ABSTRACT
The utility of interventional cardiology has developed significantly over the last two decades with the introduction of coronary angioplasty and stenting, with the associated antiplatelet medications. Acute coronary stent occlusion carries a high morbidity and mortality, and the adoption of therapeutic strategies for prophylaxis against stent thrombosis has major implications for surgeons and anaesthetists involved in the management of these patients in the perioperative period. Currently, there is limited published information to guide the clinician in the optimal care of patients who have had coronary stents inserted when they present for non-cardiac surgery. This review examines the available literature on the perioperative management of these patients. A number of key issues are identified: the role of surgery vs percutaneous coronary intervention for coronary revascularization in the preoperative period; the different types of coronary stents currently available; the emerging issues related to drug-eluting stents; the pathophysiology of coronary stent occlusion; and the recommended antiplatelet regimes that the patient with a coronary stent will be receiving. The role of preoperative platelet function testing is also discussed, and the various available tests are listed. Appropriate management by all the clinicians involved with patients with coronary stents undergoing a variety of non-cardiac surgical procedures is essential to avoid a high incidence of postoperative cardiac mortality and morbidity. The review examines the evidence available for the perioperative strategies aimed at reducing adverse outcomes in a number of different clinical scenarios.
Subject(s)
Coronary Stenosis/therapy , Perioperative Care/methods , Stents/adverse effects , Angioplasty, Balloon, Coronary , Blood Platelets/drug effects , Coronary Restenosis/prevention & control , Drug Administration Schedule , Drug Monitoring/methods , Graft Occlusion, Vascular/prevention & control , Humans , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effectsSubject(s)
Antibodies, Monoclonal/therapeutic use , Anticoagulants/therapeutic use , Coronary Disease/drug therapy , Immunoglobulin Fab Fragments/therapeutic use , Patient Transfer , Platelet Aggregation Inhibitors/therapeutic use , Abciximab , Adult , Aged , Day Care, Medical , Female , Humans , Male , Middle Aged , Referral and ConsultationABSTRACT
The clinical syndrome of cholesterol embolization is uncommon but is associated with a poor prognosis. Patients with severe atheromatous disease of the aorta appear to be at particular risk from cholesterol embolization, particularly following vascular instrumentation or surgery. Trans-oesophageal echocardiography is the investigation of choice for imaging atherosclerotic disease of the aorta, and may be useful in assessing the risk of vascular procedures, and diagnostically helpful in patients with suspected cholesterol emboli syndrome. We report five cases of athero-embolism, and illustrate the role of trans-oesophageal echocardiography in making a diagnosis of cholesterol embolization.
Subject(s)
Aortic Diseases/diagnostic imaging , Arteriosclerosis/diagnostic imaging , Echocardiography, Transesophageal , Embolism, Cholesterol/diagnostic imaging , Aged , Arteriosclerosis/complications , Embolism, Cholesterol/etiology , Female , Humans , Male , Middle Aged , Risk Factors , Vascular Surgical Procedures/adverse effectsABSTRACT
Schwannoma, or neurilemmoma, is included in the differential diagnosis of masses in the parapharyngeal space. Schwannomata do not usually cause acute inflammation, and therefore do not tend to present as emergencies as in this case, in which there was acute respiratory embarrassment.
