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1.
Int Heart J ; 60(5): 1070-1076, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484856

RESUMO

The efficacy of drug-coated balloons (DCB) for in-stent restenosis (ISR) in hemodialysis (HD) patients remains unclear.We retrospectively evaluated 153 consecutive patients who underwent DCB for ISR with follow-ups for up to 3 years after the procedure between February 2014 and June 2017. Patients were divided into an HD group (n = 39) and a non-HD group (n = 114). The primary endpoint was target lesion revascularization (TLR). The secondary endpoints were all revascularizations and major adverse cardiac events (MACE) defined as cardiac death, myocardial infarction and cerebral infarction. Kaplan-Meier curves of survival free from TLR were compared between the two groups. We also performed propensity score matching and then compared the two matched groups (n = 27 in each group). The acute procedure success rate was similar for the two groups (100% versus 99.1%, P = 0.56). The incidence of TLR was higher in the HD group than in the non-HD group (41.0% versus 9.6%, P < 0.0001). The rate of revascularizations and MACE combined was significantly higher in the HD group than in the non-HD group (64.1% versus 17.5%, P < 0.0001). Kaplan-Meier analyses showed that survival free from TLR was significantly lower in the HD group than in the non-HD group both before and after propensity score matching (P < 0.0001 and P = 0.005, respectively; log-rank test).Contrary to the similar acute procedure success, recurrent ISR and MACE occurred more frequently in HD patients than in non-HD patients after DCB, which indicates poorer long-term efficacy of DCB in HD patients.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Cateteres Cardíacos/efeitos adversos , Reestenose Coronária/terapia , Estenose Coronária/terapia , Stents Farmacológicos/efeitos adversos , Diálise Renal/métodos , Idoso , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Estudos de Casos e Controles , Causas de Morte , Materiais Revestidos Biocompatíveis , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/mortalidade , Estenose Coronária/diagnóstico por imagem , Feminino , Seguimentos , Hospitais Universitários , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Revascularização Miocárdica/mortalidade , Paclitaxel/farmacologia , Pontuação de Propensão , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
2.
Int Heart J ; 60(5): 1037-1042, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484863

RESUMO

Although high-sensitivity C-reactive protein (hs-CRP) has been used to predict the risk of adverse cardiac events in patients with coronary artery disease (CAD) after percutaneous coronary interventions (PCIs), little is known about the association between hs-CRP and long-term outcomes in patients with preserved renal function.Here, we studied 1,153 patients with stable CAD and preserved renal function (estimated glomerular filtration rate: > 60 mL/minute/1.73 m2) who underwent their first PCI between 2000 and 2011. Those with available data on preprocedural hs-CRP were included. Patients were assigned to tertiles according to preprocedural hs-CRP levels. The incidence of major adverse cardiac events (MACE), including all-cause death and nonfatal myocardial infarction, was evaluated. During a median follow-up period of 7.5 years, Kaplan-Meier curves showed ongoing divergence in the rates of MACE among the hs-CRP tertiles (hs-CRP < 0.05 mg/L, 12.1%; 0.05-0.17 mg/L, 12.1%; > 0.17 mg/L, 21.6%; log-rank P = 0.003). After adjusting for the established cardiovascular risk factors, hs-CRP levels were found to be associated with a higher incidence of MACE (hazard ratio [HR]: 3.65, 95% confidence interval [CI]: 1.77-7.07; P = 0.0008) and a higher rate of all-cause mortality (HR: 5.14, 95% CI: 2.38-10.30; P < 0.0001).In conclusion, this long-term registry showed that preprocedural hs-CRP measurement is clinically useful for long-term risk assessments in patients with stable CAD and preserved renal function.


