RESUMO
Immunoglobulin G4 (IgG4)-related disease is an emerging new clinicopathological disorder that is characterized by elevation of serum IgG4 levels and histological findings of IgG4-positive plasmacytic infiltration. IgG4-related disease may appear synchronously or metachronously in a wide variety of organs. The current patient was found to have pericardial effusion and retroperitoneal fibrosis. He was subsequently diagnosed with coronary artery stenosis. (18)F-FDG positron emission tomography showed enhanced FDG uptake in lymph nodes as well as pericardial and peri-aortic tissue. Histopathology of the mediastinal lymph node showed the infiltration of numerous IgG4-positive cells, leading to the diagnosis of IgG4-related lymphadenopathy with pericardial and periarterial involvement.
Assuntos
Aorta Abdominal/diagnóstico por imagem , Imunoglobulina G/sangue , Linfadenopatia/diagnóstico por imagem , Pericardite/diagnóstico por imagem , Derrame Pleural/terapia , Corticosteroides/administração & dosagem , Idoso , Constrição Patológica/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Drenagem/métodos , Humanos , Linfadenopatia/tratamento farmacológico , Linfadenopatia/patologia , Masculino , Pericardite/tratamento farmacológico , Pericárdio/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaRESUMO
The role of pentraxin 3 (PTX3) has been implicated in the process of plaque vulnerability. However, few studies have addressed the direct relationship between plaque morphology and plasma PTX3. We evaluated the relationship between coronary vulnerable plaque, assessed by optical coherence tomography (OCT), and plasma PTX3 in patients with coronary artery disease (CAD).OCT was used to determine plaque vulnerability in 51 patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS; n = 17) and stable angina (SA; n = 34). Both highly-sensitive C-reactive protein and systemic plasma PTX3 were measured.Based on the OCT findings, patients were divided into 3 groups; a fibrous plaque (n = 18), thick-cap fibroatheroma (ThCFA) (n = 19), and thin-cap fibroatheroma (TCFA) (n = 14) groups. ThCFA was defined as a lipid-rich plaque (lipid content in ≥ 2 quadrant) covered with ≥ 65 µm thick fibrous cap, and TCFA was that with < 65 µm. There were no differences in patient characteristics between the 3 groups except for the presence of ACS and eicosapentaenoic acid levels. TCFA was more frequently observed with plaque rupture and intraluminal thrombus compared with the other 2 groups. Plasma PTX3 levels were higher in the TCFA group compared with the fibrous plaque and ThCFA groups, and showed weak correlation with cap thickness.Plasma PTX3 level was associated with plaque vulnerability assessed by OCT in patients with CAD.
Assuntos
Proteína C-Reativa/metabolismo , Doença da Artéria Coronariana/sangue , Vasos Coronários/diagnóstico por imagem , Placa Aterosclerótica/sangue , Componente Amiloide P Sérico/metabolismo , Tomografia de Coerência Óptica/métodos , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Eletrocardiografia , Feminino , Humanos , Masculino , Placa Aterosclerótica/diagnóstico por imagem , Valor Preditivo dos Testes , Ultrassonografia de Intervenção/métodosRESUMO
Infected aneurysm (IA) of the anterior interosseal artery (AIA), the first branch of the ulnar artery, is an infrequent but serious complication of infectious endocarditis (IE). We report a successful case of excision of IA arising from AIA. In this case, the IA expanded and adhered to the ulnar artery, resulting in occlusion of the ulnar artery. Reconstruction of the ulnar artery was not needed by the preoperative evaluation and the intraoperative occlusion testing. We discuss surgical treatment of IA following IE in upper extremities.
Assuntos
Aneurisma Infectado/cirurgia , Arteriopatias Oclusivas/etiologia , Endocardite Bacteriana/complicações , Artéria Ulnar , Extremidade Superior/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Antibacterianos/uso terapêutico , Arteriopatias Oclusivas/diagnóstico por imagem , Constrição Patológica , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Enterococcus/isolamento & purificação , Humanos , Ligadura , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagemRESUMO
N,N'-Dimethylated imidazo[1,5-a]pyridinium salt having good water solubility and exhibiting fluorescence emission was found to work as not only a bioimaging agent but also a therapeutic agent under UVA-LED irradiation conditions. Because the continuous UVA-LED irradiation to HeLa cells stained by the synthesized salt resulted in the cell death due to the mitochondrial damage, the salt has a potential application as photodynamic therapy agent against tumor cells.
