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2.
J Invasive Cardiol ; 31(7): E220-E225, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31257217

RESUMO

BACKGROUND: Left main coronary artery (LMCA) chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS: We reviewed 4436 CTO-PCIs performed in 4340 patients between 2012 and 2018 at 25 sites. LMCA-CTO-PCI was performed in 20 cases (0.45%). We examined the clinical and angiographic characteristics and procedural outcomes of these cases. RESULTS: Mean patient age was 68 ± 11 years and 65% were men. Most patients (85%) had undergone prior coronary artery bypass graft surgery and had a protected left main. Mean J-CTO score was 2.7 ± 1.3, mean PROGRESS-CTO score was 1.3 ± 1.1, and mean PROGRESS-CTO Complications score was 3.8 ± 1.9. Antegrade-wire escalation was the most common successful crossing strategy (50%), followed by retrograde crossing (30%) and antegrade dissection/re-entry (10%). Technical and procedural success rates were both 85%. One patient with failed LMCA-CTO-PCI had periprocedural myocardial infarction. Median procedure time was 178 minutes (interquartile range [IQR], 123-250 minutes), median contrast volume was 190 mL (IQR, 133-339 mL), and patient air kerma radiation dose was 2.6 Gray (IQR, 1.3-3.9 Gray). CONCLUSIONS: LMCA-CTO-PCI is infrequent, is performed mostly in patients with prior coronary artery bypass graft surgery, and is associated with good procedural outcomes.


Assuntos
Angiografia Coronária/métodos , Oclusão Coronária/cirurgia , Vasos Coronários/cirurgia , Intervenção Coronária Percutânea/métodos , Idoso , Oclusão Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
3.
Circulation ; 140(5): 420-433, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31356129

RESUMO

Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.

4.
Cardiovasc Revasc Med ; 18(6S1): 45-47, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28162988

RESUMO

Subclavian artery stenosis is associated with increased cardiovascular disease mortality. It remains an important treatable cause of upper extremity, brain and cardiac ischemia. Endovascular treatment with angioplasty and stenting has become the preferred modality of treatment. Surgical revascularization is reserved for difficult cases with unfavorable anatomy to endovascular approach. Here we describe a case of subclavian artery stenosis causing subclavian steal syndrome with unfavorable anatomy to stenting treated successfully with drug coated balloon angioplasty with maintenance of patency at 6months.


Assuntos
Angioplastia com Balão , Síndrome do Roubo Coronário-Subclávio/terapia , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/cirurgia , Idoso , Angioplastia com Balão/métodos , Angioplastia Coronária com Balão/métodos , Síndrome do Roubo Coronário-Subclávio/diagnóstico , Feminino , Humanos , Síndrome do Roubo Subclávio/diagnóstico , Resultado do Tratamento
6.
Biomed Res Int ; 2016: 7194676, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27822477

RESUMO

Background. Transesophageal echocardiogram (TEE) is superior to transthoracic echocardiogram (TTE) in detecting left atrial thrombus (LAT), a risk factor for stroke, but is costly and invasive, carrying a higher risk for complications. Aims. To determine the utility of using left atrial enlargement (LAE) on TTE to predict LAT on TEE. Methods. AIS patients who presented in 06/2008-7/2013 and underwent both TTE and TEE were identified from our prospective stroke registry. Analysis consisted of multivariate logistic regression with propensity score adjustment and receiver operating characteristic (ROC) area under the curve (AUC) analyses. Results. 219 AIS patients underwent both TTE and TEE. LAE on TTE was detected in 113 (51.6%) of AIS patients. Patients with LAE on TTE had higher proportion of LAT on TEE (8.4% versus 1.0%, p = 0.018). LAE on TTE predicted increased odds of LAT on TEE (OR = 8.83, 95% CI 1.04-74.83, p = 0.046). The sensitivity and specificity for LAT on TEE by LAE on TEE were 88.89% and 52.20%, respectively (AUC = 0.7054, 95% CI 0.5906-0.8202). Conclusions. LAE on TTE can predict LAT detected on TEE in nearly 90% of patients. This demonstrates the utility of LAE on TTE as a potential screening tool for LAT, potentially limiting unneeded costs and complications associated with TEE.


