Insuffisance mitrale aigue ischémique place de l'angioplastie coronaire. A propos d'un cas / Acute ischemic mitral insuffi ciency instead of coronary angioplasty. About a case report

Introduction. L'insuffi sance mitrale ischémique est une complication fréquente et représente un facteur de mauvais pronostic. Sa prise en charge thérapeutique est diffi cile. L'objectif de ce travail est de réévaluer l'intérêt de la revascularisation par angioplastie en cas d'insuffi sance mitrale ischémique importante. Observation et conclusion. Nous rapportons le cas d'un patient âgé de 48 ans ayant comme facteurs de risque cardiovasculaire ; une hypertension artérielle non suivie et un tabagisme actif (20 Paquets/année) qui s'était présentait pour un syndrome coronaire aigu compliqué d'une insuffi sance mitrale sévère et d'une insuffi sance cardiaque gauche avec une altération de la fraction d'éjection ventriculaire gauche à l'échocardiographie. La coronarographie montrait une atteinte tritronculaire. La revascularisation complète par angioplastie a permis une bonne évolution à cinq (5) ans

Limb revascularization of peripheral artery disease in the developing countries: earliest 1-year experience from Northwestern Nigeria

Purpose: The purpose of the study is to present the preliminary audit and challenges of earliest cases of balloon angioplasty from Northwestern Nigeria. Materials and Methods: We present our first 25 cases of peripheral angioplasty in Northwestern Nigeria. The clinical diagnosis of peripheral artery disease was confirmed with Doppler ultrasound and angiography. Angioplasty was done either through femoral or brachial artery approaches. The patients were monitored for minimum of 6 months with serial clinical and Doppler ultrasound examinations. Results: Our patients consist of 19 males and 6 females. Their ages ranged from 20 to 80 years with a mean of 54 ± 17.5 years. There were 13 hypertensive and 15 diabetic patients while 5 patients have co-morbidities of diabetes and Hypertension. Although femoral antegrade route is the common access for angioplasty (14 out of 25), seven patients who were treated through the left brachial artery, six of them had either Type C or D aortoiliac disease in addition to distal lesions. At follow-up, 36% had limb amputation while one patient died a day after the procedure. Out of nine patients who had amputation, six are diabetic. Conclusion: Although more than half of them had improved blood flow with healing ischemic ulcers and reducing claudications, still substantial number of our patients often present late with severe peripheral artery disease. As a result, we had to resort to cumbersome arterial access and high amputation rate

Association between crural vessel patency and successful transmetatarsal amputation: a single centre experience

Background:Transmetatarsal amputation (TMA) has a reputation for failure, centred around wound breakdown. No study has looked at the direct association between the patency of individual crural arteries and the healing of TMA. TMA relies on a posterior skin flap which derives its blood supply from the posterior tibial (PT) artery. We investigated the association between PT patency and achievement of successful TMA. Methods: A retrospective review of all patients undergoing TMA for complications of peripheral arterial occlusive disease in a regional vascular tertiary referral centre over a 9 year period (2006­2015). TMA was considered successful by the absence of a higher-level amputation. Follow-up was for a minimum of 12 months.Results: 24 patients (21 male; mean age 64 years) were studied. TMA was successful in 16 (67%). On statistical analysis, successful TMA was not significantly associated with vessel patency in either superficial femoral artery (SFA), or any single or combination of named crural artery.Conclusion:TMA healing can be achieved in the absence of a patent posterior tibial artery. We support the role of TMA in selected patients, given its benefits compared to transtibial amputation

Traitement endovasculaire de l'accident vasculaire cérébral

Ischemic stroke (IS) is an acute pathology that requires an urgent treatment and a complex organization for the health care systems. IS is the second mortality reason around the world and the third one in industrialized countries based on World Health Organization database. IV thrombolysis started in 1996 as a treatment for IS with the administration of reteplase or Rt-PA up to 4h30 after symptoms beginning with 30 to 40% of efficacy. Mechanical thrombectomy (MT) allows to expand therapeutic window further than IV thrombolysis and higher efficacy. Therapeutic decision is multidisciplinary with senior doctors and appropriate materials: stroke unity composed by interventional neuroradiologists, angio-room, department of Neurosurgery, Intensive Care and imaging equipments to perform neuroradiological examens. MT is considered the gold standard treatment for IS if Aspect Score is > to 5 and symptoms started not more 6 hours before endovascular treatment. Randomized studies showed the superiority of MT + IV thrombolysis over IV thrombolysis only. Endovascular treatment by MT requires financial support from health care systems, but the price is justified by the lower number of disabled patients because morbidity, functional impacts and quality of life at 90 days

Short and Long-Term Outcomes of Percutaneous Coronary Intervention in Patients with Low; Intermediate and High Ejection Fraction : Cardiovascular Topics

Reduced ejection fraction (EF) has previously been shown to be a risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). However; with the advent of stents; procedural complications and restenosis rates have reduced dramatically. The aim of this study was to assess the association between left ventricular (LV) ejection fraction and in-hospital and longterm outcomes using a prospective registry. Methods : After exclusion of patients with acute myocardial infarction (MI) and those with missing data on left ventricular ejection fraction; 2 030 patients undergoing PCI between March 2002 and 2004 remained in our prospective registry. Patients were divided into three categories: group 1: EF 40(n = 293); group 2: EF = 41-49(n = 268) and group 3: EF 50(n = 1 469). The frequency of in-hospital and follow-up outcomes between groups was compared using appropriate statistical methods. Results: Stents were used for over 85of the patients in each group. The mean EF + SD in the lowest to highest EF groups was 35.8 + 5.4; 45.5 + 1.6and 57 + 5.7; respectively. The angiographic and procedural success rates were 91.8; 92.1 and 94.1; (p = 0.16); and 91.1; 90.3 and 92.9; (p = 0.09); respectively. The respective cumulative major adverse cardiac events (MACE) and cardiac death rates at follow-up were 5.8; 2.2 and 3.3(p = 0.04) and 2; 0.4 and 0.3(p = 0.02); respectively. The hazards ratio (95CI) for MACE and cardiac death in the lowest versus highest EF groups were 2.07 (1.03-4.16) and 5.49 (1.29-23.3). Conclusion : Patients with significant left ventricular dysfunction had higher long-term major adverse cardiac events and cardiac death rates. Even the use of newer techniques such as stenting did not compensate for this