Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 13 de 13
Filtrar
Mais filtros










Base de dados
Tipo de estudo
Intervalo de ano de publicação
1.
Artigo em Inglês | MEDLINE | ID: mdl-31943747

RESUMO

OBJECTIVES: To examine the outcomes of vascular brachytherapy (VBT) for recurrent drug-eluting stents (DES) in-stent restenosis (ISR). BACKGROUND: Recurrent DES-ISR can be challenging to treat. VBT has been used with encouraging results. METHODS: We report the long-term outcomes of patients with recurrent DES-ISR treated with VBT between January 2014 and September 2018 at a tertiary care institution. The main outcome was target lesion failure (TLF), defined as the composite of clinically driven target lesion revascularization (TLR), target lesion myocardial infarction (MI), and target lesion-related cardiac death. Cox proportional hazards analysis was performed to identify variables associated with recurrent TLF. RESULTS: During the study period, 116 patients (143 lesions) underwent VBT. Median follow-up was 24.7 (14.5-35.4) months. The incidence of TLR, target-lesion MI, and TLF was 18.9%, 5.6%,and 20.1% at 1 year, and 29.4%, 10.5%, and 32.9% at 2 years.Initial presentation with acute coronary syndrome (ACS) was independently associated with TLF (hazard ratio = 1.975, 95% CI [1.120, 3.485], p = .019). Lesions treated with intravascular ultrasound (IVUS) guidance had a lower incidence of TLR (14.3% vs. 39.6%, log-rank p = .038), and a trend toward lower incidence of TLF (19% vs. 42.6%, log-rank p = .086). CONCLUSIONS: VBT can improve the treatment of recurrent DES-ISR, but TLF occurs in approximately one in three patients at 2 years. Initial presentation with ACS was associated with higher TLF and the use of IVUS with a trend for lower incidence of TLF.

2.
Catheter Cardiovasc Interv ; 95(1): E17-E20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31037839

RESUMO

Acute occlusion of the left internal mammary artery (LIMA) graft late after coronary artery bypass grafting surgery is a rare and potentially life-threatening complication. We describe a case of acute myocardial infarction 19 years after coronary artery bypass graft surgery due to acute occlusion of the distal anastomosis of a LIMA graft to the left anterior descending artery. Aspiration thrombectomy failed to remove the thrombus. Laser thrombectomy caused perforation. After drug-eluting and covered stent implantation, antegrade TIMI 3 flow was restored with an uneventful postprocedural course.

4.
Angiology ; 71(3): 274-280, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31845593

RESUMO

The impact of peripheral artery disease (PAD) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 3999 CTO PCIs performed in 3914 patients between 2012 and 2018 at 25 centers, 14% of whom had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with versus without history of PAD. Patients with PAD were older (67 ± 9 vs 64 ± 10 years, P < .001) and had a higher prevalence of cardiovascular risk factors. They also had more complex lesions as illustrated by higher Japanese CTO score (2.7 ± 1.2 vs 2.4 ± 1.3, P < .001). In patients with PAD, the final crossing technique was less often antegrade wire escalation (40% vs 51%, P < .001) and more often the retrograde approach (23 vs 20%, P < .001) and antegrade dissection/reentry (20% vs 16%, P < .001). Technical success was similar between the 2 study groups (84% vs 87%, P = .127), but procedural success was lower for patients with PAD (81% vs 85%, P = .015). The incidence of in-hospital major adverse cardiac events was higher among patients with PAD (3% vs 2%, P = .046). In conclusion, patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions, and lower procedural success.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31797507

RESUMO

BACKGROUND: When crossing into the distal true lumen fails during chronic total occlusion (CTO) percutaneous coronary intervention (PCI), subintimal plaque modification (SPM) is often performed to restore antegrade flow and facilitate subsequent lesion recanalization. METHODS: Between January 2012 and May 4, 2019, 4,659 CTO PCIs were included in the PROGRESS-CTO registry, of which 935 (20%) had a prior unsuccessful attempt. Of those 935 patients, 119 (13%) had prior SPM. We analyzed the outcomes of the 58 SPM procedures for which data were available, as well as the outcomes of the 60 subsequent CTO PCI attempts. RESULTS: Mean patient age was 67 ± 9 years and 86% were men. Patients had high prevalence of cardiovascular risk factors such as dyslipidemia (91%), hypertension (93%) diabetes (48%), prior PCI (61%), and prior coronary artery bypass graft surgery (47%). The target CTO lesions often had proximal cap ambiguity (54%), moderate/severe calcification (73%), moderate/severe tortuosity (63%), and high J-CTO score (mean 3.2 ± 1.1). The technical and procedural success of subsequent CTO PCI were high (83% for both) with an acceptable rate of in-hospital major adverse cardiovascular events (3.3%). Technical and procedural success were higher for repeat attempts that were performed ≥60 days after the index CTO PCI (94% vs. 69%, p = .015). Median (interquartile range) subsequent procedure time was 147 (100, 215) min, contrast volume was 185 (150, 260) ml, and air kerma radiation dose was 2.5 (1.4, 4.2) Gray. CONCLUSION: Repeat CTO PCI attempts after SPM are associated with high likelihood for successful revascularization with acceptable risks.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31696624

