Factores asociados a la nefropatía inducida por medios de contraste en pacientes con oclusión coronaria significativa / Contrast-induced nephropathy associated factors in patients with significant coronary obstruction

El intervencionismo coronario se asocia a la aparición de nefropatía inducida por contraste. El propósito del estudio fue evaluar el riesgo de desarrollar nefropatía inducida por contraste (NIC) en pacientes con obstrucción coronaria significativa y su relación con factores de riesgo conocidos para esta nefropatía. Se diseñó un estudio de cohorte prospectiva con 160 pacientes atendidos en el cardiocentro del hospital "Hermanos Ameijeiras", Cuba, a los cuales se les realizó una coronariografía invasiva, entre enero 2016 y julio 2017. La edad promedio fue de 61,6 ± 9,2 años; el 70,6% eran hombres. Predominaron los antecedentes patológicos personales de cardiopatía isquémica (85,6%), y de hipertensión arterial (75,6%). El 75% de los casos presentó una oclusión coronaria significativa. La frecuencia de nefropatía por contraste fue de 42,5%. Los factores que guardaron importante relación estadística con la presencia de oclusión arterial significativa fueron la cardiopatía isquémica conocida (p<0,001), el intervencionismo coronario percutáneo previo (p=0,007), la creatinina después (p=0,043) y la NIC (p=0,016) así como el volumen de contraste administrado (p=0,006). En el subgrupo de pacientes con oclusión significativa el hematocrito bajo (p=0,025) y el intervencionismo coronario percutáneo de urgencia (p=0,007) fueron los factores más influyentes. Se concluye que los pacientes con oclusión coronaria significativa tienen un riesgo aumentado para el desarrollo de la nefropatía por contraste. La corrección de aquellos factores de riesgo que sean modificables (como el hematocrito bajo) y la correcta aplicación del protocolo de hidratación son esenciales para prevenir esta complicación.

Coronary intervention is associated with the appearance of contrast-induced nephropathy. The purpose of the study was to assess the risk of developing contrast-induced nephropathy in patients with significant coronary obstruction and its relationship with known risk factors for this nephropathy. A prospective cohort study was designed with 160 patients treated at the cardiocenter of the "Hermanos Ameijeiras" hospital, Cuba, who underwent invasive coronary angiography, between January 2016 and July 2017. The average age was 61.6 ± 9 ,2 years; 70.6% were men. The personal pathological history of ischemic heart disease (85.6%) and arterial hypertension (75.6%) predominated. 75% of the cases presented a significant coronary occlusion. The frequency of contrast nephropathy was 42.5%. The factors that had an important statistical relationship with the presence of significant arterial occlusion were known ischemic heart disease (p <0.001), previous percutaneous coronary intervention (p = 0.007), creatinine after the procedure (p = 0.043) and CIN (p = 0.016) as well as the volume of contrast administered (p = 0.006). In the subgroup of patients with significant occlusion, low hematocrit (p = 0.025) and emergency percutaneous coronary intervention (p = 0.007) were the most influential factors. It is concluded that patients with significant coronary occlusion have an increased risk for the development of contrast nephropathy. The correction of those risk factors that are modifiable (such as low hematocrit) and the correct application of the hydration protocol are essential to prevent this complication

Manejo del síndrome coronario agudo durante pandemia por COVID ­ 19 / Management of acute coronary syndrome during COVID ­ 19 pandemic

INTRODUCTION: Acute Myocardial Infarction is a medical emergency, being his early and adequate treatment highly effective mainly in relation to reperfusion therapy. Unfortunately, COVID ­ 19 pandemic, has brought changes in its management due to availability of conditioned hemodynamic rooms, infection risk of the professionals, patient conditions and availability of critical unit beds. A review of the topic was made aimed to give a guide for the management of these patients with the available tools. MATERIALS AND METHOD: A review of the topic was made using the Medline/ Pubmed platform, in English and Spanish. Further, published articles in journals as The journal of the American college of cardiology and Circulation were included. CONCLUSIONS: The reperfusion strategies must be used according to the clinical context of the patient. In the acute myocardial infarction with ST elevation, fibrinolytic treatment may be chosen in low risk and without hemodynamic instability. In patients with hemodynamic instability, not eligible for fibrinolytic treatment or in whom this therapy fails, percutaneous angioplasty is indicated considering the protection of personnel. In the case of acute myocardial infarction without ST elevation, the treatment by urgent percutaneous angioplasty is considered in cases of hemodynamic instability or malignant arrhythmias.

