ABSTRACT
Stenting of muscle bridge is still a controversial issue with concerns regarding high restenosis rates, plaque prolapse and stent fracture. We report a case with significant atherosclerotic disease of right coronary artery and left anterior descending artery associated with a muscle bridge, proximal to the diseased segment which became more prominent after stenting the fixed lesion. This was managed by implanting another drug eluting stent, covering the bridge. Angiographic follow-up at 9 months revealed no difference in quantitative coronary angiography parameters in the stented segment of the bridge, as compared to other stented segments.
Subject(s)
Aged , Coronary Artery Disease/drug therapy , Coronary Restenosis/prevention & control , Drug-Eluting Stents/adverse effects , Humans , Male , Myocardial Bridging/diagnosisABSTRACT
Air travel is implicated as a predisposing factor for thromboembolism, which at times can have catastrophic consequences. We present 3 cases who developed deep vein thrombosis (DVT) and subsequent pulmonary thromboembolism (PTE) after transatlantic air travel. The relevant literature is discussed.
Subject(s)
Adult , Aerospace Medicine , Aircraft , Anticoagulants/therapeutic use , Enoxaparin/therapeutic use , Fibrinolytic Agents/therapeutic use , Humans , Male , Middle Aged , Pulmonary Embolism/drug therapy , Risk Factors , Travel , Urokinase-Type Plasminogen Activator/therapeutic use , Venous Thrombosis/drug therapy , Warfarin/therapeutic useSubject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Dengue/diagnosis , Disease Outbreaks , Echocardiography , Electrocardiography , Female , Humans , India/epidemiology , Infant , Male , Middle Aged , Myocarditis/diagnosis , Prospective StudiesABSTRACT
BACKGROUND: Coronary angiography using 4 F catheters may reduce access-site complications and enable early ambulation, although earlier studies suggested that the quality of images may be an issue of concern. METHODS AND RESULTS: To ascertain the quality of angiographic images and safety of early ambulation, 500 patients were randomized to coronary angiography with either 4 F or 6 F catheters. Procedural characteristics, angiographic quality scores and results of ambulation were analyzed in the two groups. Patients in the 4 F group were mobilized at 2 hours post-procedure while those in the 6 F group were ambulated at 6 hours. There was no procedure-related complication in either group. The procedure was successfully completed in 250 of 252 patients randomized to the 4 F group. In two patients in the 4 F group, sheaths were upgraded to 6 F to complete the procedure, as difficulty was encountered in hooking the coronary ostium with a 4 F Judkin's catheter. Coronary angiographic quality scores in these two groups were comparable. Angiographic scores for the 4 F and 6 F groups for the left coronary artery averaged 4.45+/-0.5 and 4.58+/-0.3 (p>0.1), respectively. The right coronary artery scores averaged 4.30+/-0.4 and 4.35+/-0.2 (p>0.1) in the 4 F and 6 F groups. Angiographic scores for the left ventricular angiogram averaged 4.22+/-0.1 and 4.44+/-0.3 (p>0.1) in the 4 F and 6 F groups, respectively. None of the angiograms were assigned a score of <3.0 (not diagnostic). The total contrast volume consumed in the two groups was also equivalent. There were no groin-related complications in the 4 F group although these patients were ambulated 2 hours after the procedure. CONCLUSIONS: Coronary angiography performed with a 4 F catheter is a safe and reliable procedure. The quality of image obtained with a 4 F catheter is equivalent to that obtained with a 6 F catheter. Early ambulation at 2 hours is feasible without compromising safety.