Assuntos
Angioplastia Coronária com Balão/mortalidade , Angioplastia Coronária com Balão/métodos , Proteína C-Reativa/metabolismo , Causas de Morte , Doença da Artéria Coronariana/terapia , Idoso , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Biomarcadores/sangue , Estudos de Coortes , Angiografia Coronária/métodos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Taxa de Filtração Glomerular/fisiologia , Hospitais Universitários , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
3.
Int Heart J ; 60(5): 1050-1060, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484868

RESUMO

Edge restenosis has gained attention as a main cause of restenosis after first-generation drug-eluting stent (DES) implantation. The aim of this study was to assess the incidence of edge restenosis and identify the predictors of edge restenosis after second-generation DES implantation. Data were obtained from several postmarketing surveillance (PMS) studies on a cobalt-chromium everolimus-eluting stent (CoCr-EES; Xience V/PROMUS, Xience Prime, Xience Prime SV, and Xience Expedition SV), a second-generation DES, in Japan. Angiographic analysis was conducted at the baseline and after eight months on the following subsegments: in-stent region, proximal edge, and distal edge. Restenosis was defined as ≥ 50% diameter stenosis (DS) at follow-up. We used multivariate logistic regression (with lesions as a random effect) to compare the instances of restenosis between the proximal and the distal edges. Univariate and multivariate analyses of the risk factors for restenosis were performed for each subsegment. We analyzed 1,966 lesions in 1,687 patients. The restenosis rates at the in-stent region, proximal edge, and distal edge were 4.4%, 3.0%, and 1.1%, respectively. The risk of restenosis at the distal edge was significantly lower than that at the proximal edge, when adjusted for 13 variables. The predictors of restenosis were postprocedural % diameter stenosis (%DS), postprocedural reference diameter, ≥ 45° bending, stent overlap at the proximal edge, and postprocedural %DS at the distal edge. Our analysis of eight-month angiographic outcomes from CoCr-EES PMS demonstrated that postprocedural %DS is a major predictor of edge restenosis. Edge restenosis is more likely attributable to postprocedural angiographic results than to the patient's background.


Assuntos
Angiografia Coronária/métodos , Estenose Coronária/terapia , Stents Farmacológicos/efeitos adversos , Vigilância de Produtos Comercializados , Desenho de Prótese , Sirolimo/farmacologia , Fatores Etários , Idoso , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/mortalidade , Cromo , Cobalto , Estudos de Coortes , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/epidemiologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Análise de Falha de Equipamento , Feminino , Hospitais Universitários , Humanos , Incidência , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Resultado do Tratamento
4.
Pan Afr Med J ; 33: 74, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448036

RESUMO

Myocardial infarction (MI) is a major cause of cardiovascular mortality. Inferior MI accounts for 30-50% of infarctions but it is associated with a favorable prognosis compared to anterior infarct. This study aimed to study the epidemiological, clinical, electrical, echocardiographic, angiographic features of inferior MI, as well as its complications and its therapeutic approaches. Over a period of 3 years, we admitted 720 patients with STEMI, of whom 103 with inferior STEMI, reflecting a rate of 14.3%. There was a clear male predominance, with an average age of 58 years (men) and 62 years (women). Smoking was the main risk factor for cardiovascular disease (57.28% of patients were smokers). Right ventricular infarction was found in 11.65% of cases. Half of these patients had hemodynamic instability. Third-degree atrioventricular block was diagnosed in 12.6% of patients. Therapeutic approach was based on thrombolysis (7 patients) and coronary angiogram (42 patients). Inferior MI was caused by right coronary lesion in 53% of cases and circumflex artery occlusion in 47% of cases. Right coronary is responsible for right ventricular infarction in 100% of cases. Coronary angioplasty was performed in 18 patients after coronary angiogram. Eleven patients underwent transluminal coronary angioplasty in the right coronary while 2 patients underwent transluminal coronary angioplasty in the circumflex artery. Early mortality at 30 days was 1.94%. In the right ventricular infarction group mortality rate was about 17%.


Assuntos
Angioplastia Coronária com Balão/métodos , Angiografia Coronária/métodos , Infarto Miocárdico de Parede Inferior/epidemiologia , Idoso , Bloqueio Atrioventricular/epidemiologia , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Infarto Miocárdico de Parede Inferior/fisiopatologia , Infarto Miocárdico de Parede Inferior/terapia , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia
5.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 297-301, May-June 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1002228

RESUMO

Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty


Assuntos
Humanos , Feminino , Adulto , Hemorragia Uterina/complicações , Mulheres , Stents , Angioplastia , Inibidores da Agregação de Plaquetas/uso terapêutico , Angioplastia Coronária com Balão/métodos , Embolização Terapêutica/métodos , Leiomioma
6.
Lancet ; 394(10194): 230-239, 2019 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-31204115

