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1.
Rev. esp. cardiol. (Ed. impr.) ; 73(12): 994-1002, dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192957

RESUMO

INTRODUCCIÓN Y OBJETIVOS: El impacto del brote de COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) no está claro. El objetivo de este estudio es evaluar los cambios en el tratamiento del IAMCEST durante el brote de COVID-19. MÉTODOS: Se utilizó un registro multicéntrico, nacional, retrospectivo y observacional de pacientes consecutivos atendidos en 75 centros, se compararon las características de los pacientes y de los procedimientos y los resultados hospitalarios en 2 cohortes según se los hubiera tratado antes o durante la COVID-19. RESULTADOS: Los casos con sospecha de IAMCEST disminuyeron el 27,6% y los pacientes con IAMCEST confirmado se redujeron de 1.305 a 1.009 (22,7%). No hubo diferencias en la estrategia de reperfusión (más del 94% tratados con angioplastia primaria). El tiempo de isquemia fue más largo durante la COVID-19 (233 [150-375] frente a 200 [140-332] min; p <0,001), sin diferencias en el tiempo primer contacto médico-reperfusión. La mortalidad hospitalaria fue mayor durante la COVID-19 (el 7,5 frente al 5,1%; OR bruta=1,50; IC95%, 1,07-2,11; p <0,001); esta asociación se mantuvo tras ajustar por factores de confusión (OR ajustada=1,88; IC95%, 1,12-3,14; p = 0,017). La incidencia de infección confirmada por SARS-CoV-2 fue del 6,3%. CONCLUSIONES: El brote de COVID-19ha implicado una disminución en el número de pacientes con IAMCEST, un aumento del tiempo entre el inicio de los síntomas y la reperfusión y un aumento en la mortalidad hospitalaria. No se han detectado cambios en la estrategia de reperfusión. La combinación de infección por SARS-CoV-2 e IAMCEST fue relativamente infrecuente


INTRODUCTION AND OBJECTIVES: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. METHODS: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. RESULTS: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. CONCLUSIONS: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Vírus da SARS/patogenicidade , Infecções por Coronavirus/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Angioplastia Coronária com Balão/métodos , Estudos Retrospectivos , Surtos de Doenças/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Tratamento de Emergência/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Registros de Doenças/estatística & dados numéricos
2.
Sci Rep ; 10(1): 15902, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32985551

RESUMO

To determine the effect of intravenous injection of recombinant human brain natriuretic peptide (rhBNP) on lowering the incidence of asymptomatic peri-procedural myocardial injury (PMI) in patients who underwent coronary stent implantation. In this retrospective observational study, data pooled from a tertiary hospital electronic medical records were used to quantify the troponin enzyme change after patients with coronary artery disease (CAD) were pretreated with rhBNP infusion one day prior to percutaneous coronary intervention (PCI). The primary end point was to analyze the incidence of the elevated high-sensitivity cardiac troponin I serum levels above the upper normal limit after PCI. A total of 156 CAD patients were enrolled into rhBNP group (n = 76) and control group (n = 80). The incidence of asymptomatic PMI was 33% in the rhBNP group versus 51% in the control group (P = 0.02) after PCI. At eight months, the incidences of composite endpoints were 25.3% in the control group and 13% in the rhBNP group (difference, 12.3 percentage points; 95% confidence interval (CI), 0.197 to 1.048; P = 0.061). There were 7 visits in the rhBNP group and 15 visits in the control group for recurrent angina (difference, 10 percentage points; 95% CI 0.168-1.147; P = 0.087). A time-to-event analysis of the composite clinical endpoints and the recurrent angina between the control group and rhBNP group showed that the hazard ratios were 2.566 (95% CI 1.187-5.551; P = 0.017) and 2.607 (95% CI 1.089-6.244; P = 0.032) respectively. The decreased incidence of asymptomatic PMI after PCI and the reduced episodes of recurrent angina at eight months follow-up were associated with the administration of rhBNP infusion prior to PCI.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Traumatismos Cardíacos/prevenção & controle , Peptídeo Natriurético Encefálico/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Idoso , Angioplastia Coronária com Balão/métodos , Feminino , Traumatismos Cardíacos/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Troponina/sangue
4.
J Interv Cardiol ; 2020: 5246504, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32774186

