RESUMO
PURPOSE: To compare OCT identified white thrombus decline, neointimal hyperplasia and clinical outcomes of patients treated with ticagrelor plus aspirin with those patients treated with clopidogrel plus aspirin after peripheral interventions. BACKGROUND: Ticagrelor is a potent platelet inhibitor. In patients with coronary artery disease, ticagrelor and aspirin demonstrated reduced rates of stent thrombosis, compared to aspirin and clopidogrel. The clinical importance of potent antiplatelet inhibition after peripheral endovascular interventions is unknown. METHODS: We enrolled 18 patients with superficial femoral artery disease and the presence of OCT-detected clot post-stent placement. Patients were randomized to 75â¯mg clopidogrel once daily for 1â¯month vs. 90â¯mg ticagrelor twice daily for 6â¯months, both in addition to 81â¯mg aspirin for 6â¯months. Clot volumes, ankle-brachial index (ABI), 6-minute walk test, and Rutherford classification were measured at baseline and 6-month follow-up. Neointimal hyperplasia and neovascularization were calculated at 6-month follow-up. RESULTS: Nâ¯=â¯11 patients were enrolled in the clopidogrel group and Nâ¯=â¯7 in the ticagrelor group. There was a significantly greater decrease in white thrombus in the ticagrelor group (median volume/stent length (0.067 vs 0.014â¯mm3/mm, pâ¯=â¯0.05)). No differences were found in % neointima (0.412 vs 0.536â¯mm3/mm, pâ¯=â¯0.44) and neovascularization (28 vs 44, pâ¯=â¯0.16). ABI and Rutherford classification were improved significantly after 6â¯months in the clopidogrel group, with no difference between groups at 6â¯months in ABI or Rutherford. CONCLUSION: In symptomatic patients with PAD, ticagrelor showed significant improvement relative to clopidogrel with respect to white thrombus burden decline.
Assuntos
Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Procedimentos Endovasculares , Artéria Femoral , Doença Arterial Periférica/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Trombose/tratamento farmacológico , Ticagrelor/uso terapêutico , Tomografia de Coerência Óptica , Idoso , Índice Tornozelo-Braço , Aspirina/efeitos adversos , Clopidogrel/efeitos adversos , Quimioterapia Combinada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Europa (Continente) , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Neointima , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Inibidores da Agregação Plaquetária/efeitos adversos , Valor Preditivo dos Testes , Estudos Prospectivos , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Recuperação de Função Fisiológica , Stents , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Ticagrelor/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Teste de CaminhadaRESUMO
INTRODUCTION: Cardiac inflammatory myofibroblastic tumor is a rare tumor that can cause potentially fatal outcomes. CASE PRESENTATION: We describe a case where the tumor originated on the mitral valve and extended through the left ventricular outflow tract and aortic valve and into the left main artery obstructing it. Due to the hemodynamic instability of the patient, we proceeded for cardiac catheterization with the intention to aspirate the mass but were forced to do percutaneous intervention to stabilize the patient and bridge him to surgery. CONCLUSIONS: The patient underwent surgery several days later with complete resection of the tumor and coronary stent retrieval but his left ventricular ejection fraction remained poor after several months and he was referred for cardiac transplantation.