RESUMEN
BACKGROUND: Imaging modality-based evidence is limited that compares the extent of coronary arterial repair after percutaneous coronary intervention between patients with stable angina pectoris (SAP) and those with acute coronary syndrome (ACS). METHODS: Between December 2018 and November 2021, a single-center, nonrandomized, observational study was conducted in 92 patients with SAP (n = 42) or ACS (n = 50), who were implanted with Orsiro sirolimus-eluting stent (O-SES) providing a hybrid (active and passive) coating and underwent 1-year follow-up by coronary angioscopy (CAS) after implantation. CAS assessed neointimal coverage (NIC), maximum yellow plaque (YP), and mural thrombus (MT). RESULTS: Baseline clinical characteristics were comparable between the SAP and ACS groups. The follow-up periods were comparable between the two groups (390.1 ± 69.9 vs. 390.6 ± 65.7 days, p = 0.99). The incidences of MT at 1 year after implantation were comparable between the two groups (11.4% vs. 11.1%, p = 0.92). The proportions of "Grade 1" in dominant NIC grades were highest in both groups, and the proportions of maximum YP grades and MT were comparable between the two groups. CONCLUSION: O-SES-induced coronary arterial repair at the site of stent implantation, irrespective of the types of coronary artery disease.
Asunto(s)
Síndrome Coronario Agudo , Angina Estable , Enfermedad de la Arteria Coronaria , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea , Trombosis , Humanos , Sirolimus , Angina Estable/diagnóstico por imagen , Angina Estable/terapia , Angioscopía , Estudios de Seguimiento , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/terapia , Angiografía Coronaria , Resultado del Tratamiento , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Intervención Coronaria Percutánea/efectos adversos , Neointima , PolímerosRESUMEN
BACKGROUND: The loss-of-function genotype of cytochrome P450 2C19 (CYP2C19) has been proposed as a risk factor for stent thrombosis in patients with drug-eluting stent implantation. The aim of this study was to clarify the clinical features of patients with angioscopically-detected in-stent mural thrombi (ISMT). METHODS AND RESULTS: Enrolled were 100 stented segments in 55 patients with stable angina (20 bare-metal stents; 39 Cypher sirolimus-eluting stents [SES]; 26 Endeavor zotarolimus-eluting stents [ZES]; 13 Xience V everolimus-eluting stents; and 2 Nobori biolimus-eluting stents). Dual antiplatelet therapy (100 mg aspirin+75 mg clopidogrel once daily) had been continued since stenting. A poor metabolizer (PM) of clopidogrel was defined as a homozygote of CYP2C19 loss-of-function alleles. Coronary angioscopy revealed ISMT in 6 patients (5 SES, 1 ZES). Between the ISMT group and control group (n=49), there were no significant differences with regards to the VerifyNow P2Y12platelet function assay or in-stent endothelial coverage grade. Exact logistic regression analyses with stepwise forward selection at a significance level of 0.10 were performed to reveal predictive variables for ISMT (respectively: odds ratio, 95% confidence interval, P value: CYP2C19 PM genotype (3.28, 0.88-24.80, 0.09), SES implantation (3.37, 0.90-28.09, 0.08), and presence of yellow plaque (3.69, 1.14-25.70, 0.02). CONCLUSIONS: Patients with ISMT were characterized by SES implantation, poor clopidogrel metabolism, and in-stent yellow plaque.
