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1.
EuroIntervention ; 12(13): 1569-1576, 2017 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-28105993

RESUMO

AIMS: The present study explores the feasibility of telestenting, wherein a physician operator performs stenting on a patient in a separate physical location using a combination of robotics and telecommunications. METHODS AND RESULTS: Patients undergoing robotic stenting were eligible for inclusion. All manipulations of guidewires, balloons, and stents were performed robotically by a physician operator located in an isolated separate room outside the procedure room housing the patient. Communication between the operating physician and laboratory personnel was via telecommunication devices providing real-time audio and video connectivity. Among 20 patients who consented to participate, technical success, defined as successful advancement and retraction of guidewires, balloons, and stents by the robotic system without conversion to manual operation, was achieved in 19 of 22 lesions (86.4%). Procedural success, defined as <30% residual stenosis upon completion of the procedure in the absence of death or repeat revascularisation prior to hospital discharge, was achieved in 19 of 20 patients (95.0%). There were no deaths or repeat revascularisations prior to hospital discharge. CONCLUSIONS: To the best of our knowledge, the present study is the first to explore the feasibility of telestenting. Additional studies are required to determine if future advancements in robotics will facilitate telestenting over greater geographic distances.


Assuntos
Angioplastia Coronária com Balão , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea , Robótica , Telecomunicações , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/instrumentação , Angiografia Coronária/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Stents , Resultado do Tratamento
2.
Artigo em Inglês | MEDLINE | ID: mdl-26729855

RESUMO

BACKGROUND: Neoatherosclerosis is an emerging phenomenon in which lipid-rich plaques (LRPs) develop within pre-existing stents. This study was undertaken to describe near-infrared spectroscopy (NIRS) and intravascular ultrasound findings in pre-existing stents and to compare NIRS findings in pre-existing stents, in which an increased lipid signal has been speculated to indicate neoatherosclerosis, and NIRS findings in a control group of freshly implanted stents, in which any lipid signal originates from fibroatheroma under the stent. METHODS AND RESULTS: At the site of LRP detected by NIRS in a cohort of pre-existing stents, intravascular ultrasound was used to determine the presence of neointimal tissue. The lipid-core burden index and maximum lipid-core burden index in 4 mm were measured within stented segments. Findings were compared between pre-existing stents and a control group of freshly implanted stents. Among 60 pre-existing stents implanted 5.5±4.0 years earlier, NIRS detected LRP in 33%. At the site of LRP, intravascular ultrasound found no neointimal tissue in 35% of cases. NIRS findings in pre-existing stents were indistinguishable from those of freshly implanted stents (lipid-core burden index: 50±72 versus 42±58; P=0.40 and maximum lipid-core burden index in 4 mm: 156±184 versus 155±203; P=0.69). CONCLUSIONS: The detection of LRP in a pre-existing stent by NIRS alone is not reliable evidence of neoatherosclerosis, as the lipid signal may originate from fibroatheroma underlying the stent. By identifying the presence or absence of neointimal tissue at the site of LRP detected by NIRS, intravascular ultrasound may provide some insight into the potential source of the lipid signal in pre-existing stents. REGISTRATION INFORMATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01694368.


Assuntos
Doença da Artéria Coronariana/patologia , Reestenose Coronária/diagnóstico , Imagem Multimodal , Espectroscopia de Luz Próxima ao Infravermelho , Stents , Ultrassonografia de Intervenção , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Reestenose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
3.
Eur Heart J Cardiovasc Imaging ; 17(4): 393-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26800770

