RESUMEN
Our case illustrates the feasibility of high-risk PCI to salvage LMCA stenosis, possibly caused by coronary injury during direct coronary cardioplegia for a recent triple-valve operation.
Asunto(s)
Estenosis de la Válvula Aórtica , Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Intervención Coronaria Percutánea , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/etiología , Estenosis Coronaria/cirugía , Humanos , Resultado del TratamientoRESUMEN
Chronic total occlusion (CTO) remains a technical challenge for the interventional cardiologists. The application of the retrograde approach has dramatically improved success rates of CTO PCI. However, retrograde wire externalization could be very difficult especially when the antegrade guiding catheter cannot sit into the coronary ostium stably. We report a novel technique to facilitate retrograde wire externalization in aorto-ostial chronic total occlusion intervention without using snare.
Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Catéteres Cardíacos , Oclusión Coronaria/terapia , Infarto del Miocardio sin Elevación del ST/terapia , Enfermedad Crónica , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico por imagen , Infarto del Miocardio sin Elevación del ST/fisiopatología , Resultado del TratamientoRESUMEN
To the best of our knowledge, this is the first report of optical coherence tomography evaluation of superficial femoral artery atherectomy in a patient from the Asia-Pacific region. We demonstrate the feasibility of this technique in Chinese populations.
Asunto(s)
Angiografía/métodos , Aterectomía/métodos , Arteria Femoral , Enfermedad Arterial Periférica , Cirugía Asistida por Computador/métodos , Tomografía de Coherencia Óptica/métodos , Anciano , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Humanos , Claudicación Intermitente/etiología , Claudicación Intermitente/terapia , Masculino , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
OBJECTIVE: With the evolution of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) technique and equipment, the success rate of CTO PCI has improved over the years. We examined the failed cases in this expert registry and looked at the mode of failure. METHODS: In 2016, consecutive CTO PCI performed by eight high volume CTO with an agreed CTO algorithm were examined in a registry. RESULTS: There was a total of 485 patients with 497 CTOs were treated with technical and procedural success rates of 93.8% and 89.9%, respectively. The mean J-CTO score was 2.9 ± 1.2. The main mode of failure in cases with only antegrade attempt was inability to wire to true lumen despite advanced antegrade wiring technique for example, parallel wiring or IVUS guided wiring (10 out of 11 cases). The mode of failure in retrograde attempt was: 30% was due to inability to wire the collateral channel; 30% was due to failed reverse controlled antegrade and retrograde subintimal tracking (CART); 30% was due to inability to cross CTO by retrograde microcatheter. Four cases were terminated prematurely due to procedure complications. CONCLUSION: Similar to previous reported studies, primary failure mode of only antegrade attempt was inability to wire to true lumen. However, contrary to other registries where failure to cross the retrograde channel with wire was the predominant failure mode, the retrograde failure mode was equally divided between failure to cross the channel with wire, failure to do reverse CART, and failure to cross the CTO with the microcatheter.
Asunto(s)
Algoritmos , Oclusión Coronaria/terapia , Técnicas de Apoyo para la Decisión , Intervención Coronaria Percutánea , Anciano , Asia , Australia , Enfermedad Crónica , Toma de Decisiones Clínicas , Angiografía Coronaria , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Insuficiencia del TratamientoRESUMEN
We present a patient with non-obstructive intraluminal clot protrusion treated with medical therapy. Follow-up OCT scan showed layered neointimal changes similar to images observed in stent failure.
Asunto(s)
Trombosis Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Oclusión de Injerto Vascular/diagnóstico , Infarto del Miocardio con Elevación del ST/diagnóstico , Stents/efectos adversos , Trombectomía/métodos , Tomografía de Coherencia Óptica/métodos , Adulto , Trombosis Coronaria/complicaciones , Trombosis Coronaria/cirugía , Humanos , Masculino , Neointima/patología , Infarto del Miocardio con Elevación del ST/etiología , Infarto del Miocardio con Elevación del ST/cirugíaRESUMEN
Optimal GuideLiner positioning for OCT acquisition in tortuous vessels requires special attention to avoid iatrogenic dissection.