Asunto(s)
Angioscopía , Trombosis Coronaria/etiología , Citocromo P-450 CYP2C19/genética , Stents Liberadores de Fármacos , Inhibidores de Agregación Plaquetaria/farmacocinética , Polimorfismo de Nucleótido Simple , Ticlopidina/análogos & derivados , Activación Metabólica/genética , Anciano , Alelos , Angina de Pecho/etiología , Aspirina/uso terapéutico , Clopidogrel , Angiografía Coronaria , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/genética , Trombosis Coronaria/prevención & control , Citocromo P-450 CYP2C19/deficiencia , Citocromo P-450 CYP2C19/metabolismo , Resistencia a Medicamentos/genética , Quimioterapia Combinada , Stents Liberadores de Fármacos/clasificación , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Inhibidores de la Bomba de Protones/farmacología , Receptores Purinérgicos P2Y12/análisis , Ticlopidina/farmacocinética , Ticlopidina/uso terapéuticoRESUMEN
Background:The loss-of-function genotype of cytochrome P450 2C19 (CYP2C19) has been proposed as a risk factor for stent thrombosis in patients with drug-eluting stent implantation. The aim of this study was to clarify the clinical features of patients with angioscopically-detected in-stent mural thrombi (ISMT).MethodsâandâResults:Enrolled were 100 stented segments in 55 patients with stable angina (20 bare-metal stents; 39 Cypher sirolimus-eluting stents [SES]; 26 Endeavor zotarolimus-eluting stents [ZES]; 13 Xience V everolimus-eluting stents; and 2 Nobori biolimus-eluting stents). Dual antiplatelet therapy (100 mg aspirin+75 mg clopidogrel once daily) had been continued since stenting. A poor metabolizer (PM) of clopidogrel was defined as a homozygote of CYP2C19 loss-of-function alleles. Coronary angioscopy revealed ISMT in 6 patients (5 SES, 1 ZES). Between the ISMT group and control group (n=49), there were no significant differences with regards to the VerifyNow P2Y12platelet function assay or in-stent endothelial coverage grade. Exact logistic regression analyses with stepwise forward selection at a significance level of 0.10 were performed to reveal predictive variables for ISMT (respectively: odds ratio, 95% confidence interval, P value: CYP2C19 PM genotype (3.28, 0.88-24.80, 0.09), SES implantation (3.37, 0.90-28.09, 0.08), and presence of yellow plaque (3.69, 1.14-25.70, 0.02).Conclusions:Patients with ISMT were characterized by SES implantation, poor clopidogrel metabolism, and in-stent yellow plaque.
RESUMEN
The use of a drug-coated balloon (DCB) to treat dysfunctional arteriovenous fistula (AVF) has shown promising results. After percutaneous coronary intervention with DCB, late lumen enlargement (LLE) often develops in the early follow-up phase, but questions regarding the natural history of changes in lesions after DCB angioplasty have not been clearly elucidated. Here, we reported on a patient in whom angiography and angioscopy were performed immediately and 4 months after DCB angioplasty to treat cephalic vein stenosis of the dysfunctional AVF. Immediately after DCB application, angiography showed good dilatation and blood flow and mild vascular dissection that did not affect blood flow. Angioscopy showed that although the balloon had damaged the intima and the paclitaxel particles had adhered to the vessel wall. Four months after DCB treatment, follow-up angiography and angioscopy were performed. Angiography showed LLE in the cephalic vein of the AVF that had been treated by DCB angioplasty. Angioscopy showed that the intima of the vessel had almost completely healed, and the paclitaxel particles had disappeared. LLE might occur when DCB is used for AVF.
RESUMEN
We report the case of a 69-year-old male whose left circumflex coronary artery was perforated immediately after implantation of an Endeavor zotarolimus-eluting stent (E-ZES). Despite successful hemostasis by long balloon inflation, a coronary pseudoaneurysm remained at the E-ZES-implanted segment. Coronary angiography performed one year after the coronary perforation showed the pseudoaneurysm had disappeared. Simultaneous optical coherence tomography and coronary angioscopy revealed that stent struts of the E-ZES were fully covered with thick neointima. This is the first case report of a relatively rapid healing process for an E-ZES-related coronary pseudoaneurysm.
Asunto(s)
Aneurisma Falso/etiología , Antibióticos Antineoplásicos/efectos adversos , Vasos Coronarios/lesiones , Stents Liberadores de Fármacos/efectos adversos , Sirolimus/análogos & derivados , Cicatrización de Heridas/efectos de los fármacos , Anciano , Angioscopía , Antibióticos Antineoplásicos/administración & dosificación , Implantación de Prótesis Vascular/efectos adversos , Humanos , Masculino , Sirolimus/administración & dosificación , Sirolimus/efectos adversos , Tomografía de Coherencia ÓpticaRESUMEN
A 69-year-old man developed very late stent thrombosis (VLST) 3 years after Orsiro stent implantation in the proximal left anterior descending coronary artery. Intravascular imaging evaluations before and after the onset of VLST allowed us to document neoatherosclerosis as the etiology of VLST.
RESUMEN
Background: Some adults suffer sudden cardiac death after previous surgical repair of tetralogy of Fallot (TOF), and in such cases, ventricular tachycardia is believed to be the most frequent cause of death. However, we report a case of cardiac arrest due to paroxysmal complete atrioventricular block in an adult with dextrocardia and repaired TOF. Case summary: A 49-year-old woman with dextrocardia and a history of surgical treatment for TOF lost consciousness three times. A previously implanted loop recorder showed a 60-second cardiac arrest, and complete atrioventricular block was diagnosed. An electrophysiological study showed prolongation of the His-ventricular interval but no ventricular tachycardia. A dual chamber pacemaker was implanted, and there has been no recurrence of syncope in the 23 months since implantation. Discussion: There is little evidence for paroxysmal complete atrioventricular block in patients with repaired TOF. This case suggests that paroxysmal complete atrioventricular block can occur late after surgical repair of TOF, and research needs to elucidate whether it is the cause of sudden cardiac death in some patients with TOF.