RESUMO

AIMS: A recent study demonstrated that intracoronary near-infrared spectroscopy (NIRS) findings in non-target vessels are associated with major adverse cardiovascular and cerebrovascular events (MACCE). It is unknown whether NIRS findings at non-stented sites in target vessels are similarly associated with future MACCE. This study evaluated the association between large lipid-rich plaques (LRP) detected by NIRS at non-stented sites in a target artery and subsequent MACCE. METHODS AND RESULTS: This study evaluated 121 consecutive registry patients undergoing NIRS imaging in a target artery. After excluding stented segments, target arteries were evaluated for a large LRP, defined as a maximum lipid core burden index in 4 mm (maxLCBI4 mm) ≥400. Excluding events in stented segments, Cox regression analysis was performed to evaluate for an association between a maxLCBI4 mm ≥400 and future MACCE, defined as all-cause mortality, non-fatal acute coronary syndrome, and cerebrovascular events. NIRS detected a maxLCBI4 mm ≥400 in a non-stented segment of the target artery in 17.4% of patients. The only baseline clinical variable marginally associated with MACCE was ejection fraction (HR 0.96, 95% CI 0.93-1.00, P = 0.054). A maxLCBI4 mm ≥400 in a non-stented segment at baseline was significantly associated with MACCE during follow-up (HR 10.2, 95% CI 3.4-30.6, P < 0.001). CONCLUSION: Detection of large LRP by NIRS at non-stented sites in a target artery was associated with an increased risk of future MACCE. These findings support ongoing prospective studies to further evaluate the ability of NIRS to identify vulnerable patients.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
4.
J Am Coll Cardiol ; 51(5): 529-35, 2008 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-18237680

RESUMO

OBJECTIVES: This study sought to assess whether the use of eptifibatide instead of abciximab is associated with a difference in outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Pooled data from randomized controlled trials suggest that the use of abciximab may be associated with a survival advantage in patients undergoing primary PCI for acute STEMI. However, a large proportion of patients in the community are treated with eptifibatide, an agent that shares some but not all pharmacological properties with abciximab. METHODS: We evaluated the outcomes of 3,541 patients who underwent primary PCI for STEMI from October 2002 to July 2006 in a large regional consortium and who were treated with abciximab (n = 729) or with eptifibatide (n = 2,812). RESULTS: There was no difference in the incidence of in-hospital death (4.1% with abciximab vs. 3.5% with eptifibatide, p = 0.39), recurrent myocardial infarction (0.8% vs. 1.2%, p = 0.42), or stroke/transient ischemic attack (0.7% vs. 0.6%, p = 0.80). There was no difference in the need for blood transfusion (12.4% vs. 11.7%, p = 0.61), whereas there was a greater incidence of gastrointestinal bleeding with abciximab (4.8% vs. 2.8%, p = 0.01). In parsimonious risk-adjusted models, no significant difference between abciximab and eptifibatide was observed with respect to any of the outcomes measures. CONCLUSIONS: Currently, eptifibatide is used as the adjunct antiplatelet agent in the majority of patients undergoing primary PCI. There is no apparent difference in early outcomes of patients treated with eptifibatide compared with patients treated with abciximab.


Assuntos
Angioplastia Coronária com Balão , Anticorpos Monoclonais/uso terapêutico , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Infarto do Miocárdio/terapia , Peptídeos/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Abciximab , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/efeitos adversos , Eptifibatida , Feminino , Mortalidade Hospitalar , Humanos , Fragmentos Fab das Imunoglobulinas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Peptídeos/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Recidiva , Sistema de Registros , Resultado do Tratamento
5.
Am J Cardiovasc Drugs ; 7(3): 159-68, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17610343

RESUMO

Despite many recent advancements in the treatment of coronary heart disease, it continues to be an important source of patient morbidity and mortality as well as a significant source of healthcare-related expenditures. Clopidogrel has become an integral part of the management of acute coronary syndromes (ACS) and, consequently, has become one of the world's best selling drugs. Numerous trials have demonstrated the clinical efficacy of clopidogrel in revascularized and nonrevascularized ACS including unstable angina as well as non-ST elevation and ST-elevation myocardial infarction. As a result of these trials, the use of clopidogrel has been incorporated into the American College of Cardiology/American Heart Association guidelines. Additionally, numerous analyses have proven clopidogrel to be highly cost effective. However, clopidogrel remains underutilized and guideline adherence remains inadequate despite the robust clinical data and guidelines. Institution of disease-management programs and quality-improvement initiatives appear to be an excellent strategy to promote guideline adherence and appropriate use of clopidogrel.


