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Background: Caseous mitral annular calcification (CMAC) is a rare variant of mitral annular calcification. Symptoms can be related to mitral valvular dysfunction, arterial embolization, and transient aortic outflow tract obstruction. CMAC usually affects the posterior fibrous mitral annulus and is commonly diagnosed in elderly patients with a history of hypertension, dyslipidaemia, and renal failure. Case summary: A 68-year-old patient was transferred to our department for late presenting acute myocardial infarction and acute heart failure. Coronary angiography revealed a significant extrinsic compression of the circumflex artery. Transthoracic echocardiography revealed an ovoid calcified mass of 3.6â cm × 2â cm originating from the posterior mitral annulus causing moderate mitral stenosis as well as akinesia of the inferolateral wall, reduced left ventricle ejection fraction (35%), and a low-flow low-gradient severe aortic stenosis. Cardiac computed tomography scan confirmed the presence of a large calcified mass, inserted to the posterior mitral annulus evocating caseous necrosis. The patient underwent a double valve replacement with implantation of both aortic and mitral bioprostheses. Histopathology of the excised mass revealed a chronic mitral valve fibrocalcification with aseptic necrosis, consistent with a caseous calcification of the posterior mitral annulus. Discussion: Extrinsic coronary artery compression is a rare disease entity. We report a rather peculiar cause of extrinsic artery compression: CMAC inducing significant mitral stenosis and compressing the circumflex artery leading to myocardial infarction. To the best of our knowledge, this is the first case of extrinsic artery compression caused by CMAC.
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BACKGROUND: Gender-specific data addressing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in female patients are scarce and based on small sample size studies. AIMS: We aimed to analyze gender-differences regarding in-hospital clinical outcomes after CTO-PCI. METHODS: Data from 35,449 patients enrolled in the prospective European Registry of CTOs were analyzed. The primary outcome was the comparison of procedural success rate in the two cohorts (women vs. men), defined as a final residual stenosis less than 20%, with Thrombolysis In Myocardial Infarction grade flow = 3. In-hospital major adverse cardiac and cerebrovascular events (MACCEs) and procedural complications were deemed secondary outcomes. RESULTS: Women represented 15.2% of the entire study population. They were older and more likely to have hypertension, diabetes, and renal failure, with an overall lower J-CTO score. Women showed a higher procedural success rate (adjusted OR [aOR] = 1.115, confidence interval [CI]: 1.011-1.230, p = 0.030). Apart from previous myocardial infarction and surgical revascularization, no other significant gender differences were found among predictors of procedural success. Antegrade approach with true-to-true lumen techniques was more commonly used than retrograde approach in females. No gender differences were found regarding in-hospital MACCEs (0.9% vs. 0.9%, p = 0.766), although a higher rate of procedural complications was observed in women, such as coronary perforation (3.7% vs. 2.9%, p < 0.001) and vascular complications (1.0% vs. 0.6%, p < 0.001). CONCLUSIONS: Women are understudied in contemporary CTO-PCI practice. Female sex is associated with higher procedural success after CTO-PCI, yet no sex differences were found in terms of in-hospital MACCEs. Female sex was associated with a higher rate of procedural complications.
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Oclusão Coronária , Infarto do Miocárdio , Intervenção Coronária Percutânea , Masculino , Humanos , Feminino , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/terapia , Oclusão Coronária/complicações , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Infarto do Miocárdio/etiologia , Sistema de Registros , Doença Crônica , Angiografia Coronária/efeitos adversosRESUMO
Spontaneous coronary artery dissection (SCAD) accounts for 1-4% of all acute coronary syndromes (ACS). Since the first description in 1931, our understanding of the disease has evolved; however, its pathophysiology and management are still a matter of debate. SCAD typically occurs in a middle-aged woman with no or few traditional cardiovascular risk factors. Two hypotheses have been proposed to explain the pathophysiology depending on the primary event: an intimal tear in the "inside-out" hypothesis and a spontaneous hemorrhage from the vasa vasorum in the "outside-in" hypothesis. Etiology appears to be multifactorial: different predisposing and precipitating factors have been identified. Coronary angiography is the gold standard for the diagnosis of SCAD. Current recommendations on the treatment of SCAD patients are based on expert opinions: a conservative strategy is preferred in hemodynamically stable SCAD patients, while urgent revascularization should be considered in hemodynamically unstable patients. Eleven cases of SCAD in COVID-19 patients have already been described: although the exact pathophysiological mechanism remains unclear, COVID-19-related SCAD is considered a combination of significant systemic inflammatory response and localized vascular inflammation. We present a literature review of SCAD, and we report an unpublished case of SCAD in a COVID-19 patient.
