ABSTRACT
Cholesterol crystal embolization is a rare but recognized complication of cardiac catheterization. While management has traditionally been supportive only, we demonstrate the successful use of corticosteroids in treatment of a patient with cholesterol crystal embolization to the distal extremity.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Angioplasty, Balloon, Coronary/adverse effects , Embolism, Cholesterol/drug therapy , Stents , Blood Vessel Prosthesis Implantation , Coronary Stenosis/therapy , Embolism, Cholesterol/etiology , Humans , Lower Extremity/diagnostic imaging , Lower Extremity/pathology , Male , Middle Aged , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Tomography, X-Ray Computed , Ultrasonography, DopplerSubject(s)
Critical Care/methods , Shock, Cardiogenic/mortality , Shock, Cardiogenic/therapy , Age Distribution , Aged , Aged, 80 and over , Combined Modality Therapy/methods , Critical Illness , Female , Humans , Intensive Care Units , Male , Middle Aged , Prognosis , Risk Assessment , Sex Distribution , Shock, Cardiogenic/diagnosis , Survival AnalysisABSTRACT
BACKGROUND: Failure to achieve an adequate heart rate limits the sensitivity of exercise myocardial perfusion imaging (MPI) for the detection of coronary artery disease. In addition, it is often not possible to discontinue medications that may blunt the heart rate response to exercise, because of conditions such as hypertension or angina. However, if pharmacologic stress testing is performed, the ability to assess functional capacity is lost. Accordingly, we developed a protocol that incorporates adenosine stress with symptom-limited exercise. METHODS AND RESULTS: As part of a multicenter study, 35 patients were enrolled prospectively and underwent both exercise MPI and exercise MPI with a 4-minute adenosine infusion on a separate day. Technetium 99m sestamibi was injected at or near peak exercise (exercise only) and at 2 minutes into the adenosine infusion (combined exercise and adenosine). The perfusion images were interpreted in a blinded fashion. The combined adenosine and exercise protocol was well tolerated. The summed stress scores and summed difference scores were greater in the exercise-plus-adenosine group than in the exercise-only group (10.0 vs 8.5, P =.02, and 4.9 vs 3.3, P =.002, respectively). Exercise time was slightly but significantly less with the exercise-plus-adenosine protocol (8 minutes 46 seconds vs 8 minutes 11 seconds, P =.027). CONCLUSION: A protocol combining 4 minutes of adenosine infusion with symptom-limited exercise was safe and well tolerated. Furthermore, this protocol resulted in a greater amount of myocardial ischemia detected on MPI while allowing for the assessment of functional capacity. A combined exercise and adenosine protocol may be a useful test for patients undergoing MPI who are unlikely to achieve an adequate chronotropic response.
Subject(s)
Adenosine , Coronary Artery Disease/diagnosis , Exercise Test/methods , Heart Rate/drug effects , Tomography, Emission-Computed, Single-Photon , Vasodilator Agents , Adenosine/administration & dosage , Adenosine/pharmacology , Aged , Coronary Artery Disease/physiopathology , Electrocardiography , Female , Humans , Male , Middle Aged , Prospective Studies , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Vasodilator Agents/administration & dosage , Vasodilator Agents/pharmacologySubject(s)
Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Coronary Vessels/pathology , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , Coronary Angiography , Coronary Vessels/diagnostic imaging , Humans , Male , Middle Aged , Ultrasonography, InterventionalABSTRACT
BACKGROUND: Visual assessment (VA) of postprocedural % diameter stenosis (DS) is used routinely in clinical practice to determine the adequacy of coronary intervention. Although VA has been shown to underestimate final %DS after balloon angioplasty compared to quantitative coronary angiography (QCA), the impact of this effect on clinical outcomes following treatment with intracoronary radiation therapy (IRT) with Sr-90 for instent restenosis (ISR) is unknown. METHODS: To determine the effect of VA on the rate of major adverse cardiac events (MACEs) after IRT for ISR, we compared the clinical outcomes of 102 consecutive patients based on postprocedural %DS by QCA vs. %DS by VA. MACE was defined as death, M1 or need for target vessel revascularization (TVR). RESULTS: MACE rates for the 102 consecutive patients grouped according to postprocedural %DS by QCA and VA were compared. The mean %DS by QCA was 30.7%, while the mean %DS by VA was 12.5%. The mean %DS by VA across the QCA subgroups were 13.67%, 10.71% and 13.37%, respectively (P = .244). Fifty-two patients (51.0%) had %DS > 30% by QCA with the highest MACE percentage occurring in this subgroup. CONCLUSION: VA underestimated the %DS compared to QCA, and it was associated with worse MACE following treatment with Sr-90 for ISR.