Assuntos
Cardiomegalia/diagnóstico por imagem , Ecocardiografia Transesofagiana , Ecocardiografia , Átrios do Coração/patologia , Acidente Vascular Cerebral/diagnóstico por imagem , Trombose/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomegalia/complicações , Demografia , Embolia/diagnóstico , Embolia/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Curva ROC , Acidente Vascular Cerebral/complicações , Trombose/complicações
7.
Int J Cardiol ; 221: 1087-94, 2016 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-27448538

RESUMO

BACKGROUND: The Absorb bioresorbable vascular scaffold (BVS) was developed to address long-term safety issues of metallic drug-eluting stents. However, it may be associated with an increased event risk during the first year. METHODS: A systematic literature search was performed (in MEDLINE/PubMed, Cochrane CENTRAL, EMBASE, and scientific meeting abstracts) to identify studies that compared BVS and cobalt-chromium durable polymer everolimus-eluting stents (EES). For randomized clinical trials and non-randomized propensity score matched studies that reported 1-year outcome data, fixed/random-effects models were used to generate pooled estimates of outcomes, presented as odds ratios (OR) with 95%-confidence intervals (CI). RESULTS: The 1-year follow-up data of 6 trials with 5588 patients were analyzed. A device-oriented composite endpoint (DOCE - cardiac death, target vessel myocardial infarction (MI), or target lesion revascularization (TLR)) was reached by 308 BVS or EES patients (195/3253 vs. 113/2315). Meta-analysis showed that patients who received BVS had an increased risk of MI (4.3% vs. 2.3%; OR:1.63, 95%-CI: 1.18-2.25, p<0.01) and definite-or-probable scaffold thrombosis (1.3% vs. 0.6%; OR:2.10, 95%-CI: 1.13-3.87, p=0.02). However, there was no significant between-group difference in risk of DOCE (6.0% vs. 4.9%; OR:1.19, 95%-CI: 0.94-1.52, p=0.16), cardiac death (0.8% vs. 0.7%; OR:1.14, 95%-CI: 0.54-2.39, p=0.73), or TLR (2.5% vs. 2.5%; OR: 0.98, 95%-CI:0.69-1.40, p=0.92). CONCLUSIONS: During the first year of follow-up, patients treated with BVS had a higher incidence of MI and scaffold thrombosis. The risk of DOCE was not significantly different. As BVS may pay off later, future robust data on long-term clinical outcome will be of paramount importance.


Assuntos
Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/classificação , Everolimo/farmacologia , Intervenção Coronária Percutânea/instrumentação , Implantes Absorvíveis/efeitos adversos , Prótese Vascular/efeitos adversos , Reestenose Coronária/etiologia , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Desenho de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Tecidos Suporte/efeitos adversos
8.
Int J Cardiol ; 215: 487-93, 2016 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-27131770

RESUMO

BACKGROUND: Handgrip strength (HGS) and gait speed (GS) are objective components of the frailty syndrome in the elderly, and are associated with increased all-cause mortality. However, their association with cardiovascular (CVD) mortality is less lucid. The present systematic review aims to summarize the available literature assessing HGS, GS and their association with CVD Mortality. METHODS: Medline and Embase databases were searched systematically using controlled vocabulary and free text terms. A total of 344 results were obtained and scanned for inclusion. Articles were included if they presented results of original research and provided information on HGS or GS and CVD mortality. RESULTS: A total of 19 studies (N=63,396) were included for review. Twelve studies examined hand grip strength with CVD mortality and 7 studies assessed gait speed. Almost all included studies demonstrated an association of HGS/GS with CVD mortality on univariate analyses. Decreased HGS or GS were associated with increased mortality in most studies (8/12 for HGS and 6/7 for GS). In most positive studies, the association of HGS/GS was usually found to be independent of traditional CVD risk factors. CONCLUSION: The present review demonstrates that decreased HGS and GS are associated with CVD mortality, with the association found to be more consistent for GS as compared to HGS. Both of these measures provide valuable prognostic information above and beyond traditional scoring methods and should be considered for implementation in clinical practice.