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Coronary artery anomalies (CAAs) are a heterogeneous group of rare congenital diseases whose features and pathophysiological mechanisms are extremely variable, ranging from silent anomalies to sudden cardiac death (SCD) in the most severe cases. Although rare, congenital CAAs confer a high risk of myocardial ischemia and SCD, especially in young, previously "healthy" athletes during or immediately after vigorous exertion. Although some high-risk features that may lead to SCD have been identified, specific pathophysiological mechanisms related to SCD still remain poorly understood. When a CAA is incidentally diagnosed, optimal SCD risk stratification remains challenging, particularly in cases of anomalous aortic origin of a coronary artery arising from the opposite aortic sinus of Valsalva (ACAOS). In recent times, invasive imaging with intravascular ultrasound has gained a role in further identifying high-risk anatomic features; it has been integrated with traditional, non-invasive anatomic imaging evaluations, typically high-quality echocardiography, and cardiac magnetic resonance. Multidisciplinary programs and specific SCD risk scores should be developed in an endeavor to choose the right therapeutic approach, either clinical or interventional/surgical. Intravascular ultrasound is an extremely useful tool to evaluate vessel stenosis, even if prospective studies are still required to further validate this diagnostic strategy. In the present review, we aimed to analyze the pathophysiology and the clinical impact of ACAOS. We also summarized the predominant mechanisms for interference with normal coronary artery function, which might contribute to the onset of life-threatening arrhythmias and SCD.
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Anomalias dos Vasos Coronários , Seio Aórtico , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Morte Súbita Cardíaca/etiologia , Humanos , Estudos ProspectivosRESUMO
BACKGROUND: The clinical benefit of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. This study assessed the impact of circadian rhythms on the effectiveness of manual TA. METHODS AND RESULTS: We conducted an observational study of patients enrolled in the Acute Myocardial Infarction in Switzerland Plus registry. STEMI patients undergoing PPCI with (TA group) or without (PCI-alone group) manual TA were divided based on time-of-day symptom onset: group 1 (00:00-05:59), group 2 (06:00-11:59), group 3 (12:00-17:59) and group 4 (18:00-23:59). The primary endpoint was circadian variation of myocardial infarction (MI) size. The secondary endpoint was in-hospital all-cause mortality. Between 2009 and 2014, 3648 patients underwent PPCI (TA, 49%). After propensity-score matching, 2860 patients were included. Minimal myocardial Injury was observed in groups 2 and 3 (peak creatine kinase level group 1, 2723 ± 148 U/l; group 2, 2493 ± 105 U/l; group 3, 2550 ± 106 U/l; group 4, 2952 ± 144 U/l; p = 0.044) in the TA group, whereas no time-of-day dependence was found in PCI-alone group. After periodic sinusoidal regression analysis, a circadian relationship between time-of-day symptom onset and MI size was demonstrated in the TA group (p < 0.001). In-hospital all-cause mortality was 3.4% in the TA group and 4.3% in the PCI-alone group (p = 0.20). CONCLUSIONS: In this large registry of STEMI patients, manual TA did not reduce in-hospital all-cause mortality. Nonetheless, there was a circadian dependence of TA effectiveness with greatest myocardial salvage for patients with symptom onset between 06:00 and 17:59.
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Ritmo Circadiano , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Trombectomia , Idoso , Distribuição de Qui-Quadrado , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/etiologia , Traumatismo por Reperfusão Miocárdica/mortalidade , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Pontuação de Propensão , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Suíça/epidemiologia , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Operator experience influences outcomes after percutaneous coronary intervention, but this association in the controlled setting of a randomized, clinical trial is unclear. METHODS AND RESULTS: We investigated operator-related outcomes (30-day and 2-year efficacy and safety end points) among patients undergoing percutaneous coronary intervention and randomized to different dual antiplatelet therapy durations and stent types. A total of 2003 patients were analyzed, and 7 operator groups were compared. The majority of preprocedural and postprocedural characteristics were imbalanced. The primary end point of the study, the composite of death, myocardial infarction, or cerebrovascular accidents, did not differ among operators at 30 days or 2 years. There were no significant differences also for all other individual and composite end points analyzed at 30 days and 2 years, except for 2-year stent thrombosis (P=0.048) and bleeding events (P=0.022 for Bleeding Academic Research Consortium type 2, 3, or 5). Adjusted comparisons for the main end points showed slight differences among operators at 30 days, but not at 2 years. There was no interaction of operator with dual antiplatelet therapy duration (P=0.112) or stent type (P=0.300). Results remained entirely consistent when operators were stratified by their experience. CONCLUSIONS: There was a weak signal of heterogeneity across study operators for the 30-day, but not the 2-year, main study outcomes. No clear effect of operator or operator experience was observed for the comparative efficacy and safety profile of the randomized stent types or dual antiplatelet therapy duration regimens. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00611286.
