ABSTRACT
Stress computed tomography perfusion (Stress-CTP) and computed tomography-derived fractional flow reserve (FFRCT) are functional techniques that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD). This retrospective analysis from the PERFECTION study aims to assess the impact of their availability on the management of patients with suspected CAD scheduled for invasive coronary angiography (ICA) and invasive FFR. The management plan was defined as optimal medical therapy (OMT) or revascularization and was recorded for the following strategies: cCTA alone, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP. In 291 prospectively enrolled patients, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a similar rate of reclassification of cCTA findings when FFRCT and Stress-CTP were added to cCTA. cCTA, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a rate of agreement versus the final therapeutic decision of 63%, 71%, 89%, 84% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, and a rate of agreement in terms of the vessels to be revascularized of 57%, 64%, 74%, 71% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, with an effective radiation dose (ED) of 2.9 ± 1.3 mSv, 2.9 ± 1.3 mSv, 5.9 ± 2.7 mSv, and 3.1 ± 2.1 mSv. The addition of FFRCT and Stress-CTP improved therapeutic decision-making compared to cCTA alone, and a sequential strategy with cCTA+FFRCT+Stress-CTP represents the best compromise in terms of clinical impact and radiation exposure.
ABSTRACT
The coexistence of an atrial septal defect and a prominent eustachian valve is a rare congenital anomaly, rarely reported in literature. Differentiation between a giant eustachian valve and cor triatriatum dexter can be difficult. A case of a large atrial septal defect associated with cor triatriatum dexter diagnosed by echocardiography in an asymptomatic woman is reported. A watchful waiting strategy was adopted.
Subject(s)
Cor Triatriatum/complications , Cor Triatriatum/diagnostic imaging , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/diagnostic imaging , Adult , Cor Triatriatum/physiopathology , Diagnosis, Differential , Echocardiography/methods , Female , Heart Atria/diagnostic imaging , Heart Atria/physiopathology , Heart Septal Defects, Atrial/physiopathology , Humans , Young AdultABSTRACT
The guided-STAR technique is an alternative anterograde approach for treatment of coronary chronic total occlusion (CTO) and it is usually followed by implantation of multiple stents. We describe a case of residual long coronary dissection left unstented after guided-STAR, with good results at 2months follow-up. This case emphasizes the fact that sometimes even the longest coronary dissections can be left unstented especially in the contest of a CTO.
Subject(s)
Aortic Dissection/etiology , Coronary Aneurysm/etiology , Coronary Occlusion/therapy , Iatrogenic Disease , Percutaneous Coronary Intervention/adverse effects , Aortic Dissection/diagnosis , Aortic Dissection/physiopathology , Chronic Disease , Coronary Aneurysm/diagnosis , Coronary Aneurysm/physiopathology , Coronary Angiography/methods , Coronary Circulation , Coronary Occlusion/diagnosis , Coronary Occlusion/physiopathology , Humans , Male , Middle Aged , Multidetector Computed Tomography , Percutaneous Coronary Intervention/instrumentation , Stents , Time Factors , Treatment Outcome , Ultrasonography, InterventionalABSTRACT
OBJECTIVE: The aim of this article is to present a new technique for minimally invasive treatment of varicose veins disease of lower extremities. METHODS: One-shot scleroembolization is a new technique designed for the treatment of varicose veins of the lower extremities, which associates a mechanical interruption of the sapheno-femoral junction to classic sclerotherapy with no need for surgery or anesthesia. This is achieved with the combined use of a coil positioned in the terminal portion of the great saphenous vein and a foamed sclerosant drug. RESULTS: At three months' follow-up no complications have been observed. The great saphenous vein was still occluded in all patients (nine out of nine). CONCLUSIONS: One-shot scleroembolization seems to be an effective technique for the treatment of varicose veins disease in outpatients, with the advantage of causing little distress to the patient.
