ABSTRACT
La fractura del stent es una complicación que se ha comunicado luego del implante de stents liberadores de sirolimus con una frecuencia que oscila entre el 1,9% y el 16% según las series y que se asocia con una tasa mayor de reestenosis y de eventos cardíacos a largo plazo. En esta presentación se describe el caso de un paciente en el que, casi 6 años después del implante de dos stents liberadores de sirolimus telescopados, a través de tomografia computarizada multidetector y angiografía invasiva se evidenció la fractura de los stents telescopados, asociada con oclusión del stent.
The reported incidence of stent fracture after sirolimuseluting stent implantation ranges from 1.9 to 16% according to different series. It has been associated with increased rate of restenosis and long-term cardiac events. We describe the case of a patient with a telescoped stent fracture associated with stent occlusion, after 6 years of telescoped sirolimus-eluting stent implantation. It was detected using multislice computed tomography and invasive angiography.
ABSTRACT
La fractura del stent es una complicación que se ha comunicado luego del implante de stents liberadores de sirolimus con una frecuencia que oscila entre el 1,9% y el 16% según las series y que se asocia con una tasa mayor de reestenosis y de eventos cardíacos a largo plazo. En esta presentación se describe el caso de un paciente en el que, casi 6 años después del implante de dos stents liberadores de sirolimus telescopados, a través de tomografia computarizada multidetector y angiografía invasiva se evidenció la fractura de los stents telescopados, asociada con oclusión del stent.(AU)
The reported incidence of stent fracture after sirolimuseluting stent implantation ranges from 1.9 to 16% according to different series. It has been associated with increased rate of restenosis and long-term cardiac events. We describe the case of a patient with a telescoped stent fracture associated with stent occlusion, after 6 years of telescoped sirolimus-eluting stent implantation. It was detected using multislice computed tomography and invasive angiography.(AU)
ABSTRACT
A magnitude da resolução do supradesnivelamento do segmento ST é um marcador de reperfusão miocárdica em pacientes com infarto agudo do miocárdio. A resolução incompleta do supradesnivelamento do segmento ST foi identificada como preditor de resultados desfavoráveis em pacientes com infarto agudo do miocárdio após terapia de reperfusão. Este estudo teve como objetivos descrever a frequência de resolução incompleta do supradesnivelamento do segmento ST em um registro contemporâneo de pacientes submetidos a angioplastia primária e fazer uma comparação de seus resultados hospitalares com pacientes que apresentaram resolução completa do supradesnivelamento do segmento ST. Método: Entre julho de 2008 e fevereiro de 2009, foram incluídos 183 pacientes consecutivos com infarto agudo do miocárdio (< 24 horas) de oito centros na Argentina em um registro prospectivo de infarto agudo do miocárdio com supradesnivelamento do segmento ST foi definida como redução < ou igual 70 por cento do supradesnivelamento do segmento ST no eletrocardiograma...
Subject(s)
Humans , Angioplasty, Balloon, Coronary , Myocardial Infarction/diagnosis , Reperfusion , Thrombolytic Therapy , Aspirin , Electrocardiography/methods , ElectrocardiographyABSTRACT
OBJECTIVE: To investigate the major cardiac events at 1-year follow-up of multivessel versus culprit-vessel stenting in patients presenting with non-ST elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD). INTRODUCTION: Percutaneous coronary intervention is a standard revascularization strategy for patients with NSTE-ACS. However, when these patients have MVD it is not clear whether multivessel (MVR) is superior to culprit-vessel revascularization (CVR). METHODS: We screened 1,100 consecutive patients with NSTE-ACS from an institutional database. Comparisons of 1-year outcomes between multivessel and culprit-vessel revascularized patients were made. The primary outcome was the composite (MACE) of death, myocardial infarction (MI), or any revascularization. Secondary end-points were the components of the composite end-point. Regression analysis was performed to detect predictors of MACE. RESULTS: A total of 609 patients were considered for this analysis: 204 (33.5%) and 405 (66.5%) had MVR and CVR treatment, respectively. The strategy adopted was based on a clinical decision. The incidence of MACE was lower in MVR (9.45% vs. 16.34%, P = 0.02) with lower revascularization rate (7.46% vs. 13.86%, P = 0.04) than in CVR. There was no difference in death (1.99% vs. 1.98%, P = 0.8) nor death/MI (2.49% vs. 3.22%, P = 0.8) between MVR and CVR, respectively. Multivariate analysis showed CVR as the only independent predictor of improved MACE (OR 0.66, CI95% 1.12-3.47, P = 0.01). CONCLUSION: Multivessel stenting in patients with NSTE-ACS and multivessel disease using a clinical decision of treatment is associated with lower rate of MACE driven by lower repeat revascularization, compared with culprit-vessel stenting, without difference in rates of death or MI.