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Doença da Artéria Coronariana/terapia , Reestenose Coronária/prevenção & controle , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Stents , Idoso , Esquema de Medicação , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fatores de TempoAssuntos
Síndrome Coronariana Aguda/terapia , Intervenção Coronária Percutânea/efeitos adversos , Crise Tireóidea/etiologia , Tireotoxicose/complicações , Síndrome Coronariana Aguda/diagnóstico por imagem , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Idoso , Antitireóideos/uso terapêutico , Biomarcadores/sangue , Feminino , Glucocorticoides/uso terapêutico , Humanos , Crise Tireóidea/sangue , Crise Tireóidea/diagnóstico , Crise Tireóidea/tratamento farmacológico , Testes de Função Tireóidea , Tireotoxicose/sangue , Tireotoxicose/diagnóstico , Tireotoxicose/tratamento farmacológico , Tiroxina/sangue , Fatores de Tempo , Tri-Iodotironina/sangueAssuntos
Vasoespasmo Coronário/complicações , Imagem Multimodal/métodos , Fibrilação Ventricular/etiologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Angiografia Coronária , Vasoespasmo Coronário/diagnóstico por imagem , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Eletrocardiografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Prevenção Secundária/métodos , Resultado do Tratamento , Vasodilatadores/uso terapêutico , Fibrilação Ventricular/diagnósticoRESUMO
PURPOSE: To assess the feasibility and safety of the 7 French (Fr) Glidesheath Slender for complex transradial (TR) percutaneous coronary interventions (PCI). BACKGROUND: The TR approach is increasingly used worldwide for coronary and peripheral vascular interventions. However, the small size of the radial artery remains an important limitation for the use of large-bore guiding catheters (>6 Fr), restricting thereby the treatment of highly complex lesions through the TR approach. The 7 Fr Glidesheath slender (Terumo, Tokyo, Japan) is a new dedicated radial sheath with a thinner wall and hydrophilic coating. It combines an inner diameter compatible with any 7 Fr guiding catheter and an outer diameter smaller than current 7 Fr sheaths. METHODS: Prospective multicenter registry of complex TR PCI cases using the 7 Fr Glidesheath Slender to determine the procedural success, rates of vascular complications, radial spasm, and radial artery occlusion (RAO). RESULTS: A total of 60 patients were included. Procedural success was 97% with only one access-site crossover. The use of a 7 Fr guiding catheter was indicated for the treatment of highly complex coronary lesions including distal left main (LM) disease (n = 20), complex non-LM bifurcation lesions (n = 16), chronic total occlusion (n = 15), and severely calcified vessels requiring rotational atherectomy (n = 10). There were three vascular access-site complications (4.7%) including two moderate (type II) local hematoma and one uncomplicated guiding catheter-induced brachial artery dissection. None of the patients experienced major bleeding. The occurrence of radial spasm was reported in seven patients (11%). Doppler ultrasound imaging of the radial artery at 1 month was available in 62 of 64 radial access with three cases of RAO (4.8%). CONCLUSIONS: Use of the 7 Fr Glidesheath slender for complex coronary interventions is feasible and associated with a high rate of procedural success and a low rate of vascular complications. These favorable results need be confirmed in larger multicenter studies. © 2016 Wiley Periodicals, Inc.
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Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Intervenção Coronária Percutânea/instrumentação , Artéria Radial , Idoso , Bélgica , Cateterismo Cardíaco/efeitos adversos , Angiografia Coronária , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Estudos Prospectivos , Punções , Artéria Radial/diagnóstico por imagem , Sistema de Registros , Suíça , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
OBJECTIVES: We aimed to illustrate one of the mechanisms of rotational atherectomy burr entrapment in a coronary stent where the burr was rolled up in the stent's struts. METHODS: We report a case where the treatment of a mid right coronary artery (RCA) lesion using a rotational atherectomy device was attempted. During the procedure, the burr suddenly got stuck in a freshly implanted stent in the distal RCA. Despite several attempts and maneuvers, we were unable to pull back the burr. RESULTS: The patient was transferred for emergency surgery. The length of the RCA from its proximal third to the crux, including the stuck burr and the freshly implanted stent, had to be extracted. CONCLUSIONS: Physicians performing rotational atherectomy should be aware of this complication and know the principal endovascular maneuvers to extract the stuck burr. Operators should also be aware of roll-up burr entrapment, like this case, where most maneuvers to retrieve the burr will fail and should be managed, to our point of view, with surgery.
