Rdial access for concomitant coronary, subclavin and renal artery angioplasty: one case report]

Concomitant coronary and peripheral angioplasty is a more frequently reported situation. Patient's outcome is significantly conditioned by access site complications especially in femoral and brachial approaches. The radial artery access is a safe and a well established alternative in coronary interventions and could be suitable for many peripheral angioplasty cases, thanks to devices enhancement. Rport a new case. We report the case of a 56-year-old woman with multivessel coronary artery disease, significant left subclavian [SCA] and bilateral renal arteries stenoses. Because of a severe resistant hypertension and prior to scheduled coronary bypass surgery a triple angioplasty of left renal artery, SCA, and left anterior descending [LAD] was attempted. Stenting of the three sites was successful in the same procedure through the left radial artery route. Radial artery access in peripheral, combined and complex percutaneous transluminal angioplasty seems to be suitable and safe. However, prospective clinical trials are still lacking

[Immediate and 12 month outcomes of interventional reperfusion strategy in acute ST elevation myocardial infarction. about 208 successive patients]

Percutaneous coronary intervention [PCI] has been proven to be the gold standard of reperfusion therapies in acute ST-elevation myocardial infarction [STEMI] in the west world. Highly trained teams and good logistical management of cathlabs may be limiting factors in developing countries and data about outcomes following PCI in such areas is scarce. The objectives of this study were to describe the procedural and clinical outcomes of patients undergoing PCI for STEMI 51 a university hospital in Tunisia and make a comparison with outcomes from the West. We conducted a retrospective cohort study at a tertiary care university hospital in Tunis, Tunisia. A total of 208 consecutive patients undergoing PCI between January 2005 and June 2007 were reviewed. Univariate, multivariate and Kaplan meier analyses were constructed. The primary outcome was mortality: in-hospital 30 days, and 12 months later. Cardiovascular risk factors were mainly smoking [63ck and diabetes [35.1%]. The mean patient's TIMI score was 3.8-s412 [10%were in cardiogenic shok]. Procedural success was 75.5%. In-hospital, 30 days and 12-month mortality were respectively 53%. 6.7%and 8.2%, comparing favorably with TIMI's score predicted mortality and the published registries from developed countries. Multivariate predictors of in-hospital death included age>70 years, mutivessel disease and PCI failure. Multivariate predictors of 12-month death were killip score>2 at admission [odds ratio=2.1] and PCI failure [odds ratio=2.9]. We conclude that, despite the logistical difficulties, excellent outcomes for acute interventional reperfusion strategy in STEMI can be achieved in a developing country, possibly similar t those seen in the West. There is a strong need for making the practice of PCI in STEMI more widespread in developing regions

[Assessment of endothelial function reliably predicts the existence and the severity of coronary disease]

Endothelial dysfunction has been proven to be. a cornerstone of atherosclerosis occurrence, development and progression. However, its use in clinical practice is still unclearly defined, this study was to prospectively assess how accurately endothelial function assessment predicts the existence and the extensiveness of significant coronary artery disease. Fifty adults [37 men and 13 women, mean age of 59.9 +1-12.6 years] were randomly included among candidates for a coronary angiography. They previously underwent endothelial function assessment by the Flow-mediated dilation technique [FMD] according to ACC guidelines. The FMD%was expressed as maximal percent change in brachial artery diameter from baseline and the test was considered positive when FMD%was below 5%. Endothelial function impairment has been diagnosed in 36 patients and at least one significant coronary artery stenosis [>50%] in 38 patients. Endothelial dysfunction predicted significant coronary stenosis with a sensibility and a specificity of 89.5%and 83%respectively; positive predictive and negative predictive values were 94.4%and 71.4%respectively. Statistical correlation has been found between FMD%and the number of significantly diseased coronary vessels [rs-0.44; p=0.001].An FMD%less than 8%reliably predicted all multivessel coronary-diseased patients. In multivariate analysis, endothelial dysfunction was the only independent predictive factor of coronary disease [p=0.02]. Endothelial dysfunction has been proven to be highly correlated to the existence of significant coronary stenosis at coronary angiography [PPV=94 .4%]. The severity of endothelial dysfunction assessed by the FMD%has also been significantly correlated to the extensiveness of coronary disease