ABSTRACT
We describe a case of symptomatic common femoral artery stenosis following use of a vascular clip closure device (StarClose). Operative repair was performed, with removal of the clip device and subsequent vein patch angioplasty.
Subject(s)
Arterial Occlusive Diseases/etiology , Coronary Angiography/adverse effects , Femoral Artery , Hemorrhage/prevention & control , Hemostatic Techniques/instrumentation , Intermittent Claudication/etiology , Punctures , Adult , Alloys , Angioplasty , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/surgery , Constriction, Pathologic , Device Removal , Equipment Design , Female , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Hemorrhage/etiology , Hemostatic Techniques/adverse effects , Humans , Intermittent Claudication/diagnostic imaging , Intermittent Claudication/surgeryABSTRACT
PURPOSE: Clinical information regarding paclitaxel-eluting coronary artery stents is reviewed. SUMMARY: Restenosis is a significant complication of percutaneous coronary intervention. Coronary artery stenting has reduced restenosis compared with traditional balloon angioplasty, although restenosis still occurs with bare-metal coronary artery stents. The pathogenesis of in-stent restenosis is believed to involve smooth-muscle-cell proliferation and migration in response to vessel injury. A neointimal layer of extracellular matrix and collagen forms, which may impinge on the vessel lumen. Paclitaxel inhibits vascular smooth-muscle-cell proliferation and reduces neointimal mass. Local delivery of paclitaxel through a coronary stent has been shown to reduce restenosis rates and percent diameter stenosis and to produce other angiographic benefits compared with bare-metal stents. Fewer major adverse coronary events are seen with paclitaxel-eluting stents, predominantly because of a reduction in the need for target-vessel revascularization with minimal impact on rates of mortality and myocardial infarction (MI). The Taxus Express(2) stent, the only approved paclitaxel-eluting stent in the United States, costs about three times as much as a bare-metal stent. Cost-effectiveness analyses are needed to determine if the Taxus stent is cost-effective in clinical practice. CONCLUSION: Paclitaxel-eluting stents reduce the rates of restenosis and target-vessel revascularization compared with bare-metal stents and have comparable effects on mortality and MI rates.
Subject(s)
Antineoplastic Agents/therapeutic use , Coronary Artery Disease/therapy , Coronary Restenosis/etiology , Coronary Restenosis/prevention & control , Paclitaxel/therapeutic use , Stents , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/economics , Clinical Trials as Topic , Humans , Paclitaxel/administration & dosage , Paclitaxel/economics , Sirolimus/therapeutic use , Stents/adverse effectsABSTRACT
Cardiac device infections are a rare complication of pacing and defibrillator therapy. The number of implanted devices will likely continue to rise with increasing implantation of the cardioverter defibrillator and cardiac resynchronization devices. This report describes a case of an uncommon pathogen for device-associated endocarditis.
Subject(s)
Endocarditis, Bacterial/etiology , Haemophilus Infections/etiology , Haemophilus parainfluenzae , Pacemaker, Artificial/adverse effects , Adult , Endocarditis, Bacterial/diagnosis , Haemophilus Infections/diagnosis , Humans , MaleSubject(s)
Aorta/pathology , Aortic Aneurysm/diagnosis , Aortic Dissection/diagnosis , Aortic Dissection/physiopathology , Aortic Dissection/surgery , Aortic Aneurysm/physiopathology , Aortic Aneurysm/surgery , Aortography , Coronary Angiography , Dyspnea/physiopathology , Echocardiography , Heart Murmurs/physiopathology , Humans , Male , Middle Aged , Physical Exertion/physiologyABSTRACT
Cardiac involvement in patients with advanced HIV/AIDS is common, including pericardial effusion and pulmonary hypertension. Although there is an increased incidence of pericardial effusion in patients with AIDS, most are small and asymptomatic. The presence of a pericardial effusion and/or pulmonary hypertension is associated with shortened survival. We present a case of a 43-year-old man with AIDS and advanced cardiovascular involvement who developed severe cor pulmonale and a large pericardial effusion with cardiac tamponade.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Cardiac Tamponade/etiology , Hypertension, Pulmonary/etiology , Pericardial Effusion/etiology , Pulmonary Heart Disease/etiology , Adult , Autopsy , Cardiac Tamponade/diagnosis , Diagnosis, Differential , Echocardiography , Fatal Outcome , Humans , Hypertension, Pulmonary/diagnosis , Male , Pericardial Effusion/diagnosis , Pericardial Effusion/therapy , Pericardiocentesis , Pulmonary Heart Disease/diagnosisABSTRACT
We report on an acute coronary syndrome resulting from a complex severe lesion within a stent over 6 years after implantation. This may represent an uncommon long-term limitation of coronary artery stenting.
Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Coronary Stenosis/therapy , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/therapy , Stents/adverse effects , Angioplasty, Balloon, Coronary/instrumentation , Coronary Angiography , Coronary Restenosis/diagnostic imaging , Coronary Restenosis/therapy , Coronary Stenosis/diagnostic imaging , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Risk Assessment , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
We prospectively evaluated 59 patients who were deemed candidates for coronary bypass surgery after coronary artery angiography for subclavian artery narrowing, which could compromise the ipsilateral internal thoracic artery graft. Bilateral arm blood pressure (BP) measurements, auscultation for supraclavicular or cervical bruits, and questioning about cerebrovascular ischemic symptoms were compared to brachiocephalic-subclavian arteriography. One neurologic complication occurred during arteriography. An upper extremity BP difference of > or = 15 mm Hg identified all patients with > or = 50% subclavian artery narrowing. We recommend brachiocephalic-subclavian arteriography only in patients with abnormal noninvasive screening for subclavian stenosis, not routinely.