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Angioplastia Coronária com Balão , Aterectomia Coronária , Estenose Coronária , Vasos Coronários , Procedimentos Endovasculares , Idoso , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Aterectomia Coronária/efeitos adversos , Aterectomia Coronária/instrumentação , Aterectomia Coronária/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/complicações , Estenose Coronária/diagnóstico , Estenose Coronária/etiologia , Estenose Coronária/fisiopatologia , Estenose Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Masculino , Transferência de Pacientes , Ajuste de Prótese/métodos , Stents/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosAssuntos
Anomalias dos Vasos Coronários , Vasos Coronários , Infarto do Miocárdio sem Supradesnível do Segmento ST , Intervenção Coronária Percutânea , Doenças Vasculares/congênito , Reanimação Cardiopulmonar/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/fisiopatologia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Stents Farmacológicos , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Recidiva , Reoperação/métodos , Resultado do Tratamento , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/fisiopatologia , Doenças Vasculares/cirurgiaAssuntos
Angioplastia com Balão/métodos , Artéria Femoral , Doença Arterial Periférica/terapia , Idoso , Angiografia , Angioplastia com Balão/instrumentação , Doença Crônica , Circulação Colateral , Constrição Patológica , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Radiografia Intervencionista , Fluxo Sanguíneo Regional , Stents , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
Newer-generation drug-eluting stents (DES) with enhanced biocompatibility that deliver antiproliferative drugs from a durable polymer have significantly improved safety and efficacy outcomes, compared with both early-generation DES and bare-metal stents, and they represent the current standard of care in all patient and lesion subsets. However, newer durable polymers have been associated with the occurrence of chronic inflammation, delayed vascular healing, incomplete endothelialisation, and neoatherosclerosis, which may result in persistent late adverse cardiovascular events, particularly in patients with high-risk baseline clinical features and angiographic complex coronary artery disease. Newer-generation DES with biodegradable polymer and controlled drug release have been recently introduced to overcome long-term adverse outcomes observed with both early-generation and newer-generation permanent polymer-based DES, and they may be of incremental clinical value in subgroups of patients at higher risk of stent failure. The recent ultrathin-strut cobalt-chromium Orsiro Hybrid DES (BIOTRONIK AG, Bülach, Switzerland) eluting sirolimus from a biodegradable polymer was designed to improve arterial healing and clinical outcomes. The Orsiro Hybrid DES has demonstrated clinical performance comparable to the current state-of-the-art newer-generation thin-strut cobalt-chromium, permanent polymer-based everolimus-eluting stent in a broad patient population. In subgroups of patients at highest-risk of adverse ischemic events, such as patients with diabetes mellitus, small vessels, long lesions, complex coronary lesions, multivessel disease, chronic total occlusion, or ST-segment elevation myocardial infarction, the Orsiro Hybrid DES has shown low rates of adverse clinical outcomes, similar to rates observed in lower-risk patients, and extremely low rates of definite stent thrombosis. This article reviews current evidence on safety and efficacy of the recent ultrathin-strut biodegradable polymer Orsiro Hybrid DES in high-risk subgroups.
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Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Intervenção Coronária Percutânea/métodos , Ligas de Cromo/química , Everolimo , Humanos , Polímeros/química , Desenho de Prótese , Fatores de Risco , Sirolimo/administração & dosagemRESUMO
This report describes a solution for a restenosis and for the fracture of a stent in the vertebral artery in a patient suffering from vertebrobasilar symptoms. Angiography demonstrates restenosis of a vertebral stent as well as its fracture and migration into the subclavian artery. This complication was managed percutaneously by passing a guide wire through the fractured stent. Pre-dilatation and kissing balloon techniques were applied in both the vertebral and subclavian arteries to modify the stent's dimensions and shape it into the form of a "ring." Postprocedural angiography demonstrated an excellent final result with the assistance of StentBoost visualization. Control angiography at six months also utilized StentBoost imaging and confirmed the patency of the bifurcation and that the stent was not displaced.