Assuntos
Doenças Cardiovasculares/mortalidade , Avaliação Geriátrica/métodos , Força da Mão/fisiologia , Velocidade de Caminhada/fisiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/fisiopatologia , Idoso Fragilizado , Humanos , Prognóstico
9.
Catheter Cardiovasc Interv ; 86(6): E268-71, 2015 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-25914155

RESUMO

Coronary chronic total occlusions (CTOs) are known to cause significant patient morbidity. Over the past several years, the techniques and devices for treating these CTOs have advanced tremendously. The interventional management of CTOs within previously placed coronary stents, however, remains challenging. Here, we present a case of an in-stent restenosis of the right coronary artery CTO bypassed using a controlled subintimal dissection re-entry technique via antegrade approach creating side-by-side stents.


Assuntos
Oclusão Coronária/terapia , Reestenose Coronária/diagnóstico , Reestenose Coronária/terapia , Falha de Prótese , Stents/efeitos adversos , Doença Crônica , Angiografia Coronária/métodos , Oclusão Coronária/diagnóstico por imagem , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/diagnóstico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Retratamento/métodos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia de Intervenção
10.
Heart Lung ; 44(3): 209-11, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25766043

RESUMO

Dabigatran, a direct thrombin inhibitor, is one of the new oral anticoagulants. As more patients receive treatment with Dabigatran, and as the clinical indications for Dabigatran use expand, reporting serious adverse effects is fundamental to future safety assessment. Although patients taking Dabigatran had fewer life-threatening bleeds when compared to Coumadin, those events continue to be reported. We describe, in the same patient, a sanguineous pleuro pericardial effusion that was diagnosed incidentally on a pre-ablation cardiac CT angiography. The diagnosis was made approximately two months after initiating Dabigatran treatment for non-valvular atrial fibrillation in a 63-year-old patient.


Assuntos
Anticoagulantes/efeitos adversos , Dabigatrana/efeitos adversos , Derrame Pericárdico/induzido quimicamente , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Ablação por Cateter , Dabigatrana/uso terapêutico , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico
12.
Cardiovasc Revasc Med ; 15(5): 305-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24907226

RESUMO

BACKGROUND: The left renal vein (LRV) entrapment syndrome is a rare condition. Here, we present a 22-year-old female presenting with recurrent nausea, vomiting, weight loss and evidence of the LRV compression by the superior mesenteric artery and the abdominal aorta. Hemodynamic assessment confirmed a pressure gradient of >3 mmHg between the LRV and the inferior vena cava. A self-expandable stent was then deployed in the LRV. Subsequent clinical follow-ups ensure full resolution of the patient's symptoms. METHODS: Multilingual search was performed in PubMed, Google scholar, Scielo, Korea Med and EMBASE with the medical subheadings "nutcracker syndrome", "nutcracker phenomenon" and "compression vein syndrome" from January 1983 to September 2013. RESULTS: Review of the literature exhibited a plethora of individual case reports (291 citations). Importantly, few retrospective case series [5] comprising a total of 157 patients included successful endovascular interventions. CONCLUSION: Endovascular therapy for nutcracker syndrome represents a safe and suitable treatment option, but prospective studies are needed to confirm these data.


Assuntos
Aorta Abdominal/cirurgia , Síndrome do Quebra-Nozes/cirurgia , Veias Renais/cirurgia , Aorta Abdominal/diagnóstico por imagem , Procedimentos Endovasculares , Humanos , Masculino , Radiografia , Síndrome do Quebra-Nozes/diagnóstico , Estudos Retrospectivos , Risco , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-24683307

RESUMO

Double-chambered right ventricle (DCRV) is a rare congenital heart disorder involving 2 different right ventricle (RV) pressure compartments that is often associated with ventricular septal defect (VSD). Usually, the obstruction is caused by an anomalous muscle bundle crossing the RV from the interventricular septum to the RV free wall. We are reporting a case of double-chambered right ventricle associated with ventricular septal defect and congenital absence of the pulmonary valve, a rare form of congenital infundibular pulmonary stenosis. In addition to ventricular septal defect, our patient had congenital absence of the pulmonary valve, which is very unusual and has never been reported to our knowledge.

