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1.
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
2.
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.

3.
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.

4.
Curr Treat Options Oncol ; 20(6): 47, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31056717

RESUMO

OPINION STATEMENT: The increased risk for cardiovascular events in aging cancer survivors and those undergoing certain chemotherapeutic treatments has raised concern for more rigorous screening and surveillance methods above that of the general population. At this time, there are limited guidelines for how to best manage this vulnerable cohort. Questions regarding timing of screening, choice of imaging modality and risk reduction strategies-especially in those patients with known atherosclerotic disease-remain to be elucidated. Over a decade of case series, retrospective studies and clinical trials have shed light on the evolving role of cardiac computed tomography (CT) in this population, of which there is a relative paucity of data regarding its potential utility in the specific cardio-oncology population. Focusing on ability of cardiac CT to evaluate multiple cardiac and vascular structures, provide diagnostic and prognostic information, as well as assist interventional and surgical colleagues in surgical/percutaneous valve replacement and revascularization strategies is the premise for this review.

5.
Curr Treat Options Cardiovasc Med ; 20(5): 40, 2018 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-29627870

RESUMO

PURPOSE OF REVIEW: Cancer is a common cause of morbidity and mortality in the USA. While the association between venous thrombosis and malignancy is well established, arterial thrombosis has more recently been recognized as a serious complication of cancer and certain chemotherapeutic agents. This review aims to summarize the most recent literature regarding the incidence and risk factors for cancer-related arterial thrombosis, understand the pathophysiologic mechanisms of thrombosis, and highlight the specific diagnostic and treatment considerations relevant to cancer patients. RECENT FINDINGS: Based on a recent study looking at the Surveillance, Epidemiology, and End Results (SEER) database, the incidence of arterial thromboembolic events (ATEs) in patients with cancer at 6 months is 4.7%; the presence of an ATE is predictive of worse outcomes. Certain drugs such as platinum-based agents, vascular endothelial growth factor inhibitors, tyrosine kinase inhibitors, and taxanes have been associated with high rates of ATEs. Increased platelet reactivity appears crucial to development of arterial thrombosis in cancer patients. Cancer patients have an increased risk of arterial thrombosis that is likely due to both a cancer-associated procoagulant state as well as the adverse effects of certain chemotherapeutic agents. Treatment of arterial thromboembolism in cancer patients typically requires a multidisciplinary approach in part due to high rates of thrombocytopenia and stent thrombosis in the setting of percutaneous interventions. More studies are needed to investigate optimal prophylaxis, surveillance strategies, and treatments of cancer-related arterial thromboembolic disease.

6.
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
7.
Curr Cardiol Rep ; 19(6): 56, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28484995

RESUMO

PURPOSE OF REVIEW: Coronary artery disease in patients with active cancer presents particular challenges for clinicians, as optimum management is required in order to treat the underlying malignancy and to reduce morbidity and mortality associated with cardiovascular diseases. Special considerations must be made in respect to either primary or secondary thrombocytopenia, the presence of coagulopathies and the propensity of bleeding, vascular access complications, and increased risk of stent thrombosis. RECENT FINDINGS: In presence of acute coronary symptoms, the cardio-oncology team has to make a complex decision between conservative medical management or early angiography (within 24 h) and revascularization. There is a lack of reliable data on the outcomes of patients with active cancer who undergo invasive procedures for the diagnostic and treatment of coronary artery disease. Cardiac catheterization recommendations in cancer patients are being currently elaborated by cardio-oncologists in order to improve the overall survival in cancer patients with coronary artery disease.


Assuntos
Cardiologistas , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/terapia , Tomada de Decisões , Neoplasias/complicações , Cateterismo Cardíaco , Tratamento Conservador , Angiografia Coronária , Humanos , Revascularização Miocárdica
9.
Catheter Cardiovasc Interv ; 85(5): 904-5, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25789736

RESUMO

Severe mitral regurgitation (MR) may lead to worsening renal function due to a decrease in stroke volume, increase in systemic vascular resistance, and venous pooling. Percutaneous treatment with MitraClip seems to improve renal function in certain patient groups. Larger studies are needed to prove that MitraClip is the preferred strategy in patients with severe MR and chronic kidney disease.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Próteses Valvulares Cardíacas , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Insuficiência Renal/fisiopatologia , Feminino , Humanos , Masculino
12.
Turk Kardiyol Dern Ars ; 41(4): 347-50, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23760125

RESUMO

Ectopic kidneys are rare and usually present incidental findings during invasive or non-invasive angiography. Their parenchyma is not more susceptible to disease and symptoms occur mainly due to alteration of the anatomic relations. The main renal artery of the ectopic kidney derives invariably from the aorta; however, accessory renal arteries may originate from almost any arterial branch adjacent to the ectopic kidney. Knowledge of the common anatomic variations is important during complex peripheral interventions. We present the case of a 46-year-old male with symptoms of claudication secondary to left common iliac artery occlusion. He was diagnosed as occlusion of the left common iliac artery at the aortoiliac bifurcation in close proximity to the ectopic renal artery by peripheral angiography, and percutaneous intervention of the left common iliac artery was successful. Percutaneous intervention led to resolution of the patient's symptoms of claudication as well as preservation of the ectopic renal artery. In such cases, renal ectopy and aberrant arteries should be promptly recognized in order to avoid vascular or renal complications.


Assuntos
Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/cirurgia , Artéria Ilíaca/cirurgia , Rim/anormalidades , Anormalidades Múltiplas , Angiografia , Aorta Abdominal/anormalidades , Aorta Abdominal/diagnóstico por imagem , Humanos , Artéria Ilíaca/anormalidades , Artéria Ilíaca/diagnóstico por imagem , Rim/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Artéria Renal/anormalidades , Artéria Renal/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares
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