Subject(s)
Acute Coronary Syndrome/therapy , Angioplasty, Balloon, Coronary , Stents , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/pathology , Coronary Artery Disease/pathology , Coronary Artery Disease/therapy , Female , Humans , Incidence , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Time FactorsABSTRACT
INTRODUCTION AND OBJECTIVES: Intravascular ultrasound (IVUS) studies in conventional stent angioplasty with predilatation have demonstrated that late luminal narrowing is caused by neointimal proliferation. In the present study, we analyzed the degree and distribution of in-stent neointimal proliferation after direct stent implantation and aimed to identify variables that predict a proliferative response. MATERIAL AND METHOD: We studied 45 patients who underwent successful stent implantation without predilatation and 23 patients with similar clinical and angiographic characteristics who underwent conventional stent angioplasty with predilatation. IVUS imaging was performed at 7.85+/-2.81 months. The cross-sectional area was measured at five predetermined points in the stented coronary segment. The inflation pressure used in patients who underwent direct stent implantation was higher than that employed in those who underwent conventional angioplasty with predilatation (13+/-3 atm vs 10+/-2 atm; P=.005). RESULTS: Luminal and stent cross-sectional areas were greater in the group that did not undergo predilatation than in the group that did. Neointimal proliferation in the 5 sections analyzed along the axis of the stent was similar in the 2 groups. There was a weak linear relationship between the amount of plaque outside the stent and neointimal proliferation in both the group that underwent predilatation (r=0.37; P=.005) and the group that did not (r=0.33; P=.005). CONCLUSIONS: As with conventional angioplasty, the neointimal proliferation that occurred after direct stent implantation showed a diffuse homogeneous pattern along the length of the stent. There was a weak correlation between this proliferative response and the amount of plaque outside the stent.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Restenosis/etiology , Stents , Tunica Intima/pathology , Aged , Angioplasty, Balloon, Coronary/methods , Coronary Restenosis/diagnostic imaging , Coronary Restenosis/pathology , Data Interpretation, Statistical , Female , Follow-Up Studies , Humans , Male , Middle Aged , Time Factors , Ultrasonography, InterventionalABSTRACT
Introducción y objetivos. En la implantación de stent con predilatación la ecografía intracoronaria ha demostrado que la reducción luminal tardía se debe a la proliferación neointimal. En la presente serie analizamos el grado y la distribución de la proliferación neointimal intra-stent después de la implantación sin predilatación, así como las variables implicadas en esta respuesta proliferativa. Material y método. Se analizó a 45 pacientes después de la implantación exitosa de un stent sin predilatación y 23 pacientes con lesiones de características clínicas y angiográficas similares después de la implantación de un stent con predilatación. La ecografía intracoronaria en el seguimiento se realizó a los 7,85 ± 2,81 meses. Se midieron las áreas transversales (AT) en 5 segmentos predeterminados del segmento con stent. En el grupo de stent directo se empleó una presión de hinchado mayor que en el grupo con predilatación (13 ± 3 atm frente a 10 ± 2 atm; p = 0,005).Resultados. Los AT luminal y del stent fueron mayores en el grupo sin predilatación que en el grupo con predilatación. La proliferación neointimal en los 5 segmentos a lo largo del eje axial del stent fue similar en los dos grupos. Se observó una ligera relación lineal entre la placa fuera del stent y la proliferación neointimal en el grupo con predilatación (r = 0,37; p = 0,005) y sin predilatación (r = 0,33; p = 0,005). Conclusiones. De forma similar a la angioplastia convencional, en el stent directo la respuesta neointimal presenta un patrón difuso y homogéneo a lo largo del eje longitudinal del stent. Esta respuesta proliferativa se correlacionó ligeramente con la placa excluida por el stent (AU)
Introduction and objectives. Intravascular ultrasound (IVUS) studies in conventional stent angioplasty with predilatation have demonstrated that late luminal narrowing is caused by neointimal proliferation. In the present study, we analyzed the degree and distribution of in-stent neointimal proliferation after direct stent implantation and aimed to identify variables that predict a proliferative response. Material and method. We studied 45 patients who underwent successful stent implantation without predilatation and 23 patients with similar clinical and angiographic characteristics who underwent conventional stent angioplasty with predilatation. IVUS imaging was performed at 7.85±2.81 months. The cross-sectional area was measured at five predetermined points in the stented coronary segment. The inflation pressure used in patients who underwent direct stent implantation was higher than that employed in those who underwent conventional angioplasty with predilatation (13±3 atm vs 10±2 atm; P=.005). Results. Luminal and stent cross-sectional areas were greater in the group that did not undergo predilatation than in the group that did. Neointimal proliferation in the 5 sections analyzed along the axis of the stent was similar in the 2 groups. There was a weak linear relationship between the amount of plaque outside the stent and neointimal proliferation in both the group that underwent predilatation (r=0.37; P=.005) and the group that did not (r=0.33; P=.005). Conclusions. As with conventional angioplasty, the neointimal proliferation that occurred after direct stent implantation showed a diffuse homogeneous pattern along the length of the stent. There was a weak correlation between this proliferative response and the amount of plaque outside the stent (AU)