RESUMO

Objectives: To determine the outcome predictors of in-hospital mortality in acute total occlusion of the left main coronary artery (ATOLMA) patients referred to emergent angioplasty and to describe the clinical presentation and the long-term outcome of these patients. Background: ATOLMA is an uncommon angiographic finding that usually leads to a catastrophic presentation. Limited and inconsistent data have been previously reported regarding true ATOLMA, yet comprehensive knowledge remains scarce. Methods: This is a multicenter retrospective cohort that includes patients presenting with myocardial infarction due to a confirmed ATOLMA who underwent emergency percutaneous coronary intervention (PCI). Results: In the period of the study, 7930 emergent PCI were performed in the five participating centers, and 46 of them had a true ATOLMA (0.58%). At admission, cardiogenic shock was present in 89% of patients, and cardiopulmonary resuscitation was required in 67.4%. All the patients had right dominance. Angiographic success was achieved in 80.4% of the procedures, 13 patients (28.2%) died during the catheterization, and the in-hospital mortality rate was 58.6% (27/46). At one-year and at the final follow-up, 18 patients (39%) were alive, including four cases successfully transplanted. Multivariate analysis showed that postprocedural TIMI flow was the only independent predictor of in-hospital mortality (OR 0.23, (95% CI 0.1-0.36), p < 0.001). Conclusions: Our study confirms that the clinical presentation of ATOLMA is catastrophic, presenting a high in-hospital mortality rate; nevertheless, primary angioplasty in this setting is feasible. Postprocedural TIMI flow resulted as the only independent predictor of in-hospital mortality. In-hospital survivors presented an encouraging outcome. ATOLMA and left dominance could be incompatible with life.


Assuntos
Angioplastia Coronária com Balão , Oclusão Coronária , Vasos Coronários/patologia , Infarto do Miocárdio , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/mortalidade , Doença Catastrófica , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Prognóstico , Sistema de Registros/estatística & dados numéricos , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Espanha/epidemiologia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(30): e21295, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791712

RESUMO

BACKGROUND: Drug-coated balloons (DCB) have been a novel alternative therapeutic strategy in de novo coronary artery diseases. However, the clinical feasibility of the DCB-only approach in treating small vessel disease remains controversial, while study aimed to assess the efficacy and safety of the DCB-only approach versus stent approaches in treating large vessel disease is limited. METHODS: From February 2020 to May 2020, we will search Cochrane Library, PubMed, EMBASE, ScienceDirect, Scopus, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, and Chongqing VIP Database for eligible trials comparing DCB with drug-eluting stents for treatment of de novo lesions in both small vessel disease and large vessel disease. The primary endpoint is major adverse cardiac events (MACE); the secondary endpoints include in-lesion late lumen loss, binary restenosis, myocardial infarction, target lesion revascularization (TLR), mortality and target vessel thrombosis. Meta-analysis will be conducted using Review Manager software (V.5.3). RESULTS: The results will be presented as risk ratios for dichotomous data, and weighted mean differences for continuous data. CONCLUSION: We will assess outcomes of the DCB-only approach in the treatment of de novo lesions compared with the stent approach. PROSPERO REGISTRATION NUMBER: CRD42020164484.


Assuntos
Angioplastia Coronária com Balão/métodos , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
7.
World J Pediatr Congenit Heart Surg ; 11(5): 649-651, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32662353

RESUMO

Coronary ostial stenosis is a rare congenital cardiac anomaly, frequently associated with hypoplasia of the proximal coronary artery. This condition is potentially life-threatening, as it may present with myocardial ischemia and sudden death. We present a case of left coronary ostial stenosis in a 48-day-old infant symptomatic for sudden cardiac arrest, who successfully underwent surgical angioplasty. Any cardiac arrest in a neonate or young infant should raise suspicion of coronary ostial stenosis/atresia, considering the difficulty in diagnosing this congenital heart defect.


Assuntos
Angioplastia Coronária com Balão/métodos , Estenose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Angiografia Coronária , Estenose Coronária/cirurgia , Vasos Coronários/cirurgia , Humanos , Lactente
8.
J Ayub Med Coll Abbottabad ; 32(2): 259-262, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584005