RESUMO

An 84-year-old patient with prior coronary artery bypass surgery presented with non-ST segment elevation acute myocardial infarction. The culprit lesion was at the distal anastomosis of a saphenous vein graft (SVG) to the right posterior descending artery. The proximal right coronary artery was chronically occluded. Because of significant disease both proximal and distal to the SVG anastomosis, percutaneous intervention of the SVG carried high risk for acute vessel closure. The native right coronary artery chronic total occlusion was successfully recanalized, enabling complete revascularization of the right coronary artery. The SVG was then occluded using an Amplatzer vascular plug.

9.
J Stroke Cerebrovasc Dis ; 28(12): 104415, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31669071

RESUMO

BACKGROUND: Stratification of overall vascular risk in patients with ischemic stroke is important as it may guide management decisions. Currently available schemes have only modest prognostic accuracy. The TRA2°P score aids in vascular risk stratification in patients with previous myocardial infarction (MI). AIM: We investigated whether the prognostic performance of TRA2°P can be extended in patients with ischemic stroke and whether it can improve the risk stratification made by CHA2DS2VASc and Essen-Stroke-Risk-Score (ESRS). METHODS: We analyzed the Athens Stroke Registry using Kaplan-Meier survival and Cox-regression analyses to assess if TRA2°P (in different categorizations) predicts the composite endpoint of stroke recurrence, MI or cardiovascular death. We compared its incremental predictive value over CHA2DS2-VASc and ESRS and calculated continuous net reclassification indices (cNRI). RESULTS: In 2833 patients (followed for 9278 patient-years) and 776 events, there was decreased survival probability for TRA2°P-based high-risk patients compared to low-risk (log-rank-test P < .001), but the discriminatory power for the occurrence of the composite endpoint was only modest (Harrell's-C:.566, 95% CI:.545-.587). Combined with ESRS, TRA2°P conferred incremental discrimination (Harrell's-C:.544, 95% CI:.513-.574 versus .574, 95% CI:.543-.605 respectively, P = .049) and reclassification value (cNRI = 9.8%, P = .02). Combined with CHA2DS2-VASc, TRA2°P did not improve discrimination (Harell's-C:.578, 95% CI: .547-.608 versus .585, 95% CI:.554-.616, P = .738). CONCLUSION: The currently available prognostic scores have generally low performance to predict the overall cardiovascular risk in ischemic stroke patients. Further research is needed to improve vascular risk stratification in ischemic stroke patients.

10.
J Invasive Cardiol ; 31(9): 253-259, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31478890

RESUMO

BACKGROUND: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) often requires administration of large contrast volume. The DyeVert system (Osprey Medical) is a disposable, Food and Drug Administration (FDA)-approved device that interfaces with standard manifold systems to reduce the amount of contrast used in cardiac catheterization. METHODS: We compared the procedural outcomes of patients in whom the DyeVert system was used vs those in whom it was not used during CTO-PCI at a single center between 2017 and 2018. RESULTS: The DyeVert system was used in 39 of 134 CTO-PCIs performed in 130 patients (30%). Most patients (79%) were men and the mean age was 66.6 ± 10.9 years. The most common target vessel was the right coronary artery (54.5%), followed by the left anterior descending artery (26.1%), and circumflex artery (15.7%). The median contrast volume used in DyeVert patients was significantly lower (200 mL [interquartile range, 153-256 mL] vs 250 mL [interquartile range, 170-303 mL]; P=.04). There were no in-hospital major complications with the DyeVert system, nor device-related procedural complications. One patient in the DyeVert group had contrast-induced nephropathy following CTO-PCI that did not require dialysis. CONCLUSION: Use of the DyeVert system is feasible during CTO-PCI and may reduce the contrast volume administered to the patient. Additional larger studies with a primary clinical endpoint are needed to confirm these findings.

11.
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
13.
Expert Rev Med Devices ; 16(4): 267-273, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30929525

RESUMO

INTRODUCTION: Use of a microcatheter is essential for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Several microcatheters have recently been introduced in clinical practice aiming to improve deliverability and resistance to deformation. Areas covered: We review the technical characteristics of several new microcatheters (Mamba, Mamba Flex, Teleport Control, Teleport, Nhancer Rx, Sasuke, and ReCross) and compare them with existing microcatheters. Expert opinion: The recently developed microcatheters offer additional options for guidewire support during CTO PCI. Accumulation of clinical experience and performance of comparative effectiveness studies are needed for better understanding the role of these devices in contemporary CTO PCI.


Assuntos
Cateterismo/métodos , Cateterismo/tendências , Oclusão Coronária/cirurgia , Doença Crônica , Angiografia Coronária , Humanos , Intervenção Coronária Percutânea/instrumentação , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA