[MINOCA and Coronary Ectasia: a rare combination of causes of infarction] / MINOCA y Ectasia Coronaria: una combinación inusual de causas de infarto

Objective: to describe a patient with myocardial ischemia with multiple causes. Clinical Case: This clinical case describes a 58-year-old man with a history of hypertension, dyslipidemia, COPD and previous myocardial infarction (AMI). He went to the emergency room with chest pain and dyspnea. Findings included bibasal crackles, electrocardiogram with old anterior fibrosis, elevated NT-ProBNP, and echocardiogram with septoapical akinesia. During hospitalization, he experienced tachyarrhythmia and hemodynamic deterioration, undergoing electrical cardioversion (CVE). Non-ST segment elevation acute coronary syndrome (NSTEACS) complicated with ventricular arrhythmia and acute pulmonary edema was diagnosed. Coronary angiography revealed coronary ectasias without obstructive lesions, but with mild stenosis in three vessels. The patient was successfully treated with non-invasive ventilation, diuretics, vasodilators and anticoagulation. The discharge was granted with the plan to further studies to optimize and guide treatment and finally the diagnosis of Myocardial Infarction with Non-Obstructive Arteries (MINOCA) and the presence of coronary ectasias was addressed. Conclusion: it is important to highlight the non-ischemic causes in MINOCA and the association between coronary ectasia and cardiovascular events, which is why we emphasize the need for more studies to better understand the relationship between these phenomena.

Objetivo: describir un paciente con isquemia miocárdica con múltiples causas. Caso Clínico: En este caso clínico se describe a un hombre de 58 años con antecedentes de hipertensión, dislipidemia, EPOC e infarto de miocardio (IAM) previo. Acudió a urgencias con dolor torácico y disnea. Los hallazgos incluyeron crepitantes bibasales, electrocardiograma con fibrosis anterior antigua, NT-ProBNP elevado y ecocardiograma con acinesia septoapical. Durante la hospitalización, experimentó taquiarritmia y deterioro hemodinámico, siendo sometido a cardioversión eléctrica (CVE). Se diagnosticó síndrome coronario agudo sin elevación del segmento ST (SCASEST) complicado con arritmia ventricular y edema pulmonar agudo. La angiografía coronaria reveló ectasias coronarias sin lesiones obstructivas, pero con estenosis leve en tres vasos. El paciente fue tratado con éxito mediante ventilación no invasiva, diuréticos, vasodilatadores y anticoagulación. Se otorgó el alta con el plan de profundizar estudios para optimizar y guiar tratamiento y finalmente se abordó al diagnóstico de Infarto de Miocardio con Arterias No Obstructivas (MINOCA) y la presencia de ectasias coronarias. Conclusión: es importante destacar las causas no isquémicas en MINOCA y la asociación entre ectasia coronaria y eventos cardiovasculares, por lo que subrayamos la necesidad de más estudios para comprender mejor la relación entre estos fenómenos.

Utilidad de la ecografía Doppler color en el seguimiento de la angioplastia carotídea / Doppler in Carotid Stent Follow-up

Los ataques cerebrovasculares (ACV), representan un problema mayor en salud y son una causa importante de discapacidad en todo el mundo. La estenosis u oclusión carotídea aterosclerótica causa alrededor del 20% de las isquemias cerebrovasculares.¹ Los ACV en los enfermos con estenosis carotídea se producen, en la mayoría de los casos, por la aparición de embolismos distales de trombo formado en la placa, oclusión trombótica aguda debido a rotura de la placa, o bien secundarios a las alteraciones hemodinámicas atribuibles a la estenosis, la cual produce disminución de la perfusión cerebral por el hipoflujo, en casos de estenosis críticas o suboclusivas. El tratamiento de la patología carotídea ha evolucionado de forma considerable a lo largo de los últimos años. Existen dos tratamientos invasivos para la estenosis carotídea significativa, que consisten en el abordaje quirúrgico con endarterectomía o tratamiento por vía percutánea con angioplastia y colocación de stent. En nuestra institución se realizaron, en el periodo comprendido entre marzo de 2013 y junio de 2017, aproximadamente 100 angioplastias carotídeas con colocación de stent. Todas fueron valoradas con ecografía Doppler color (EDC) al mes, a los seis meses y al año (en casos no complicados). En esta revisión bibliográfica es nuestra intención desarrollar las indicaciones, aplicaciones, hallazgos normales y patológicos en el examen de EDC en la evaluación de un paciente con stent carotídeo.