RESUMO

BACKGROUND: The optimal technique of percutaneous coronary intervention in patients at high bleeding risk is not known. The hypothesis of the DEBUT trial was that percutaneous coronary intervention with drug-coated balloons is non-inferior to percutaneous coronary intervention with bare-metal stents for this population. METHODS: The DEBUT trial is a randomised, single-blind non-inferiority trial done at five sites in Finland. Patients were eligible if they had an ischaemic de-novo lesion in a coronary artery or bypass graft that could be treated with drug-coated balloons, at least one risk factor for bleeding, and a reference vessel diameter of 2·5-4·0 mm. Those with myocardial infarction with ST-elevation, bifurcation lesions needing a two-stent technique, in-stent restenosis, and flow-limiting dissection or substantial recoil (>30%) of the target lesion after predilation were excluded. After successful predilation of the target lesion, patients were randomly assigned (1:1), by use of a computer-generated random sequence, to percutaneous coronary intervention with a balloon coated with paclitaxel and iopromide or a bare-metal stent. The primary outcome was major adverse cardiac events at 9 months. Non-inferiority was shown if the absolute risk difference was no more than 3%. All prespecified analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01781546. FINDINGS: Between May 22, 2013, and Jan 16, 2017, 220 patients were recruited for the study and 208 patients were assigned to percutaneous coronary intervention with drug-coated balloon (n=102) or bare metal stent (n=106). At 9 months, major adverse cardiac events had occurred in one patient (1%) in the drug-coated balloon group and in 15 patients (14%) in the bare-metal stent group (absolute risk difference -13·2 percentage points [95% CI -6·2 to -21·1], risk ratio 0·07 [95% CI 0·01 to 0·52]; p<0·00001 for non-inferiority and p=0·00034 for superiority). Two definitive stent thrombosis events occurred in the bare metal stent group but no acute vessel closures in the drug-coated balloon group. INTERPRETATIONS: Percutaneous coronary intervention with drug-coated balloon was superior to bare-metal stents in patients at bleeding risk. The drug-coated balloon-only coronary intervention is a novel strategy to treat this difficult patient population. Comparison of this approach to the new generation drug-eluting stents is warranted in the future. FUNDING: B Braun Medical AG, AstraZeneca, and Competitive State Research Funding of the Kuopio University Hospital Catchment Area.


Assuntos
Angioplastia Coronária com Balão/instrumentação , Materiais Revestidos Biocompatíveis , Doença da Artéria Coronariana/terapia , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/patologia , Reestenose Coronária/prevenção & controle , Feminino , Hemorragia/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Método Simples-Cego , Stents , Moduladores de Tubulina/administração & dosagem
7.
Medicine (Baltimore) ; 98(21): e15622, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124941

RESUMO

BACKGROUND: Drug-coated balloon as a novel therapeutic strategy has been used to treat restenosis in cases of bare metal and drug-eluting stents. However, evidence of its safety and efficacy is scarce in de novo small coronary artery vessel disease. This meta-analysis aimed to compare the safety and efficacy of the drug-coated balloon and the drug-eluting stent. METHODS: The PubMed, EMBASE, Web of Science, and Cochrane library databases were searched for studies published up to October 17, 2018. Studies comparing the drug-coated balloon with the drug-eluting stent strategy in patients with de novo small coronary artery vessel disease (reference diameter, <3 mm) were identified. The clinical outcomes were nonfatal myocardial infarction, cardiac death, all-cause death, target lesion revascularization, and target-vessel revascularization. Data were analyzed using the statistical software RevMan (version 5.3). Fixed effects models were performed to calculate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). Sensitivity analyses were used to detect potential sources of heterogeneity, while subgroup analyses were implemented to assess the differential effects. RESULTS: Three randomized controlled trials and 3 nonrandomized controlled studies were identified. Six studies including a total of 1800 patients compared the differences between the drug-coated balloon and the drug-eluting stent strategies in patients with de novo small coronary artery vessel disease. The results indicated that the drug-coated balloon strategy was associated with a significant reduction in nonfatal myocardial infarction (OR 0.53, 95% CI 0.31-0.90, P = .02) compared with the drug-eluting stent strategy, while insignificant inter-strategy differences were observed in cardiac death (OR 1.56, 95% CI 0.73-3.33, P = .25), all-cause death (OR 0.56, 95% CI 0.25-1.23, P = .15), target lesion revascularization (OR 1.24, 95% CI 0.73-2.1, P = .43), and target-vessel revascularization (OR 0.95, 95% CI 0.59-1.52, P = .84). CONCLUSIONS: This meta-analysis suggests that the drug-coated balloon strategy is noninferior to the drug-eluting stent strategy, delivering a good outcome in nonfatal myocardial infarction, and can be recommended as an optimal treatment strategy in patients with de novo small coronary artery vessel disease. Larger randomized controlled studies with longer follow-up periods are needed to further confirm the benefits of the drug-coated balloon strategy.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/efeitos adversos , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Razão de Chances , Complicações Pós-Operatórias/mortalidade , Desenho de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 297-301, may.-june. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1006182

