RESUMO
We describe a case of symptomatic common femoral artery stenosis following use of a vascular clip closure device (StarClose). Operative repair was performed, with removal of the clip device and subsequent vein patch angioplasty.
Assuntos
Arteriopatias Oclusivas/etiologia , Angiografia Coronária/efeitos adversos , Artéria Femoral , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Claudicação Intermitente/etiologia , Punções , Adulto , Ligas , Angioplastia , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Constrição Patológica , Remoção de Dispositivo , Desenho de Equipamento , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/cirurgiaRESUMO
PURPOSE: Clinical information regarding paclitaxel-eluting coronary artery stents is reviewed. SUMMARY: Restenosis is a significant complication of percutaneous coronary intervention. Coronary artery stenting has reduced restenosis compared with traditional balloon angioplasty, although restenosis still occurs with bare-metal coronary artery stents. The pathogenesis of in-stent restenosis is believed to involve smooth-muscle-cell proliferation and migration in response to vessel injury. A neointimal layer of extracellular matrix and collagen forms, which may impinge on the vessel lumen. Paclitaxel inhibits vascular smooth-muscle-cell proliferation and reduces neointimal mass. Local delivery of paclitaxel through a coronary stent has been shown to reduce restenosis rates and percent diameter stenosis and to produce other angiographic benefits compared with bare-metal stents. Fewer major adverse coronary events are seen with paclitaxel-eluting stents, predominantly because of a reduction in the need for target-vessel revascularization with minimal impact on rates of mortality and myocardial infarction (MI). The Taxus Express(2) stent, the only approved paclitaxel-eluting stent in the United States, costs about three times as much as a bare-metal stent. Cost-effectiveness analyses are needed to determine if the Taxus stent is cost-effective in clinical practice. CONCLUSION: Paclitaxel-eluting stents reduce the rates of restenosis and target-vessel revascularization compared with bare-metal stents and have comparable effects on mortality and MI rates.
Assuntos
Antineoplásicos/uso terapêutico , Doença da Artéria Coronariana/terapia , Reestenose Coronária/etiologia , Reestenose Coronária/prevenção & controle , Paclitaxel/uso terapêutico , Stents , Antineoplásicos/administração & dosagem , Antineoplásicos/economia , Ensaios Clínicos como Assunto , Humanos , Paclitaxel/administração & dosagem , Paclitaxel/economia , Sirolimo/uso terapêutico , Stents/efeitos adversosRESUMO
Cardiac device infections are a rare complication of pacing and defibrillator therapy. The number of implanted devices will likely continue to rise with increasing implantation of the cardioverter defibrillator and cardiac resynchronization devices. This report describes a case of an uncommon pathogen for device-associated endocarditis.
Assuntos
Endocardite Bacteriana/etiologia , Infecções por Haemophilus/etiologia , Haemophilus parainfluenzae , Marca-Passo Artificial/efeitos adversos , Adulto , Endocardite Bacteriana/diagnóstico , Infecções por Haemophilus/diagnóstico , Humanos , MasculinoAssuntos
Aorta/patologia , Aneurisma Aórtico/diagnóstico , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/fisiopatologia , Dissecção Aórtica/cirurgia , Aneurisma Aórtico/fisiopatologia , Aneurisma Aórtico/cirurgia , Aortografia , Angiografia Coronária , Dispneia/fisiopatologia , Ecocardiografia , Sopros Cardíacos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Esforço Físico/fisiologiaRESUMO
Cardiac involvement in patients with advanced HIV/AIDS is common, including pericardial effusion and pulmonary hypertension. Although there is an increased incidence of pericardial effusion in patients with AIDS, most are small and asymptomatic. The presence of a pericardial effusion and/or pulmonary hypertension is associated with shortened survival. We present a case of a 43-year-old man with AIDS and advanced cardiovascular involvement who developed severe cor pulmonale and a large pericardial effusion with cardiac tamponade.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Tamponamento Cardíaco/etiologia , Hipertensão Pulmonar/etiologia , Derrame Pericárdico/etiologia , Doença Cardiopulmonar/etiologia , Adulto , Autopsia , Tamponamento Cardíaco/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Evolução Fatal , Humanos , Hipertensão Pulmonar/diagnóstico , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapia , Pericardiocentese , Doença Cardiopulmonar/diagnósticoRESUMO
We report on an acute coronary syndrome resulting from a complex severe lesion within a stent over 6 years after implantation. This may represent an uncommon long-term limitation of coronary artery stenting.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Estenose Coronária/terapia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/terapia , Stents/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/terapia , Estenose Coronária/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
We prospectively evaluated 59 patients who were deemed candidates for coronary bypass surgery after coronary artery angiography for subclavian artery narrowing, which could compromise the ipsilateral internal thoracic artery graft. Bilateral arm blood pressure (BP) measurements, auscultation for supraclavicular or cervical bruits, and questioning about cerebrovascular ischemic symptoms were compared to brachiocephalic-subclavian arteriography. One neurologic complication occurred during arteriography. An upper extremity BP difference of > or = 15 mm Hg identified all patients with > or = 50% subclavian artery narrowing. We recommend brachiocephalic-subclavian arteriography only in patients with abnormal noninvasive screening for subclavian stenosis, not routinely.