Acute stroke represents a major problem in health and is a major cause of disability worldwide. Atherosclerotic carotid stenosis or occlusion causes around 20% of cerebrovascular ischemias.¹ Stroke in patients with carotid stenosis occurs, in most cases, due to embolisms of thrombus formed in the plaque, acute thrombotic occlusion due to rupture of the plaque, or secondary to hemodynamic alterations, attributable to stenosis, which produces decreased cerebral perfusion by low flow, in cases of critical or sub occlusive stenosis. The treatment of carotid disease has evolved considerably over recent years. There are two invasive treatments for significant carotid stenosis, which consist of the surgical approach with endarterectomy or percutaneous treatment with angioplasty and stenting. In our institution, in the period between March 2013 and June 2017, ~100 carotid angioplasties with stent placement were performed. All were assessed with color Doppler ultrasound (DUS) at month, six months and one year (in non complicated cases). In this literature review it is our intention to develop the indications, applications, normal and pathological findings in the DUS examination in the evaluation of a patient with carotid stent.

Clinical outcome in nonagenarians undergoing transcatheter valve replacement.

BACKGROUND: Nonagenarians are mostly denied from different therapeutic strategies due to high preoperative risk. We present the results of nonagenarians with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). METHODS: Our retrospective analysis include baseline and procedural data along with clinical outcome. Clinical follow-up was performed in all patients after TAVR. RESULTS: Out of 689 patients, 33 nonagenarians with a mean age of 90.9±1.4years suffering from severe AS and elevated comorbidity index (logistic EuroSCORE of 16.3±9.6%, STS score 11.1±9.9%) underwent TAVR between September 2009 and July 2016 using self-expanding prosthesis. Baseline transthoracic echocardiography reported a mean aortic valve area (AVA) of 0.64±0.12cm2 with a mean pressure gradient of 56.1±16.1mmHg. Five (16.2%) patients had postprocedural moderate/severe aortic regurgitation. One patient died intraoperally due to ventricular perforation during predilatation, while two patients died within the first 30days, one due to cardiogenic shock and the other due to pneumonia. No patient experienced a myocardial infarction or a stroke, while ten (30.3%) required permanent pacemaker placement. At follow-up (mean 20.3 months, range 1-78 months), all cause and cardiovascular mortality was 24.2% and 15.1%, respectively. Two patients presented heart failure and 12 (40%) had exertional dyspnea. By echo, mean valve area was 1.72±0.12cm2 and mean gradient 11.2±1.4mmHg. Two patients (16.7%) presented moderate aortic regurgitation. CONCLUSION: Our case series demonstrate that even with elevated comorbidity index, clinical endpoints and valve-associated results are relatively favorable in nonagenarians treated with TAVR.

Correlação dos escores de risco com a anatomia coronária na síndrome coronária aguda sem supra-ST / Correlation of risk scores with coronary anatomy in non-ST-elevation acute coronary syndrome

FUNDAMENTO:Há poucas publicações sobre a correlação entre escores de risco e anatomia coronária na síndrome coronária aguda (SCA). OBJETIVO: Correlacionar os escores de risco com a gravidade da lesão coronária na SCA sem supra-ST. MÉTODOS: Foram analisados 582 pacientes entre julho de 2004 e outubro de 2006. Avaliou-se a correlação entre os escores de risco TIMI, GRACE hospitalar e em seis meses com lesão coronária > 50%, por método não paramétrico de Spearman. Modelo de regressão logística múltipla foi realizado para determinar a habilidade preditiva dos escores em discriminar quem terá ou não lesão coronária > 50%. RESULTADOS: Foram 319 (54,8%) homens e a média de idade era 59,9 (± 10,6) anos. Correlação positiva foi observada entre a pontuação dos escores de risco e lesão coronária > 50% (escore de risco TIMI r = 0,363 [p < 0,0001]; escore GRACE hospitalar r = 0,255 [p < 0,0001]; escore GRACE em seis meses r = 0,209 [< 0,0001]). A área sob a curva ROC de cada escore para discriminar quem terá ou não lesão coronária > 50% foi: TIMI = 0,704 [IC95% 0,656-0,752; p <0,0001]; GRACE hospitalar = 0,623 [IC 95% 0,573-0,673; p < 0,0001]; GRACE em seis meses = 0,562 [IC95% 0,510-0,613; p = 0,0255]. Na comparação entre as áreas sob a curva ROC, tem-se: TIMI versus GRACE hospitalar: p = 0,01; TIMI versus GRACE em seis meses: p < 0,0001; GRACE hospitalar versus GRACE em seis meses: p = 0,0461. CONCLUSÃO: Os escores de risco se correlacionam com a gravidade das lesões coronárias, sendo o escore de risco TIMI o que demonstrou melhor habilidade preditiva.