RESUMO

Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty


Assuntos
Humanos , Feminino , Adulto , Hemorragia Uterina/complicações , Mulheres , Stents , Angioplastia , Inibidores da Agregação de Plaquetas/uso terapêutico , Angioplastia Coronária com Balão/métodos , Embolização Terapêutica/métodos , Leiomioma
9.
Rev. chil. cardiol ; 38(1): 64-67, abr. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1003639

RESUMO

Abstracts: Successful treatment following percutaneous angioplasty (PTCA) and percutaneous trans aortic valve aortic valve stenosis and critical obstruction of the main left coronary artery is presented. Due to a very high estimated surgical risk the patient underwent PTCA of the main left trunk followed, a week later, by trans catheter implantation of an aortic valve (TAVI). The procedure was uneventful, and the clinical condition of the patient was excellent at one year (Functional class I).


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/cirurgia , Angioplastia Coronária com Balão/métodos , Implante de Prótese de Valva Cardíaca , Valva Aórtica/transplante , Stents , Implante de Prótese Vascular/métodos , Doenças das Valvas Cardíacas
10.
Am J Ther ; 26(2): e208-e212, 2019 Mar/Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30839369

RESUMO

BACKGROUND: Ischemic heart disease represents the most important cause of mortality worldwide, and the management of patients with ST-elevation myocardial infarction (STEMI) still remains a great challenge. For a great number of patients who do not have immediate access to primary percutaneous coronary intervention (PCI), facilitated angioplasty may be a reasonable therapeutic option. AREAS OF UNCERTAINTY: The goal of reperfusion therapy is achieving repermeabilization of the infarct-related artery. However, the restoration of normal epicardial flow is not always followed by microvascular tissue perfusion and the presence of myocardial blush. Early studies assessing the benefits of facilitated angioplasty over primary PCI encountered disappointing results, with an increased number of bleeding complications. The invasive strategy following fibrinolysis mainly consists in angiography and PCI of the infarct-related artery between 2 and 24 hours after successful fibrinolysis or rescue PCI in failed fibrinolysis, hemodynamic, electrical instability, or worsening ischemia. Currently, a strategy of routine early angiography after fibrinolysis is recommended, taking into account studies that have demonstrated a reduced rate of reinfarction and recurrent ischemia, without an increased risk of stroke or major bleeding complications. THERAPEUTIC ADVANCES: After evaluating 1892 patients with STEMI within 3 hours after the onset of symptoms and revealing, beyond clear benefit of fibrinolysis, an increased risk of bleeding complications, the STREAM trial was the one that led to halving the tenecteplase dose for patients aged >75 years. A safety profile of adjusted-dose fibrinolytic therapy in elderly patients with STEMI will be further investigated by the ongoing STREAM-2 trial. CONCLUSIONS: With the current increased burden of acute coronary syndromes and the lack of immediate primary PCI facilities for all patients with STEMI, facilitated angioplasty seems a feasible therapeutic option. Another benefit of facilitated angioplasty may be represented by a major contribution of thrombolytic therapy in re-establishing microvascular myocardial blood flow.


