RESUMEN
OBJECTIVES: The aim of this prospective, multicenter study was to assess the safety, feasibility, acceptance, and cost of ambulatory transradial percutaneous coronary intervention (PCI) under the conditions of everyday practice. BACKGROUND: Major advances in PCI techniques have considerably reduced the incidence of post-procedure complications. However, overnight admission still constitutes the standard of care in most interventional cardiology centers. METHODS: Eligibility for ambulatory management was assessed in 370 patients with stable angina referred to three high-volume angioplasty centers. On the basis of pre-specified clinical and PCI-linked criteria, 220 patients were selected for ambulatory PCI. RESULTS: The study population included a substantial proportion of patients with complex procedures: 115 (52.3%) patients with multivessel coronary artery disease, 50 (22.7%) patients with multilesion procedures, and 60 (21.5%) bifurcation lesions. After 4-6 hr observation period, 213 of the 220 patients (96.8%) were cleared for discharge. The remaining seven (3.2%) patients were kept overnight for unstable angina (n = 1), atypical chest discomfort (n = 2), puncture site hematoma (n = 1), or non-cardiovascular reasons (n = 3). Within 24 hr after discharge, no patients experienced readmission, stent occlusion, recurrent ischemia, or local complications. Furthermore, 99% of patients were satisfied with ambulatory management and 85% reported no anxiety. The average non-procedural cost was lower for ambulatory PCI than conventional PCI (1,230 ± 98 Euros vs. 2,304 ± 1814 Euros, P < 10(-6)). CONCLUSIONS: Ambulatory PCI in patients with stable coronary artery disease is safe, effective, and well accepted by the patients. It may both significantly reduce costs and optimize hospital resource utilization.
Asunto(s)
Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Angioplastia Coronaria con Balón/métodos , Enfermedad de la Arteria Coronaria/terapia , Ahorro de Costo , Adulto , Anciano , Anciano de 80 o más Años , Angina Estable/diagnóstico por imagen , Angina Estable/terapia , Angioplastia Coronaria con Balón/economía , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Análisis Costo-Beneficio , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/terapia , Alta del Paciente/economía , Alta del Paciente/tendencias , Estudios Prospectivos , Arteria Radial , Stents , Factores de Tiempo , Resultado del TratamientoRESUMEN
The retrograde approach has been shown to improve the success rate of percutaneous coronary intervention for coronary chronic total occlusion (CTO) when performed by highly experienced operators. We report a very challenging case of a retrograde approach by the "reverse controlled antegrade and retrograde subintimal tracking (CART) technique" with a single guiding catheter for a CTO of the right coronary artery via an anomalous left circumflex artery.
Asunto(s)
Angioplastia Coronaria con Balón/métodos , Circulación Colateral , Oclusión Coronaria/terapia , Vasos Coronarios , Anciano , Humanos , Masculino , Tomografía Computarizada Espiral , Resultado del TratamientoAsunto(s)
Síndrome Coronario Agudo/diagnóstico , Displasia Ventricular Derecha Arritmogénica/diagnóstico , Ventrículos Cardíacos/anomalías , Displasia Ventricular Derecha Arritmogénica/complicaciones , Angiografía Coronaria , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía , Humanos , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Derecha/diagnóstico , Disfunción Ventricular Derecha/etiologíaRESUMEN
Compared with the approved dose regimen of clopidogrel (300-mg loading dose [LD], 75-mg maintenance dose [MD]), prasugrel has been demonstrated to reduce ischaemic events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). In ACS, antiplatelet effects of a prasugrel MD regimen have not been previously compared with either a higher clopidogrel MD or after switching from a higher clopidogrel LD. The objective of this study was to evaluate the antiplatelet effect of a prasugrel 10-mg MD versus a clopidogrel 150-mg MD in patients with ACS who had received a clopidogrel 900-mg LD. Patients with non-ST elevation ACS, treated with aspirin and a clopidogrel 900-mg LD, were randomised within 24 hours post-LD to receive a prasugrel 10-mg or clopidogrel 150-mg MD. After 14 days of the initial MD, subjects switched to the alternative treatment for 14 days. The primary endpoint compared maximum platelet aggregation (MPA, 20 microM adenosine diphosphate [ADP]) between prasugrel and clopidogrel MDs for both periods. Responder analyses between treatments were performed using several platelet-function methods. Of 56 randomised subjects, 37 underwent PCI. MPA was 26.2% for prasugrel 10 mg and 39.1% for clopidogrel 150 mg (p<0.001). The prasugrel MD regimen reduced MPA from the post-900-mg LD level (41.2% to 29.1%, p=0.003). Poor response ranged from 0% to 6% for prasugrel 10 mg and 4% to 34% for clopidogrel 150 mg. Thus, in ACS patients a prasugrel 10-mg MD regimen resulted in significantly greater platelet inhibition than clopidogrel at twice its approved MD or a 900-mg LD.