14.
J Invasive Cardiol ; 26(1): 22-9, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24402808

RESUMO

BACKGROUND: Revascularization of the peripheral arteries remains technically challenging. By decreasing the volume of the atherosclerotic plaque, debulking procedures may confer superior primary patency after revascularization. AIMS: To assess the impact of atherectomy on primary patency rates at 12 months compared to balloon angioplasty and/or stent placement alone in patients with infrainguinal arterial disease. METHODS: A database search for "directional," "orbital," "rotational," and "laser atherectomy" in peripheral arterial disease (PAD) was performed. Studies were screened according to the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) critical appraisal tool and summarized by population, methodology, and outcomes (primary patency and major adverse events). RESULTS: Only two randomized studies were found. Most of the data were obtained from single-arm studies and registries. The primary patency with directional atherectomy approaches 60% at 12 months as a stand-alone technique, whereas orbital atherectomy in conjunction with balloon angioplasty and stenting achieved primary patency rates of 90%. Laser atherectomy is universally employed with balloon angioplasty and stenting for in-stent restenosis lesions with a primary patency rate of 64%. Although there are data for the safe use of rotational atherectomy, robust data to support its effectiveness are lacking. The combination of drug-coated balloons and atherectomy for the treatment of heavily calcified lesions in patients with critical limb ischemia is under evaluation. CONCLUSION: Despite the successful procedural outcomes reported in clinical registries, the available data do not support the use of atherectomy alone in PAD. Larger randomized controlled studies are warranted to define its role in contemporary endovascular practice.


Assuntos
Aterectomia/métodos , Canal Inguinal/irrigação sanguínea , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/terapia , Grau de Desobstrução Vascular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão , Terapia Combinada , Bases de Dados Factuais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
15.
Ochsner J ; 14(4): 576-85, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25598723

RESUMO

BACKGROUND: The safety and efficacy of endovascular therapies for ascending aortic pseudoaneurysms (AAPs) are still controversial. METHODS: We report an endovascular correction of an AAP in a high-risk surgical patient and present the results of a literature review focusing on AAP treatment strategies. A multilingual search of AAP therapy was performed with limiting dates of January 1980 to May 2014. The studies were classified by intervention. RESULTS: A 79-year-old male with a 9 × 10 × 7 cm AAP in the anterior mediastinum was considered too high risk for surgery. An endovascular closure with a 12 mm Amplatzer septal occluder device (St. Jude Medical) was performed, and computed tomography angiography at 3-month follow-up exhibited a thrombosed AAP with minimal residual shunt. In our literature search, we identified 355 cases of AAPs, mostly case reports (91.5%) and a few patient series (8.5%). Surgical correction accounted for 73.8% of the cases, 5% of the patients were conservatively treated or considered too critically ill for any intervention, and 21.2% were treated with endovascular techniques. The most commonly reported endovascular techniques were stent grafts (9.8%) and septal occluder devices (9.8%). CONCLUSION: Although endovascular closure of AAPs with off-label devices is a reliable option for controlling the expansion and symptoms in high-risk surgical patients, solid data on survival are lacking. Efforts to promote discussion within the heart team to expand the application of endovascular techniques can provide groundbreaking evidence to support the use of endovascular techniques as guideline therapy when facing these complicated cases.

