Double guiding catheters for complex percutaneous coronary intervention.

A large-lumen guiding catheter is often used for complex percutaneous coronary intervention-particularly when a final kissing-balloon or 2-stent technique is required. However, catheter insertion is sometimes restricted by diseased vascular access sites or a tortuous vascular route.We report 2 cases in which a unique double guiding catheter technique was used to create a lumen of sufficient size for complex percutaneous coronary intervention. In each patient, two 6F guiding catheters were used concurrently to engage the ostium of 1 target vessel. In 1 patient, these catheters were used for the delivery of 2 balloons to complete kissing-balloon dilation after single-stent placement. In the other patient, the catheters were used to deliver 2 stents sequentially to their respective target lesions. The stents were then deployed simultaneously as kissing stents, followed by high-pressure kissing-balloon postdilation.

Antiplaquetários nas síndromes coronarianas agudas: revisão / Antiplatelet drugs for treating acute coronary syndromes: A review

As síndromes coronarianas agudas sem supradesnivelamento do segmento ST são causadas, na maioria das vezes, por instabilização ou ruptura da placa de ateroma, com consequente formação de trombo não oclusivo. A escolha adequada de antiplaquetários é fundamental no tratamento, com redução dos eventos isquêmicos e da mortalidade. O objetivo deste artigo é a revisão crítica atualizada dos principais agentes antiplaquetários disponíveis para uso no Brasil, os mecanismos de ação de cada droga, bem como suas indicações e contraindicações em pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST. A aspirina, isoladamente, é capaz de reduzir eventos de forma significativa. Sua associação com derivados tienopiridínicos, principalmente com o clopidogrel, acarretou sinergismo de ação com importante redução de eventos adversos. Novas drogas surgiram, gerando redução de recorrência de infarto e aumento nas taxas de sangramento, tornando mais complexa a escolha de antiplaquetários. O prasugrel, na sala de hemodinâmica, é opção basicamente nos pacientes que não receberam clopidogrel e que se submetem à angioplastia precoce, com baixo risco de sangramento avaliado por escores. O ticagrelor é uma opção ao clopidogrel para pacientes submetidos a tratamento invasivo, com possível benefício adicional na mortalidade. A escolha de antiplaquetários deve ser individualizada, conforme as circunstâncias definidas no texto, conforme o perfil de risco hemorrágicoe também conforme o perfil de risco de morte ou infarto do paciente.

Acute coronary syndromes without ST segment elevation are usually caused by destabilization or rupture of the atheroma plaque and the subsequent formation of non-occlusive thrombus. The right choice of antiplatelet drugs is crucial for treatment and to reduce both ischemicevents and mortality. This paper provides an updated critical review of the main antiplatelet drugs available in Brazil, describing the mechanisms of action, indications and contraindications of each drug for patients with acute coronary syndrome without ST segment elevation.Aspirin alone is capable of reducing events significantly. Its association with thienopyridine derivatives, especially with clopidogrel leads to synergisms and meaningful reduction of adverse events. Choosing the most adequate antiplatelet drug has become increasingly difficultas new drugs have been developed, which have reduced infarction recurrence but increased bleeding rates. Prasugrel is basically an option for patients that have not been treated with clopidogrel and undergo angioplasty in early stages, with low risks of bleeding as assessedthrough scores. Ticagrelor is an alternative to clopidogrel for patients that have undergone invasive treatment. The choice of antiplatelet drugs should be individualized for each patient, according to circumstances herein described, and according to patients? death and bleeding risk rankings.

A importância da criação de rede de cuidado para o tratamento do IAM com supra de ST e a experiência da Unidade Coronariana do Hospital das Clínicas / UFMG / The importance of creating a health care network to treat myocardial infarction with ST segment elevation and the experience of the Coronary Unit of UFMG University Hospital

O infarto com supradesnivelamento do segmento ST (IAMCSST) é uma importante causa de morbimortalidade no Brasil. O tratamento ideal para o IAMCSST depende principalmente do diagnóstico precoce e da rápida seleção de estratégia de reperfusão apropriada. A angioplastia coronária percutânea (ICP) primária é a estratégia de escolha em hospitais com serviço de hemodinâmica. Em hospitais sem esse serviço, duas estratégias de reperfusão são possíveis: transferência para ICP primária ou terapia com trombolíticos. A ICP primária apresenta melhores resultados, com redução de eventos cardiovasculares, entretanto, essa vantagem pode ser perdida, dependendo do tempo de atraso para transferência. A criação de rede de cuidado para pacientes com IAMCSST é um desafio para nosso município e pretende possibilitar o acesso à terapia de reperfusão em tempo adequado, levando em consideração as condições clínicas do paciente e do sistema de saúde em que ele é atendido.