Factores de riesgo asociados al daño renal agudo inducido por medios de contraste en pacientes revascularizados mediante angioplastia transluminal percutánea / Risk factors associated with the acute renal damage induced by contrast media in patients revascularized by means of transluminal percutaneous angioplasty

Introducción: los pacientes necesitados de angioplastia transluminal percutánea tienen una elevada probabilidad de presentar daño renal inducido por medios de contraste. Objetivo: determinar los factores de riesgo asociados al daño renal agudo inducido por dichos medios. Métodos: estudio descriptivo de 57 pacientes con cardiopatía, quienes requirieron de angioplastia transluminal percutánea en el Cardiocentro del Hospital Clinicoquirúrgico Hermanos Ameijeiras de Ciudad de la Habana, desde enero hasta diciembre de 2016. Para ello se conformaron 2 grupos (con nefropatía y sin ella). Se consideró la existencia de daño renal si la creatinina sérica se incrementaba en 25 por ciento o más a las 72 horas de realizado el proceder. Para estratificar el riesgo se empleó la escala de Mehran modificada. Resultados: existió daño renal en 49,1 por ciento de los pacientes. Los factores asociados fueron la angiografía previa, la angioplastia transluminal percutánea urgente y el volumen de contraste empleado. Según la escala de Mehran hubo un predominio de los afectados en los grupos de riesgo bajo y moderado; sin embargo, teniendo en cuenta los factores de riesgo identificados, estos pacientes prevalecieron en los grupos de riesgo alto y muy alto. Conclusiones: la angiografía previa, la realización urgente de angioplastia transluminal percutánea y el volumen de contraste empleado aumentan el riesgo de daño renal. Se determinó que la escala de Mehran modificada no fue útil para estratificar a los pacientes de bajo riesgo

Introduction: patients in need of transluminal percutaneous angioplasty have a high probability of presenting renal damage induced by contrast media. Objective: to determine the risk factors associated with the acute renal damage induced by this contrast media. Methods: descriptive study of 57 patients with heart disease who required transluminal percutaneous angioplasty in the Cardiology Center of Hermanos Ameijeiras Clinical Surgical Hospital of Havana City, from January to December, 2016. Two groups were conformed for that purpose (with nephropathy and without it). It was considered the existence of renal damage if the serum creatinine increased in 25 percent or more at the 72 hours of having carried out the procedure. The Mehran scale modified was used to stratify the risk. Results: there was renal damage in 49.1 percent of the patients. The associated factors were the previous angiography, the emergency percutaneous transluminal angioplasty and the volume of contrast used. According to the scale of Mehran there was a prevalence of the affected patients in the groups of low and moderate risk; however, taking into account the identified risk factors, these patients prevailed in the groups of high and very high risk. Conclusions: the previous angiography, the emergency of transluminal percutaneous angioplasty and the volume of contrast used increase the risk of renal damage. It was determined that the modified Mehran scale was not useful to stratify the patients of low risk.

RE: Percutaneous Angioplasty in Diabetic Patients with Critical Limb Ischemia

No abstract available.

Impotence due to External Iliac Steal Syndrome: Treatment with Percutaneous Transluminal Angioplasty and Stent Placement

We report a case of erectile dysfunction caused by external iliac artery occlusion, associated with pelvic steal syndrome; bilateral internal iliac arteries were patent. The patient stated that he had experienced erectile dysfunction at similar times along with claudication, but he did not mention it before angiography. He expressed that the erectile dysfunction did not last long and that he felt completely okay after the interventional procedure, in addition to his claudication. Successful treatment of the occlusion, by percutaneous transluminal angioplasty and stent implantation, helped resolve erectile dysfunction completely and treat the steal syndrome.