16.
Int Urol Nephrol ; 46(1): 27-39, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23443874

RESUMO

Several studies have shown that HDL has altered antioxidant and anti-inflammatory effects in chronic uremia, either by the reduction in its antioxidant enzymes or by the impairment of their activity. Systemic oxidative stress, which is highly prevalent in chronic kidney disease (CKD) patients, has been shown to decrease antioxidant and anti-inflammatory effects of HDL and even transform it into a pro-oxidant and pro-inflammatory agent. For this reason, we believe that the propensity for accelerated cardiovascular disease in CKD is facilitated by a few key features of this disease, namely, oxidative stress, inflammation, hypertension, and disorders of lipid metabolism. In a nutshell, oxidative stress and inflammation enhance atherosclerosis leading to increased cardiovascular mortality and morbidity in this population. In this detailed review, we highlight the current knowledge on HDL dysfunction and impairment in chronic kidney disease as well as the available therapy.


Assuntos
Dislipidemias/tratamento farmacológico , Lipoproteínas HDL/metabolismo , Insuficiência Renal Crônica/metabolismo , Uremia/sangue , Acetatos/uso terapêutico , Acetil-CoA C-Acetiltransferase/antagonistas & inibidores , Anti-Inflamatórios , Anticolesterolemiantes/uso terapêutico , Antioxidantes , Apolipoproteína A-I/uso terapêutico , Aterosclerose/sangue , Aterosclerose/etiologia , Colesterol/metabolismo , Proteínas de Transferência de Ésteres de Colesterol/antagonistas & inibidores , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipolipemiantes/uso terapêutico , Niacina/uso terapêutico , PPAR alfa/agonistas , Quinolinas/uso terapêutico , Insuficiência Renal Crônica/complicações , Ácidos Sulfônicos/uso terapêutico , Uremia/etiologia
17.
Vascular ; 22(3): 214-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23539069

RESUMO

A 75-year-old woman with past medical history of coronary bypass, atrial fibrillation, mitral valve repair undergoes percutaneous coronary intervention of left circumflex artery with a drug eluting stent. An Anglo-Seal vascular closure device was used post procedure to obtain hemostasis. Shortly after deployment, frank bleeding was observed necessitating manual compression at the arteriotomy site. After hemostasis was achieved, the right lower extremity was found to be pale, bluish with feeble pulses. Doppler ultrasound was emergently performed revealing decreased blood flow after mid superficial femoral artery (SFA) and an echo lucent object lodged luminally in the SFA. Patient was urgently taken to the vascular laboratory where an Angio-Seal device, including the collagen plug and anchor, was successfully removed endovascularly patient made full recovery and was discharged home the following day.


Assuntos
Implantes Absorvíveis/efeitos adversos , Síndrome Coronariana Aguda/cirurgia , Angioplastia Coronária com Balão/efeitos adversos , Remoção de Dispositivo/métodos , Artéria Femoral , Isquemia , Hemorragia Pós-Operatória , Falha de Prótese , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Angioplastia Coronária com Balão/métodos , Colágeno/uso terapêutico , Angiografia Coronária , Stents Farmacológicos , Procedimentos Endovasculares/métodos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Artéria Femoral/cirurgia , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/métodos , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/fisiopatologia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/fisiopatologia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/cirurgia , Falha de Prótese/efeitos adversos , Falha de Prótese/etiologia , Resultado do Tratamento , Ultrassonografia Doppler/métodos
18.
Congenit Heart Dis ; 9(2): E61-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23663401

RESUMO

We report an extremely rare case of thebesian vein microfistulae to both ventricles. A 65-year-old woman, with no major cardiovascular risk factors, presented with multiple episodes of chest pain. The resting electrocardiogram showed T-wave inversion in leads V(1) -V(4). A Dipyridamole myocardial perfusion imaging revealed large and severe inferior defect with complete reversibility. Coronary angiography showed no coronary artery disease. On contrast injection, an exaggerated capillary blush from the distal portions of the right and left coronary artery systems was seen in both ventricles, mimicking the image of ventriculography. This appearance suggests prominent thebesian vessels, a congenital communication between the coronaries and the two ventricles. The clinical relevance of these myocardial sinusoids is still not well established. Although the majority of these fistulas are small in size and with no clinical significance, they can rarely present with chest pain, cardiac arrhythmia, syncope, myocardial infarction, and/or pulmonary hypertension. These fistulae when excessive can cause significant shunting of blood to the ventricles, leading to coronary steal phenomena and ischemia. This phenomenon is facilitated by the low resistance in these microfistulae as opposed to the higher resistance in the normal coronary circulation. Due to the diffuse nature of these microfistulae, neither surgery nor transcatheter therapy is feasible. This condition can only be managed medically; however, it should be noted that vasodilator agents, such as nitrates, can worsen the coronary steal phenomenon. Our patient was treated with ranolazine with significant improvement in her symptoms, which was not reported previously. Multiple coronary artery microfistulae could be an underestimated condition of angina in patient with normal coronaries.


