Assuntos
Síndrome Coronariana Aguda/terapia , Angioplastia Coronária com Balão/instrumentação , Aterectomia Coronária/instrumentação , Calcinose/terapia , Catéteres , Doença da Artéria Coronariana/terapia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Calcinose/complicações , Calcinose/diagnóstico , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia , Desenho de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Angioplastia Coronária com Balão/efeitos adversos , Arritmias Cardíacas/etiologia , Estenose Coronária/terapia , Insuficiência Cardíaca/terapia , Idoso , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Pressão Sanguínea , Determinação da Pressão Arterial , Estenose Coronária/complicações , Estenose Coronária/fisiopatologia , Eletrocardiografia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Balão Intra-Aórtico , Masculino , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Iatrogenic coronary perforation complicates 0.1-0.8% of percutaneous coronary interventional (PCI) procedures. The incidence is higher if atheroablative therapy is used. When coronary perforation occurs, it may rapidly result in cardiac tamponade, myocardial infarction or death, hence prompt treatment is required. PTFE-covered stents have been used to seal coronary perforations, but these are bulky devices that lack flexibility, and rapid deployment in calcified or tortuous vessels can be difficult, particularly in emergency situations. Furthermore, difficulties in achieving adequate stent expansion and the prospect of delayed re-endothelialization have led to concern about the increased potential for stent thrombosis or restenosis. We present the first report of the successful use of a novel, highly deliverable pericardial covered stent to treat an iatrogenic coronary perforation during PCI, with angiographic follow up.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/métodos , Doença das Coronárias/terapia , Vasos Coronários/lesões , Pericárdio , Stents , Idoso , Angioplastia Coronária com Balão/instrumentação , Animais , Eletrocardiografia , Cavalos , Humanos , Masculino , Ruptura , Resultado do TratamentoRESUMO
BACKGROUND: Atherosclerotic renal artery (RA) stenosis contributes to hypertension, renal insufficiency and end stage renal disease, and is independently associated with adverse cardiovascular events. Percutaneous renal intervention is efficacious in treating renovascular hypertension and may be effective in stabilizing or improving renal function, thereby reducing cardiovascular risk. However, high rates of procedural complications have been reported. OBJECTIVES: To determine the nature and frequency of complications of percutaneous renal intervention using contemporary techniques and equipment in a high-volume cardiac catheterization laboratory. METHODS: Consecutive patients undergoing attempted RA stenting for atherosclerotic RA stenosis in the cardiac catheterization laboratory at the Vancouver General Hospital (Vancouver, British Columbia) between June 2000 and March 2007 were enrolled in a prospective registry. Baseline clinical characteristics, procedural and technical information, and complications were recorded. RESULTS: A total of 132 RAs were stented in 106 patients during 108 procedures. The procedural success rate was 100%, with no related death, myocardial infarction, nephrectomy or dialysis. Major complications included three pseudoaneurysms (2.8%) and acute deterioration in renal function in six patients (5.5%), although renal function returned to baseline in one patient at 12 months. CONCLUSIONS: RA stenting can be successfully and safely performed using contemporary techniques, and the low complication rates described should be the minimum standard for contemporary trials evaluating RA stenting.
Assuntos
Angioplastia com Balão/efeitos adversos , Aterosclerose/terapia , Obstrução da Artéria Renal/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Resultado do TratamentoRESUMO
Right coronary arteries with anomalous origin (ARCA) may be associated with myocardial ischemia and sudden death. Selective catheterization and percutaneous coronary intervention (PCI) of ARCA can be technically challenging due to their slit-like orifice and aortic intramural course with abrupt angulation. The 3DRCA guide catheter is a unique catheter with a helical configuration that provides optimal guide support during PCI. We describe three cases of successful PCI to right coronary arteries with anomalous origin (two from the left sinus of Valsalva, one with ectopic origin from the right sinus of Valsalva) using 3DRCA guide catheters after a variety of other catheters were tried unsuccessfully.