RESUMO
UNLABELLED: From february 1995 to february 1997 we implanted 157 stents in 105 patients. Age ranged from 38 to 81 years (mean 58), there were 83 males and 22 females. In 62.8% cases we implanted one stent and in 39 (37.2%) cases 2 to 6. Eighty three were Palmaz/Schatz (P/S), 27 ACT-ONE, 18 Wiktor (W), 9 Gianturco Rubin (GR), 8 Wallstent, 6 XT-Bard and 6 microstent. Indication were de novo in 23.8%, 87.5% post failure PTCA and in 13.3% late PTCA restenosis. Implant was successful al 96.1% of the patients. The first 32 patients received oral anticoagulation, the last 72 received aspirin and ticlopidine only. COMPLICATIONS: 4.7% acute thrombosis, 0.9% sub-acute thrombosis, three of them (2.5%) developed myocardial infarction, 0.9% emergency surgical treatment, 2.8% vascular complications and death in 2.8%. During follow-up (1 to 18 months, mean 7.7) we repeated angiography and 35 patients two to 14 months (m = 5.6), 12 of them had restenosis, during dilation two cases had dissection of the main left coronary artery and were send to surgery, the others were dilated without complications. One case had restenosis of the stent with obstructive lesions in other vessels and was send to elective surgery. The reminded patients are symptom free and had negative stress test. We conclude that this technology is an excellent alternative to percutaneous myocardial revascularization. Larger trials with long term follow-up is necessary to determine the true incidence of restenosis with the different types of stents.
Assuntos
Doença das Coronárias/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Stents/efeitos adversosAssuntos
Embolia de Colesterol , Idoso , Arteriosclerose/complicações , Biópsia , Embolia de Colesterol/diagnóstico , Embolia de Colesterol/patologia , Feminino , Pé/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Prognóstico , Fatores de Risco , Pele/patologia , SíndromeRESUMO
Coronary branch occlusion complicating percutaneous coronary angioplasty has been recognized in certain bifurcation lesions. The utilization of double angioplasty systems simultaneously has been called "kissing" because the image of contact between balloons, and has been utilized as an alternative to protect the jeopardized branch or prevent snowplow lesion of the principal artery. The technological advance with the use of wide lumen catheters and low profile dilation balloons make the application of this technique possible in those type of lesions using a single guiding catheter. The present paper describes one case treated with this technique using conventional angioplasty systems in a complex bifurcating lesion of the circumflex artery. Some technical considerations about the procedure are made.
Assuntos
Angina Pectoris/terapia , Cateterismo/métodos , Cateterismo/instrumentação , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Exercise stress test before hospital discharge in patients treated with percutaneous transluminal coronary angioplasty (PTCA) has been used from the beginning of this technique to know the immediate clinical results, although there is not enough and clear information about the prognostic value and the possible complications related to this procedure. The objective of this study was to determine the safety and prognostic value of an early stress test post PTCA in our Hospital. In a retrospective fashion the charts of consecutive patients treated with PTCA were reviewed, with selection of those in whom a stress test was done in the first 10 days after the procedure. From 224 consecutive patients with PTCA, 83 (34%) had pre discharge stress test (mean age 52.8 +/- 9.7 years, 84% were male). In all 83, the PTCA procedure was successful in 112 lesions. 78% were treated for one vessel, and 19 and 2.5% in two or three vessels respectively. Stress tests were done at 5.1 days (range 2 to 10) and in 27 (32%) the tests were done in the first 3 days. There were no local vascular complications at the puncture site, and none of the patients had angina or myocardial infarction related to the test. There were 4 positive early tests (5%). Of them, in two cases there was incomplete revascularization. In all four cases, the thallium perfusion test was positive, and restenosis was seen in three of the cases at 3 to 6 months. The remaining patient is in class I, with minor inferolateral ischemia and the treating physician decided not to recatheterized her. Eight patients (9%) with negative pre discharge stress test had a positive one at control. Of them, three had angiographic control, and two had restenosis. It can be concluded that an early stress test post PTCA is safe, and can be done before discharge, with the possible exception of those with high risk of acute reocclusion. A positive result do not implicate immediate recatheterization, but can be associated with a major probability of late persistent myocardial ischemia and restenosis.
