Disección espontánea de arteria ilíaca asociada a ejercicio y uso de ergotamina / Spontaneous dissection of iliac artery related with excercise and ergotamine. A case report

Introduction: Spontaneous dissection of the iliac artery (SDIA) is an extremely rare clinical manifestation, associated to different etiologies, and it usually shows an ischemia of the involved lower extremity. Clinical case: We report a case of a 48-year-old man, with past medical history of chronicle consumption of ergotamine, which presented left lower limb ischemia, while practicing physical exercise. An emergent contrast-enhanced computed tomography scan showed a spontaneous dissection of the common and the external left iliac artery. An endovascular therapy of the lesion was performed with self-expanding stents, achieving the reconstruction of the lesion, the recovery of the blood flow and of the lower limb ischemia. Conclusions: There are no previous descriptions of the association between ergotamine consumption, sport and this very rare pathology. Endovascular treatment represents a less invasive and, such as in our case report, successful management of the SDIA, and it should be considered among the alternative therapies.

Introducción: La disección espontánea de la arteria ilíaca es un cuadro muy poco frecuente asociado a diferentes etiologías que habitualmente se presenta como isquemia de la extremidad comprometida. Caso clínico: Se reporta el caso de un paciente masculino de 48 años con antecedente de consumo crónico de ergotamina, quien mientras practicaba deporte presenta cuadro de isquemia aguda de la extremidad inferior izquierda. Angio tomografía computada demostró disección espontánea de la arteria ilíaca común y externa izquierda. Se realizó terapia endovascular de la lesión con stents auto expandibles, logrando la reparación de la lesión, el restablecimiento del flujo y la recuperación de la isquemia de la extremidad. Discusión y conclusiones: No existen reportes previos de esta patología poco frecuente, en que se asocie en forma conjunta la práctica de deporte y el uso de ergotamina. Dentro de las alternativas terapéuticas, la reparación endovascular representa una opción menos invasiva y, como en este caso, con óptimos resultados.

Seguimiento clínico al año de angioplastias coronarias exitosas en pacientes no seleccionados / One year follow up of successful coronary angioplasty in non selected patients

Background:Re-stenosis after percutaneous Coronary Angioplasty (PTCA) is related to clinical and angiographic features. Aim: To describe the clinical and angiographic characteristic of our patients with coronary cardiopathy subjected to PTCA and the predictor factors for re-stenosis. Material and methods: We gathered the clinical and angiographic characteristics of all patients who underwent a successful PTCA of a native coronary artery. All patients had a clinical assessment one year after the procedure. Patients were classified in Group 1, if they did not have angina or coronary events after the angioplasty or Group 2, if they had angina or a coronary event after the procedure. Only Group 2 patients were subjected to a coronary angiogram. Results: We collected 383 PTCA procedures. Follow up information was obtained in 92.2 percent. Three hundred forty two patients (89.3 percent) were assessed one year the procedure. Nine patients (2.3 percent) died of a cardiovascular cause. Ninety patients (26.3 percent) were classified in Group 2. In 65 patients, angiographic re-stenosis was demonstrated (19 percent). Re-stenosis occurred in 36 and 13 percent of patients with an without Diabetes Mellitus, respectively (p <0.01). The other clinical predictor variables were a history of myocardial infarction (p =0.007), obesity (p =0.041) and hypercholesterolemia (p =0.050). None of the angiographic characteristics predicted restenosis. Stents were protective factors against restenosis (15.6 percent in stented lesions vs 25.4 percent in nonstented; p =0.01). Conclusions: Re-stenosis after angioplasty occured in 19 percent of our patients with angina or coronary events. The clinical variables associated with a higher risk of re-stenosis were diabetes (the main risk factor), previous myocardial infarction, obesity and hypercholesterolemia. Angiographic variables were not associated with re-stenosis. The use of stents decreases the incidence of re-stenosis in all groups).

[One year follow up of successful coronary angioplasty in non selected patients]. / Seguimiento clínico al año de angioplastias coronarias exitosas en pacientes no seleccionados.

BACKGROUND: Re-stenosis after percutaneous coronary angioplasty (PTCA) is related to clinical and angiographic features. AIM: To describe the clinical and angiographic characteristic of our patients with coronary cardiopathy subjected to PTCA and the predictor factors for re-stenosis. MATERIAL AND METHODS: We gathered the clinical and angiographic characteristics of all patients who underwent a successful PTCA of a native coronary artery. All patients had a clinical assessment one year after the procedure. Patients were classified in Group 1, if they did not have angina or coronary events after the angioplasty or Group 2, if they had angina or a coronary event after the procedure. Only Group 2 patients were subjected to a coronary angiogram. RESULTS: We collected 383 PTCA procedures. Follow up information was obtained in 92.2%. Three hundred forty two patients (89.3%) were assessed one year the procedure. Nine patients (2.3%) died of a cardiovascular cause. Ninety patients (26.3%) were classified in Group 2. In 65 patients, angiographic re-stenosis was demonstrated (19%). Re-stenosis occurred in 36 and 13% of patients with an without Diabetes Mellitus, respectively (p <0.01). The other clinical predictor variables were a history of myocardial infarction (p =0.007), obesity (p =0.041) and hypercholesterolemia (p =0.050). None of the angiographic characteristics predicted restenosis. Stents were protective factors against restenosis (15.6% in stented lesions vs 25.4% in nonstented; p =0.01). CONCLUSIONS: Re-stenosis after angioplasty occurred in 19% of our patients with angina or coronary events. The clinical variables associated with a higher risk of re-stenosis were diabetes (the main risk factor), previous myocardial infarction, obesity and hypercholesterolemia. Angiographic variables were not associated with re-stenosis. The use of stents decreases the incidence of re-stenosis in all groups).

Proteína C reactiva: rol en enfermedad cardiovascular / C-reactive protein: role in cardiovascular disease

La patología cardiovascular ha adquirido una importancia creciente en el último tiempo, debido a que es la principal causa de muerte en países desarrollados. Esto ha llevado al desarrollo de múltiples estudios dentro de los que destacan aquellos que asocian los niveles plasmßticos basales de Proteína C reactiva (PCR) con el riesgo cardiovascular y la magnitud de su aumento durante un evento coronario con el pronóstico del paciente. Valores elevados de la línea basal de PCR se han visto asociados a síndromes metabólicos, lo que sugiere que el aumento de los marcadores de inflamación puede reflejar un estado metabólico particular que resulta ser también proaterogénico y/o predisponer a los eventos aterotrombóticos. Esta asociación es especialmente valiosa en los pacientes sin factores de riesgo tradicionales, porque nos permitiría pesquisarlos y realizar una prevención activa de futuros eventos aterotrombóticos.En esta revisión se explican los conceptos actuales tras una dÚcada de investigación, haciendo hincapié en la gÚnesis del proceso patológico, la utilidad clínica de la PCR tanto en la prevención como en el pronóstico de la patología aterotrombótica y las interrogantes que persisten.