RESUMO
OBJECTIVES: To identify the impact of occlusion duration (OD) and, in particular, an indeterminate occlusion duration (IOD) on immediate angiographic success and long-term clinical outcomes in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: From May 2003 to October 2006, all patients having PCI for a CTO were consecutively registered. In addition to an assessment of procedural outcomes, patients were followed long-term for occurrence of major adverse cardiac events (MACE). RESULTS: 202 consecutive patients were included. Of these, 123 (60.9%) had a known OD while in the remaining 79 (39.1%), OD was indeterminate. Overall technical success was 82.7% and was lower in the IOD group (70.9% vs. 90.2%, P = 0.0004). An IOD was a predictor of procedural failure (adjusted OR 4.51, 95% CI 1.7-11.5, P = 0.002). An IOD (HR 2.59, 95%CI 1.08-6.23, P = 0.032) and procedural success (HR 0.26, 95%CI 0.11-0.60, P = 0.002) were the only independent predictors of long-term MACE. Patients with a failed PCI and an IOD had a 5-fold increased risk of MACE compared to those with known OD (37.0% vs. 7.1%, log rank P = 0.0036). CONCLUSIONS: In addition to the traditional predictors of procedural success and clinical outcome, this study, for the first time uncovered the importance of OD and, in particular, of an IOD. Still, in patients who are successfully recanalized, a long or IOD bears the same low rate of MACE as the general CTO population while in patients with failed PCI, an IOD carries a considerable risk of adverse prognosis.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Doenças Cardiovasculares/etiologia , Oclusão Coronária/terapia , Idoso , Calcinose/complicações , Doenças Cardiovasculares/mortalidade , Angiografia Coronária , Circulação Coronária , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/mortalidade , Oclusão Coronária/fisiopatologia , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Razão de Chances , Inibidores da Agregação Plaquetária/uso terapêutico , Modelos de Riscos Proporcionais , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Falha de TratamentoRESUMO
BACKGROUND: Stenting the main vessel with provisional stenting of the side branch (SB) is the method of choice for most bifurcation lesions. There is limited data on which of the two techniques of bifurcation stenting compatible with a provisional approach, culotte or T-stenting, offers the best outcome. METHODS: Between February 2004 and October 2005, 80 consecutive patients with bifurcation lesions requiring a second stent on the SB were treated with either culotte (n = 45) or T-stenting (n = 35). Coronary angiograms were analyzed using a quantitative angiography system dedicated to bifurcations. Propensity scores were used to adjust for baseline differences between groups. RESULTS: Acute procedural success was 100% for both groups. Residual diameter stenosis of the SB ostium was 3.44% +/- 7.39% in the culotte group versus 12.55% +/- 11.47% in the T-stenting group (P < .0001). One patient (2.2%) in the culotte group had subacute thrombosis 2 days after the procedure. The culotte group had a lower target lesion revascularization rate compared with the T-stenting group (8.9% vs 27.3% propensity score adjusted; P = .014) and a trend toward lower major cardiac adverse events at 9 months (13.3% vs 27.3%; P = .051). CONCLUSION: Both techniques of provisional SB stenting in bifurcation lesions achieve high procedural success with low complication rates. The culotte technique yields a better immediate angiographic result at the SB ostium, and, using drug-eluting stents, a better clinical outcome at 9 months.
Assuntos
Angioplastia Coronária com Balão/métodos , Estenose Coronária/terapia , Imunossupressores/administração & dosagem , Stents , Idoso , Angiografia Coronária , Estenose Coronária/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Sirolimo/administração & dosagemRESUMO
A 48-year-old woman was referred to the cardiology department due to a large mobile mass in the right ventricle. The patient had undergone radical hysterectomy and bilateral salpingo-oophorectomy for a uterine squamous cell carcinoma approximately 3.5 years before. In order to protect the patient from circulatory collapse, the intracardiac mass was resected surgically. A diagnosis of cardiac metastasis of the uterine cervical squamous cell carcinoma was confirmed histologically. Herein we discuss the possible therapeutic approach to and prognosis of this rare condition by reviewing 24 papers on intracardiac uterine cancer metastasis published in the past 10 years.
RESUMO
A 36-year-old man presented with near-syncope. He was found to have massive pericardial effusion with a giant pericardial tumorous lesion. The pericardial effusion exhibited a bloody nature; however, neither malignant cells nor infectious organisms were detected. (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed an increased uptake of FDG in the pericardial tumor only. Although the tumor was not resectable, thoracotomy and tissue sampling were performed. A histological analysis showed CD99 positivity and SYT gene rearrangement, leading to a diagnosis of synovial sarcoma arising from the left lateral pericardial surface. The patient is now receiving chemotherapy.
