RESUMEN
Heavily calcified coronary lesions increase the complexity of percutaneous coronary interventions (PCI) and represent a challenge for interventional cardiologists. They are an important cause of stent underexpansion and poor clinical outcome. Nowadays, there are different dedicated devices which enhance the chances of success. Rotational atherectomy is the first-line modality which permits to cross balloons or stents through severe calcified lesions. However, when circumferential deep calcium plaques exist may not be enough to achieve adequate expansion of these devices. In these cases, the complementary use of intracoronary lithotripsy ("RotaTripsy") can be an effective approach that further modifies the calcified plaque and enables optimal stent implantation. We present the first case series undergoing PCI using "RotaTripsy" technique.
Asunto(s)
Aterectomía Coronaria , Enfermedad de la Arteria Coronaria , Litotricia , Intervención Coronaria Percutánea , Calcificación Vascular , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Humanos , Intervención Coronaria Percutánea/efectos adversos , Resultado del Tratamiento , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/terapiaRESUMEN
Rotational atherectomy (RA) and intravascular lithotripsy (IVL) are complementary calcium-debulking techniques. RA ablates intimal calcium and makes a channel that permits crossing of the Shockwave balloon, which cannot be easily delivered through severe lesions. Shockwave IVL completes lesion preparation, cracking deep calcium. When RA is discouraged, excimer-laser coronary angioplasty (ELCA) in combination with IVL (ELCA-Tripsy) may be useful, as ELCA facilitates Shockwave balloon delivery without impairment of recently implanted stents. To the best of our knowledge, this is the first description of this technique.
Asunto(s)
Angioplastia Coronaria con Balón , Aterectomía Coronaria , Litotricia , Aterectomía Coronaria/efectos adversos , Angiografía Coronaria , Humanos , Láseres de Excímeros , Stents , Resultado del TratamientoRESUMEN
The angiotensin-converting enzyme 2 (ACE2) is a type I integral membrane that was discovered two decades ago. The ACE2 exists as a transmembrane protein and as a soluble catalytic ectodomain of ACE2, also known as the soluble ACE2 that can be found in plasma and other body fluids. ACE2 regulates the local actions of the renin-angiotensin system in cardiovascular tissues, and the ACE2/Angiotensin 1-7 axis exerts protective actions in cardiovascular disease. Increasing soluble ACE2 has been associated with heart failure, cardiovascular disease, and cardiac remodelling. This is a review of the molecular structure and biochemical functions of the ACE2, as well we provided an updated on the evidence, clinical applications, and emerging potential therapies with the ACE2 in heart failure, cardiovascular disease, lung injury, and COVID-19 infection.
Asunto(s)
Enzima Convertidora de Angiotensina 2/metabolismo , COVID-19/metabolismo , Insuficiencia Cardíaca/metabolismo , Remodelación Ventricular/fisiología , Biomarcadores/metabolismo , COVID-19/complicaciones , Insuficiencia Cardíaca/complicaciones , Humanos , Sistema Renina-Angiotensina , SARS-CoV-2/aislamiento & purificaciónRESUMEN
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