Assuntos
Angioplastia Coronária com Balão , Fibrinolíticos/farmacologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/métodos , Humanos , Medição de Risco
11.
Int Heart J ; 60(2): 255-263, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799375

RESUMO

Previous clinical studies have shown inconsistent results regarding the effect of erythropoietin in ST-segment elevation myocardial infarction (STEMI). This study investigated whether directed intracoronary infusion of darbepoetin-α into ischemic myocardium before reperfusion would reduce infarct size or post-infarct remodeling in STEMI patients.Eighty STEMI patients received one of the following treatments simultaneously with the first balloon inflation: intracoronary darbepoetin-α 300 µg (n = 40) or saline (n = 40), administered via the over-the-wire balloon system. The primary endpoint was infarct size estimated by serial cardiac enzyme levels after procedure. The secondary endpoints were (1) infarct size and proportion of salvaged myocardium measured with cardiac magnetic resonance (CMR) at baseline; (2) post-infarct remodeling (PIR), defined as an increase in left ventricular end-diastolic volume more than 20% at 4 months compared to the baseline on CMR; and (3) composite cardiovascular endpoints assessed at 4 months.The peak CK-MB [median 270.0 (interquartile range 139.8-356.3) versus 231.5 (131.0-408.5) ng/mL, P = 0.55] and troponin-I [128.5 (63.5-227.8) versus 109.0 (43.8-220.0) ng/mL, P = 0.52) ] did not differ between the darbepoetin-α and control group. Fifty-seven patients completed the baseline and 4-month follow-up CMR. There were no differences in infarct size [30.6 (18.1-49.8) versus 31.5 (22.5-47.3) cm3, P = 0.91), proportion of salvaged myocardium [26.7% (15.9-42.6%) versus 35.8% (22.4-48.8%), P = 0.12) or PIR (8.0% versus 6.7%, P = 0.62) between the two groups. Composite cardiovascular outcomes did not differ between the two groups.In conclusion, administration of intracoronary darbepoetin-α before reperfusion did not reduce infarct size or post-infarct remodeling in STEMI patients.


Assuntos
Angioplastia Coronária com Balão/métodos , Darbepoetina alfa , Miocárdio/patologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Remodelação Ventricular/efeitos dos fármacos , Idoso , Vasos Coronários , Darbepoetina alfa/administração & dosagem , Darbepoetina alfa/efeitos adversos , Monitoramento de Medicamentos/métodos , Feminino , Hematínicos/administração & dosagem , Hematínicos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Volume Sistólico/efeitos dos fármacos , Resultado do Tratamento
12.
Int Heart J ; 60(2): 457-461, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799381

RESUMO

Delayed complete atrioventricular (AV) block associated with an occluded septal perforator branch (SPB) is an uncommon complication after performing percutaneous coronary intervention (PCI) for the left anterior descending coronary artery (LAD). Here we report the case of a 74-year-old man who underwent elective PCI for proximal LAD complicated with occlusion of the first major SPB and developed a complete AV block 78 hours after PCI was performed. The patient received a temporary transvenous pacemaker via the jugular vein and successfully underwent balloon angioplasty of the lethal "jailed" SPB, resulting in recovery from the complete AV block. Permanent pacemaker implantation was avoided. Our findings indicate the importance of postprocedural monitoring and consideration of rescue PCI for an occluded SPB in cases of complicated AV conduction disturbances.


Assuntos
Angioplastia Coronária com Balão/métodos , Bloqueio Atrioventricular , Estimulação Cardíaca Artificial/métodos , Oclusão Coronária , Vasos Coronários , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Oclusão Coronária/diagnóstico , Oclusão Coronária/etiologia , Oclusão Coronária/fisiopatologia , Oclusão Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Remoção de Dispositivo/métodos , Septos Cardíacos , Humanos , Masculino , Marca-Passo Artificial , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Recuperação de Função Fisiológica , Resultado do Tratamento
13.
Am J Case Rep ; 20: 198-203, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30765685