BACKGROUND: The literature lacks studies regarding the correlation between risk scores and coronary anatomy in acute coronary syndrome (ACS) OBJECTIVE: Correlate risk scores with the severity of the coronary lesion in ACS with non-ST elevation. METHODS: A total of 582 patients were analyzed between July 2004 and October 2006. The correlation between TIMI risk scores and GRACE (hospital and six months) scores was performed for patients with coronary lesion > 50%, using Spearman´s non-parametric method. Multiple regression logistics was used to determine the predictive ability of the scores to discriminate to discriminate who will have a coronary lesion > 50%. RESULTS: Most subjects were male (319 or 54.8%), mean age of 59.9 (± 10.6) years. A positive correlation was observed between risk scores and >coronary lesion > 50% (TIMI r = 0.363 [p < 0.0001]; hospital GRACE r = 0.255 [p < 0.0001]; GRACE at six months r = 0.209 [< 0.0001]). The area under the ROC curve for each score to determine to discriminate who will have a coronary lesion > 50% was: TIMI = 0.704 [CI95% 0.656-0.752; p <0.0001]; hospital GRACE = 0.623 [CI95% 0.573-0.673; p < 0.0001]; GRACE at six months= 0.562 [CI95% 0.510-0.613; p ;= 0.0255]. Comparing the areas under the ROC curve, it was found: TIMI versus hospital GRACE: p = 0.01; TIMI versus GRACE at six months:p < 0.0001; hospital GRACE versus GRACE at six months: p = 0.0461. CONCLUSION: Risk scores correlate with the severity of coronary lesions, and the TIMI risk score showed the best predictive ability.

Correlation of risk scores with coronary anatomy in non-ST-elevation acute coronary syndrome.

BACKGROUND: The literature lacks studies regarding the correlation between risk scores and coronary anatomy in acute coronary syndrome (ACS) OBJECTIVE: Correlate risk scores with the severity of the coronary lesion in ACS with non-ST elevation. METHODS: A total of 582 patients were analyzed between July 2004 and October 2006. The correlation between TIMI risk scores and GRACE (hospital and six months) scores was performed for patients with coronary lesion ≥ 50%, using Spearman's non-parametric method. Multiple regression logistics was used to determine the predictive ability of the scores to discriminate to discriminate who will have a coronary lesion ≥ 50%. RESULTS: Most subjects were male (319 or 54.8%), mean age of 59.9 (± 10.6) years. A positive correlation was observed between risk scores and coronary lesion ≥ 50% (TIMI r = 0.363 [p < 0.0001]; hospital GRACE r = 0.255 [p < 0.0001]; GRACE at six months r = 0.209 [< 0.0001]). The area under the ROC curve for each score to determine to discriminate who will have a coronary lesion > 50% was: TIMI = 0.704 [CI95% 0.656-0.752; p <0.0001]; hospital GRACE = 0.623 [CI95% 0.573-0.673; p < 0.0001]; GRACE at six months= 0.562 [CI95% 0.510-0.613; p ;= 0.0255]. Comparing the areas under the ROC curve, it was found: TIMI versus hospital GRACE: p = 0.01; TIMI versus GRACE at six months:p < 0.0001; hospital GRACE versus GRACE at six months: p = 0.0461. CONCLUSION: Risk scores correlate with the severity of coronary lesions, and the TIMI risk score showed the best predictive ability.

Initial experience with transradial access for carotid artery stenting.

We report our experience using transradial access (TRA) for carotid artery stenting (CAS). Eighty-eight patients underwent CAS using a nonfemoral approach, 79 of them by TRA. Carotid artery stenting was performed using standard techniques with a long hydrophilic sheath. Mean age was 69.5 years. A total of 46 patients were symptomatic and 34 were asymptomatic. Transradial access and procedural success were achieved in 98.8% and 96.6% of the cases, respectively. There were no deaths, myocardial infarction, or radial access site complications. In all, 2 patients sustained a stroke, 1 hemorrhage, and 1 ischemia. Carotid artery stenting using TRA was safe and technically feasible.