Myocardial infarction with ST segment elevation is one of the major causes of morbimortality in Brazil. The ideal treatment for the disease depends mostly on early diagnosis and choice of adequate reperfusion strategy. Primary percutaneous coronary angioplasty (PCI) is a strategywidely adopted in hospitals that provide cardiac services, whereas hospitals without such services usually adopt either transfer for PCI or therapy with thrombolytic drugs. Primary PCI usually provides better results, reducing cardiovascular events, but this may not be effective in the event of significant transference delay. The creation of a health care network for patients with the disease is a challenge in our Municipality that can provide access to reperfusion therapy as soon as possible considering both patients? clinical conditions and health insurance.

Influence of community and hospital comprehensive health management on life quality after PCI in elderly patients / 中国医师杂志

Objective To assess the influence of community and hospital comprehensive Health management on quality of life in aged patients with coronary artery disease (CAD) after PCI.Methods 147 patients with CAD after PCI were divided into experimental group(72 cases) and control group (75 cases) accordance with their residential community.In control group,community health education was introduced.While in experimental group,hospital and community comprehensive healthy education lasted for one year.Before and after invention,major adverse cardiac events (MACE) was recorded and generic quality of life inventory (CQOLI-74),self-rating anxiety scale (SAS),and self-rating depression scale (SDS) were carried out on the basis of giving unite guiding words.Results The observation items of the SAS(34±6 vs41 ±7,t =2.714,P ＜0.01)and SDS(35 ±7 vs 41 ±8,t =2.572,P ＜0.05)scores in experimental group were lower than those in control group.Meanwhile the body health dimension(63 ± 12 vs 59 ±11,t =5.935,P ＜0.01 ),psychological health dimension(64 ± 14 vs 58 ± 13,t =6.116,P ＜0.01 ),social function dimension(64 ± 11 vs 58 ± 10,t =6.157,P ＜0.01 ) were higher than those in control group,but the difference of the material life dimension and the MACE rate were not statistically significant( P ＞0.05).Conclusions Community and Hospital comprehensive health management is a practical and valuable strategy for palliating the depression and anxiety and improving quality of life after PCI in aged patients.

Drug-eluting stent thrombosis 1,659 days after stent deployment: case report and literature review.

Drug-eluting stents are considered to be superior to bare-metal stents in reducing restenosis rates at 6 months. However, drug-eluting stents appear to be subject to stent thrombosis, a concern that has been reported more frequently in recent times. In November 2003, a 64-year-old man with a medical history of hypertension, type 2 diabetes mellitus, and coronary artery disease underwent percutaneous coronary intervention for the deployment of a sirolimus-eluting stent in the left anterior descending coronary artery. He experienced no complications. More than 4 years later, at age 69, he underwent neurosurgical treatment for a subdural hematoma that resulted from a fall, and he was advised to stop taking aspirin and clopidogrel. Thirty-three days later--1,659 days after stent deployment--he presented with a clinical event that was associated with very late stent thrombosis. After undergoing emergent coronary angiography and the placement of 2 bare-metal stents, he resumed antiplatelet therapy, recovered uneventfully, and was discharged from the hospital in stable condition. To the best of our knowledge, 1,659 days is the longest reported interval between the deployment of a drug-eluting stent and the occurrence of a clinical event that was associated with very late stent thrombosis. Herein, we discuss the case of our patient, review the pertinent medical literature, reinforce the importance of continuous and uninterrupted antiplatelet therapy in drug-eluting stent recipients, and offer considerations regarding the use of drug-eluting stents.

The comparative efficacy of percutaneous and surgical coronary revascularization in 2009: a review.

Medical, percutaneous, and surgical therapies for coronary atherosclerotic disease are developing rapidly, with many recent breakthroughs in metabolic control, improvements in catheter and stent engineering, and advances in surgical technique. Treatment guidelines are still in their infancy and do not take into account several of these recent innovations. Consequently, determining the most appropriate treatment for many patients remains challenging. In this review, we examine the most recent revascularization guidelines, discuss important new data and trials comparing contemporary stent technology and coronary artery bypass surgery, and conclude with updated revascularization recommendations.

