a right radial procedure, but there are several reports demonstrating the feasibility and safety of LIMA angiography from a right radial access. This case report demonstrates that transradial coronary and bypass graft angiography including LIMA angiography from the right radial approach is technically feasible with a single catheter. Catheter options for LIMA angiography from right radial access will also be discussed.