Assuntos
Tamponamento Cardíaco/etiologia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico , Derrame Pericárdico/complicações , Pericárdio/patologia , Sarcoma Sinovial/complicações , Sarcoma Sinovial/diagnóstico , Adulto , Antibióticos Antineoplásicos/uso terapêutico , Doxorrubicina/uso terapêutico , Ecocardiografia , Fluordesoxiglucose F18 , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/terapia , Humanos , Masculino , Derrame Pericárdico/etiologia , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Sarcoma Sinovial/diagnóstico por imagem , Sarcoma Sinovial/terapia , Resultado do Tratamento , Imagem Corporal TotalRESUMO
Recent studies suggest that the cardiovascular system might be a possible target of immunoglobulin G4-related disease. Here we present a 66-year-old man who was admitted to our hospital because of chest symptoms suggestive of acute coronary syndrome. Besides luminal narrowing of the coronary arteries, marked periarterial thickening around the coronary artery was observed by computed tomography coronary angiography. Serum immunoglobulin G4 levels of this patient were elevated (564 mg/dL). The patient underwent coronary bypass surgery. After incision of the pericardium, a glittery white-yellowish, elastic-hard periarterial mass surrounding the left circumflex artery could be seen. Histologic analysis of the biopsy specimen showed the formation of lymphoid follicles and the presence of immunoglobulin G4-positive plasma cells; therefore, the diagnosis was immunoglobulin G4-related coronary periarteritis accompanied by physiologically significant myocardial ischemia.
Assuntos
Arterite/complicações , Vasos Coronários/patologia , Imunoglobulina G/sangue , Isquemia Miocárdica/complicações , Plasmócitos/patologia , Idoso , Arterite/sangue , Arterite/cirurgia , Vasos Coronários/cirurgia , Humanos , Masculino , Isquemia Miocárdica/sangue , Isquemia Miocárdica/cirurgiaRESUMO
BACKGROUND: The introduction of optical coherence tomography (OCT) as an intracoronary imaging modality has allowed accurate assessment of strut apposition and neointimal tissue coverage. This study set out to assess the inter and intraobserver variability of measurements of acute stent apposition and strut tissue coverage using OCT. METHODS: Thirty patients were studied (14 immediately after stent implantation and 16 during follow-up angiography [mean of 4.7+/-2.8 months]) using OCT (LightLab, Westford, Massachusetts, US). Data analysis was performed by 2 experienced observers. Struts were classified as "embedded", "protruding" or "malapposed" to the vessel well and recorded as percentage of total struts. Intimal coverage at follow-up was measured as the thickness of tissue covering each strut expressed in mum. Intra and interobserver variability was assessed by Bland-Altman plots and by calculation of the intraclass correlation coefficient (ICC). RESULTS: An average of 3967 struts was examined by each observer and, overall, 53.7% of struts was embedded, 36.4% protruding and 9.9% malapposed. Low intraobserver variability for all measures of strut apposition was found, with repeatability coefficients that ranged between 5.1% and 9.3% and ICC exceeding 95% in all cases. Interobserver variability was also low (repeatability coefficients 6.6-10.8 and ICC>91.3%). Mean intimal thickness in the follow-up group was 172.5 microm. Bland-Altman plots demonstrated a low intraobserver and interobserver variability for intimal thickness, with repeatability coefficients 26.7 mum and 24.1 mum, respectively and ICC exceeding 98.6% for both. CONCLUSIONS: Low intra and interobserver variability can be expected when analyzing OCT data for stent apposition and tissue coverage. This supports the validity of OCT as a clinical and research tool in the setting of intracoronary stent imaging.
