Percutaneous treatment for Aneurigsmal coarctation of the aorta with covered stenting: a case report

The coarctation of the aorta [CoA] is rare in adulthood. Diagnosis is made by clinical suspicion and physical findings such as blood pressure difference between the upper and lower extremities, pulse delay in the femoral artery, and systolic murmur over the thoracic spine. The CoA in adulthood and in patients with associated aneurysm is challenging and different complications even with proper treatment can occur. Covered stents are indicated in concomitant aneurysm, older age, and tight coarctation. A 26-year-old male with resistant hypertension due to a CoA diagnosed by computed tomography angiography referred to our center for an attempted stent implantation. Cardiac catheterization and aortography revealed a long CoA after the origin of the left subclavian artery with a 60 mmHg gradient. Moreover, there was a large aneurysm in the site of the coarctation. Under general anesthesia and fluoroscopic guidance, two balloon-expandable covered Cheatham-Platinum stents [size 18 in 44 millimeters and size 18 in 50 millimeters] were successfully implanted across the CoA with no residual gradient. On 2 years' follow-up, the patient had no symptoms except for mild hypertension. In this patient, the use of a covered stent within the aneurysm was safe and effective

Bone mineral density and coronary atherosclerosis

The association between low bone mineral density [BMD] and atherosclerosis is still unknown. In this study BMD assessed in patients with and without coronary artery atherosclerosis is determined by angiography. A total number of 123 consecutive patients referred for coronary angiography were evaluated by dual X-ray absorptiometry. Obstructive CAD was diagnosed when >/= 50% of lumen was narrowed. Conventional atherosclerosis risk factors were also assessed. The mean age of the patients was 59 +/- 8 years. There was frequency of 48.7% male. The prevalence of diabetes was 31.2%, hypertension 57%, dyslipoproteinaemia 51%, vitamin D deficiency 50% and history of smoking 80.8%. Coronary angiography was normal in 15 patients [12.6%] while 67 patients [55.5%] had obstructive CAD. DXA scan showed 25 patients [21%] with normal BMD, 39 patients [32.7%] with osteopenia, and 55 others [46.2%] with osteoporosis. Lower BMD results were significantly associated with older age and lower BMI but it was not associated significantly with diabetes, hypertension, lipids levels or smoking. Moreover the prevalence of obstructive CAD and minimal CAD differed between groups with normal and low bone density but this was not significant [p = 0.67 and 0.52, respectively]. The mean T score comparison between patients with and without CAD was also not different. In patients with and without obstructive CAD the prevalence of low BMD results are not different

Prevalence of obesity and diabetes in coronary artery disease

Obesity is a common public health problem reaching epidemic proportions in recent decades. Increased BMI imposes a pro- inflammatory state, releasing factors such as high sensitivity-C reactive protein which is strongly associated with plaque rupture and acute cardiovascular events. Also the prevalence of type 2 diabetes has reached epidemic level. A total of 400 consecutive patients recruited in this cross sectional study from April 2009 to December 2009 who was candidate for coronary angiography. Baseline clinical characteristics and coronary angiography data collected. Data analysis performed using 2-sided independent-sample t-tests. Out of 400 patients recruited in the study 253 were male. Obesity and diabetes observed in 65.7% and 32.5% of these patients respectively. Hypertension was more prevalent in obese patients [p=0.013] while dyslipidemia was not significantly different. The severity of coronary artery lesions were significantly associated with diabetes but not related to obesity [pvalue=0.0001 and 0.316 respectively]. The main finding of this preliminary study was that diabetes is significantly related to severity of coronary artery disease and hypertension and hyperlipidemia is more prevalent in diabetic patients. Moreover, obesity is not significantly related to severity of coronary artery lesions