RESUMEN
Very late stent thrombosis (VLST), a rare complication of stenting, has been reported to develop more frequently at later than 1 year after the deployment of the drug-eluting stent (DES) compared with the bare-metal stent (BMS). However, the causes for the difference in the incidence remain unknown. Serial angioscopy on 1,591 and 1,952 days after BMS deployment in a Japanese male patient with acute myocardial infarction revealed incomplete neointimal coverage (INC) without the development of cardiovascular event. Therefore, the potential development of VLST remains undeniable in BMS-deployed patients who had INC.
Asunto(s)
Angioplastia Coronaria con Balón , Angioscopía , Angiografía Coronaria , Trombosis Coronaria/etiología , Metales , Infarto del Miocardio/terapia , Stents , Túnica Íntima/patología , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/instrumentación , Trombosis Coronaria/patología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/patología , Diseño de Prótesis , Medición de Riesgo , Factores de TiempoRESUMEN
PURPOSE: The purpose of this study is to elucidate the impact of out-stent plaque characteristics on vascular response after implantation of second generation drug-eluting stent (G2-DES). METHODS: Enrolled were 37 patients with 39 coronary artery lesions into which three types of G2-DES were successfully implanted (9 Nobori biolimus-, BES; 15 Xience everolimus-, EES; 15 Resolute zotarolimus-eluting stents; R-ZES). Immediately after (baseline) and one year after the implantation (follow-up), iMAP-intravascular ultrasound (IVUS) was performed to measure out-stent plaque volume (OSPV) and its components. Percent OSPV and vulnerable plaque index (VPI) were defined as percentile of OSPV to vessel volume and as percentile of lipidic plus necrotic volume to OSPV. Coronary angioscopy at follow-up rated the degree of arterial repair by neointimal stent coverage (NSC). RESULTS: Poor NSC was found in approximately 60% of each G2-DES. In BES, % OSPV at baseline was significantly greater in poor NSC than in good NSC (36.2⯱â¯3.9 vs. 27.3⯱â¯4.0%, Pâ¯=â¯0.01). In EES, %OSPV was significantly greater in poor NSC than in good NSC (41.0⯱â¯4.1 vs. 32.6⯱â¯2.7%, Pâ¯<â¯0.01). In R-ZES implantation, there was no significant difference with regards to %OSPV between poor and good NSC. In BES, VPI at baseline was significantly greater in poor NSC than good NSC (54.0⯱â¯5.8 vs. 42.2⯱â¯5.1%, Pâ¯=â¯0.02). There was no significant difference with regards to VPI between poor and good NCS in EES and R-ZES. CONCLUSIONS: Impact of out-stent plaque characteristics on vascular response was different among the three types of G2-DES.
RESUMEN
BACKGROUND: Arterial repair delays after intracoronary implantation of Cypher sirolimus-eluting stents (SES), a representative first-generation drug-eluting stent. It remains unclear whether this delay would catch up with bare metal stents (BMS) during extremely long observation. The aim of this study was angioscopic observation of extremely late arterial repair after Cypher SES implantation. METHODS: Thirty-seven SES and 17 BMS were implanted into 22 and 9 patients with angina pectoris, respectively. Duration after implantation (DAI) ranged from 3 to 10.5years in both stents. Coronary angioscopy revealed neointimal stent coverage (NSC), presence of in-stent yellow plaque (YP), and mural thrombi (MT). NSC was semi-quantified into 4 grades (grade 0, no coverage; grade 1, thin coverage; grade 2, thick coverage; grade 3, fully embedded into neointima). RESULTS: In the BMS-implanted lesions (BMSL), NSC was either grade 1 (24%) or grade 3 (74%), with rare YP and no MT. In the SES-implanted lesions (SESL), NSC was various, i.e. grade 0 (5%), grade 1 (59%), grade 2 (22%), and grade 3 (14%). YP and MT were observed in 27 and 24% of in SESL, respectively. In SESL with DAI>8years (n=5), NSC was either grade 1 (40%) or grade 3 (60%), although YP and MT were more frequently observed (60 and 40%, respectively). CONCLUSIONS: Arterial repair after SES implantation caught up with BMS at around 8years with regards to NSC, although prevalence of YP and MT remained still greater in SESL than BMSL at extremely late phase.
