ABSTRACT
Coronary artery perforation (CAP) is a rare but potentially fatal complication of percutaneous coronary intervention. Polytetrafluoroethylene-covered stents prevent blood leakage between struts with a high rate of success. However, they lack elasticity and rapid and correct deployment is difficult. They have also a higher rate of stent restenosis and thrombosis. For these reasons, optimal deployment is essential. Although severe CAP needs an emergent solution, after stabilizing the patient, intracoronary imaging techniques may be useful to ensure correct expansion and reduce further adverse events. We present a case that shows the potential role of intravascular ultrasound in the resolution of a CAP.
Subject(s)
Coronary Vessels/diagnostic imaging , Coronary Vessels/injuries , Ultrasonography, Interventional , Aged , Humans , MaleSubject(s)
Accidents, Traffic , Aneurysm, False/diagnosis , Aneurysm, False/etiology , Coronary Vessels/injuries , Wounds and Injuries/complications , Aneurysm, False/therapy , Coronary Angiography , Coronary Vessels/diagnostic imaging , Electrocardiography , Endovascular Procedures , Humans , Male , Middle Aged , Percutaneous Coronary Intervention , Stents , Treatment OutcomeABSTRACT
OBJECTIVES: This study sought to investigate the clinical impact of the use of intravascular ultrasound (IVUS) during revascularization of patients with left main coronary artery (LM) disease with drug-eluting stents (DES). BACKGROUND: Whether the use of IVUS during the procedure adds a clinical benefit remains unclear. There is only 1 previous observational study, with relevant limitations, supporting the value of this strategy. METHODS: We performed a patient-level pooled analysis of 4 registries of patients with LM disease treated with DES in Spain. A propensity score-matching method was used to obtain matched pairs of patients with and without IVUS guidance. RESULTS: A total of 1,670 patients were included, and 505 patients (30.2%) underwent DES implantation under IVUS guidance (IVUS group). By means of the matching method, 505 patients without the use of IVUS during revascularization were selected (no-IVUS group). Survival free of cardiac death, myocardial infarction, and target lesion revascularization at 3 years was 88.7% in the IVUS group and 83.6% in the no-IVUS group (p = 0.04) for the overall population, and 90% and 80.7%, respectively (p = 0.03), for the subgroups with distal LM lesions. The incidence of definite and probable thrombosis was significantly lower in the IVUS group (0.6% vs. 2.2%; p = 0.04). Finally, IVUS-guided revascularization was identified as an independent predictor for major adverse events in the overall population (hazard ratio: 0.70, 95% confidence interval: 0.52 to 0.99; p = 0.04) and in the subgroup with distal lesions (hazard ratio: 0.54, 95% confidence interval: 0.34 to 0.90; p = 0.02). CONCLUSIONS: The results of this pooled analysis show an association of IVUS guidance during percutaneous coronary intervention with better outcomes in patients with LM disease undergoing revascularization with DES.
Subject(s)
Blood Vessel Prosthesis Implantation/methods , Coronary Artery Disease/surgery , Drug-Eluting Stents , Myocardial Revascularization/methods , Registries , Surgery, Computer-Assisted/methods , Ultrasonography, Interventional , Aged , Coronary Artery Disease/diagnosis , Coronary Artery Disease/mortality , Female , Humans , Male , Postoperative Complications/epidemiology , Propensity Score , Spain/epidemiology , Survival Rate/trendsSubject(s)
Aneurysm, False/etiology , Aneurysm, Ruptured/etiology , Aortic Dissection/etiology , Heart Valve Prosthesis Implantation/adverse effects , Renal Artery , Abdominal Pain/etiology , Aged , Aortic Valve , Aortic Valve Stenosis/surgery , Cardiac Catheterization/adverse effects , Heart Valve Prosthesis , Humans , MaleABSTRACT
El diagnóstico final de hipertensión pulmonar se realizamediante cateterismo cardíaco derecho. Existe hipertensiónpulmonar cuando la presión media en la arteria pulmonarsupera los 25 mmHg en situación basal. Una adecuadaexploración hemodinámica permite encuadrar la hipertensiónpulmonar en algunos de los cinco grupos de la clasificaciónclínica actual. Se dan las recomendaciones para los diferentesespecialistas de cuándo efectuar el cateterismo derecho, quéparámetros se deben de registrar y como realizar e interpretaruna prueba aguda de vasorreactividad en la hipertensiónarterial pulmonar.
The final diagnosis of pulmonary hypertension is made byright heart catheterization. Pulmonary hypertension is presentwhen the average pressure in the pulmonary artery exceeds 25mm Hg at baseline. Proper hemodynamic assessment allowsclassification of pulmonary hypertension into one of five clinicalcategories. Recommendations are provided for specialists, whento conduct right heart catheterization, which parameters mustbe recorded and how to perform and interpret a test for acutevasoreactivity in pulmonary arterial hypertensio.