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Falha de Prótese , Stents/efeitos adversos , Insuficiência Vertebrobasilar/cirurgia , Idoso , Feminino , Migração de Corpo Estranho , Humanos , Recidiva , Artéria Subclávia , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
OBJECTIVES: Management of degenerated aortic valve bioprosthesis classically requires redo surgery, but transcatheter aortic valve-in-valve implantation is becoming a valid alternative in selected cases. In the case of a degenerated Mitroflow bioprosthesis, TAVR is associated with an additional challenge due to a specific risk of coronary occlusion. We aimed to assess the safety and feasibility of transfemoral valve-in-valve implantation of the new Edwards Sapien 3 (Edwards Lifesciences) in a degenerated Mitroflow bioprosthesis (Sorin Group, Inc). METHODS: We report here the safety and feasibility of transfemoral valve-in-valve implantation of a 23 mm Edwards Sapien 3 in a degenerated 25 mm Mitroflow valve and describe the specific assessment of the risk of coronary obstruction using a multi-imaging modality. RESULTS: The final result showed an absence of aortic regurgitation and a mean transvalvular gradient of 14 mm Hg. The patient had no major adverse cardiovascular events at 30-day follow-up. CONCLUSION: Transcatheter valve-in-valve implantation of an Edwards Sapien 3 in a degenerated Mitroflow is feasible and safe, considering a careful assessment of the risk of coronary obstruction with Mitroflow bioprosthesis due to leaflets mounted externally to the stent.
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Insuficiência da Valva Aórtica/cirurgia , Bioprótese , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/diagnóstico , Ecocardiografia Transesofagiana , Feminino , Artéria Femoral , Humanos , Desenho de PróteseRESUMO
Although surgical aortic valve replacement has been the standard of care for patient with severe aortic stenosis, transcatheter aortic valve implantation (TAVI) is now a fair standard of care for patients not eligible or high risk for surgical treatment. The decision of therapeutic choice between TAVI and surgery considers surgical risk (estimated by the Euro-SCORE and STS-PROM) as well as many parameters that go beyond the assessment of the valvular disease's severity by echocardiography: a multidisciplinary assessment in "Heart Team" is needed to assess each case in all its complexity.
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Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Seleção de Pacientes , Substituição da Valva Aórtica Transcateter , Humanos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/métodos , Resultado do TratamentoRESUMO
Coronary artery injury after blunt chest trauma is rare, but can be life-threatening, resulting in severe myocardial ischaemia and acute myocardial infarction. We report a case of a 56-year-old male who presented a few days after a blunt chest trauma with crescendo unstable angina. Coronary angiography demonstrated left main coronary artery dissection that was fixed with stent implantation. After a blunt chest trauma symptoms and electrocardiographic findings of a coronary dissection can be nonspecific and confounded by the chest tenderness. In such cases careful evaluation to rule out traumatic coronary injuries is warranted and early intervention should not be delayed in the presence of clear evidence of myocardial ischemia.
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Vasos Coronários/lesões , Traumatismos Cardíacos/cirurgia , Infarto do Miocárdio/cirurgia , Ferimentos não Penetrantes/cirurgia , Angina Instável/etiologia , Angina Instável/cirurgia , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/etiologia , Aneurisma Coronário/cirurgia , Traumatismos Cardíacos/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Resultado do TratamentoRESUMO
AIMS: The radial approach is safer than the femoral for percutaneous coronary procedures. However its feasibility is lower, mainly for technical issues, often related to failure to puncture or cannulate the radial artery. The ulnar approach is a valid alternative to radial. We aimed to test the incidence, feasibility and safety of a direct homolateral ulnar approach in case of failed radial sheath insertion. METHODS AND RESULTS: Five operators collected their 1-year activity (diagnostic and interventional) with focus on entry site. Entry site choice was left to operators' discretion. In case of failed radial sheath insertion, an attempt to cannulate the homolateral ulnar artery was mandated, if ulnar pulse was present. All patients in whom this attempt was performed were followed until discharge. Out of 2403 procedures (1271 interventions), the final successful entry site was radial in 66.5%, femoral in 31.0%, ulnar in 2.1% and brachial in 0.4%. Radial failure occurred in 117 patients (6.9%). In 75 patients, the radial failure was not due to sheath insertion (which was successful), but to lack of catheter support or to tortuosity of the subclavian/brachial arteries. In the remaining 42 (35.9% of all radial failures), a homolateral ulnar approach was attempted. A successful cannulation of the ulnar artery occurred in 36 patients (85.7%) with further performance of the complete procedure. Concerning local complications, 1 radial pseudo-aneurysm (treated with additional compression) occurred, while no cases of early hand ischemia were reported. CONCLUSIONS: In this multicenter registry, in case of failed radial sheath insertion, switching directly to the homolateral ulnar artery for percutaneous coronary procedures is feasible and it appears to be safe, without cases of symptomatic hand ischemia.