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1.
Artif Organs ; 46(3): 387-397, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34954849

RESUMO

INTRODUCTION: Mechanical circulatory support (MCS) devices are increasingly used as a treatment option in resuscitation or in patients with cardiogenic shock (CS). Prophylactic implantation in high-risk percutaneous coronary interventions (HRPCI) is another upcoming indication. The i-cor ECG-synchronized cardiac assist device combines the hemodynamic support of a veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with the ability to generate a pulsatile flow and thus decreasing adverse effects of VA-ECMO on myocardial function. Aim of this study was to obtain data concerning feasibility, safety and outcomes in both indications. METHODS: A total of 47 patients (34 HRPCI, 13 CS) were included in nine German centers and participated in this study. Demographic and clinical parameters, procedural as well as follow-up data were prospectively recorded and analyzed. RESULTS: Device implantation and initiation of ECG-synchronized cardiac assist was technical successful in all cases and no failures of the consoles or disposable parts were observed. Furthermore, intended percutaneous coronary interventions and successful weaning from cardiac assist was achieved in 97.1% of HRPCI patients. We observed a 30d-survival of 94.1% in the HRPCI group and 69.2% in the CS group. Main complications in both groups were bleeding events (14.7% HRPCI, 23.1% CS) and critical limb ischemia (2.9% HRPCI, 38.5% CS). CONCLUSION: The i-cor ECG-synchronized cardiac assist device appears safe and feasible showing clinical outcomes comparable to existing data in the setting of high-risk percutaneous coronary interventions and acute cardiogenic shock. Further prospective trials are warranted to identify optimal patient and interventional characteristics that will benefit most of this novel kind of mechanical circulatory support.


Assuntos
Eletrocardiografia , Coração Auxiliar , Idoso , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Masculino , Intervenção Coronária Percutânea , Estudos Prospectivos , Fluxo Pulsátil , Choque Cardiogênico/terapia
2.
Int J Angiol ; 32(4): 284-287, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37927837

RESUMO

Fibromuscular dysplasia is a rare, systemic arteriovascular disease that often affects the renal arteries. Balloon angioplasty is recommended for uncontrolled hypertension and compromised renal function; stenting is a bailout option. Drug-eluting stents have been suggested in case reports. We report the successful intervention with an everolimus-coated stent in a very young patient. The patient was followed for 2 years after placing the stent. The success of this case suggests that drug-eluting stents should be used more frequently in comparable situations.

3.
Cardiol Ther ; 10(1): 241-253, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33821448

RESUMO

INTRODUCTION: Transradial access (TRA) has become the primary route for coronary angiography (CAG) and percutaneous coronary interventions (PCI). Recently a new puncture site more distally in the area of the anatomical snuffbox has been described. With this multicenter registry, we wish to demonstrate the feasibility and safety of the distal radial access (dRA). METHODS: Between December 2018 and May 2019 all patients with a planned CAG or PCI via dRA in three cardiology centers in Germany were entered into this registry. Procedural data, puncture success, crossover rate and complications were registered. Proximal and distal radial artery patency were examined by ultrasound within 48 h. RESULTS: A total of 327 patients were enrolled (mean age: 69 ± 12 years, 69% male gender, 49% PCI), in 5 cases bilateral distal puncture was performed. Puncture success, defined as completed sheath placement was high (N = 316/332, 95%) and the crossover rate was low (27/332, 8%). The rate of proximal radial artery occlusion after 1-48 h was low (2/332 1%), the rate of occlusion at the distal puncture site was also very low (3/332, 1%). Major complications were not encountered. CONCLUSION: Coronary angiography and interventions via the distal transradial access in the area of the anatomical snuffbox can be performed with a high rate of success and safety. This data suggests a reduced rate of radial artery occlusion compared to previously reported data after cannulation via the standard forearm radial artery puncture site. Randomized studies are needed to further investigate these results. TRIAL REGISTRATION: This study was registered in the German registry for clinical trials: DRKS00017110, retrospectively on 07.May 2019.

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