Drug-eluting stents vs bare metal stents for the treatment of large coronary vessels

Background Lately drug-eluting stents (DES) have dramatically reduced restenosis rates and need for repeat revascularization in a wide subset of lesion and patients. However, their benefit for the treatment of large vessels (N3.0 mm)

has yet to be established. Objective We investigated whether DES are superior to bare metal stents (BMS) in terms of clinical outcomes for the treatment of large coronary vessels. Methods This study assessed the long-term outcomes (cardiac death, acute myocardial infarction, and need for repeat

intervention in the treated vessel) of patients treated with either a DES (Cypher and Taxus) or a BMS of z3.5 mm in diameter. A total of 250 consecutive patients who underwent DES implantation were clinically followed for 1 year and compared to

250 patients who were treated with BMS. Interventions in the setting of acute ST elevation myocardial infarction and treatment of bypass grafts were excluded. Results Cypher was the DES deployed in 70.8% of cases. Most of the enrolled patients were men (78%) with single

vessel disease (65.6%). The left anterior descending artery was the culprit vessel in 34.2% of cases. Bare metal stent and DES cohorts had equivalent interpolated reference vessel diameter (3.19 F 0.3 mm for BMS vs 3.18 F 0.2 for DES; P = .1).

Lesion was significantly longer in the group treated with DES (13.4 F 5.1 mm for BMS group vs 14.3 F 3.5 for DES; P = .0018). After 1 year of clinical follow-up, 95.2% of patients treated with DES and 91.2% of the patients who received BMS

were free of major events ( P = .2). A trend toward higher target-lesion revascularization was noticed in the group treated with BMS (4.8% vs 1.6%; P = .07). Conclusion Percutaneous treatment of large coronary vessels carries a low risk of clinical events irrespective of the type

Reperfusão endovascular pós-embolia cerebral durante arterografia carotídea / Endovascular reperfusion following crebral embolism during carotid arteriography

Relatamos um caso de um paciente de 72 anos que, durante a realização de uma arteriografia carotídea, apresentou embolia arterial intracerebral sintomática. O paciente foi submetido imediatamente à reperfusão endovscular (mecânica) intracerebral com sucesso (clínico e angiográfico).

Late outcome of sirolimus-eluting stents: comparison of multidetector computed tomography with quantitative coronary angiography and intravascular ultrasound

Objective: To assess the performance of multidetector computed tomography in determining late clinical outcomes of patients undergoing sirolimus-eluting stent implantation.Methods: Thirty patients, successfully submitted to sirolimus-eluting stent implantation for more than six months, were

selected to participate in the study. All underwent invasive angiography and intravascular ultrasound following CT angiography

using iodinated contrast medium at a dose of 1.5 ml/kg.Results: Mean proximal reference diameter was 3.01 ± 0.31 mm by tomography and 3.14 ± 0.31 mm by angiography (p

= 0.04). When the left circumflex artery was excluded from the analysis, the difference between both examinations was

no longer significant (tomography = 3.01 ± 0.32 mm; angiography = 3.10 ± 0.30 mm, p = 0.65). Mean distal reference

diameter was 2.86 ± 0.30 mm by tomography and 2.92 ± 0.32 by angiography (p = 0.25). Mean in-stent minimal lumen

diameter was 2.85 ± 0.25 mm by tomography and 2.85 ± 0.29 mm by angiography (p = 0.27). Mean minimal in-stent crosssectional

area was 7.19 ± 1.47 mm2 by tomography and 6.90 ± 1.52 mm2 by intravascular ultrasound (p = 0.36), but there

was only a weak correlation between these measurements (r = 0.33).Conclusion: Computed tomography allows the qualitative assessment of sirolimus-eluting stents, accurate estimate of proximal

and distal reference diameters of the target vessel, and in-stent minimal lumen diameter. Its correlation with measurements

performed using intravascular ultrasound, however, is less strong.

Influence of age and coronary artery disease on homocysteine levels in the young old compared with the old old and the oldest old

A total of 172 elderly individuals, divided into case and control groups based on the diagnosis of coronary artery disease, underwent coronary angiography to investigate the influence of age and coronary artery disease on homocysteine levels. The subjects were divided into three age ranges: 65–74 years, 75–79 years, and 80 years and older. Continuous homocysteinemia was associated with a risk ratio for coronary artery disease of 1.07 for each ìmol/L increase in homocysteine level. Hyperhomocysteinemia (values above 14 ìmol/L) constituted an independent risk factor for coronary artery disease, with a risk ratio of 2.03. There was a progression of homocysteine levels between the young old and the oldest old only among the case group elderly. There was no difference among the control group elderly. There were no significant differences in vitamin levels. The rise in homocysteine levels from the young old to the oldest old may be considered not a normal pattern, but rather a pattern associated with coronary artery disease. (AJGC. 2006;15:165–173)

Double balloon pulmonary valvuloplasty: multi-track system versus conventional technique

the Multi-Track system (MTS) may help to simplify the procedure. Background: DBPV

is usually required for patients with pulmonary valve stenosis with large annulus. However,

it needs two venous accesses and can be technically demanding. Methods: From

07/03, 20 consecutive patients (19 6 10 yrs) with typical pulmonary valve stenosis

underwent DBPV using the MTS (G1). The results were compared with those achieved

by conventional DBPV performed in a matched historical group of 28 patients (21 6

11 yrs; P = NS) (G2). Results: MTS balloons were easily advanced through the skin and

inflated across the valve. Similar results were observed in regards to residual gradients

(12 6 11 vs 14 6 10 mm Hg; P = NS) and right ventricular to systemic pressures (0.35

6 0.22 vs 0.37 6 0.26; P = NS). Procedure and fluoroscopic times were significant

lower in G1 (78 6 24 vs 126 6 28; 15 6 12 vs 25 6 8 min, respectively; both P < 0.001).