Asunto(s)
Angioscopía , Enfermedad de la Arteria Coronaria/cirugía , Stents Liberadores de Fármacos , Inmunosupresores/administración & dosificación , Sirolimus/administración & dosificación , Anciano , Anciano de 80 o más Años , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Stents Metálicos Autoexpandibles , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Arterial repair after intracoronary stenting depends on stent types and plaque vulnerability. The aim of this study was angioscopic comparison of arterial repair after implantation of the second-generation drug-eluting stents (G2-DES) between the stable and vulnerable plaques. METHODS: Four types of G2-DES were successfully implanted into stable plaques (n=41) and vulnerable plaques (n=34): 13 and 9 Xience-everolimus-, 7 and 6 Endeavor-zotarolimus-, 15 and 9 Resolute-zotarolimus-, and 6 and 10 Nobori-biolimus-eluting stents (EES, E-ZES, R-ZES, and BES), respectively. Coronary angioscopy at 1-year follow-up revealed in-stent appearance, such as neointimal stent coverage (NSC), presence of yellow plaques (YP), and in-stent mural thrombus (MT). NSC was graded into poor and good coverage. RESULTS: Yellow plaques and mural thrombi were found more frequently in the vulnerable plaques than in the stable plaques (29% vs. 12%, P=0.06; 12 vs. 0%, P=0.02; respectively). In EES, poor NSC was observed more frequently in the vulnerable plaques than in the stable plaques (54% vs. 11%, P=0.04). In BES, YP was observed more frequently in the vulnerable plaques than in the stable plaques (80% vs. 17%, P=0.01). In E-ZES and R-ZES, there were no significant differences with regards to angioscopic parameters between the stable and vulnerable plaques. CONCLUSIONS: Arterial repair after EES and BES implantation into the vulnerable plaques remained vulnerable even at 1-year follow-up.
Asunto(s)
Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/terapia , Anciano , Angiografía Coronaria/tendencias , Stents Liberadores de Fármacos/tendencias , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Bulky DNA lesions are mainly repaired by nucleotide excision repair (NER), in which the interaction of ERCC1 with XPA protein recruits the ERCC1-XPF complex, which acts as a structure-specific endonuclease in the repair process. However, additional functions besides NER have been suggested for the ERCC1-XPF complex, because ERCC1- or XPF-deficient rodent cells are significantly more sensitive to DNA interstrand cross-linking (ICL) agents such as cis-diamminedichloroplatinum(II) (CDDP) than any other NER-deficient cells and because ERCC1-deficient mice suffer a more severe phenotype than XPA-deficient mice. By using RNA interference we show here that suppression of ERCC1 expression increases the sensitivity of xeroderma pigmentosum group A (XPA)-deficient human cells to CDDP but not to UV. This increased sensitivity to CDDP is observed in mouse cells defective in Xpa as well but not in cells defective both in Xpa and the mismatch repair gene Msh2. These data suggest that ERCC1 and MSH2 are involved co-operatively in CDDP resistance in mammalian cells. As a possible molecular basis, we show further a physical interaction between endogenous ERCC1 and MSH2 complexes in HeLa cell extracts. Using tagged ERCC1 in COS7 cells, the minimum region in ERCC1 necessary for the immuno-precipitation of MSH2 is turned out to be the carboxyl-terminal domain between the 184th and 260th amino acid, which is partly overlapping with the XPF-binding domain of ERCC1. This interaction may be important in additional functions of ERCC1-XPF including the repair of CDDP-induced DNA damage.
