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1.
Cardiovasc Revasc Med ; 21(1): 101-107, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31395436

RESUMO

PURPOSE: Zilver PTX nitinol self-expanding drug-eluting stent with paclitaxel coating is effective for treatment of superficial femoral artery (SFA) disease. However, as with any stent, it induces a measure of vascular inflammatory response. The current clinical trial (NCT02734836) aimed to assess vascular patency, remodeling, and inflammatory markers with intravascular optical coherence tomography (OCT) in patients with SFA disease treated with Zilver PTX stents. METHODS: Serial OCT examinations were performed in 13 patients at baseline and 12-month follow-up. Variables evaluated included neointimal area, luminal narrowing, thrombus area, stent expansion as well as measures of inflammation including, peri-strut low-intensity area (PLIA), macrophage arc, neovascularization, stent strut apposition and coverage. RESULTS: Percentage of malapposed struts decreased from 10.3 ±â€¯7.9% post-intervention to 1.1 ±â€¯2.2% at 12-month follow-up, but one patient showed late-acquired stent malapposition (LASM). The percent of uncovered struts at follow-up was 3.0 ±â€¯4.5%. Average expansion of stent cross-sectional area from baseline to follow-up was 35 ±â€¯19%. The average neointimal area was 7.8 ±â€¯3.8 mm2. Maximal luminal narrowing was 61.1 ±â€¯25.0%, and average luminal narrowing was 35.4 ±â€¯18.2%. Average peri-strut low-intensity area (PLIA) per strut was 0.017 ±â€¯0.018 mm2. Average number of neovessels per mm of stent was 0.138 ±â€¯0.181. Average macrophage angle per frame at follow-up was 7 ±â€¯11°. Average thrombus area at follow-up was 0.0093 ±â€¯0.0184 mm2. CONCLUSION: At 12-month follow-up, OCT analysis of Zilver PTX stent shows outward remodeling and minimal neointimal growth, but evidence of inflammation including PLIA, neovessels, thrombus and macrophages. SUMMARY: Thirteen patients with PAD had paclitaxel-coated stents implanted in their SFAs and were then imaged with OCT at baseline and 12-month follow-up. OCT proxy metrics of inflammation were quantified.

2.
J Invasive Cardiol ; 31(12): E356-E361, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786526

RESUMO

OBJECTIVES: To evaluate the efficacy of advanced stent technology in the management of failing arteriovenous grafts (AVGs). BACKGROUND: End-stage renal disease rates and the need for hemodialysis are increasing worldwide. AVG remains a common dialysis access site. Several techniques have been previously suggested to restore and preserve AVG patency. A quantitative evaluation and synthesis of this information are essential in elucidating the role of newer stent platforms for the management of failing AVG. METHODS: We performed a literature search using PubMed, Web of Science, and Embase from January 2006 to December 2017. Studies comparing the primary patency rates with stent placement vs balloon angioplasty alone in patients with failed AVGs were included. RESULTS: Seven studies with a total of 1109 patients met the inclusion criteria. The mean graft age was 2.89 years in the stent group and 3.29 years in the balloon angioplasty group. Stent placement was associated with improved primary patency rates compared with balloon angioplasty alone at short-term (3-month) follow-up (73.2% vs 42.6%, respectively; risk ratio [RR], 0.55; 95% confidence interval [CI], 0.35-0.88; P=.01) and mid-term (6-month) follow-up (50.8% vs 18.4%, respectively; RR, 0.65; 95% CI, 0.51-0.82; P<.001). The primary patency rates remained favorable with stent placement at 12-month (40.3% vs 13.0%, respectively; RR, 0.69; 95% CI, 0.63-0.77; P<.001) and 24-month follow-up (20.5% vs 6.8%; RR, 0.86; 95% CI, 0.80-0.92; P<.001) compared with balloon angioplasty alone. CONCLUSIONS: Stent placement is associated with improved patency rates compared with balloon angioplasty alone.

3.
Tex Heart Inst J ; 46(3): 195-198, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708702

RESUMO

The MitraClip system can be used to control regurgitant blood flow in patients with mitral regurgitation who cannot tolerate open surgery to replace the mitral valve. Technical limitations make the right femoral vein the standard access point for placing the MitraClip. However, this route is not always suitable. We present the case of an 85-year-old woman in whom we successfully used a left-sided approach for inserting a MitraClip because her right femoral vein was occluded. This apparently novel left femoral approach merits consideration as an option for device insertion when right femoral vein access is precluded.


