RESUMO
BACKGROUND: In recent years there has been a debate about the functional severity of restenosis of drug-eluting stents. The aim of the present study was to assess the functional severity of stenosis in patients with moderate angiographic restenosis after paclitaxel-eluting stents (PES) deployment. METHODS AND RESULTS: Forty-two patients with moderate angiographic restenosis at the in-stent segment and/or approximately 5mm from the stent edge were enrolled. For comparison, furthermore, 42 patients with de novo stenosis lesions matched for angiographic severity were assigned to the control group. Quantitative coronary angiography and functional assessment using fractional flow reserve (FFR) were performed. Although percent diameter stenosis was not significantly different between the 2 groups (PES group, 40.6±11.2%; de novo group, 40.6±9.0%, P=0.981), the functional severity of stenosis was significantly less in the PES group than in the de novo group (FFR: PES group, 0.86±0.07; de novo group, 0.79±0.10, P=0.002). CONCLUSIONS: FFR was preserved in patients with moderate angiographic restenosis after PES deployment, and the functional severity of restenosis is often limited. Therefore, revascularization should be performed with caution for patients with moderate angiographic restenosis after PES deployment.
Assuntos
Cateterismo Cardíaco , Fármacos Cardiovasculares/administração & dosagem , Angiografia Coronária , Reestenose Coronária/diagnóstico , Reestenose Coronária/terapia , Stents Farmacológicos , Paclitaxel/administração & dosagem , Intervenção Coronária Percutânea/instrumentação , Idoso , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/fisiopatologia , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Desenho de Prótese , Fatores de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: The predominant mechanism of early failure of saphenous vein grafts (SVG) after coronary bypass remains unclear, so angioscopy was used to identify the morphological changes. METHODS AND RESULTS: Of the 31 SVGs assessed 15 had both yellow plaque and thrombi, whereas in the remaining 16 SVGs the intima was clear white. The serum low-density lipoprotein cholesterol level was significantly higher in the diseased SVG group. Eight patients of the normal SVG group were prescribed ticlopidine, compared with only 1 from the diseased SVG group (p=0.015). CONCLUSIONS: This is the first direct demonstration of yellow plaque and/or thrombosis in SVGs by intravascular angioscopy. In addition to the importance of prescribing statins, it might be vital to also add ticlopidine to aspirin therapy.
Assuntos
Angioscopia/métodos , Anticoagulantes/uso terapêutico , Oclusão de Enxerto Vascular/prevenção & controle , Veia Safena/patologia , Veia Safena/transplante , Idoso , Idoso de 80 Anos ou mais , Aspirina/uso terapêutico , Ponte de Artéria Coronária/métodos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/uso terapêuticoRESUMO
Multislice spiral computed tomography (MSCT) permits the noninvasive visualization of coronary artery stenoses and occlusions, as well as atherosclerotic plaques, in patients with coronary artery disease. This report describes a patient with stable angina pectoris in whom the regression of the plaque and coronary artery remodeling was documented by serial MSCT.
Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Imageamento Tridimensional , Tomografia Computadorizada Espiral , Estenose Coronária/diagnóstico por imagem , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Espiral/métodosRESUMO
Multislice spiral computed tomography was performed in 16 adolescents and young adults who had Kawasaki's disease to assess coronary artery abnormalities. Adequate images were obtained for 96% of major coronary segments. The sensitivity of multislice spiral computed tomography to detect coronary artery aneurysms was 100%, and that for significant stenoses and occlusions was 87.5%, whereas false-positive results due to severe calcification was present in 5 arteries and those due to cardiac motion artifact were present in 2, resulting in a specificity of 92.5%.