Assuntos
Anomalias dos Vasos Coronários/complicações , Angina Microvascular/etiologia , Isquemia Miocárdica/etiologia , Fístula Vascular/complicações , Acetanilidas/uso terapêutico , Idoso , Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Fármacos Cardiovasculares/uso terapêutico , Angiografia Coronária , Circulação Coronária , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/fisiopatologia , Eletrocardiografia , Feminino , Hemodinâmica , Humanos , Microcirculação , Angina Microvascular/diagnóstico , Angina Microvascular/tratamento farmacológico , Angina Microvascular/fisiopatologia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/fisiopatologia , Imagem de Perfusão do Miocárdio/métodos , Piperazinas/uso terapêutico , Ranolazina , Resultado do Tratamento , Fístula Vascular/diagnóstico , Fístula Vascular/fisiopatologia
19.
Cardiol Rev ; 22(2): 69-78, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23584424

RESUMO

Breast arterial calcification (BAC), observed as an incidental finding on screening mammograms, represents degenerative calcific changes occurring in the mammary arteries, with increasing age. The aim of this review is to discuss relevant literature examining relation between BAC and atherosclerosis. After a thorough literature search, in OVID and PubMed, 199 studies were identified, of which 25 were relevant to our review. Data were abstracted from each study and statistical analysis was done, including calculation of odds ratios and construction of forest plots. A total of 35,542 patients were enrolled across 25 studies looking at an association between BAC and coronary artery disease, cardiovascular disease, stroke, cerebral artery disease, carotid and peripheral artery diseases, and coronary artery calcification. A majority of the studies showed a statistically significant relation between BAC and presence of coronary artery disease cardiovascular disease and associated mortality. Sensitivity of BAC in predicting cardiovascular events was low, but specificity was high. BAC was predictive of incident and prevalent stroke but not mortality of stroke. Similarly, BAC was predictive of cerebral, carotid, and peripheral artery diseases. The role of BAC as a surrogate marker of coronary and systemic atherosclerosis is currently uncertain. Its role may be further elucidated by more large-scale prospective studies and clinical experience.


Assuntos
Aterosclerose/epidemiologia , Mama/irrigação sanguínea , Calcinose/diagnóstico , Calcinose/patologia , Artéria Torácica Interna/patologia , Mamografia/métodos , Doenças Cardiovasculares/epidemiologia , Doenças Arteriais Cerebrais/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Razão de Chances , Valor Preditivo dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Acidente Vascular Cerebral/epidemiologia
20.
J Invasive Cardiol ; 25(8): 412-4, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23913608

RESUMO

Off-label "double-wire" technique for closure of large-bore vascular access has been reported in the setting of percutaneous aortic valvuloplasty. We present 5 cases of high-risk percutaneous coronary intervention (HRPCI) supported by a 2.5 LP Impella assist device with 13 and 14 Fr size femoral access. Following successful HRPCI, vessel closure was complicated by unsuccessful deployment of a suture-mediated closure device. Subsequently, deployment of two successive collagen-based closure devices with a "double-wire" technique was performed. Our cases warrant further studies to test the feasibility of using double-closure device as an alternative for vessel closure when left ventricular assist devices are needed to support HRPCI.


Assuntos
Cardiomiopatias/terapia , Doença da Artéria Coronariana/terapia , Coração Auxiliar , Intervenção Coronária Percutânea/métodos , Idoso , Angiografia , Técnicas Hemostáticas , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Suturas , Resultado do Tratamento
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