Reemplazo percutáneo de la válvula aórtica en pacientes con estenosis aórtica grave y riesgo quirúrgico elevado / Percutaneous Aortic Valve Replacement in Patients with Severe Aortic Stenosis and High Surgical Risk / Percutaneous Aortic Valve Replacement in Patients with Severe Aortic Stenosis and High Surgical Risk

Introducción La cirugía de reemplazo valvular aórtico es el tratamiento de elección en pacientes con estenosis aórtica. Sin embargo, en una proporción considerable de pacientes, el riesgo quirúrgico y la presencia de algunas comorbilidades, que aumentan este riesgo, impiden la cirugía. El reemplazo percutáneo de la válvula aórtica representa una alternativa a la cirugía valvular convencional para pacientes seleccionados de riesgo elevado. Objetivo Comunicar la experiencia inicial de reemplazo percutáneo de la válvula aórtica con prótesis autoexpandible CoreValve® (Medtronic, Minneapolis, MN, USA) en pacientes portadores de estenosis aórtica grave. Material y métodos Registro multicéntrico en el que se incluyeron 21 pacientes con estenosis aórtica grave (área < 1 cm²) sintomática y riesgo quirúrgico elevado sometidos a implante percutáneo en cuatro centros cardiovasculares argentinos de alta complejidad. Para el procedimiento se implementó una estrategia multidisciplinaria que involucró a diversos especialistas: anestesiólogo, cirujano, expertos en imágenes y cardiólogos intervencionistas. Resultados La edad media fue de 80,8 ± 7,1 años (rango: 63-90), el 57% de sexo masculino, área valvular media de 0,59 ± 0,25 cm² y EuroSCORE de 18,1% ± 4%. El 73% y el 27% de los pacientes se encontraban en clase funcional III y IV, respectivamente. El éxito del procedimiento fue del 95,2% (20/21), que se tradujo en una reducción pronunciada del gradiente pico transvalvular aórtico (82 ± 14 mm Hg a 12 ± 3 mm Hg; p < 0,001), mientras que el desarrollo posprocedimiento de regurgitación aórtica de grado moderado-grave fue del 14%. El 85,8% de los pacientes evolucionaron a clase funcional I. El requerimiento de marcapasos definitivo fue del 38% (8/21). La mortalidad del procedimiento y a los 30 días fue del 4,7% y del 9,5%, respectivamente; se observó un caso de accidente cerebrovascular isquémico menor con restitución ad integrum dentro de la semana. Se detectaron 4 óbitos en el seguimiento alejado (mediana 7 meses), dos de origen cardíaco (mortalidad cardíaca 19%) y otros dos de causa no cardíaca. Conclusiones El tratamiento de la estenosis aórtica grave en pacientes de riesgo quirúrgico elevado mediante reemplazo valvular percutáneo con prótesis CoreValve® es una alternativa factible que se asocia con una mejoría funcional notoria. La selección adecuada de pacientes, el perfeccionamiento de la técnica del procedimiento y el desarrollo de nuevos diseños incrementarán su eficacia y seguridad.

Background Aortic valve replacement is the treatment of choice in patients with aortic stenosis. However, a significant number of patients are not candidates for surgery due to high surgical risk and to the presence of comorbidities. Percutaneous aortic valve replacement represents an alternative option to conventional aortic valve surgery for selected high risk patients. Objective To inform about the initial experience with percutaneous aortic valve replacement with a self-expanding CoreValve® aortic valve prosthesis (Medtronic, Minneapolis, MN, USA). Material and Methods We conducted a multicenter registry including 21 patients with severe symptomatic aortic stenosis (aortic valve area < 1 cm²) and high surgical risk undergoing percutaneous aortic valve replacement in four high complexity cardiovascular centers. A multidisciplinary strategy was used involving several specialists: anesthesiologist, surgeon, diagnostic images specialists and interventional cardiologists. Results Mean age was 80.8±7.1 years (range: 63-90); 57% were men. Mean aortic valve area was 0.59±0.25 cm² and mean EuroSCORE was 18.1%±4%. The percentages of patients in functional class III and IV were 73% and 27%, respectively. The procedure was successful in 95.2% (20/21) of patients, with a pronounced reduction in peak transvalvular aortic gradient (from 82±14 mm Hg to 12±3 mm Hg; p <0,001); 14% of patients developed moderate to severe aortic regurgi-tation after the procedure. 85.5% of patients evolved to FC I. Definite pacemaker implantation was required in 38% (8/21). Procedure-related mortality was 4.7% and mortality after 30 days was 9.5%. One patient developed a minor stroke with complete recovery within a week. Four patients died in the long-term follow-up (median 7 months): 2 due to cardiac causes (cardiac mortality 19%) and 2 due to non-cardiac causes. Conclusions Percutaneous aortic valve replacement with CoreValve® aortic valve prosthesis is a feasible option for patients with high surgical risk that is associated with significant clinical improvement. The adequate selection of patients, improvement of the surgical technique and the development of new designs will increase the efficacy and safeness of the procedure.