Angioplastia de tronco de coronária esquerda / Angioplasty of left main coronary artery

Reportamos o caso de uma paciente de 92 anos comquadro de insuficiência cardíaca e angina instável recorrente,em vigência de tratamento clínico otimizado, queapresentava alto risco cirúrgico e foi submetida à angioplastiapercutânea e colocação de kissing stent revestidoem lesão distal de tronco de coronária esquerda não protegido,apresentando após o procedimento melhora doquadro sem novos episódios de angina ou insuficiênciacardíaca.

We report the case of a patient of 92 years with heartfailure and unstable angina despite optimal medicaltreatment with high surgical risk who underwent angioplastyand kissing coated stent placement distal to thelesion in the left main coronary artery. After the procedurepresented clinical improvement without new episodesof angina or heart failure.

Carcinoma of stomach detected by routine transabdominal ultrasound

Assessment of the stomach is not commonly included in routine scanning protocol of upper abdominal ultrasound (USG). However, assessment of the stomach in patients presenting with epigastric pain can yield invaluable results. This paper presents, as an illustration, a case of carcinoma of stomach detected by transabdominal ultrasound. The diagnosis is confirmed by subsequent CT, upper endoscopy and operation.

The safety and therapeutic efficacy for application of biodegradable stent excel with biodegradble polymer combined with firofiban in patients with acute coronary syndrom / 中华急诊医学杂志

ObjectiveTo evaluate the safety, and the brief-and prolongedterm therapeutic efficacy for im- plantation of biodegradable stent Excel combined with Tirofiban made in China into patients with acute coronary syndrome(ACS). MethodA total of 301 patients were divided into Excel group (n = 100), Cypher group (n =102) and bare metal stem(BMS) (n = 99). The Tirofiban used in three groups was administered intravenously during and after operation.The loading dose of Tirofiban was 10 μg/kg given within 3 min followed by a Tirofiban intravenous maintenance infusion in 0.15 μg/(kg·min) with micro pump for 48 hours. Safety and efficacy were compared among three groups after stents implantation by the observation of TIMI flow, complication of bleeding, changes of platelet count, haematoglobin and hematocrit, incidence of angina, acute and subacute thrombosis inner stent and major adverse cardiac events (MACE) (cardiac death, nonfatal myocardial infarction and target ves-sel revascularization). Follow-up information got from out-patient clinic and telephone call including incidence of angina, MACE and rehospitalization were comapared sucessively 1 month, 6 monthes and 12 monthes after dis- charge. ResultsAmong there groups,there were no significant differences in demographics,and physical and lab-oratory findings before treatment. Successful rate of implantation was 100 percent and the TIMI flow of class Ⅲ was found in all patients. There was no complication of stroke and massive hemorrhage of gastrointestinal tract, and no significant differences in complication of bleeding, platelet count, hemoglobin and hematocrit after implantation. Incidence rates of acute thrombosis were 0, 0.98 and 1.01 percent in three groups, and there was no significant difference in acute thrombosis inner stent among three groups (P >0.05). The rates of angina, sub.acute stent thrombosis, MACE and rehospitalization among three groups had no differences at 1 month and 6 monthes follow-up (P > 0.05), but significant differences were not found until 12 monthes follow-up (P < 0.05). Conclusions Drug-eluting stent Excel with biodegradable polymer combined with Tirofiban made in China implanted in patients with ACS were capable of preventing acute and later thrombosis inner stent. This procedure had favourable safety, and brief-term and proionge-term therapeutic efficacy.

Isquemia intestinal por estenosis de la arteria mesentérica superior. Tratamiento con angioplastia e implante de stent / Intestinal ischemia due to stenosis of the superior mesenteric artery. Treatment with angioplasty and stent implantation

La isquemia intestinal crónica es un cuadro poco frecuente que se encuentra asociado a una alta morbilidad y mortalidad. La causa más frecuente es la arterioesclerosis. Los pacientes sufren de dolor abdominal periumbilical o en epigastrio, que aparece de 10 a 30 minutos luego de la ingestión de alimentos. Presentamos un caso de isquemia intestinal crónica diagnosticado por colonoscopia con biopsias. Se practicó arteriografía que mostró estenosis de la arteria mesentérica superior y se trató con angioplastia percutánea e implante de stent. El paciente presentó completa mejoría clínica y endoscópica. Se comentan los hallazgos clínicos, endoscópicos, radiológicos y el procedimiento terapéutico. Creemos que el tratamiento con arteriografía, angioplastia y colocación de stent es una alternativa que puede mejorar los resultados clínicos disminuyendo la morbimortalidad en esta patología.