RESUMO

BACKGROUND: Stents are now deployed in almost 95% of all percutaneous coronary interventions (PCIs). Recent advances in balloon and stent technology has improved the technique of direct stent (DS) strategy, i.e., stent delivery without pre-dilatation instead of conventional stenting (CS), i.e., stent implantation after balloon pre-dilatation with multiple advantages. METHODS: This randomized controlled trial was conducted at the Cardiology. Department, Punjab Institute of Cardiology, Lahore from April to September, 2017. One hundred patients who were being treated by percutaneous coronary intervention (PCI) were enrolled into two Groups e.g., Group I & group II. 50 patients undergoing direct stenting were enrolled in group I and 50 patients undergoing stenting after balloon pre-dilatation were enrolled in group II after randomization. All patients were treated by single type drug eluting or bare metal stents. Chi square test was used for association and t-test for mean difference between two groups in comparison to post dilatation, fluoroscopy time, procedure time, amount of contrast used, procedural success, side branch compromise, slow flow. The p-value of ˂ 0.05 was significant. RESULTS: This study consisted of 76 males and 24 females out of a total count of 100, with the average age of 52.2±0.01 years. Overall, 43 (43%) patients were diabetic and overall, 44 (44%) were hypertensive. Most of the patients 55 (55%) had PCI to LAD. Average fluoroscopy time 4.l±2.5 minutes in Group I was significantly lesser as compared to 6.7±3.8 minute group II (p-value <0.05). The average procedure time was also marginally lesser in Group I, 23.4±11.6 in comparison to the second Group 33.7±14 (p-value <0.05). Side branch compromise was observed in 10 (20%) in the first group as compared to 8 (16%) the second group. CONCLUSIONS: In comparison to stenting preceded by balloon predilatation, direct stenting is a safer and more feasible procedure with respect to radiation exposure, cost and time duration of the procedure.


Assuntos
Angioplastia Coronária com Balão , Intervenção Coronária Percutânea , Stents , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/estatística & dados numéricos , Doença das Coronárias/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos
9.
PLoS One ; 15(6): e0234340, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579587

RESUMO

The experimental quantification and modeling of the multiaxial mechanical response of polymer membranes of coronary balloon catheters have not yet been carried out. Due to the lack of insights, it is not shown whether isotropic material models can describe the material response of balloon catheter membranes expanded with nominal or higher, supra-nominal pressures. Therefore, for the first time, specimens of commercial polyamide-12 balloon catheters membranes were investigated during uniaxial and biaxial loading scenarios. Furthermore, the influence of kinematic effects on the material response was observed by comparing results from quasi-static and dynamic biaxial extension tests. Novel clamping techniques are described, which allow to test even tiny specimens taken from the balloon membranes. The results of this study reveal the semi-compliant, nonlinear, and viscoelastic character of polyamide-12 balloon catheter membranes. Above nominal pressure, the membranes show a pronounced anisotropic mechanical behavior with a stiffer response in the circumferential direction. The anisotropic feature intensifies with an increasing strain-rate. A modified polynomial model was applied to represent the realistic mechanical response of the balloon catheter membranes during dynamic biaxial extension tests. This study also includes a compact set of constitutive model parameters for the use of the proposed model in future finite element analyses to perform more accurate simulations of expanding balloon catheters.


Assuntos
Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Nylons/química , Anisotropia , Fenômenos Biomecânicos/fisiologia , Cateteres Cardíacos/tendências , Análise de Elementos Finitos , Coração/fisiologia , Membranas/metabolismo , Modelos Biológicos , Miocárdio/metabolismo , Nylons/farmacologia , Estresse Mecânico , Resistência à Tração/fisiologia
10.
JACC Cardiovasc Interv ; 13(9): 1112-1122, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32381188

RESUMO

OBJECTIVES: The aim of this study was to determine whether an active side branch protection (SB-P) strategy is superior to the conventional strategy in reducing side branch (SB) occlusion in high-risk bifurcation treatment. BACKGROUND: Accurate prediction of SB occlusion after main vessel stenting followed by the use of specific strategies to prevent occlusion would be beneficial during bifurcation intervention. METHODS: Eligible patients who had a bifurcation lesions with high risk for occlusion as determined using the validated V-RESOLVE (Visual Estimation for Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention) score were randomized to an active SB-P strategy group (elective 2-stent strategy for large SBs and jailed balloon technique for small SBs) or a conventional strategy group (provisional stenting for large SBs and jailed wire technique for small SBs) in a 1:1 ratio stratified by SB vessel size. The primary endpoint of SB occlusion was defined as an angiography core laboratory-assessed decrease in TIMI (Thrombolysis In Myocardial Infarction) flow grade or absence of flow in the SB immediately after full apposition of the main vessel stent to the vessel wall. RESULTS: A total of 335 subjects at 16 sites were randomized to the SB-P group (n = 168) and conventional group (n = 167). Patients in the SB-P versus conventional strategy group had a significantly lower rate of SB occlusion (7.7% [13 of 168] vs. 18.0% [30 of 167]; risk difference: -9.1%; 95% confidence interval: -13.1% to -1.8%; p = 0.006), driven mainly by the difference in the small SB subgroup (jailed balloon technique vs. jailed wire technique: 8.1% vs. 18.5%; p = 0.01). CONCLUSIONS: An active SB-P strategy is superior to a conventional strategy in reducing SB occlusion when treating high-risk bifurcation lesions. (Conventional Versus Intentional Strategy in Patients With High Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention [CIT-RESOLVE]; NCT02644434).


