RESUMO
We report the case of a 37-year-old transgender patient with a history of orchiectomy on gender-affirming estrogen therapy who was hospitalized with an acute onset of chest pain with a resolution shortly after the presentation. On presentation, the patient had a rapid rise in troponin level and was urgently taken to the cardiac catheterization lab where spontaneous coronary artery dissection was diagnosed and treated with cutting balloon angioplasty and medical management. After a multidisciplinary discussion, the only notable risk factor was estrogen supplementation after gender reassignment surgery. To our knowledge, this is the only report of a male to female transgender patient reported to have spontaneous coronary artery dissection.
Assuntos
Infarto do Miocárdio , Pessoas Transgênero , Adulto , Anomalias dos Vasos Coronários , Vasos Coronários , Estrogênios/efeitos adversos , Feminino , Humanos , Masculino , Infarto do Miocárdio/etiologia , Resultado do Tratamento , Doenças Vasculares/congênitoRESUMO
Coronary artery perforation is an uncommon, but potentially devastating, complication of PCI, and is observed most frequently in complex procedures. Clinical outcomes, including periprocedural and long-term mortality, are markedly worse with increasing degree of perforation. Perforation required covered stent usage predicts a high in-hospital and overall mortality, although no difference is noted between covered stent type.
Assuntos
Traumatismos Cardíacos , Intervenção Coronária Percutânea , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/terapia , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Stents , Resultado do TratamentoRESUMO
Stroke occurs infrequently following percutaneous coronary intervention (PCI) with 30-day and 1-year cumulative incidence of 0.4 and 1.5%, respectively. Patient comorbidities, acute presentations, and complex coronary lesions are more prevalent among patients who sustain a stroke. The occurrence of stroke is associated with higher short-term and overall mortality compared with bleeding or myocardial infarction.
Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Acidente Vascular Cerebral , Humanos , Incidência , Sistema de Registros , Resultado do TratamentoRESUMO
Treatment of bifurcation lesions has advanced with the development of second-generation drug-eluting stents and state-of-the-art percutaneous coronary interventions techniques. This subanalysis of SYNTAX II demonstrates similar major adverse cardiac or cerebrovascular events in patients with bifurcation and nonbifurcation lesions, with a trend toward higher target lesion failure in the bifurcation cohort. The results, while compelling, require larger studies with longer follow-up, stratified by bifurcation strategy.
Assuntos
Doença da Artéria Coronariana , Stents Farmacológicos , Intervenção Coronária Percutânea , Estudos de Coortes , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Resultado do TratamentoRESUMO
Lead barriers to reduce operator radiation exposure in the catheterization laboratory are effective. This study of a novel vertical radiation shield suggests significant reduction in operator radiation exposure when used in addition to standard protection methods. Although additional barriers may help reduce radiation exposure, further education and training of operators in radiation safety may be as effective and perhaps more effective than additional barriers.
Assuntos
Exposição Ocupacional , Exposição à Radiação , Proteção Radiológica , Cateterismo Cardíaco , Doses de Radiação , Radiografia Intervencionista , Resultado do TratamentoRESUMO
As indications for TAVR expand, there is a need for predictive models of procedural complications. Application of the HAS-BLED score demonstrated patient comorbidities that contribute to increased bleeding events and mortality. Further adequately powered studies will be needed to validate the HAS-BLED score for use in the TAVR population or further elucidate important risk factor to incorporate into future predictive risk models.
Assuntos
Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter , Hemorragia , Humanos , Fatores de Risco , Resultado do TratamentoRESUMO
Robotic-assisted PCI appears to be safe and feasible in both simple and complex lesions. In this small cohort study, analysis of manual versus robotic PCI suggests comparable clinical outcomes. Further adequately powered, randomized, multicenter studies are needed to definitively evaluate outcomes in manual versus robotic-assisted PCI.
Assuntos
Intervenção Coronária Percutânea , Procedimentos Cirúrgicos Robóticos , Robótica , Estudos de CoortesRESUMO
Endothelial progenitor cells (EPCs) may allow accelerated and functional endothelialization of stents, theoretically reducing late stent complications as well reducing the duration of DAPT. In a pilot study of 193 patients at high risk of target vessel failure (TVF), the Genous EPC capturing stent (ESC) and TAXUS Liberté paclitaxel-eluting second-generation stent (PES) were similar at 5-years. Events rates appear higher for ESC within the first-year followed by higher rate of complications for PES during years 2-5. A larger randomized multi-center trials powered for non-inferiority of ECS to PES is underway.