Safety and feasibility of balloon-expandable stent implantation for the treatment of type I endoleaks following endovascular aortic abdominal aneurysm repair.

AIMS: The occurrence of type I endoleaks represent an ominous sign after endovascular aneurysms repair (EVAR). We report our experience using balloon-expandable stents (BES) for the treatment of proximal Type I endoleaks at five high-volume hospitals in Argentina. METHODS AND RESULTS: Of 1,395 patients who underwent EVAR, we retrospectively collected data of 29 (2%) consecutive patients who underwent additional BES to repair proximal type I endoleaks. The mean age was 75.8 years old (range 63-87) and 93% were male. A hostile anatomy was found in 89.6% of the cases. BES oversize (balloon/neck diameter ration ≥ 30%) was frequent (69%); whereas, BES/prosthesis diameter ratio was less than 1 in 79% of the cases. Complete and partial sealing was obtained 72 and 28% of the cases, respectively. There were no immediate or late surgical conversion or major complications related with stent implantation. At a median time follow-up of 14.9 months (25-75% interquartiles: 4.5-17.5 months), there were no cardiovascular deaths, evidence of aneurysm sac enlargement or need for re-intervention. CONCLUSIONS: Our preliminary results suggest that BES implantation for the treatment of proximal type I endoleaks is feasible and safe with favourable mid-term results and may preclude the need for surgical conversion.

Use of a self-expanding super-elastic all-metal endoprosthesis; to treat degenerated SVG lesions: the SESAME first in man trial.

UNLABELLED: We prospectively evaluated a novel nano-synthesized, membrane-covered self-expanding super-elastic all-metal endoprosthesis stent (SESAME Stent) in patients undergoing percutaneous intervention (PCI) of degenerated saphenous vein graft (SVG) lesions. METHODS: SESAME investigators prospectively enrolled 20 patients/21 lesions at 2 outside United States (OUS) centers, between February 2005 and August 2005. Patients underwent elective intervention of symptomatic SVG lesions with ≥ 50% stenosis. PCI was performed without embolic protection devices. The primary end point was technical and procedural success. Secondary end points included major adverse cardiac events (MACE) at 30 days and 9 months. RESULTS: Twenty patients (twenty-one SVG lesions) received SESAME stents. The acute success was 100%. No procedural or in hospital complications occurred. One patient underwent a planned staged PCI at 28 days in a separate SVG. Follow-up was present in 20 patients at 30 days, with clinical (n = 19) and angiographic evaluation (18 patients/19 lesions) at 9 months. No MACE events occurred at 30 days. At 9 months, 3 patients underwent repeat PCI. One TLR (restenosis at the overlap of two stents) and two nonindex lesion TVR for a MACE rate of 14% at 9 months. CONCLUSIONS: This study demonstrated the ABPS SESAME Stent has excellent acute success, low 30 day MACE rates and 9 month patency of the SESAME is similar to balloon expandable stents without embolic protection.

Tomografia computadorizada e Dor Torácica. A contribuição da tomografia computadorizada na avaliação na avaliação da dor torácica aguda / Tomografia computadorizada e Dor Torácica. A contribuição da tomografia computadorizada na avaliação na avaliação da dor torácica aguda

A doença cardíaca isquêmica é uma das principais causas de morte no mundo. Segundo os dados de 2010 do Heart Disease and Stroke Statistics aproximadamente uma morte a cada segundo mais de 151.000 americanos com menos de 65 anos já morreram este ano de doenças cardiovasculares. Os custos diretos e indiretos com doenças cardiovasculares , acidente vascular cerebral e condições relacionadas nos Estados Unidos da América são estimados em torno de 503,2 bilhões de dólares por ano. Isso inclui custos médicos, cuidados hospitalares, antendimento residencial, medicações, além de custos indiretos relacionados à perda de produtividade...