Assuntos
Angioplastia Coronária com Balão/métodos , Doença da Artéria Coronariana/terapia , Oclusão Coronária/prevenção & controle , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Doença da Artéria Coronariana/diagnóstico por imagem , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Método Simples-Cego , Stents , Fatores de Tempo , Resultado do Tratamento
15.
Adv Ther ; 37(5): 2210-2223, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32274746

RESUMO

INTRODUCTION: Scoring balloon angioplasty (SBA) for lumen gain prior to stent implantations or drug-coated balloon angioplasty (DCB) is considered an essential interventional tool for lesion preparation. Recent evidence indicates that SBA may play a pivotal role in enhancing the angiographic and clinical outcomes of DCB angioplasty. METHODS: We studied the systematic use of SBA with a low profile, non-slip element device prior to DCB angioplasty in an unselected, non-randomized patient population. This prospective, all-comers study enrolled patients with de novo lesions as well as in-stent restenotic lesions in bare metal stents (BMS-ISR) and drug-eluting stents (DES-ISR). The primary endpoint was the target lesion failure (TLF) rate at 9 months (ClinicalTrials.gov Identifier NCT02554292). RESULTS: A total of 481 patients (496 lesions) were recruited to treat de novo lesions (78.4%, 377), BMS-ISR (4.0%, 19), and DES-ISR (17.6%, 85). Overall risk factors were acute coronary syndrome (ACS, 20.6%, 99), diabetes mellitus (46.8%, 225), and atrial fibrillation (8.5%, 41). Average lesion lengths were 16.7 ± 10.4 mm in the de novo group, and 20.1 ± 8.9 mm (BMS-ISR) and 16.2 ± 9.8 mm (DES-ISR) in the ISR groups. Scoring balloon diameters were 2.43 ± 0.41 mm (de novo), 2.71 ± 0.31 mm (BMS-ISR), and 2.92 ± 0.42 mm (DES-ISR) whereas DCB diameters were 2.60 ± 0.39 mm (de novo), 3.00 ± 0.35 mm (BMS-ISR), and 3.10 ± 0.43 mm (DES-ISR), respectively. The overall accumulated TLF rate of 3.0% (14/463) was driven by significantly higher target lesion revascularization rates in the BMS-ISR (5.3%, 1/19) and the DES-ISR group (6.0%, 5/84). In de novo lesions, the TLF rate was 1.1% (4/360) without differences between calcified and non-calcified lesions (p = 0.158) and small vs. large reference vessel diameters with a cutoff value of 3.0 mm (p = 0.901). CONCLUSIONS: The routine use of a non-slip element scoring balloon catheter to prepare lesions suitable for drug-coated balloon angioplasty is associated with high procedural success rates and low TLF rates in de novo lesions.


Assuntos
Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/normas , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/normas , Guias de Prática Clínica como Assunto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
17.
J Vis Exp ; (155)2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-32065158

RESUMO

Major adverse cardiovascular events (MACEs) negatively impact the cardiovascular prognosis of patients undergoing coronary angioplasty due to coronary ischemic injury. The extent of coronary damage and the mechanisms of vascular repair are factors influencing the future development of MACEs. Intrinsic vascular features like the plaque characteristics and coronary artery complexity have demonstrated prognostic information for MACEs. However, the use of intracoronary circulating biomarkers has been postulated as a convenient method for the early identification and prognosis of MACEs, as they more closely reflect dynamic mechanisms involving coronary damage and repair. Determination of coronary circulating biomarkers during angioplasty, such as the number of subpopulations of mononuclear progenitor cells (MPCs) as well as the concentration of soluble molecules reflecting inflammation, cell adhesion, and repair, allows for assessment of future developments and the prognosis of MACEs 6 months post coronary angioplasty. This method is highlighted by its translational nature and better performance than peripheral blood circulating biomarkers regarding prediction of MACEs and its effect on the cardiovascular prognosis, which may be applied for risk stratification of patients with coronary artery disease undergoing angioplasty.