There was no major complication. Median follow-up was 1.8 yr for G1 and 5 yr for G2

(P = 0.037). At the last visit, peak instantaneous gradient across the right ventricular

outflow tract by echocardiography was a mean 22 6 10 mm Hg for G1 and 25 6 9 mm

Hg for G2 (P = NS). No patient had severe pulmonary insufficiency or required reintervention.

Conclusions: The use of the MTS helped to expedite the procedure providing

satisfactory midterm clinical outcomes, similar to those observed with the conventional

Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults

More information is needed to clarify whether stenting is superior to balloon angioplasty (BA) for unoperated coarctation of the aorta (CoA). From September 1997, 21 consecutive adolescents and adults (24 6 11 years) with discrete CoA underwent stenting (G1). The results were compared to those achieved by BA performed in historical group of 15 patients (18 6 10 years; P = 0.103; G2). After the procedure, systolic gradient reduction was higher (99% 6 2% vs. 87% 6 17%; P = 0.015), residual gradients

lower (0.4 6 1.4 vs. 5.9 6 7.9 mm Hg; P = 0.019), gain at the CoA site higher (333% 6 172% vs. 190% 6 104%; P = 0.007), and CoA diameter larger (16.9 6 2.9 vs. 12.9 6 3.2 mm; P < 0.001) in G1. Aortic wall abnormalities were found in eight patients in G2 (53%) and in one in G1 (7%; P < 0.001). There was no major complication. Repeat catheterization (n = 33) and/or MRI (n = 2) was performed at a median follow-up of 1.0 year for G1 and 1.5 for G2 (P = 0.005). Gradient reduction persisted in both groups, although higher late gradients were seen in G2 (median of 0 mm Hg for G1 vs. 3 for

G2; P = 0.014). CoA diameter showed no late loss in G1 and a late gain in G2 with a trend to being larger in G1 (16.7 6 2.9 vs. 14.6 6 3.9 mm; P = 0.075). Two patients required late stenting due to aneurysm formation or stent fracture in G1. Aortic wall abnormalities did not progress and one patient required redilation in G2. Blood

pressure was similar in both groups at follow-up (126 6 12/81 6 11 for G1 vs. 120 6 15/80 6 10 mm Hg for G2; P = 0.149 and 0.975, respectively). Although satisfactory and similar clinical outcomes were observed with both techniques, stenting was a better means to relieve the stenosis and minimize the risk of developing immediate aortic

wall abnormalities.

Implante percutâneo de endopróteses nas artérias carótidas com uso adjunto de filtros para a proteção cerebral: experiência inicial / Carotide arteries endosprothesis percutaneous implant with filters adjunct use for cerebral protection: Initial experience

Objetivos: Avaliar a evolução hospitalar de pacientes submetidos a implante percutâneo de stents nas artérias carótidas (ISC) com uso adjunto de filtros para a proteção cerebral. Métodos: No período de dezembro de 2001 a agosto de 2002 estudamos 14 pacientes que apresentaram lesão obstrutiva significativa na artéria carótida e foram tratados com ISC. Mensuramos o sucesso do implante , do procedimento, os tipos de stents utilizados, os tipos de filtros utilizados, a mortalidade e as complicações neurológicas relacionadas ao procedimento. Resultados: O sucesso do implante e do procedimento foi alcançado em 100% dos casos. O stent mais utilizado foi o WALLSTENT carotídeo em 12 pacientes (85,7%). Não houve acidente vascular cerebral (AVC) transitório, AVC maior e AVC menor...

Resultados imediatos e tardios após implante de stents curtos e longos no tratamento de lesões em enxertos de veia safena / Immediate and late results after lesions treatment of saphenous vein graft

A terapia percutânea com implante de stents em lesões de enxerto de veia safena tem se apresentado como interessante alternativa a uma nova cirurgia de revascularização do miocárdio, tanto por sua menor morbimortalidade como também por índices des sucesso bem aceitáveis. Entretanto, diversos estudos em artérias coronárias nativas demonstraram que os índices de reestenose estão diretamente relacionados com a extensão do segmento tratado, isto é com a extensão do stent utlizado. Em relação aos enxertos de veia safena esta relação ainda necessita investigação adicional. No Instituto "Dante Pazzanese" de Cardiologia de 1994 a 2001, 352 pacientes revascularizados foram submetidos a implante de stents, sendo subdivididos em dois grupos, de acordo com a extensão dos stents...