Perfil demográfico e resultados imediatos dos pacientes submetidos a angioplastia primária no registro SOLACI / Patient demographics and immediate results of primary angioplasty in the SOLACI Registry

FUNDAMENTO: A superioridade da angioplastia primária em relação aos fibrinolíticos já foi amplamente demonstrada em diversos estudos, mas, muitas vezes, por questões logísticas, observamos retardo na incorporação das recomendações nos diversos cenários de vida real. Comparamos o desempenho da angioplastia primária no Registro SOLACI em três períodos a partir de 1995. MÉTODO: O Registro SOLACI incluiu dados de 43.725 angioplastias primárias realizadas nos períodos de 1995-1997 (n = 6.793), 2000-2003 (n = 23.007) e 2007-2008 (n = 13.925). RESULTADOS: Observamos complexidade crescente dos pacientes tratados, com incremento do porcentual de mulheres, diabéticos, e pacientes com infarto agudo do miocárdio prévio e com disfunção ventricular moderada a grave. O sucesso do procedimento manteve-se elevado (> 91%) em todos os períodos, independentemente do instrumental utilizado. Adicionalmente, notamos diminuição expressiva do tempo porta-balão, uso crescente dos stents e redução de 45% na utilização dos inibidores da glicoproteína IIb/IIIa. No que tange à evolução hospitalar, em comparação ao período de 1995-1997, observamos, nos períodos de 20002003 e 2007-2008, decréscimo da mortalidade (9,1% vs. 5,3% e 4,5%) e redução do reinfarto (4,1% vs. 2,6% e 2,7%) e da necessidade urgente de nova revascularização (3,5% vs. 0,7% e 0,7%). CONCLUSÃO: Apesar do perfil de risco mais complexo, a incorporação dos avanços tecnológicos e a redução do tempo porta-balão resultaram em melhora dos desfechos cardíacos hospitalares pós-angioplastia primária na América Latina.

INTRODUCTION: The superiority of primary angioplasty compared to fibrinolytic agents has been broadly demonstrated in different studies, but due to logistic issues we have observed a delay in the implementation of the recommendations in real world scenarios. We compared primary angioplasty results at three different timepoints in the SOLACI Registry. METHOD: The SOLACI Registry included data of 43,725 primary angioplasties carried out from 1995-97 (n = 6,793), 2000-03 (n = 23,007) and 2007-08 (n = 13,925). RESULTS: An increasing complexity of treated patients was observed, with an increment in the percentage of women, diabetics, patients with prior myocardial infarction and patients with moderate to severe ventricular dysfunction. Procedural success remained high (> 91%) at all timepoints, regardless of the device used. In addition, we observed a significant decrease of door-to-balloon time, increased use of stents and a 45% decrease in the use of glycoprotein IIb/IIIa inhibitors. Regarding in-hospital outcomes, a decreased mortality (9.1% vs. 5.3% vs. 4.5%), reinfarction (4.1% vs. 2.6% vs. 2.7%) and target vessel revascularization procedures (3.5% vs. 0.7% vs. 0.7%) was observed. CONCLUSION: Despite the more complex risk profile, the incorporation of technological advances and the reduction of door-to-balloon time led to improved inhospital cardiac outcomes after primary angioplasty in Latin America.

Tratamiento percutáneo del pseudoaneurisma femoral por punción directa bajo control radiológico con inyección de trombina humana. Trombina y angiografía / Percutaneous treatment of femoral pseudoaneurysms by direct punction under radiologic-control with human thrombin injection

La incidencia del pseudoaneurisma femoral como complicación de intervenciones percutáneas ha mostrado un incremento en los últimos años, debido entre otros factores, al creciente número de procedimientos y a la cada vez más frecuente utilización de potentes fármacos antiplaquetarios y anticoagulantes. El tratamiento de dicha complicación se ha logrado por diferentes métodos, desde la compresión manual o guiada por Ecografía hasta la reparación quirúrgica...El objetivo del presente artículo es, utilizando un caso clínico como modelo, describir una nueva técnica de inyección de trombina para el tratamiento de dicha complicación

Tratamiento percutáneo del pseudoaneurisma femoral por punción directa bajo control radiológico con inyección de trombina humana. Trombina y angiografía / Percutaneous treatment of femoral pseudoaneurysms by direct punction under radiologic-control with human thrombin injection