RESUMO

BACKGROUND Despite improvements in percutaneous coronary intervention (PCI) devices and operator expertise, coronary chronic total occlusion (CTO) poses a management dilemma for interventional cardiologists. Occasionally, in CTO lesions and in bifurcation lesions with severe curvature and stenosis, wires cannot be introduced into the main artery, although wiring into the side branch is possible. We herein report a case of stumpless ostial left anterior descending artery (LAD) CTO that was successfully treated with a novel strategy. CASE REPORT A 64-year-old female with symptoms of heart failure was admitted to our hospital. Coronary angiography showed CTO of the stumpless ostial LAD. The patient had invisible and continuous collaterals; therefore, we used the antegrade approach for CTO access. However, the wire could be guided only in the direction of the diagonal branch due to a severe angulation at the CTO exit site, despite successful wire crossing into the CTO lesion. We attempted intravascular ultrasound-guided direct wire entry technique to obtain additional information about the occlusion cap location and to assist in negotiating the wire into the true lumen. The guidewire (Conquest pro) could cross the lesion after several approaches and successfully advance the device over the wire through the occluded segment after the modified See-saw wiring technique was employed. CONCLUSIONS This method appears to be a promising novel strategy for difficult and complex lesions when performing CTO revascularization.


Assuntos
Angioplastia Coronária com Balão/métodos , Oclusão Coronária/terapia , Ultrassonografia de Intervenção , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Stents
16.
Can J Cardiol ; 34(12): 1564-1572, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527144

RESUMO

Coronary calcification often complicates atherosclerosis. With an aging population, coinciding with lower thresholds for coronary angiography and percutaneous coronary intervention (PCI), severe calcific coronary stenoses remain a challenge for interventional cardiologists. Although advances in coronary guidewires, percutaneous balloons, and adjunctive procedural devices have improved success of PCI, recalcitrant calcified lesions not amenable to the conventional technique frequently occur. Coronary atherectomy with plaque modification provides a therapeutic alternative. As such, various modalities such as rotational, orbital or laser atherectomy, and more recently shockwave lithoplasty have become therapeutic options for PCI. We provide a summary of the principles, technique, and contemporary evidence for these currently approved devices designed to treat severe coronary calcific lesions.


Assuntos
Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea , Calcificação Vascular/terapia , Angioplastia Coronária com Balão/métodos , Aterectomia Coronária/efeitos adversos , Aterectomia Coronária/métodos , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/prevenção & controle , Reestenose Coronária/terapia , Humanos , Lasers de Excimer , Litotripsia , Fenômeno de não Refluxo , Índice de Gravidade de Doença
18.
Angiol Sosud Khir ; 24(4): 151-156, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30531783

RESUMO

Analysed herein are the in-hospital and remote (12 months) results of transcutaneous coronary interventions (TCI) carried out in patients with non-ST elevation acute coronary syndrome (nSTE-ACS) and multivessel coronary artery disease with the use of extracorporeal membrane oxygenation (ECMO). From 2013 to 2015, the study included a total of 18 patients with nSTE-ACS and multivessel coronary artery disease who had been denied "open" surgical myocardial revascularization. The mean values (scores) of the scales in the group were as follows: GRACE - 119.7±67.6, SYNTAX Score - 33.5±8.1, Euroscore II - 5.2±21.9. The ejection fraction was averagely moderately low - 49.3±19.4%. During the in-hospital stay of the patients and 12 months after TCI we assessed the major adverse cardiovascular events (MACE): death, myocardial infarction, acute cerebral circulation impairment/transitory ischaemic attack, repeat revascularization of the target vessel - both as separate parameters and in a composite form. Additionally, we analysed perioperative and in-hospital complications, their structure, the volume of replacement therapy with blood components and the length of hospital stay. During the in-hospital period and at 12 months of follow up, the composite number of cases of adverse cardiovascular events amounted to 1 (5.5%) and 3 (16.5%), respectively. One patient died during in-hospital treatment and one more lethal outcome was registered by 12 months of follow up; hence, the mortality rate amounted to 1 (5.5%) and 2 (11%) cases, respectively. Stroke was observed in 1 (5.5%) patient only during the in-hospital period. No repeat revascularisation of the target vessel was performed. By the end of the hospital stay, BARC type 3-5 haemorrhagic complications were observed in 50% of patients. The in-hospital and remote (12 months) results of high-risk TCI with ECMO support in patients with nSTE-ACS and multivessel coronary artery disease, who had been denied surgical revascularization demonstrated an acceptable level of unfavourable outcomes. This approach may be regarded as a method alternative to revascularization and used in an utterly severe cohort of patients.


