Percutaneous coronary intervention-induced variations in systemic parameters of inflammation: relationship with the mode of stenting.

BACKGROUND: During percutaneous coronary intervention, the technique of stent implantation (both direct and complementary stenting) is guided using both clinical and angiographic features. We assessed potential relationships between procedural parameters and angioplasty-induced variations in inflammatory parameters in patients treated by these two different techniques. METHODS: A total of 85 consecutive patients due to undergo stent implantation were prospectively enrolled. Inflammation was assessed in terms of C-reactive protein, fibrinogen, erythrocyte sedimentation rate and leukocyte count in samples taken before and 24 h after angioplasty. Patients were classified based on whether they underwent complementary (n=47) or direct stenting (n=38). RESULTS: Inflammation after complementary stenting was related to the duration of inflation (r=0.59; p<0.001), whereas inflammation after direct stenting was related to the inflation pressure (r=0.61; p=0.007), as assessed by C-reactive protein variation. None of the other parameters influenced the inflammatory response. CONCLUSIONS: The inflammatory response after stent implantation depends on the mode of stenting. We therefore hypothesize that the inflammatory response after stenting might be related to the histological composition of the atherosclerotic plaques involved.

Infected multiple fibroelastomas in hypertrophic cardiomyopathy.

Cardiac papillary fibroelastomas are rare benign tumors of the heart with potential for life-threatening complications. The incidence of multiple lesions is less than 10% of all reported cases. Preoperative transesophageal echocardiography is important for detecting all cardiac sites involving this tumor, because excision of all such tumors must be performed to prevent serious complications. Here, the first ever case is reported of multiple infected papillary fibroelastoma of the mitral valve, aortic valve and left ventricular outflow tract with massive mitral insufficiency in a patient with hypertrophic cardiomyopathy.

Direct stent implantation without predilatation through 5 French guiding catheter following transfemoral coronary angiogram: a feasibility study.

Direct stenting (DS) is accepted as reducing procedural cost and duration and 5 Fr guiding catheters as lowering peripheral vascular complications. We aimed to evaluate the feasibility and safety of both strategies. We retrospectively studied 150 consecutive patients treated with DS strategy using a 5 Fr femoral approach. A need for 6 Fr devices or balloon predilatation defined 5 Fr DS failure. Procedural success was defined as good angiographic result (residual stenosis < 30% and TIMI flow 3) without ischemic complications. A total of 161 out of 174 lesions were elected as suitable for DS. The success rate of 5 Fr DS was 87.6% (141/161 lesions). The procedural success rate was 92% (138/150 patients). The angiographic success rate was 96.3% (155/161 lesions). Other complications were six non-Q-wave MI and one repeat angioplasty for acute in-stent thrombosis. Only one major peripheral vascular complication occurred. Direct stenting through 5 Fr guiding catheters in selected lesions is safe and effective with a low incidence of peripheral arterial complications.

Subacute development of a coronary artery pseudoaneurysm after primary angioplasty and stenting for acute myocardial infarction.

Three months after successful primary angioplasty with stent implantation for an acute myocardial infarction, we were confronted with an intra-stent pseudoaneurysm. It was located at the proximal part of the left anterior descending coronary artery and associated with an early severe restenosis on a marginal branch; the choice was made for surgical treatment. Despite a review of the literature and an examination of the procedural data, we were not able to explain the pseudoaneurysm. We assume that either the guidewire perforated the arterial wall when it cleared the occlusion or a non-angiographically visible dissection provoked this phenomenon.