La incidencia del pseudoaneurisma femoral como complicación de intervenciones percutáneas ha mostrado un incremento en los últimos años, debido entre otros factores, al creciente número de procedimientos y a la cada vez más frecuente utilización de potentes fármacos antiplaquetarios y anticoagulantes. El tratamiento de dicha complicación se ha logrado por diferentes métodos, desde la compresión manual o guiada por Ecografía hasta la reparación quirúrgica...El objetivo del presente artículo es, utilizando un caso clínico como modelo, describir una nueva técnica de inyección de trombina para el tratamiento de dicha complicación(AU)

Outcomes percutaneous interventions in diabetics treatd with drug eluting stents or Bare Metal Stents: The SOLACI Registry results

Fundamentos: Estudos randomizados ajudaram a elucidar o valor dos stents com eluição de fármacos (SEF) em subgrupos selecionados de pacientes diabéticos, mas pouco se sabe se estes resultados podem ser generalizados para a prática clinica cotidiana. Nós relatamos a experiência latino-americana contemporânea com o implante de SEF em diabéticos, utilizando o banco de dados do registro SOLACI do ano de 2003. Método e Resultado: dados foram coletados de 5.509 dibéticos que se submeteram ao implante de stents coronários, em 67 centros médicos de nove países. Destes, 4.724 (85,8%) receberam stents metálicos não recobertos (SM), 440 (8,0%) stents om eluição de paclitaxel (SEP). A média das idades foi de 62,1 anos e 62,6% eram do sexo masculino...

IMPACT Trial: angiographic and intravascular ultrasound observations of the first human experience with mycophenolic acid-eluting polymer stent system.

The purpose of the study was to examine the safety and efficacy of two different formulations of mycophenolic acid (MPA)-eluting Duraflex stents on coronary de novo lesions. Recent data indicate that local delivery of MPA in the porcine overstretch coronary model significantly reduces neointimal hyperplasia (NIH). Patients were divided into three consecutive groups. The first (n=50) and second (n=55) groups received moderate- and slow-release MPA-eluting Duraflex stent, respectively. The last group (n=50) received the bare metal Duraflex stent. Clinical, angiographic, and intravascular ultrasound analysis were performed at 6-month follow-up. All stents were successfully deployed and patients were discharged home without clinical events. Compared to controls, 6-month in-lesion and in-stent minimum luminal diameter as well as late lumen loss were not significantly different in the moderate- and slow-release treatment groups. At follow-up, percentage obstruction and NIH volume were also similar between the three groups. At 30 days and 6 and 12 months, there were no differences noted between the three groups with respect to major adverse cardiac events as well as the individual rates of mortality, myocardial infarction, or repeat revascularization. There were no cases of subacute or late thrombosis. In this feasibility trial, the MPA-eluting Duraflex stents in either slow- or moderate-release formulations were well tolerated, but showed no benefit for treatment of coronary lesions when compared to controls. Further testing with different drug dosing or delivery rate might improve these results.

IMPACT trial: angiographic and intravascular ultrasound observations of the first human experience with mycophenolic acid-eluting polymer stent system

The purpose of the study was to examine the safety and efficacy of two different formulations of mycophenolic acid (MPA)-eluting Duraflex stents on coronary de novo lesions. Recent data indicate that local delivery of MPA in the porcine overstretch coronary

model significantly reduces neointimal hyperplasia (NIH). Patients were divided into three consecutive groups. The first (n 5 50) and second (n 5 55) groups received moderate- and slow-release MPA-eluting Duraflex stent, respectively. The last group (n 5 50) received the bare metal Duraflex stent. Clinical, angiographic, and intravascular

ultrasound analysis were performed at 6-month follow-up. All stents were successfully deployed and patients were discharged home without clinical events. Compared to controls, 6-month in-lesion and in-stent minimum luminal diameter as well as late

lumen loss were not significantly different in the moderate- and slow-release treatment groups. At follow-up, percentage obstruction and NIH volume were also similar between the three groups. At 30 days and 6 and 12 months, there were no differences

noted between the three groups with respect to major adverse cardiac events as well as the individual rates of mortality, myocardial infarction, or repeat revascularization.

There were no cases of subacute or late thrombosis. In this feasibility trial, the MPAeluting Duraflex stents in either slow- or moderate-release formulations were well tolerated, but showed no benefit for treatment of coronary lesions when compared to

controls. Further testing with different drug dosing or delivery rate might improve these results.