Assuntos
Angiografia Coronária/métodos , Stents , Tomografia de Coerência Óptica , Angioplastia Coronária com Balão , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Ajuste de Prótese , Túnica Íntima/diagnóstico por imagemRESUMO
BACKGROUND: Stent strut malapposition correlates with poor intimal coverage and this may increase the risk of late stent thrombosis. At present, there is limited data on whether stent strut thickness and stent design impact on acute apposition. We aimed to investigate the influence of stent strut thickness and design on acute stent strut apposition (SSA) immediately following drug-eluting stent (DES) implantation using optical coherence tomography (OCT), a technique with higher resolution and fewer artefacts than intravascular ultrasound. METHODS: Thirty-six DES in 23 patients (25 lesions) were studied by OCT. SSA was defined as embedded when a strut was buried in the intima for more than half its thickness, protruding when apposed to the intima but not embedded and malapposed when there was no intimal contact. RESULTS: Cypher Select stents were implanted in 52%, Taxus Liberte in 32%, Costar in 12% and Endeavour in 4%. A total of 6402 struts were evaluated. Despite stent optimisation using balloons with a final balloon/artery ratio of 1.26+/-0.19 at a maximum inflation pressure of 17.5+/-3.0 atm, only 57.1+/-20.7% of struts were embedded, whereas 33.8+/-18.4% were protruding and 9.1+/-7.4% were malapposed. Stent type was a strong predictor of malapposition on logistic multilevel analysis (OR 3.95, 95%CI: 1.27-12.23, p=0.017). At 12 months follow-up, there were no adverse clinical events. CONCLUSION: Despite angiographic optimisation with high pressures and adequately sized balloons, malapposed stent struts are frequently found in complex coronary lesions and more often following the implantation of Cypher Select stents which have a thicker stent strut and closed cell design. With no adverse clinical events at 12 months follow-up, this likely represents a benign phenomenon at least as long as combined anti-platelet therapy is maintained.
Assuntos
Angioplastia Coronária com Balão/métodos , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Desenho de Prótese , Tomografia de Coerência Óptica/métodos , Idoso , Artefatos , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Stents Farmacológicos/efeitos adversos , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Túnica ÍntimaRESUMO
Heavily calcified lesions (HCL) continue to present challenges that are not always solved by modern low-profile, non-compliant high-pressure balloons, or bladed balloons. Uncrossable or unexpandable lesions need lesion modification, using ablating devices such as rotational atherectomy. Three cases of HCL treated with drug-eluting stents, using a new intravascular imaging device, Optical Coherence Tomography with 10-fold superior resolution and fewer artifacts compared with conventional intravascular ultrasound, are presented. Insights from using this highly sensitive imaging technique outline the high prevalence of persistent stent strut malapposition in this group, despite the use of high-pressure dilatation or rotational atherectomy.
Assuntos
Aterectomia Coronária , Calcinose , Cateterismo , Doença da Artéria Coronariana/terapia , Implantação de Prótese/normas , Stents , Tomografia de Coerência Óptica , Idoso , Stents Farmacológicos , Humanos , Masculino , Erros Médicos , Pessoa de Meia-IdadeRESUMO
We report a case of restenosis following ostial stenting of the right coronary artery, with protrusion of the stent into the aorta. Despite multiple attempts, no wire could be advanced coaxially inside the stent. The solution was to pass a wire through the struts of the protruding stent and crush it using progressively larger balloons and, finally, a drug-eluting stent was expanded to high pressure. The highlight of this case report is the final intravascular ultrasound image, revealing the profound deformation of the previous stent to restore a large ostial lumen and regain vessel access.
Assuntos
Angioplastia Coronária com Balão/métodos , Reestenose Coronária/terapia , Stents/efeitos adversos , Idoso , Angiografia Coronária , Humanos , Masculino , Ultrassonografia de IntervençãoRESUMO
AIMS: Overlapping drug-eluting stents (DES) are frequently implanted to cover long segments of diseased and injured vessel, or as a bailout technique for edge dissection or incomplete lesion coverage. DES overlap is, nevertheless, associated with strut malapposition and poor intimal coverage, which may increase the risk of stent thrombosis. The aim of this study is to evaluate stent strut apposition in overlapping DES. METHODS AND RESULTS: We assessed strut apposition in 10 overlapped segments (20 DES, 10 patients, 661 struts) immediately after implantation, using optical coherence tomography (OCT). Struts were defined as malapposed when no contact with the intima was detected by OCT, taking into consideration the strut thickness of each stent type. Despite aggressive stent optimisation using balloons with a final balloon/artery ratio of 1.26+/-0.18 at a maximum inflation pressure of 18.0+/-1.9atm, 41.8+/-21.5% of struts were malapposed in the overlapping segment, compared to 20.1+/-17.6% in the proximal and 9.7+/-10.6% in the distal segment (p =0.05 for both). CONCLUSIONS: OCT revealed that 40% of struts within an overlapped DES segment were malapposed, and this may explain the reported delay in endothelialisation in such segments.