Assuntos
Cateterismo Cardíaco/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Veia Femoral , Fluoroscopia , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Resultado do Tratamento
4.
Catheter Cardiovasc Interv ; 94(3): 479-480, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31670881

RESUMO

Predilation with a balloon aortic valvuloplasty (BAV) was the standard of care for transcatheter aortic valve replacement (TAVR) until recently. Both the operators increased experiences as well as smaller device sizes and improved device designs have much improved omitting the use of BAV in majority of the cases in today's clinical practice. Predilation with BAV seems to help in selected group of patients with severe aortic leaflet calcium volumes to avoid post-dilation.

5.
Cardiol Clin ; 37(4): 469-486, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587788

RESUMO

Comorbidities specific to the cardio-oncology population contribute to the challenges in the interventional management of patients with cancer and cardiovascular disease (CVD). Patients with cancer have generally been excluded from cardiovascular randomized clinical trials. Endovascular procedures may represent a valid option in patients with cancer with a range of CVDs because of their minimally invasive nature. Patients with cancer are less likely to be treated according to societal guidelines because of perceived high risk. This article presents the specific challenges that interventional cardiologists face when caring for patients with cancer and the modern tools to optimize care.


Assuntos
Cardiologia/métodos , Doença da Artéria Coronariana/cirurgia , Oncologia/métodos , Revascularização Miocárdica/métodos , Neoplasias/epidemiologia , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Saúde Global , Humanos
6.
Artigo em Inglês | MEDLINE | ID: mdl-31627988

RESUMO

BACKGROUND: Randomized trials demonstrated that the rate of access to the center of the CFA was low and not different with fluoroscopy vs. anatomic landmarks. We investigated the role a novel fluoroscopic-guided technique with the micropuncture needle (MPN) for the common femoral artery (CFA) access. METHODS: A MPN was advanced to the center of pubis in the 20° ipsilateral right- or left anterior oblique view for the CFA access in 150 patients undergoing cardiac catheterization. After the CFA puncture and guidewire advancement, if the MPN tip was within pelvic-femoral line (the line between pelvic brim and inferior border of the femoral head), a sheath was inserted into the CFA and femoral angiography was performed. The acceptable sites of CFA access were defined zone III, as the sheath position in the middle third of the CFA; Zone II, between the pelvic brim and Zone III; and Zone IV, between the femoral bifurcation and Zone III. High or low access sites were zones I and V, respectively. RESULTS: The primary-end point, the CFA access to the center of CFA (zone III) was significantly higher than zones II and IV (64% vs. 13% and 23%; P < 0.001, respectively). The MPN tip was high or low in 17 and 11 patients (19%), respectively, which was readvanced to the center of pubis using fluoroscopy; this resulted in CFA access in 100% of patients. There were no bleeding complications; the baseline and next day hemoglobin levels were 13.0 ±â€¯2.0 g/dl vs. 12.4 ±â€¯1.9 g/dl, respectively; P = NS. CONCLUSIONS: The use of this novel fluoroscopic-guided technique with the MPN resulted in access to the CFA in all patients and to the center of the CFA in the majority of patients. There was no significant hemoglobin drop or bleeding complications after the procedure.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31257173

RESUMO

Percutaneous left atrial appendage occlusion has been shown to be a safe and cost-effective treatment for stroke prevention in patients with nonvalvular atrial fibrillation with increased stroke and bleeding risk. Venous system might be occluded from prior procedures or have structural abnormalities. Herein, we present a successful WATCHMAN device implantation in a patient with inferior vena cava filter thrombosis and iliac vein occlusions.

