ABSTRACT
Introducción y objetivos. El abordaje de las lesiones en bifurcación se puede realizar con estrategia simple o compleja. La estrategia compleja no se ha mostrado superior a la simple con stents farmacoactivos de primera generación. Sin embargo, hasta ahora no se ha definido la mejor estrategia con los stents farmacoactivos de segunda generación. Métodos. Estudio prospectivo aleatorizado de comparación de la estrategia simple frente a la compleja mediante T-stenting en la revascularización de las lesiones en bifurcación con el uso de stent farmacoactivo liberador de everolimus. Se realizó un seguimiento clínico y angiográfico a los 9 meses. Resultados. Se incluyeron 70 lesiones de 69 pacientes, a los que se aleatorizó a estrategia simple (34 lesiones de 33 pacientes) o compleja (36 lesiones de 36 pacientes). El 85,6% de las lesiones en bifurcación fueron verdaderas. La tasa de crossover fue del 17,1%. La tasa total de reestenosis binaria fue del 12,1%, sin diferencias entre grupos de estrategia. La reestenosis del ramo lateral mostró en la estrategia simple tendencia a ser superior que en la compleja (el 10,7 frente al 0%) en el análisis por intención de tratar, pero no en el análisis por protocolo (el 5,9 frente al 4,2%). La tasa de eventos cardiacos adversos (muerte cardiaca, infarto de miocardio y nueva revascularización) fue del 9,2%, sin diferencias entre grupos. No hubo ningún caso de trombosis del stent. Conclusiones. No parece que la estrategia compleja aporte ventajas clínicas o angiográficas respecto a la simple en la revascularización de lesiones en bifurcación con stent farmacoactivo de segunda generación liberador de everolimus (AU)
Introduction and objectives: Coronary bifurcation lesions can be approached using a simple or a complex strategy. In clinical trials with first-generation drug-eluting stents, the complex strategy was not superior to the simple approach. However, to date, the best strategy when using second-generation drug-eluting stents has not been defined. Methods: We performed a prospective randomized study comparing a simple vs a complex strategy involving T-stenting for the percutaneous revascularization of bifurcation lesions using the everolimuseluting stent. Angiographic and clinical follow-up were performed at 9 months. Results: We included 70 lesions in 69 patients, who were randomized to the simple (34 lesions, 33 patients) or complex strategy (36 lesions and patients). In all, 85.6% of the lesions included were true bifurcations. The crossover rate was 17.1%. The binary restenosis rate was 12.1%, with no differences between the groups. Side branch restenosis tended to be higher with the simple strategy in the intention to treat analysis (10.7% vs 0%) but not in the per protocol analysis (5.9% vs 4.2%). The incidence of major adverse cardiac events (cardiac death, myocardial infarction, and target vessel revascularization) was 9.2%, with no differences between groups. There were no cases of stent thrombosis. Conclusions: According to the clinical and angiographic findings, the complex strategy was not significantly superior to the simple approach in the revascularization of bifurcation lesions with secondgeneration everolimus-drug eluting stents (AU)
Subject(s)
Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary/instrumentation , Angioplasty, Balloon, Coronary/methods , Angioplasty, Balloon, Coronary , Angioplasty/methods , Myocardial Revascularization/methods , Myocardial Revascularization/trends , Myocardial Revascularization , Prospective Studies , Coronary Restenosis/complications , Coronary Restenosis/diagnosis , Coronary Restenosis/surgery , Stents , Drug-Eluting StentsABSTRACT
INTRODUCTION AND OBJECTIVES: Coronary bifurcation lesions can be approached using a simple or a complex strategy. In clinical trials with first-generation drug-eluting stents, the complex strategy was not superior to the simple approach. However, to date, the best strategy when using second-generation drug-eluting stents has not been defined. METHODS: We performed a prospective randomized study comparing a simple vs a complex strategy involving T-stenting for the percutaneous revascularization of bifurcation lesions using the everolimus-eluting stent. Angiographic and clinical follow-up were performed at 9 months. RESULTS: We included 70 lesions in 69 patients, who were randomized to the simple (34 lesions, 33 patients) or complex strategy (36 lesions and patients). In all, 85.6% of the lesions included were true bifurcations. The crossover rate was 17.1%. The binary restenosis rate was 12.1%, with no differences between the groups. Side branch restenosis tended to be higher with the simple strategy in the intention to treat analysis (10.7% vs 0%) but not in the per protocol analysis (5.9% vs 4.2%). The incidence of major adverse cardiac events (cardiac death, myocardial infarction, and target vessel revascularization) was 9.2%, with no differences between groups. There were no cases of stent thrombosis. CONCLUSIONS: According to the clinical and angiographic findings, the complex strategy was not significantly superior to the simple approach in the revascularization of bifurcation lesions with second-generation everolimus-drug eluting stents.
Subject(s)
Coronary Artery Disease/therapy , Drug-Eluting Stents , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/therapeutic use , Percutaneous Coronary Intervention/methods , Sirolimus/analogs & derivatives , Aged , Coronary Angiography , Coronary Artery Disease/drug therapy , Coronary Restenosis , Everolimus , Female , Humans , Male , Middle Aged , Prospective Studies , Sirolimus/administration & dosage , Sirolimus/therapeutic useABSTRACT
Transcatheter aortic valve implantation by an apical approach has been developed as an alternative to conventional aortic valve replacement. Complications with these relatively new procedures are being reported. We report a case of transapical transcatheter aortic valve implantation, in which a pseudoaneurysm at the apex of the left ventricle as a complication of the procedure developed in the patient and was treated without surgery. The defect spontaneously closed.
Subject(s)
Aneurysm, False/diagnosis , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Cardiac Catheterization , Heart Aneurysm/diagnosis , Heart Valve Prosthesis Implantation , Minimally Invasive Surgical Procedures , Postoperative Complications/diagnosis , Aged , Comorbidity , Echocardiography , Follow-Up Studies , Humans , Male , Postoperative Complications/surgery , Prosthesis Design , Remission, Spontaneous , Reoperation , Thoracotomy , Tomography, X-Ray ComputedABSTRACT
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Subject(s)
Male , Adult , Humans , Tachycardia, Ventricular/etiology , Exercise Test/adverse effects , Bundle-Branch Block/complicationsABSTRACT
The infectious complications that occur following vascular access for catheterization are frequently associated with an unfavourable outcome, mainly because diagnosis is delayed. Although its incidence is low, clinicians should be aware of this complication as the use of invasive procedures is increasing. Here, we report our experience with five patients.
Subject(s)
Catheterization/adverse effects , Escherichia coli Infections/etiology , Staphylococcal Infections/etiology , Vascular Diseases/microbiology , Adult , Aged , Humans , Male , Middle AgedABSTRACT
Las complicaciones infecciosas del acceso vascular tras el cateterismo se asocian con frecuencia con una evolución desfavorable debido a un retraso en el diagnóstico. A pesar de su baja incidencia, los clínicos deben estar atentos ante su aparición debido al creciente uso de técnicas intervencionistas. Presentamos nuestra experiencia con 5 pacientes
The infectious complications that occur following vascular access for catheterization are frequently associated with an unfavourable outcome, mainly because diagnosis is delayed. Although its incidence is low, clinicians should be aware of this complication as the use of invasive procedures is increasing. Here, we report our experience with five patients