Assuntos
Angioplastia Coronária com Balão , Teste de Esforço , Isquemia Miocárdica/diagnóstico , Adulto , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Segurança , Fatores de TempoRESUMO
Acute coronary occlusion as a consequence of dissection or thrombosis occurs in 2 to 11% of patients treated with percutaneous transluminal coronary angioplasty (PTCA), and continues to be the principal cause of early morbidity and mortality. In this study the experience of one center is presented with the application of two types of stents, Wiktor (Medtronic Inc.) or Gianturco-Roubin (Cook Inc.) for bailout of acute or threatening coronary occlusion that persisted after treatment with prolonged balloon inflation. All patients received a complete anticoagulation scheme with heparin, dextran, dipyridamole, aspirin and coumadin. From January to November 1993, 26 patients with 27 prosthesis were included. There were 21 men and 5 women with mean age of 58 years (range 36 to 73). The indications for stenting were: total occlusion in five (19%) threatening occlusion in 13 (50%) and severe persistent dissection in eight (31%). Initial implantation success was 93% (25/27). Procedure related clinical complications were death in one patient, bypass surgery in two (8%) and myocardial infarction in four (15%). Acute stent thrombosis occurred in three cases and subacute in one (11 and 4% respectively). Three patients, had non-fatal bleeding complications. Final clinical success without myocardial infarction, bypass surgery or death was 77%. In conclusion, coronary stenting for bailout of acute or threatening coronary occlusion after PTCA is a good alternative to emergency surgery. New antithrombotic strategies and better anticoagulation schemes may improve further this procedure.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Doença das Coronárias/terapia , Vasos Coronários , Stents , Doença Aguda , Adulto , Idoso , Angioplastia Coronária com Balão/métodos , Terapia Combinada , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/etiologia , Emergências , Feminino , França , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Due to the recent technological advances, it is possible to perform percutaneous coronary angioscopy in a straightforward fashion in most patients. To know the safety and usefulness of this technique we present 200 observations in 100 patients candidates for coronary intervention. We used a coronary angioscope (Baxter, Edwards LIS Division), that can be placed using the conventional technique for percutaneous coronary angioplasty. The system incorporates a proximal occluding balloon, and distally a movable optical fiber. Case selection considered non-ostial coronary segments relatively straight. It was possible to obtain adequate images in 86 percent of cases. The technique is safe in experienced hands: there were two cases of ventricular fibrillation, and two cases of local dissection occurred, none of these associated with clinical consequences. No myocardial infarction, surgery or death, related to this procedure occurred. Valuable diagnostic information is derived from angioscopy as the method provides some histopathological correlation. Stable plaques are usually uniformly white or yellow. Unstable plaques are yellow and ulcerated. Thrombus can be easily recognized in acute coronary syndromes. Also in percutaneously treated segments, the final result and the presence of dissection or hemorrhage can be visualized. Coronary percutaneous angioscopy is safe and brings useful clinical information. Its applications in the clinical practice are still to be determined.
Assuntos
Angioplastia Coronária com Balão , Angioscopia , Vasos Coronários , Angioscópios , Angioscopia/efeitos adversos , Estudos de Avaliação como Assunto , HumanosRESUMO
We describe the incidence, clinical, radiologic, electrocardiographic, echocardiographic and angiographic findings of two cases with dextrocardia in situ viscerum inversus with ischaemic heart disease. The first patient had coronary artery saphenous bypass graft and is currently asymptomatic with a negative maximal stress test. The other patient with diabetes mellitus and unfavorable coronary anatomy was not operated and is currently with stable angina on class II of the NYHA. The electrocardiographic, echocardiographic and angiographic strategies are commented.