8.
Curr Cardiol Rep ; 21(8): 83, 2019 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286273

RESUMO

PURPOSE OF REVIEW: Aging is associated with an increased prevalence of both cancer and heart disease. The progression of aortic valve calcification to aortic stenosis may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy with mediastinal involvement. Symptomatic aortic stenosis is occasionally diagnosed in cancer patients undergoing cardiovascular evaluation; likewise, cancer is often recognized during assessment preceding aortic valve interventions. In these complex cases, physicians face difficult treatment decisions. Due to a myriad of clinical presentations of cancer and valve disease, specific guidelines for this patient population are not currently in place. Management is currently based on clinical judgment, on an individual basis. RECENT FINDINGS: Patients with cancer in remission or with a favorable prognosis should be treated according to current cardiovascular guidelines. In these patients, aortic valve replacement can be performed either by surgery or transcatheter. Significant challenges arise in patients with active cancer, especially those receiving anti-cancer treatment. Recent data suggests that these patients can be offered aortic valve replacement, with a trend of favoring the transcatheter route in order to minimize perioperative risk and complications associated with major surgery. Patients with advanced cancer and severe aortic stenosis should be offered palliative care and can benefit from aortic balloon valvuloplasty if indicated. Modern cancer treatments associated with improved long-term prognosis may allow the appropriate cure of aortic stenosis. We discuss the protocol, outcomes, and evolving recommendations of aortic valve replacement in cancer patients with aortic stenosis.

9.
Catheter Cardiovasc Interv ; 94(6): 820-826, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30938045

RESUMO

OBJECTIVES: To evaluate the safety and efficacy of percutaneous mitral valve repair for the management of functional mitral insufficiency. BACKGROUND: Severe FMR is present in 25-30% of patients with heart failure and is an independent predictor of mortality and hospitalizations in patients with both ischemic and nonischemic cardiomyopathy. MitraClip therapy has been approved for high surgical risk patients with primary mitral regurgitation. Recent studies including two randomized trials have yielded conflicting results in terms of its clinical efficacy and outcomes for FMR. A quantitative evaluation and synthesis of this information are essential in elucidating the role of MitraClip repair for FMR. METHODS: We performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from September 2008 to September 2018. Studies comparing percutaneous mitral valve repair using the MitraClip device against conservative therapy for the management of functional mitral regurgitation were included. RESULTS: Seven studies with 1,174 patients in MitraClip group and 1,015 patients in medical therapy group met inclusion criteria. The 12-month mortality in the MitraClip group was 18.4% compared with 25.9% in the medical therapy group (odds ratio [OR]: 0.65 [0.50, 0.86]; p < .002). The rate of readmission at 12 months was 29.9% in the MitraClip group compared with 54.1% in the medical therapy group (OR: 040 [0.32-0.49]; p < .0001. The prognostic efficacy of MitraClip repair appears to be more substantial over longer follow-up period over medical therapy alone. CONCLUSIONS: Based on the results of this meta-analysis, percutaneous mitral valve repair with MitraClip appears to be superior to medical therapy for symptomatic moderate-to-severe functional mitral insufficiency. Further clinical research is needed to identify the ideal patient subgroups who receive maximum benefit with the MitraClip therapy.

12.
Catheter Cardiovasc Interv ; 94(3): 438-445, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30549397

RESUMO

OBJECTIVES: We compared the outcomes of aortic valve replacement (AVR) by transcatheter (TAVR) and surgical (SAVR) routes with those of optimal medical management in patients with cancer and severe aortic stenosis (AS). BACKGROUND: Cancer therapy requires optimal cardiac output; however, the treatment of AS in cancer patients is not established. METHODS: Cancer patients with severe AS during January 2009 through February 2018 at a large cancer center were identified. Demographic and clinical characteristics including previous or active cancer diagnosis, history of chest radiotherapy, AS treatment, and survival were collected. Univariate Cox proportional hazards regression, the Kaplan-Meier analysis, and log-rank tests were used to compare overall survival (OS) between AS treatment groups. RESULTS: Sixty-five cancer patients with severe AS were identified; 28 received optimal medical treatment alone, 30 received TAVR, and seven received SAVR. The patients were predominantly male (n = 44, 68%) with a mean age of 71.17 years. The median OS was 9.87 months, and the most common cause of death was cancer (n = 29, 94% of deaths). AVR was associated with a lower risk of death than no AVR (hazard ratio [HR] 0.38, P = 0.007), and patients who underwent TAVR (HR 0.36, P = 0.01) had better survival than those with no AVR. Malignancy type, stage, and treatment were not associated with OS. CONCLUSIONS: Patients with cancer and severe AS who underwent AVR, predominantly TAVR, experienced better survival than those who had no AVR regardless of cancer type or cancer treatment. TAVR may be considered in patients with cancer and AS.