Assuntos
Síndrome Coronariana Aguda , Angioplastia Coronária com Balão , Doença da Artéria Coronariana/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Complicações Pós-Operatórias , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/cirurgia , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/mortalidade , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Índice de Gravidade de Doença , Sibéria , Resultado do Tratamento
19.
BMC Cardiovasc Disord ; 18(1): 228, 2018 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-30526488

RESUMO

BACKGROUND: The failure of aspiration thrombectomy may negatively impact outcomes in patients with acute myocardial infarction (AMI), but the available options are limited. CASE PRESENTATION: A 41-year-old man with chest pain for 2 h presented with ST-segment elevation myocardial infarction. Coronary angiography revealed a large filling defect extending from the distal left main (LM) coronary artery into the proximal left circumflex (LCX) coronary artery. The whole thrombus moved and occluded the proximal left anterior descending (LAD) artery, while the guidewire crossed the lesion. Dedicated manual aspiration thrombectomy (MAT) and balloon dilation failed to reduce thrombus burden. We considered thrombus extraction as impossible when it moved forward to occlude the middle LAD. To reduce infarct size, a new balloon-pushing technique was successfully performed to move the thrombus to the terminal LAD based on the actual condition of the LAD. The final angiogram demonstrated no stenosis in the LM artery and stent deployment was not performed. A 1-week follow-up coronary angiography revealed the complete resolution of thrombus and flow restoration in the left coronary artery. Intravascular ultrasound (IVUS) showed nonsignificant residual stenosis of the LM artery. No adverse events occurred during a 12-month follow-up period. CONCLUSION: This case suggests that the new balloon-pushing technique is a useful remedy if repeated MAT fails during AMI.


Assuntos
Angioplastia Coronária com Balão/métodos , Trombose Coronária/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia de Salvação/métodos , Trombectomia/efeitos adversos , Adulto , Angioplastia Coronária com Balão/instrumentação , Cateteres Cardíacos , Angiografia Coronária , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/fisiopatologia , Humanos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Terapia de Salvação/instrumentação , Sucção , Trombectomia/métodos , Falha de Tratamento , Ultrassonografia de Intervenção
20.
Medicine (Baltimore) ; 97(45): e13208, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30407362

RESUMO

RATIONALE: The safety and efficacy of drug-coated balloon (DCB) technology have primarily been proven in the treatment of coronary in-stent restenosis. Whereas increasing evidences show that DCB use was feasible in certain de novo coronary lesions. In 2012, Vassilev reported the 1st case in which a coronary aneurysm formed after a DCB was used to treat drug-eluting stent (DES) restenosis. To date, limited information has been reported on coronary artery aneurysm (CAA) development following DCB treatment of de novo lesions. PATIENT CONCERNS: A 42-year-old male underwent delayed coronary angiography due to extensive anterior wall myocardial infarction. After balloon predilation in the mid-left anterior descending (LAD) artery, the residual 30% stenosis without major dissection was treated with a DCB. Angiographic follow-up at 6 and 12 months revealed an aneurysm in the treated area of the LAD artery, with positive vascular remodeling behind this aneurysm. A 54-year-old male with nonstent thrombosis elevation myocardial infarction underwent elective catheterization. Coronary angiography revealed critical stenosis in the LAD and significant narrowing at the distal segments of both the left circumflex artery (LCX) and the nondominant right coronary artery. After predilation of the lesion in the LCX, the residual 30% stenosis was treated with a DCB. The lesion in the LAD was treated with a DCB either. Angiography follow-up at 6 months revealed good results in the LAD; however, an aneurysm was observed in the DCB-treated area of the LCX. DIAGNOSIS: The CAA formation after DCB treatment of de novo lesions. INTERVENTIONS AND OUTCOMES: Because the 2 patients were asymptomatic upon diagnosis, the aneurysms were left untreated. Long-term dual antiplatelet therapy and intense follow-up were recommended. LESSONS: Our cases raise questions regarding the safety of DCB treatment for de novo lesions in real-world contexts. There might be a need to clarify the appropriate doses for drugs coated on DCBs. Although indications for DCB treatment for de novo coronary lesions should not be overly aggressively broadened, the potential role of such treatment in this context merits additional elucidation in future studies.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Aneurisma Coronário/etiologia , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/efeitos adversos , Adulto , Angioplastia Coronária com Balão/métodos , Angiografia Coronária/métodos , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Resultado do Tratamento
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