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Antineoplásicos/farmacología , Cisplatino/farmacología , Proteínas de Unión al ADN/metabolismo , Resistencia a Medicamentos , Endonucleasas/metabolismo , Proteínas Proto-Oncogénicas/metabolismo , Animales , Células COS/efectos de los fármacos , División Celular/efectos de los fármacos , Chlorocebus aethiops , Ensayo de Unidades Formadoras de Colonias , Cricetinae , Reparación del ADN , Proteínas de Unión al ADN/antagonistas & inhibidores , Proteínas de Unión al ADN/genética , Proteínas de Unión al ADN/fisiología , Endonucleasas/antagonistas & inhibidores , Endonucleasas/genética , Células HeLa/efectos de los fármacos , Humanos , Ratones , Proteína 2 Homóloga a MutS , Pruebas de Precipitina , Unión Proteica , Proteínas Proto-Oncogénicas/antagonistas & inhibidores , Proteínas Proto-Oncogénicas/genética , Interferencia de ARN , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Eliminación de Secuencia , Rayos Ultravioleta , Xerodermia Pigmentosa , Proteína de la Xerodermia Pigmentosa del Grupo ARESUMEN
Coronary pseudoaneurysm is a rare complication of percutaneous coronary intervention with a drug-eluting stent. Neither precise incidence of the complication has been known, nor there has been any established therapeutic approach for it. A 69-years-old male with effort angina underwent percutaneous coronary intervention to his left main coronary artery (LMCA). After pre-dilatation with a balloon, Endeavor zotarolimus-eluting stent (E-ZES) was successfully implanted into the lesion that extended from his LMCA to left anterior descending artery. At 6 months after stenting, coronary angiography (CAG) and intravascular ultrasound (IVUS) revealed coronary pseudoaneurysm at the stented segment. Follow-up CAG at 13 months after stenting showed the spontaneous and complete resolution of the pseudoaneurysm. Subsequent IVUS, optical coherence tomography, and coronary angioscopy visualized complete neointimal coverage of stent struts. This is the first case report of E-ZES-related pseudoaneurysm with relatively rapid resolution. Our patient suggests that E-ZES might incidentally contribute to this favorable outcome.
Asunto(s)
Aneurisma Falso/tratamiento farmacológico , Stents Liberadores de Fármacos , Inmunosupresores/uso terapéutico , Sirolimus/análogos & derivados , Anciano , Humanos , Masculino , Sirolimus/uso terapéuticoRESUMEN
We aimed to determine the effects of the oral direct renin inhibitor aliskiren on in vivo oxidative stress in atrial fibrillation (AF) patients. In this study, 150 mg oral direct renin inhibitor aliskiren was administered once daily to 12 permanent AF patients. Aliskiren significantly reduced urinary excretion of the oxidative stress biomarker 8-iso-prostglandin F2α and serum levels of matrix metalloproteinase-2(MMP-2). We concluded that aliskiren reduces in vivo oxidative stress and serum MMP-2 levels in patients with permanent AF.
RESUMEN
Cardiac involvement in progressive systemic sclerosis (PSS) is common and has a strong negative impact on the prognosis, especially when autoantibodies are present. To determine whether ultrasonic tissue characterization can detect early ultrastructural changes in the sclerodermal myocardium, we analyzed the transmural heterogeneity in myocardial integrated backscatter (THIB). "A-THIB" was defined as the absolute difference in integrated backscatter between the left (subendocardial) and right (subepicardial) ventricular halves of the myocardium in the septum and posterior wall, and was measured in 11 patients with PSS and 10 age- and sex-matched healthy participants. A-THIB in patients with PSS was higher than that in healthy participants (1.3 +/- 1.3 vs 4.0 +/- 1.4 dB for the septum and 1.1 +/- 0.7 dB vs 2.8 +/- 0.4 dB for the posterior wall; mean +/- SD, respectively, P <.0005). Septal A-THIB was higher in patients with PSS with than without anti-Scl70 or antinucleolar antibodies (3.2 +/- 1.1 vs 5.0 +/- 1.0 dB, P =.0165). Early changes in the myocardium of patients with PSS, possibly related to increased interstitial collagen deposition, can be detected by quantitative analysis of THIB.
Asunto(s)
Cardiomiopatías/diagnóstico por imagen , Ecocardiografía , Miocardio/patología , Esclerodermia Sistémica/diagnóstico por imagen , Adulto , Anciano , Autoanticuerpos , Cardiomiopatías/complicaciones , Cardiomiopatías/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Miocardio/inmunología , Variaciones Dependientes del Observador , Valores de Referencia , Reproducibilidad de los Resultados , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/fisiopatologíaRESUMEN
In the era of the drug-eluting stent, very late stent thrombosis has been the most serious issue in the field of interventional cardiology. A sirolimus-eluting stent (SES) was implanted in an in-stent restenotic lesion in the left circumflex artery of a 69-year-old man. Repetitive coronary angiography and angioscopy revealed that stent struts were covered with yellow neointima at 2 years after the SES deployment. At 4 years after the deployment, coronary angiography revealed the total occlusion of the SES. Angioscopy showed massive mural thrombi and yellow atherosclerotic plaques. Dual anti-platelet therapy (DAPT), ticlopidine and aspirin, had been continued since the SES deployment. Interventional cardiologists should heed the risk of silent chronic thrombotic occlusion even if struts of SES are fully covered with neointima under continued DAPT.
