ABSTRACT
We report the use of excimer-laser angioplasty for the treatment of Wiktor and Gianturco-Roubin in-stent restenosis of in two patients. Case 1-a 48-year-old man presented unstable angina five months after Wiktor stent was deployed in right coronary artery. Cardiac catheterization revealed stenosis (95) within the stent. Case 2-a 65-year-old man presented stable angina four months after Gianturco-Roubin stent was deployed in left anterior descending artery. Cardiac catheterization revealed stenosis (80) within the stent. Excimer-laser angioplasty within the stent reduced the stenosis to 19and 30, respectively. The patients recovered and currently, six months post-procedure, are free of chest pain, and cardiac catheterization revealed stenosis to 30and 35, respectively, within the stent. Therefore, the procedure was an effective means of treating restenosis after coronary stent placement, and a prospective comparison of excimer-laser angioplasty and other management alternatives to in-stent restenosis is needed.
Subject(s)
Humans , Male , Middle Aged , Coronary Disease , Angioplasty, Balloon, Laser-Assisted/methods , Recurrence , Angiography, Digital Subtraction , Stents , Treatment Outcome , Coronary Disease , Cardiac CatheterizationABSTRACT
The authors describe a rare case of circumflex coronary artery perforation during rotational coronary atherectomy complicated with cardiac tamponade and good outcome. The possible causes of perforation are discussed and the burr oversize (burr/artery ratio was 0.58) was refused. Shortening and artery plicature (accordeon effect) might have been the cause of this event. Quantitative measurement was made in order to strengthen this hypothesis. It is emphasized the importance of selecting lesions that should be submitted to rotational coronary atherectomy
É relatado caso raro de perfuração da artéria circunflexa durante aterectomia rotacional (AR), complicado com tamponamento cardíaco, que evoluiu favoravelmente. São discutidas as prováveis causas, afastando a possibilidade da ocorrência de um superdimensionamento da oliva utilizada (relação de diâmetro oliva-artéria foi de 0,58), e é sugerido o encurtamento e plicatura da artéria (efeito sanfona) como provável causa dessa perfuração. São feitas medidas quantitativas para reforçar essa hipótese, e ressaltam-se os cuidados necessários na escolha das lesões a serem submetidas à ablação com AR
Subject(s)
Humans , Male , Middle Aged , Coronary Disease , Coronary Vessels , Atherectomy, Coronary/adverse effects , Cardiac Tamponade/etiology , Cineangiography , Atherectomy, Coronary/instrumentationABSTRACT
A chronic total occlusion lasting 9.5 years, was successfully treated with a Prima (TN) Laser catheter, of Spectranectics. The authors report a case of a fifty seven year old male that suffered an inferior myocardial infarction 9.5 years ago. Although the morphological characteristics of the lesion seemed easy to pass through the obstruction with the guide wire, the balloon dilatation was not possible because of the hardness of a chronic lesion lasting that long. The intervention was concluded successfully in another opportunity using the laser catheter with certain facility. This case, reported as the first one in Latin America, rises new possibilities and increases the success rate of coronary angioplasty of total chronic occlusions. We hope that in the following cases we will be able to reach the same result, widening the indications of coronary angioplasty
Subject(s)
Humans , Male , Middle Aged , Coronary Disease/therapy , Angioplasty, Balloon, Laser-Assisted/methods , Angioplasty, Balloon, Coronary/methods , Coronary Disease/etiology , Chronic Disease , Myocardial Infarction/complicationsABSTRACT
Um caso raro de drenagem anômale das veias interventricular anterior e diagonal na cava superior em portadora de estenose pulmonar e comunicaçqao interatrial é apresentado para chamar a atençäo para a necessidade da idenficaçäo desta nomalia em portadores de outros defeitos congênitos do coraçäo com indicaçäo para correçäo cirúrgica, visto que, durante a instalaçäo da circulaçäo extracorpórea, a colocaçäo de uma sonda na cava superior poderá obstruir as veias anômalas com consegüente alteraçäo no fluxo coronário