13.
Cardiovasc Revasc Med ; 20(5): 424-431, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30025660

RESUMO

Stroke remains among the leading causes of disability and death worldwide. Fibrinolytic therapy is associated with poor patency and functional outcomes. Recently, multiple randomized trials have been published that have consolidated the role of endovascular therapy for ischemic stroke due to large vessel occlusion in the anterior cerebral circulation. This manuscript reviews the current understanding of the endovascular management of acute stroke including technical aspects and current evidence base.

14.
Cardiovasc Revasc Med ; 20(11): 1027-1030, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30503037

RESUMO

MitraClip is an effective treatment method for severe mitral regurgitation in high-risk populations in terms of reducing morbidity and frequency of hospitalizations. Efficacy and safety of MitraClip device in elderly population have been established, yet there are only 2 case reports of MitraClip implantation in the younger patients, who generally tend to have less surgical risk (Gorenflo et al.; Joffe et al., 2016). We describe a 19-year-old patient with severe mitral regurgitation with prior mitral valve annuloplasty and received MitraClip implantation due to high-surgical risk.

16.
Am J Cardiol ; 122(9): 1465-1470, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30180958

RESUMO

Little data is available on the bleeding risk and outcomes of cancer patients with chronic thrombocytopenia who underwent cardiac catheterization. We sought to assess the safety of coronary angiography, percutaneous coronary intervention, and antiplatelet therapy in cancer patients with acute coronary syndrome (ACS) and chronic thrombocytopenia. We performed a retrospective study of patients with chronic thrombocytopenia who underwent cardiac catheterization for ACS between November 2009 and November 2015. Preprocedural platelet counts were classified into 3 groups: mild thrombocytopenia (50,000 to 100,000/µL), moderate thrombocytopenia (30,000 to 50,000/µL), and severe thrombocytopenia (<30,000/µL). Postprocedural bleeding complications and overall survival (OS) were recorded. A total of 98 patients were included. Mean platelet count on admission was 47.63 ± 29.85 K/µL. Severe thrombocytopenia was identified in 36 patients (36.7%), moderate thrombocytopenia in 20 patients (20.4%), and mild thrombocytopenia in 42 patients (42.9%). Aspirin therapy (alone or in combination with clopidogrel) was used in 66 patients (67.3%), whereas 27 patients (27.6%) were on dual antiplatelet therapy. One procedure-related retroperitoneal hematoma and 3 procedure-related small hematomas were identified. No cerebrovascular events related to the procedure or the antiplatelet therapy were noted. Moderate thrombocytopenia was associated with decreased OS, whereas aspirin, dual antiplatelet therapy, and statin use showed a trend of improved OS. In conclusion, we suggest that coronary angiography and percutaneous coronary intervention can be performed safely in cancer patients with chronic thrombocytopenia. Aspirin therapy and dual antiplatelet therapy should be considered in cancer patients with chronic thrombocytopenia and ACS.


Assuntos
Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/terapia , Cateterismo Cardíaco , Neoplasias/complicações , Inibidores da Agregação de Plaquetas/uso terapêutico , Trombocitopenia/complicações , Síndrome Coronariana Aguda/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspirina/uso terapêutico , Doença Crônica , Clopidogrel/uso terapêutico , Corantes/uso terapêutico , Angiografia Coronária , Quimioterapia Combinada , Feminino , Insuficiência Cardíaca/mortalidade , Hematoma/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Intervenção Coronária Percutânea , Estudos Retrospectivos , Índice de Gravidade de Doença , Texas/epidemiologia , Trombocitopenia/mortalidade
17.
Curr Oncol Rep ; 20(10): 78, 2018 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-30132257

RESUMO

PURPOSE OF REVIEW: Coronary artery disease and cancer often co-exist. Patients with cancer have been excluded by most major cardiology trials and registries and their management remains largely empiric. Cancer patients experience an approximately 10-times increased mortality compared to the general population. Conservative therapy of ACS in cancer therapy results in 1-year mortality of 74%. This review article aims to describe the mechanisms of acute coronary syndromes in cancer patients, their clinical presentation, and their management. RECENT FINDINGS: Newer studies have shed light on the mechanisms of ACS in cancer patients, which are different and related to the type of malignancy and its associated therapy. Medication-specific coronary effects (vasospasm, endothelial dysfunction, spontaneous thrombosis, accelerated atherosclerosis), radiation vasculitis, cancer cell coronary embolism, and coronary compression from thoracic malignancies are unique ACS mechanisms in cancer patients. Close collaboration between oncologists and cardiologists for thoughtful patient selection and decision making strategies is necessary to provide optimal medical care.