Asunto(s)
Catéteres Cardíacos/efectos adversos , Angiografía Coronaria/métodos , Vasos Coronarios , Complicaciones Intraoperatorias , Infarto del Miocardio sin Elevación del ST , Intervención Coronaria Percutánea , Lesiones del Sistema Vascular , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/lesiones , Stents Liberadores de Fármacos , Análisis de Falla de Equipo , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/etiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/etiología , Infarto del Miocardio sin Elevación del ST/cirugía , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/métodos , Intensificación de Imagen Radiográfica/métodos , Cirugía Asistida por Computador/métodos , Tomografía de Coherencia Óptica/métodos , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/etiologíaRESUMEN
A reliable stenting strategy for treating isolated side branch (SB) ostium stenosis is not well established. The purpose of this study was to examine the 6-month angiographic outcome of a novel technique, called the shoulder technique, on this lesion subtype. Symptomatic patients with isolated SB ostium stenosis, defined as ≥75% diameter stenosis at SB ostium and <50% diameter stenosis in main vessel (MV), were treated with paclitaxel-eluting balloon in MV and drug-eluting stent in SB using the shoulder technique. Angiographic restudy was performed at 5-9 months and clinical follow-up was scheduled regularly every 3 months. There were 46 patients of age 66 ± 12 years with male predominance (76%) recruited. Diagonal ostium (67%) was the most frequent target lesion site. The size and length of paclitaxel-eluting balloon and drug-eluting stent used in MV and SB were 3.01 ± 0.25 and 20 ± 4 mm, and 2.39 ± 0.25 and 17 ± 6 mm, respectively. Angiographic restudy was performed on 43 (93.5%) patients at 6.5 ± 1.6 months. The late loss in MV and SB were 0.04 ± 0.19 and 0.19 ± 0.32 mm, respectively. Angiographic restensosis was seen in 2 (4.7%) patients at SB, whereas no stenosis was induced in MV. Improvement of symptom was reported in 36 (78%) patients. At 1-year follow-up, no death, myocardial infarction, and stent thrombosis was observed; target vessel revascularization was performed on 3 (6.5%) patients. Treatment of isolated SB ostium stenosis using the shoulder technique is associated with a favorable short-term angiographic outcome.
Asunto(s)
Angioplastia Coronaria con Balón/métodos , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Stents Liberadores de Fármacos , Paclitaxel/farmacología , Intervención Coronaria Percutánea/métodos , Anciano , Antineoplásicos Fitogénicos/farmacología , Reestenosis Coronaria/prevención & control , Estenosis Coronaria/cirugía , Vasos Coronarios/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Diseño de Prótesis , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/instrumentación , Aneurisma Coronario/etiología , Enfermedad de la Arteria Coronaria/cirugía , Vasos Coronarios/patología , Falla de Prótesis , Stents , Aneurisma Coronario/diagnóstico , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Tomografía de Coherencia Óptica , Remodelación VascularRESUMEN
OBJECTIVES: This study sought to evaluate the safety and effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) for patients with large coronary vessels. BACKGROUND: Randomized trials have demonstrated that DES reduce the risk of target vessel revascularization (TVR) compared to BMS. This benefit is less pronounced as artery diameter increases. Whether DES are superior to BMS for larger coronary arteries in the setting of routine clinical practice is unknown. METHODS: We analyzed data from 869 patients undergoing de novo lesion PCI with reference vessel diameter greater than or equal to 3.5 mm in the NHLBI Dynamic Registry according to whether they were treated with DES or BMS. Patients were followed for 3 years for the occurrence of cardiovascular events. RESULTS: At 3-year follow-up, rates of TVR at 3 years were similar and low in both groups (4.4% vs. 3.7%, P = 0.62). After adjustment for differences in baseline characteristics, the adjusted hazard ratio for 3-year MI for DES was 1.85 (95% CI 0.93-3.7, P = 0.08), for TVR at 3 years 1.14 (95% CI 0.52-2.49, P = 0.75) and for mortality 0.89 (95%CI 0.49-1.62, P = 0.71). CONCLUSIONS: In our study of the unrestricted use of DES for patients with lesions in larger diameter coronary arteries, first generation DES did not reduce 3-year risk of TVR. Our findings do not support the preferred use of DES over BMS for patients with lesions located in arteries >3.5 mm. It is unknown whether secondary generation DES can offer better outcome compared to BMS in large coronary vessels. Further study on this issue is warranted.
Asunto(s)
Enfermedad de la Arteria Coronaria/cirugía , Vasos Coronarios/cirugía , Stents Liberadores de Fármacos , National Heart, Lung, and Blood Institute (U.S.)/estadística & datos numéricos , Intervención Coronaria Percutánea/métodos , Sistema de Registros , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Estados UnidosRESUMEN
BACKGROUND: Elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with acute coronary syndrome (ACS). However, the prognostic value of diabetic control (ie, hemoglobin A(1c) levels) in patients with ACS is still undefined. HYPOTHESIS: Hemoglobin A(1c) level may predict short-term outcome in patients with ACS. METHODS: We conducted a retrospective study with prospective follow-up in 317 diabetic patients with ACS. Patients were stratified into 2 groups based on HbA(1c) level, checked within 8 weeks of the index admission (optimal control group, HbA(1c) ≤7%; suboptimal control group, HbA(1c) >7%). All patients were followed up prospectively for major adverse cardiovascular events (MACE) and mortality for 6 months. Short-term clinical outcomes were also compared between the 2 study groups. RESULTS: In our cohort, 27.4%, 46.4%, and 26.2% patients had unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, respectively. In-hospital mortality was similar in both HbA(1c) groups (3.37% vs 2.88%, P = 0.803). Six-month MACE was also similar (26.40% vs 26.47%, P = 0.919). All-cause mortality, cardiovascular mortality, symptom-driven revascularization, rehospitalization for angina, and hospitalization for heart failure were also similar in both groups. The hazard ratios for 6-month MACE and individual endpoints were also similar in both groups. CONCLUSIONS: This study suggests that HbA(1c) levels before admission are not associated with short-term cardiovascular outcome in diabetic patients subsequently admitted with ACS.