Asunto(s)
Síndrome Coronario Agudo/tratamiento farmacológico , Piperazinas/administración & dosificación , Inhibidores de Agregación Plaquetaria/administración & dosificación , Agregación Plaquetaria/efectos de los fármacos , Tiofenos/administración & dosificación , Ticlopidina/análogos & derivados , Síndrome Coronario Agudo/sangre , Adenosina Difosfato , Adulto , Anciano , Anciano de 80 o más Años , Clopidogrel , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paris , Piperazinas/efectos adversos , Inhibidores de Agregación Plaquetaria/efectos adversos , Pruebas de Función Plaquetaria , Clorhidrato de Prasugrel , Tiofenos/efectos adversos , Ticlopidina/administración & dosificación , Ticlopidina/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Percutaneous coronary intervention (PCI) of complex coronary lesions in patients with severely depressed left ventricular (LV) function may increasingly constitute an alternative to surgical revascularization. The availability of hemodynamic support devices offers a promising option to reduce PCI-related complications in such high-risk procedures. We report the case of successful distal left main coronary artery T-stenting supported by the Impella Recover LP 2.5 assist device in a patient with severe LV dysfunction.
Asunto(s)
Angina Inestable/terapia , Angioplastia Coronaria con Balón/instrumentación , Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Stents , Anciano de 80 o más Años , Angina Inestable/diagnóstico por imagen , Angina Inestable/epidemiología , Angiografía Coronaria , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Factores de RiesgoRESUMEN
OBJECTIVE: We aimed to assess the safety and feasibility of thrombectomy with the Export Aspiration Catheter (EAC) before angioplasty, and its ability to improve angiographic results in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Distal embolization of atherothrombotic material often occurs during angioplasty in STEMI, compromising optimal myocardial reperfusion. METHODS: We performed a thrombus-aspiration with EAC prior to angioplasty in 64 consecutive patients with STEMI. Successful thrombectomy was defined as an improvement of TIMI flow grade >or=1. RESULTS: Successful thrombectomy (increase of TIMI flow >or=1) was achieved in 40 patients (62.5%). Mean TIMI flow grade increased from 0.7 +/- 1 to 1.9 +/- 1.2 (p < 0.0001) after thrombectomy. TIMI flow grade 3 was observed more frequently after EAC compared with guidewire alone (51.5% vs. 9%, p = 0.0062). Direct stenting was performed in most of the patients (n = 41, 64%). Distal embolization and no reflow/slow flow phenomenon occurred in 8 patients (12.5%). No vessel injury after EAC thrombectomy was reported. After treatment with balloon angioplasty and/or stenting, final TIMI flow grade 3 was achieved in 54 patients (84.5%). By multivariate analysis, ischemic time < 6 hours was a significant independent predictor of successful thrombectomy (p = 0.0437). CONCLUSIONS: Our series suggests that EAC thrombectomy prior to angioplasty in the setting of STEMI is safe and feasible. It might reduce the culprit coronary lesion's thrombus burden, leading to improved flow restoration and myocardial reperfusion. Further large randomized studies are warranted to confirm these preliminary results and to assess the impact of thrombus-aspiration on infarct size as well as on clinical outcomes.