Assuntos
Síndrome Coronariana Aguda/terapia , Neoplasias/fisiopatologia , Síndrome Coronariana Aguda/epidemiologia , Humanos , Incidência , Prognóstico
18.
Catheter Cardiovasc Interv ; 91(7): 1363-1364, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29894594

RESUMO

Transcatheter aortic valve replacement is now the standard of care for severe symptomatic aortic stenosis patients who are at high-surgical risk. Percutaneous approach without a surgical cut down has been increasingly adapted by some centers in USA. Percutaneous approach seems to be associated with shorter hospital stay, similar short and late vascular complications, less disabling stroke, similar mortality as well as significantly less hospital cost. However, this technique also requires operators to be able to manage any vascular complications using advanced endovascular interventions to achieve complete hemostasis.


Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Humanos , Fatores de Risco
19.
Cardiovasc Revasc Med ; 19(6S): 7-11, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29937383

RESUMO

BACKGROUND AND PURPOSE: Transradial percutaneous coronary intervention (TR-PCI) has been increasingly popular over the last decade in the US. Previous studies have shown that same-day (SD) discharge after elective PCI is as safe as overnight (ON) observation. Our study was performed to assess the clinical and financial impact of early discharge in patients undergoing TR-PCI. METHODS: This is a single center registry of patients undergoing elective TR-PCI. Timing of discharge was determined by the treating physician. (Groups: Same Day Discharge -SD-; Overnight Stay -ON-). Demographic data, procedural characteristics and adverse outcomes were recorded. Outcomes included 30 day-MACE and procedure- related complications, as well as total operative costs in patients from both groups. Propensity score matching for patient demographics, coronary symptoms and procedure indicators was used to compare both groups. RESULTS: The entire cohort included 852 patients (429 in SD group and 423 in ON group) and the propensity score matched groups of 245 patients in the SD group and 245 patients in the ON group. The two groups had no significant baseline clinical differences, and had similar clinical outcomes. Specifically, no significant difference was noted in procedural complications (3.7% vs 2.5%, p = 0.43), re-hospitalization (4.1% vs 4.1%, p = 0.92), re-intervention (2.5% vs 2.1%, p = 0.77), myocardial infarction (0% vs 0.08%, p = 0.15), stroke (0% vs 0%, p = 1.0) and all-cause mortality (0% vs 0%, p = 1.0). SD Group patients had a significant lower procedure-related cost compared to overnight stay patients ($3,346.45 vs $4,681.99, p < 0.0001) and lower 30-day post procedure-associated cumulative costs/total operating costs ($4,493.22 vs $7,112.21, p < 0.0001). CONCLUSION: In elective patients undergoing low risk TR-PCI, same-day discharge seems to be a safe and feasible clinical practice, with significant potential savings to the US healthcare system.


Assuntos
Cateterismo Cardíaco/métodos , Cateterismo Periférico/métodos , Doença da Artéria Coronariana/cirurgia , Tempo de Internação , Alta do Paciente , Intervenção Coronária Percutânea/métodos , Artéria Radial , Idoso , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/economia , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/economia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/economia , Redução de Custos , Análise Custo-Benefício , Estudos de Viabilidade , Feminino , Custos Hospitalares , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Alta do Paciente/economia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/economia , Pontuação de Propensão , Punções , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
20.
Cardiovasc Revasc Med ; 19(7 Pt A): 778-784, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29550045

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 75 mg clopidogrel once daily for 1 month vs. 90 mg ticagrelor twice daily for 6 months, both in addition to 81 mg aspirin for 6 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: N = 11 patients were enrolled in the clopidogrel group and N = 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 0.014 mm3/mm, p = 0.05)). No differences were found in % neointima (0.412 vs 0.536 mm3/mm, p = 0.44) and neovascularization (28 vs 44, p = 0.16). ABI and Rutherford classification were improved significantly after 6 months in the clopidogrel group, with no difference between groups at 6 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 de Plaquetas/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 de Plaquetas/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 Caminhada
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