Assuntos
Doença das Coronárias/tratamento farmacológico , Inibidores da Agregação Plaquetária/farmacologia , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/análogos & derivados , Doença Aguda , Angina Instável/tratamento farmacológico , Angina Instável/terapia , Angioplastia Coronária com Balão , Clopidogrel , Ponte de Artéria Coronária , Doença das Coronárias/terapia , Análise Custo-Benefício , Fidelidade a Diretrizes , Hemorragia/induzido quimicamente , Humanos , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/terapia , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Agregação Plaquetária/economia , Guias de Prática Clínica como Assunto , Ticlopidina/efeitos adversos , Ticlopidina/economia , Ticlopidina/farmacologia , Ticlopidina/uso terapêutico
7.
Circulation ; 110(11 Suppl 1): II237-42, 2004 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-15364869

RESUMO

BACKGROUND: There are less data on the clinical and diagnostic imaging characteristics, management, and outcomes of patients with previous cardiac surgery (PCS) presenting with acute type A aortic dissection (AAD). METHODS AND RESULTS: In 617 patients with AAD, we evaluated the differences in the clinical characteristics, management, and in-hospital outcomes of the cohorts with and without PCS. A history of PCS was present in 100 of 617 patients. Patients with PCS were more likely to be males (P=0.02), older (P=0.014), and to have a history of previous aortic dissection (P<0.001) or aneurysms (P<0.001). In contrast, PCS patients were less likely to have presenting chest pain (P<0.001). Cardiac tamponade was less common in PCS patients (P=0.007). Fewer AAD patients with PCS underwent surgical repair (P=0.001). Hospital mortality was not adversely influenced by PCS (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.81 to 2.63), but a trend for increased death was seen in patients with previous aortic valve replacement (AVR) (OR, 2.31; 95% CI, 0.98 to 5.43). Age 70 years or older, previous AVR, shock, and renal failure identified PCS patients at risk for death. CONCLUSIONS: Our study highlights differences in clinical characteristics, management, and outcomes of AAD patients with PCS. Importantly, PCS, with the exception of previous AVR, does not adversely influence early outcomes of AAD patients, including those undergoing surgical repair. However, because of otherwise dismal outcomes with medical management of AAD, our data indicate that a history of PCS (even that of previous AVR) should not preclude physicians from recommending surgical correction of type A aortic dissection in appropriate patients.


Assuntos
Aneurisma Aórtico/epidemiologia , Dissecção Aórtica/epidemiologia , Administração de Caso , Complicações Pós-Operatórias/epidemiologia , Injúria Renal Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/cirurgia , Dissecção Aórtica/terapia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico/terapia , Valva Aórtica/cirurgia , Tamponamento Cardíaco/etiologia , Dor no Peito/etiologia , Estudos de Coortes , Feminino , Implante de Prótese de Valva Cardíaca , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Recidiva , Fatores de Risco , Choque/epidemiologia , Inquéritos e Questionários , Análise de Sobrevida , Síncope/etiologia , Resultado do Tratamento
8.
Herz ; 27(6): 548-54, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12378401

RESUMO

BACKGROUND: Acute myocardial infarction during pregnancy has been reported and has been shown to be associated with poor maternal and fetal outcomes. However, the vast majority of these patients do not have previously recognized ischemic heart disease. Pregnancy and delivery pose significant cardiac stress and risk to the mother and fetus. However, it is unknown how available therapies can be utilized in the pregnant patient with identified ischemic heart disease to minimize these risks. CASE REPORT: We present a 39-year-old asymptomatic diabetic female with a positive stress echocardiogram at 16 weeks of pregnancy who remained asymptomatic throughout pregnancy with medical management and went on to have a normal vaginal delivery in the process suffering a small non-ST elevation myocardial infarction with pulmonary edema following delivery due to volume overload. She ultimately underwent cardiac catheterization and successful four-vessel CABG 1 months after her delivery. CONCLUSION: We present this patient to suggest a successful strategy of managing a patient with non-revascularized asymptomatic coronary artery disease during pregnancy. In addition to reviewing the appropriate medical therapy during pregnancy, we discuss the data on revascularization procedures as well as recommendations for delivery and stress testing for such patients.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Angiopatias Diabéticas/terapia , Complicações Cardiovasculares na Gravidez/terapia , Gravidez em Diabéticas/terapia , Adulto , Terapia Combinada , Ponte de Artéria Coronária , Diabetes Mellitus Tipo 1/diagnóstico por imagem , Angiopatias Diabéticas/diagnóstico por imagem , Ecocardiografia sob Estresse , Extração Obstétrica , Feminino , Hidratação/efeitos adversos , Humanos , Recém-Nascido , Infarto do Miocárdio/terapia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Gravidez em Diabéticas/diagnóstico por imagem , Transtornos Puerperais/terapia
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