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Angioscopía/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/patología , Trombosis Coronaria/patología , Vasos Coronarios/patología , Stents Liberadores de Fármacos/efectos adversos , Sirolimus/efectos adversos , Anciano , Enfermedad Crónica , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Trombosis Coronaria/diagnóstico por imagen , Humanos , MasculinoRESUMEN
A 62-year-old man presented to hospital with chest oppression. Coronary angiography revealed total occlusion of the right coronary artery and inferior myocardial infarction was diagnosed. He was treated by percutaneous coronary intervention with stenting for myocardial infarction. After four months, echocardiography revealed a huge aneurysm protruding below the inferior surface of the left ventricle. It was considered to be a pseudoaneurysm from the echocardiographic findings. The patient had no symptoms and he refused surgery, so progression of the aneurysm was monitored carefully. At seven months after revascularization, the aneurysm showed a marked increase in size, with a maximal diameter of 48 mm and orifice diameter of 22 mm. Accordingly, the patient agreed to undergo surgical excision. The aneurysm was resected and the defect was closed with a pericardial patch. Pathological examination revealed all of the myocardial elements in the aneurysm wall and thrombus in its lumen. In conclusion, this was a rare case of ventricular subepicardial aneurysm.
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Aneurisma Falso/diagnóstico , Aneurisma Falso/etiología , Ecocardiografía , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiología , Infarto de la Pared Inferior del Miocardio/complicaciones , Aneurisma Falso/patología , Aneurisma Falso/cirugía , Angioplastia Coronaria con Balón , Progresión de la Enfermedad , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/patología , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos , Humanos , Infarto de la Pared Inferior del Miocardio/terapia , Masculino , Persona de Mediana Edad , Pericardio , Stents , Tomografía Computarizada Espiral , Resultado del TratamientoRESUMEN
Saphenous vein grafts (SVGs) are common, as is their degeneration and early failure after coronary artery bypass graft surgery (CABG). Percutaneous SVG intervention with drug-eluting stents (DES) was associated with superior short-term clinical outcomes. However, SVG intervention compared with coronary intervention often results in distal embolisation and periprocedural myocardial infarction. In this case, we discuss 9 and 14 month follow-up neointimal coverage of a DES implanted in a 15 year-old SVG and other morphological changes using angioscopy.
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Angioplastia Coronaria con Balón , Puente de Arteria Coronaria , Inmunosupresores/administración & dosificación , Vena Safena/trasplante , Sirolimus/administración & dosificación , Anciano , Angioscopía , Stents Liberadores de Fármacos , Estudios de Seguimiento , Humanos , Masculino , Factores de TiempoRESUMEN
BACKGROUND: Clinical features of diastolic heart failure (DHF) have not been well characterized, leading to an inaccuracy in the diagnosis of DHF. Recently, the ratio of transmitral E velocity to early diastolic mitral annular velocity (E/E') has been shown to be useful to assess LV filling pressure. PURPOSE: We tested the hypothesis that persistent elevation of E/E' ratio is one of the characteristics of patients with DHF. METHODS: Candidates of this study were 89 patients who presented to the emergency department because of acute pulmonary congestion. Those with an ejection fraction of >45% on admission comprised the DHF group (n=18). A control group consisted of consecutive 30 hypertensive patients with an ejection fraction of >45%. Doppler echocardiographic data were obtained with plasma BNP measure in the chronic stage >6 months after the emergent admission. RESULTS: The E/E' ratio was higher in the DHF group than in the control group (16.7±2.8 vs. 9.4±3.3, p<0.01). BNP level was also elevated in the DHF group. CONCLUSION: A persistent elevation of E/E' ratio may be an indicator of patients with or at risk of DHF among subjects with preserved systolic function independent of LV hypertrophy.
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Ecocardiografía Doppler , Insuficiencia Cardíaca Diastólica/fisiopatología , Enfermedad Aguda , Femenino , Humanos , Masculino , Persona de Mediana Edad , Función Ventricular IzquierdaRESUMEN
Treatment of de novo coronary stenosis with sirolimus-eluting stents is associated with very low rates of target lesion revascularization and other major adverse cardiac events in the short-term after implantation, but a definite frequency of late-stent thrombosis (LST) over a long-term follow-up has become evident. One of the predictors of LST is stent overlap. We reported the angioscopic findings of very delayed healing at sites of sirolimus-eluting stent overlap 21 months post-implantation.