Chronic mesenteric arterial ischemia is an uncommon condition associated with a high morbidity and mortality. It is most commonly caused by atherosclerotic occlusive disease. Patients may suffer epigastric or periumbilical post prandial pain, ten to thirty minutes after eating. A case of chronic mesenteric ischemia is presented due to superior mesenteric artery stenosis. The diagnosis was performed with colonoscopy and biopsy. We present a case report of a patient with chronic mesenteric ischemia. Mesenteric arteriography was performed and documented estenosis of the mesenteric superior artery. Then, percutaneus arteriography with angioplasty and implant of stent was performed. The patient became completely asymptomatic and normal colon mucosa is observed in a control colonoscopy. The purpose of this report is to present the case, endoscopic, clinic and radiological features and to describe the percutaneous angioplasty and implant of stent.We believe that angioplasty treatment offers an improvement in this pathology with a low complication rate, and increasing patient confort degree.

Treatment of High-Grade Basilar Artery Stenosis by Primary Stenting

Patients with symptomatic stenosis of the basilar artery have a poor prognosis and the treatment options are limited. Surgical bypasses are technically difficult and there is no proven benefit. Percutaneous angioplasty shows significant complications because of dissection, restenosis secondary to elastic recoil and embolic phenomena. The medical treatment with aspirin and wafarin showed the annual risk of 20% for symptomatic basilar artery stenosis as repoted in WASID(Warfarin-Aspirin Symptomatic Intracranial Disease)study. We report a patient with symptomatic high grade stenosis of the basilar artery refractory to appropriate maximal medical therapy, in whom endovascular stenting was performed successfully without preliminary balloon angioplasty. Excellent angiographic result was achieved and there were no procedural and periprocedural complications. The patient was asymptomatic except preprocedural mild dysarthria and had no neurological symptoms during clinical follow-up of 2 months at outpatient department. Primary stenting of basilar artery stenosis may be an alternative to balloon angioplasty for patient with symptomatic lesions refractory to medical therapy or in whom anticoagulation is contraindicated.

The Effect of Percutaneous Angioplasty on the Treatment of Stenosis and Obstruction of Arteriovenous Fistula in the Hemodialysis Patients / 대한신장학회잡지

Providing satisfactory vascular access for hemodialysis remains one of the most challenging problems confronting nephrologists. We evaluated the effect of percutaneous angioplasty on the treatment of stenosis and obstruction of arteriovenous fistula (AVF) in the chronic hemodialysis patients. Twenty-six dilatations of stenotic or occluded lesions in hemodialysis access fistulas were performed. The type of AVF was an native AVF in 19 cases and a graft in 7 cases. The lesions involved fore arm vein in 16 cases and an upper arm veins in 10 cases. Indications for angioplasty included acute obstruction of blood flow(9 patients), increased venous dialysis(VDP) or urea recirculation ratio(URR)(8 patients), arm edema or difficulty in needle placement(6 patients), poor maturation before first needling(3 patients). The PTA initially succeeded in 23 of 26 cases(88.5%) and 3 month patency rate was 80.5%. In 8 patients with increased VDP or URR, both VDP and URR significantly decreased after PTA (VDP;118.1+/-20.7mmHg vs 89.5+/-23.8 mmHg, P= 0.04, URR;23.9+/-18.4% vs 7.5+/-6.1%, P=0.02). The complications of PTA were vessel rupture(1 patient) and hematoma(2 patients). In conclusion, PTA seems to be effective therapy in the treatment of stenosis and obstruction of arteriovenous fistula(AVF) without serious complications in the chronic hemodialysis patients.