Persuasão como estratégia para modificar as crenças nos comportamentos de risco para a doença arterial coronariana / Persuasion as a strategy to modify beliefs in risk behaviors related to coronary arterial disease / La persuasión como estrategia para modificar creencias en comportamientos de riesgo para la enfermedad arterial coronaria

Considerando os preceitos da Teoria de Persuasão de Fotheringham e o Sistema de Crenças de Rokeach, buscou-se identificar quanto um material didático pedagógico é capaz de modificar as crenças que favorecem a adoção de comportamentos de prevenção de doença coronariana. Trata-se de um estudo quase-experimental cuja amostra foi de 200 sujeitos: 50% do sexo masculino, idade entre 30 e 73 anos; 34% com hipertensão grau I; 75% com 10% risco para DAC; e 34% com níveis aumentados de colesterol total. Foram emitidas 1 297 crenças nos comportamentos de fumar, ingerir bebida alcoólica, ingerir alimentos ricos em gordura em excesso, estresse, não controlar PA, não controlar o diabetes, ingerir sal e açúcar em excesso, não controlar o peso e não realizar atividades físicas. Dessas, 248 eram referentes a comportamentos envolvidos na determinação de escores de risco para desenvolvimento de doença arterial coronariana, assim distribuídas: crenças do tipo B (36,%), D (28%) e E (36%). Para a análise dos dados foi utilizado o teste Mcnemar ou Binomial e o teste x2. Após a exposição ao material didático, foram realizadas duas avaliações (pós-teste 1 e pós-teste 2). Os resultados foram estatisticamente significantes para a maioria dos comportamentos considerados, exceto no comportamento de controlar o diabetes e dosagem de glicemia. O referencial de crenças mostrou-se oportuno para explicar a dificuldade de obter adesão às recomendações terapêuticas e de prevenção, bem como a técnica da persuasão válida por maximizar o impacto dos riscos e influenciar no deslocamento de crenças.

The study aims to identify the extent to which didactic-pedagogic material can modify beliefs favoring the adoption of preventive behavior towards coronary artery disease (CAD). The premises of Fotheringham's Persuasion Theory and Rokeach's Beliefs System were taken into account. It is a quasi-experimental study with a sample of 200 participants, half of whom were men. Participants'age ranged from 30 to 73 years. Thirty four percent of the patients had hypertension level I and 75% had a 10% CAD risk. Total cholesterol levels were increased in 34% of the patients. In all, 1,297 beliefs in several behaviors were produced: smoking, alcohol consumption, excessive intake of high-fat food, stress, not controlling blood pressure, not controlling diabetes, excessive salt and sugar intake, not controlling weight and not exercising; of these, 248 were related to behaviors involved in the assessment of risk scores for coronary artery disease, distributed as follows: Type B (36%), D (28%) and E (36%) beliefs. McNemar's Binomial test and chi-square test were used for data analysis. After exposure to didactic material, two assessments took place (post-test 1 and post-test 2). The results concerning most of the behaviors under analysis were statistically significant, except those for diabetes control and blood glucose measurement. The beliefs reference framework was appropriate to explain the difficulty in achieving adherence to therapeutic and preventive recommendations and the persuasion technique was valid to maximize the impact of risks and influence the displacement of beliefs.

Considerando los preceptos de la Teoría de la Persuasión de Fotheringham y el Sistema de Creencias de Rokeach, se intentó identificar en qué grado un material didáctico pedagógico es capaz de modificar las creencias que favorecen la adopción de comportamientos de prevención de la enfermedad coronaria. Se trata de un estudio casi-experimental cuya muestra incluyó a 200 sujetos, el 50% del sexo masculino, con edad entre 30 y 73 años, el 34% con hipertensión grado I, el 75% con el 10% de riesgo para EAC, el 34% con niveles aumentados de colesterol total. Se emitieron 1297 creencias en los comportamientos de fumar, ingerir bebida alcohólica, ingerir alimentos ricos en grasas, estrés, no controlar PA, no controlar la diabetes, ingerir sal y azúcar en exceso, no controlar el peso y no realizar actividades físicas; entre ellas: 248 se refirieron a comportamientos involucrados en la determinación de scores de riesgo para el desarrollo de enfermedad arterial coronaria, distribuidas así: creencias tipo B (36%), D (28%) y E (36%). Para el análisis de datos se utilizaron el test Mcnemar o Binomial y el test x2. Tras la exposición al material didáctico se efectuaron dos evaluaciones (post-test 1; post-test 2). Los resultados fueron estadísticamente significativos para la mayoría de los comportamientos considerados, excepto para el comportamiento de controlar la diabetes y dosaje de glicemia. El referente de creencias se mostró oportuno para explicar la dificultad para obtener adhesión a las recomendaciones terapéuticas y de prevención y la técnica da persuasión válida por maximizar el impacto de los riesgos e influir en el desplazamiento de creencias.