Assuntos
Angioplastia Coronária com Balão/métodos , Biomarcadores/sangue , Doença da Artéria Coronariana/cirurgia , Células-Tronco/metabolismo , Feminino , Humanos , Masculino , Prognóstico
18.
J Coll Physicians Surg Pak ; 30(2): 222-224, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32036837

RESUMO

The objective of study was to compare effects of rapamycin-eluting single and double stenting on serum markers like high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) in patients with coronary bifurcation lesions. It was an experimental study carried out from April 2016 to July 2017. One hundred and twenty-six patients were divided into two equal groups according to different treatment regimens. Group A was treated with rapamycin-eluting single stenting and group B with rapamycin-eluting double stenting. Three months after operation, hs-CRP, TNF-α, IL-6, IL-8 and MCP-1 levels in group B were lower than those in group A (p=0.010, p <0.001, p <0.001, p <0.001 and p <0.001, respectively). After one year of follow-up, rate of intrasegmental restenosis of branch vessels was higher in group A than in group B (p=0.011). Compared with rapamycin-eluting single stenting, rapamycin-eluting double stenting may regulate more effectively the above serum markers levels, reduce the incidence of intrasegmental restenosis of branch vessels.


Assuntos
Angioplastia Coronária com Balão/métodos , Proteína C-Reativa/metabolismo , Quimiocina CCL2/sangue , Estenose Coronária/cirurgia , Vasos Coronários/cirurgia , Citocinas/sangue , Sirolimo/farmacologia , Idoso , Biomarcadores , Angiografia Coronária , Estenose Coronária/sangue , Estenose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Stents Farmacológicos , Feminino , Humanos , Imunossupressores/farmacologia , Masculino , Pessoa de Meia-Idade
19.
Medicine (Baltimore) ; 99(1): e18371, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895771

RESUMO

INTRODUCTION: Kawasaki disease (KD) is an acute vasculitis syndrome that mainly affects children and is the first cause of acquired heart disease. Coronary artery lesion is the most serious complication of KD. Only two previous studies have reported similar cases, but we reported patient was younger and had a longer follow-up. PATIENT CONCERNS: We reported a case of coronary sequelae of KD treated with rotational atherectomy and drug coated balloon (DCB). During the week after surgery, the patient complained of a slight chest pain intermittently, but no longer appeared after that. DIAGNOSIS: We diagnosed by electrocardiogram and angiography. Angiography showed that the anterior descending branch (LAD) proximal stenosis was 95%, the right coronary artery (RCA) middle stenosis was 99%, and the calcification was severe. INTERVENTIONS: We treat the patient with rotational atherectomy using a 1.25 mm burr, pre-dilatation of the stenosis lesion with a 3.5 mm × 15 mm non-compliant balloon was achieved. Then 3.5 mm × 15 mm drug eluting balloon was inflated at 10 atm for 60 seconds. OUTCOMES: After the 6-month follow-up (from October 2018 to March 2019), the symptom of angina disappeared. Coronary angiography 6 months later showed no apparent progression of vessel narrowing. CONCLUSION: The present case suggests that rotational atherectomy followed by DCB dilation could be an alternative revascularization therapy of choice in coronary KD sequelae complicated with atherosclerosis.


Assuntos
Aterectomia Coronária/métodos , Aneurisma Coronário/cirurgia , Síndrome de Linfonodos Mucocutâneos/complicações , Adulto , Angioplastia Coronária com Balão/métodos , Calcinose/patologia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/etiologia , Vasos Coronários/patologia , Eletrocardiografia , Humanos , Masculino
20.
Expert Opin Drug Deliv ; 17(2): 201-211, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31918593

RESUMO

Introduction: Newer-generation drug-eluting stents (DES) are the standard of care for the treatment of symptomatic coronary artery disease. However, their efficacy is limited by in-stent restenosis and stent thrombosis. Drug-coated balloons (DCB) are a treatment option for in-stent-restenosis and for certain clinical and anatomical situations in de novo diseases such as small coronary arteries, bifurcation lesions, and high bleeding risk situations.Areas covered: This review summarizes the current clinical status of DCB angioplasty in coronary artery disease.Expert opinion: DCB deliver an anti-proliferative drug into the vessel wall without implanting a stent and are a promising and technique in the treatment of coronary artery disease. Several studies and meta-analysis have demonstrated the safety and efficacy of DCB angioplasty for several indications such as in-stent restenosis, small-vessel disease, and high bleeding risk. Due to absent short- and long-term complications of stent implantation and a short dual antiplatelet therapy duration, DCB angioplasty has the potential to achieve a clear role in the interventional field in clinical settings with a comparable or even a superior efficacy in comparison with DES use.


Assuntos
Angioplastia Coronária com Balão/métodos , Doenças Cardiovasculares/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Animais , Vasos Coronários , Humanos
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