Asunto(s)
Angioplastia Coronaria con Balón , Cateterismo/instrumentación , Infarto del Miocardio/terapia , Trombectomía/métodos , Resultado del Tratamiento , Enfermedad Aguda , Anciano , Angiografía Coronaria , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Prospectivos , Seguridad , Trombectomía/instrumentación , Factores de TiempoRESUMEN
We report the case of a 74-year-old patient admitted for acute anterior myocardial infarction and treated by intravenous thrombolysis. Because of hemodynamic instability, an intra-aortic balloon pump (IABP) was inserted. However, the patient's systolic blood pressure deteriorated early after IABP placement. Echocardiography revealed a dynamic left ventricular outflow tract obstruction occurring only during assisted ventricular systoles. Interruption of counterpulsation allowed complete resolution of the dynamic obstruction and improvement of hemodynamic status.
Asunto(s)
Cardiomiopatía Hipertrófica/etiología , Contrapulsador Intraaórtico/efectos adversos , Infarto del Miocardio/terapia , Obstrucción del Flujo Ventricular Externo/etiología , Anciano , Cardiomiopatía Hipertrófica/patología , Cardiomiopatía Hipertrófica/fisiopatología , Ecocardiografía , Femenino , Hemodinámica/fisiología , Humanos , Hipotensión/etiología , Hipotensión/patología , Hipotensión/fisiopatología , Infarto del Miocardio/fisiopatología , Obstrucción del Flujo Ventricular Externo/patología , Obstrucción del Flujo Ventricular Externo/fisiopatologíaRESUMEN
Diagnosis of patent foramen ovale (PFO) is commonly made by echocardiography with contrast injection. PFO can be responsible for a transient right-to-left shunting with paroxysmal dyspnoea but punctual measurements of oxygen saturation may fail to detect arterial desaturations. Thus, claiming the imputability of PFO in dyspnoeic symptoms remains difficult. We report on the case of a 64-year-old man presenting an intermittent disabilitating dyspnoea, for which the pulse oximetry monitoring allowed to impute symptoms to the right-to-left shunting through the PFO and influenced the decision of percutaneous closure.
Asunto(s)
Disnea/etiología , Defectos del Tabique Interatrial/diagnóstico , Monitoreo Ambulatorio , Oximetría , Disnea/sangre , Ecocardiografía Transesofágica , Electrocardiografía Ambulatoria , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/diagnóstico , Defectos del Tabique Interatrial/sangre , Defectos del Tabique Interatrial/cirugía , Tabiques Cardíacos , Humanos , Hipertensión/sangre , Hipertensión/diagnóstico , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Remodelación Ventricular/fisiologíaRESUMEN
AIMS: Radial artery spasm remains the major limitation of transradial approach for percutaneous coronary interventions. The aim of our study was to evaluate the efficacy of vasodilators in the prevention of radial artery spasm during percutaneous coronary interventions. METHODS AND RESULTS: 1,219 patients were consecutively randomized to receive placebo (n = 198), molsidomine 1 mg (n = 203), verapamil 2.5 mg (n = 409), 5 mg (n = 203) or verapamil 2.5 mg and molsidomine 1 mg (n = 206). All drugs were administered through the arterial sheath. The primary end point was the occurrence of a radial artery spasm defined by the operator as severe limitation of the catheter movement, with or without angiographic confirmation. Main characteristics including age, sex, wrist and arterial sheath diameters and procedure duration were identical across the groups. The rate of radial artery spasm was lowest in patients receiving verapamil and molsidomine (4.9%), compared to verapamil 2.5 mg or 5 mg (8.3 and 7.9%), or molsidomine 1 mg (13.3%); and placebo (22.2%) (P < 0.0001). CONCLUSION: Radial artery spasm during transradial percutaneous interventions was effectively prevented by the administration of vasodilators. The combination of verapamil 2.5 mg and molsidomine 1 mg provided the strongest relative risk reduction of spasm compared to placebo and should therefore be recommended during percutaneous coronary interventions through the radial approach.