RESUMO
UNLABELLED: Polytetrafluoroethylene-covered stents (PCS) were recently proposed as a new modality mainly for the treatment of saphenous vein graft lesions, but restenosis occurring principally at the edges restricted their clinical use in the management of coronary aneurysms and perforations. AIMS: To investigate the safety and effectiveness of the overlapping implantation of drug-eluting stents (DES) with PCS in clinical scenarios where the latter are indicated. METHODS: Since April 2002, when DES were introduced in clinical practice, 14 consecutive patients were -treated with overlapping implantation of PCS with DES in 3 centres. Seven patients were treated for coronary aneurysms, 5 for coronary perforations and 2 for branch occlusion. The incidence of any major adverse cardiac events defined as death, myocardial infarction (MI), and target vessel revascularisation (TVR) was retrospectively evaluated. A control angiography was available in 13 patients, and quantitative coronary angiography was performed before and after the intervention and at follow-up to evaluate restenosis rate and late loss. RESULTS: At a mean clinical follow-up of 21.9 months there were no deaths or MI's, while one patient with occlusive restenosis underwent successful TVR (7.7%). At angiographic follow-up (mean: 9.7 months) there was one patient with restenosis (7.7%), who had a total occlusion. After excluding the patient with the occlusive restenosis mean diameter stenosis was 22.4+/-11.7% and late loss was 0.18+/-0.35 mm at follow-up. No early or late stent thrombosis occurred. CONCLUSION: Overlapping implantation of PCS with DES seems to be a safe and effective therapeutic modality demonstrating a low incidence of clinical and angiographic restenosis.
RESUMO
OBJECTIVE: To study the incidence and management of intermittent claudication in primary care. DESIGN: In a longitudinal survey among 161 general practitioners (GPs) all incident diagnoses of intermittent claudication (IC) were selected and available information on GP management was studied. SETTING: Dutch National Survey of Morbidity and Interventions in General Practice. SUBJECTS: 74153 patients aged 55 years and over. MAIN OUTCOME MEASURES: Age- and sex-specific incidence rates. RESULTS: The overall incidence rate of IC was 6.4 per 1000 person years (95% confidence interval (CI) 5.3-7.7). Incidence rate in creased from 4.0 per 1000 person years in men aged 55-59 to 12.9 per 1000 person years in men aged over 85, and for women in the same age categories from 3.3 per 1000 person years to 8.2 per 1000 person years, respectively. Of the 117 incident cases of IC, 43 (37%) were referred to a hospital specialist. In 55 cases (47%), drugs were prescribed by the GP and in 101 cases (86%) the GP gave advice, notably pertaining to exercise and cessation of smoking. CONCLUSION: The incidence rate of IC in primary care is high in both men and women, and clearly increases with age. Only a minority of patients are referred to a hospital specialist, while the vast majority receive lifestyle advice.