Assuntos
Doença da Artéria Coronariana , Reestenose Coronária , Stents Farmacológicos , Células Progenitoras Endoteliais , Seguimentos , Humanos , Paclitaxel , Projetos Piloto , Estudos Prospectivos , Stents , Resultado do TratamentoRESUMO
As indications for TAVR continue to grow, experienced centers strive to adopt further minimally invasive techniques and continue to improve outcomes. Meta-analysis of the available data demonstrate that conscious sedation is associated with decreased ICU and hospitalization time, and is not associated with decreased procedural efficacy or safety. Randomized Controlled clinical Trial data will be needed to confirm observational findings suggesting decreased mortality with conscious sedation versus general anesthesia.
Assuntos
Sedação Consciente , Substituição da Valva Aórtica Transcateter , Anestesia Geral , Valva Aórtica/cirurgia , Humanos , Resultado do TratamentoRESUMO
The authors suggest that the early durability of the CoreValve implant should not be in question based on the results of this modestly sized, but well-done postmortem observational study. Given the ever-expanding knowledge of valvular degeneration, one thing is clear: more research and study is needed before any routine change in clinical practice, such as change it antithrombotic therapy, can be recommended. Further autopsy studies of patients who die outside of typical healthcare settings and who have had a longer median implant time would aid greatly in furthering the understanding of the degeneration and natural history of bioprosthetic transcatheter heart valves.
Assuntos
Doenças das Valvas Cardíacas , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Humanos , Resultado do TratamentoRESUMO
Prosthesis-patient mismatch (PPM) is defined as a small effective orifice area (EOA) of a normally functioning prosthetic valve in relation to patient body size. Even moderate impediment to forward flow has been associated with an increase in all-cause mortality. We report an unusual cause of PPM where a transcatheter implantation of a large EOA valve in an aortic position results in relative PPM in a patient with morbid obesity. © 2016 Wiley Periodicals, Inc.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Obesidade Mórbida/complicações , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Índice de Massa Corporal , Superfície Corporal , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler , Humanos , Masculino , Obesidade Mórbida/diagnóstico , Desenho de Prótese , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoRESUMO
Reimbursement in the healthcare system is shifting from pure volume to a mixed volume/value-based metric. Using complex statistical modeling to adjust for unknowns, the study provides real world data that the use of Co-Cr EES is more cost effective than BMS assuming that clinicians select clopidogrel for P2Y12 inhibition. More cost-effectiveness analyses should be conducted to guide the use of ever costlier novel medical devices and drugs.
Assuntos
Stents Farmacológicos , Intervenção Coronária Percutânea , Cromo , Cobalto , Análise Custo-Benefício , Everolimo , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , StentsRESUMO
Authors suggest the use of an investigator-owned and directed, prospective, non-randomized, single-arm multicenter registry at 23 Italian hospitals to follow 500 STEMI patients who receive BVS. Follow-up of patients is out to 5 years to determine how a BVS which has been deployed according to the IFU performs in these ACS patients. There is no comparator arm. Mandate that patients included in this registry follow a strict BVS implantation protocol which is felt to mitigate the not insignificant stent thrombosis rates noted with BVS to date.
Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Implantes Absorvíveis , Everolimo , Humanos , Itália , Estudos Prospectivos , Desenho de Prótese , Resultado do TratamentoRESUMO
Increasing annular calcification portends more adverse outcomes and worse hemodynamic results following percutaneous structural heart interventions. Though the Direct Flow prosthesis did not appear to have significantly different post-procedural gradients based on aortic valve calcium burden in a selected group of patients, the average residual gradients were relatively high in all cases and the presence of a paravalvular leak was more common with increasing valvular calcification. It is unclear how the Direct Flow prosthesis fits into the armamentarium of TAVR prostheses.
Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Valva Aórtica/cirurgia , Cálcio , Cateterismo Cardíaco , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca , Humanos , Desenho de Prótese , Resultado do TratamentoRESUMO
Pressure-bound (pb) coronary flow reserve (CFR) is a novel estimation of CFR, calculated from easily obtained baseline and hyperemic pressure assessment Validation of pb-CFR in previously reported lesions showed accuracy of 84% to CFR with sensitivity of 96% and specificity of 60% FFR >0.75 and low pb-CFR in DEFER was associated with increased angina and complications compared to high pb-CFR and this risk was not modified by elective revascularization.
Assuntos
Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Hiperemia , Velocidade do Fluxo Sanguíneo , Humanos , Sensibilidade e EspecificidadeRESUMO
Subintimal tracking and reentry (STAR) has been used as a bailout strategy and involves an uncontrolled dissection and recanalization into the distal lumen to reestablish vessel patency. In the current study, thrombolysis in myocardial infarction (TIMI) flow < 3 was the only variable which they found to be significantly associated with restenosis and reocclusion after stent placement. It may be reasonable to consider second generation drug eluting stent placement in patients receiving STAR that have TIMI 3 flow, however, this should only be done if there is no compromise of major side branches. If unsure, we recommend to perform balloon angioplasty without stenting.
Assuntos
Stents Farmacológicos , Resultado do Tratamento , Angioplastia Coronária com Balão , Angiografia Coronária , Humanos , Infarto do Miocárdio , Stents , Grau de Desobstrução VascularRESUMO
The TRYTON study evaluated routine side branch (SB) stenting with a novel bare metal stent (BMS) designed for true bifurcation lesions (Medina 1,1,1; 1,0,1; 0,1,1) and compared it to a strategy of balloon angioplasty with provisional stenting. It failed to meet the primary endpoint of non-inferiority in target vessel failure mainly driven by peri-procedural myocardial infarction (MI) with elevated CK-MB > 3× the upper limit of normal. In this substudy, 41% of patients who had a SB diameter > 2.25 mm were evaluated and the new stent was found to be non-inferior in the primary outcome of target vessel failure with no difference in post-procedural MI. This substudy suggests that appropriately sized SB stents with TRYTON may be useful when the SB is >2.25 mm in diameter. However, further studies could evaluate routine use of FFR for SBs; drug eluting versions of the stent as well as stents designed for vessels 2.25 mm in diameter which are frequently felt to be clinically larger when not subjected to core lab analysis.
Assuntos
Angiografia Coronária , Stents Farmacológicos , Angioplastia Coronária com Balão , Humanos , Estudos Prospectivos , Stents , Resultado do TratamentoRESUMO
Provisional use of rotational atherectomy (RA) is indicated for procedural success in heavily calcified lesions. In the current study, RA use at three high volume percutaneous coronary intervention (PCI) centers between 2005 and 2013 was 1.4%. MACE rate was 17.8% at median follow-up of 22 months. Peripheral vascular disease (PVD), diabetes mellitus (DM), acute coronary syndrome (ACS), and SYNTAX > 23 were found to be independently associated with MACE. With increasing complexity of disease and SYNTAX score, there is usually an increase in severity of calcification and need for atherectomy. Complete revascularization with residual SYNTAX reduced to < 8 is associated with improved outcomes. Incompleteness of revascularization in patients with SYNTAX > 33 rather than procedural success of the target vessel with atherectomy may have contributed to the adverse outcomes.
Assuntos
Doença da Artéria Coronariana , Calcificação Vascular , Angiografia Coronária , Humanos , Resultado do TratamentoRESUMO
With the plethora of clinical trials, it is difficult for busy interventional cardiologists to stay up to date. Therefore, the SCAI Publications Committee concisely summarizes and provides editorial commentary on the most important structural heart and peripheral arterial disease trials from the large international meetings of 2014. The intent is to allow quick assimilation of trial results into interventional practice.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiologia/métodos , Ensaios Clínicos como Assunto , Congressos como Assunto , Cardiopatias/cirurgia , Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares , Humanos , Estudos RetrospectivosRESUMO
With the plethora of clinical trials, it is difficult for busy interventional cardiologists to stay up to date. Therefore, the SCAI publications committee concisely summarizes and provides editorial commentary on the most important trials from recent, large international meetings. The intent is to provide this summary every six months to allow quick assimilation of trial results into interventional practice. © 2014 Wiley Periodicals, Inc.