The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess ...long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis.
Objectives
Aim of this study is to evaluate safety, feasibility, and mid‐term outcome of transcatheter aortic valve implantation (TAVI) in cardiogenic shock (CS).
Background
Balloon aortic ...valvuloplasty in patients with severe aortic valve stenosis (SAS) complicated by CS is indicated but associated with a grim prognosis. TAVI might be a more reasonable treatment option in this setting but data are scant.
Methods
From March 2008 to February 2019, 51 patients with severe aortic valvulopathy (native SAS or degenerated aortic bioprosthesis) and CS treated by TAVI in 11 European centers were included in this multicenter registry. Demographic, clinical, and procedural data were collected, as well as clinical and echocardiographic follow‐up.
Results
The mean age of our study population was 75.8 ± 13, 49% were women, and mean Society of Thoracic Surgeons (STS) score was 19 ± 15%. Device success was achieved in 94.1%, with a 5% incidence of moderate/severe paravalvular leak. The 30‐day events were mortality 11.8%, stroke 2.0%, vascular complications 5.9%, and acute kidney injury 34%. Valve Academic Research Consortium‐2 early safety endpoint was reached in 35.3% of cases. At 1‐year of follow‐up, the mortality rate was 25.7% and the readmission for congestive heart failure was 8.6%.
Conclusions
TAVI seems to be a therapeutic option for patients with CS and SAS or degenerated aortic bioprosthesis in terms of both safety and efficacy at early and long‐term follow‐up.
Drug-eluting stents (DESs) have minimized the limitations of bare-metal stents (BMSs) after percutaneous coronary interventions. Nevertheless, serious concerns remain about possible late ...complications of stenting, such as stent thrombosis (ST) and in-stent restenosis (ISR), although the introduction of second-generation DESs seems to have softened the phenomenon, compared to the first-generation ones. ST is a potentially catastrophic event, which has been markedly reduced by optimization of stent implantation, novel stent designs, and dual antiplatelet therapy. The exact mechanism to explain its occurrence is under investigation, and, realistically, multiple factors are responsible. ISR of BMSs has been previously considered as a stable condition with an early peak (at 6 months) of intimal hyperplasia, followed by a regression period beyond 1 year. On the contrary, both clinical and histologic studies of DESs have demonstrated evidence of continuous neointimal growth during long-term follow-up, named "late catch-up" phenomenon. The acknowledgment that ISR is a relatively benign clinical condition has been recently challenged by evidences which reported that patients with ISR can experience acute coronary syndromes. Intracoronary imaging is an invasive technology that allows identifying features of atherosclerotic plaque of stent implanted and of vascular healing after stenting; it is often used to complete diagnostic coronary angiography and to drive interventional procedures. Intracoronary optical coherence tomography is currently considered a state-of-the-art imaging technique; it provides, compared to intravascular ultrasound, better resolution (at least >10 times), allowing the detailed characterization of the superficial structure of the vessel wall. Imaging studies "in vivo," in agreement with histological findings, suggest that chronic inflammation and/or endothelial dysfunction may induce late de novo "neoatherosclerosis" inside both BMSs and DESs. So, neoatherosclerosis has become the prime suspect in the pathogenesis of late stent failure.
Right coronary artery arising from the pulmonary trunk Capuano, Cinzia; Sesana, Marco; Capuano, Fabio ...
Cardiovascular revascularization medicine,
2007, 2007 Jan-Mar, 2007-1-00, 20070101, Letnik:
8, Številka:
1
Journal Article
Recenzirano
Abstract The right coronary artery (RCA) abnormally originating from the pulmonary trunk (PT) is a rare congenital anomaly. Our patient is a 62-year-old woman with longstanding systemic arterial ...hypertension and angina pectoris. Angiographic images documented the RCA arising from the PT, and coronary angiography showed severe stenosis (70%) on the distal tract of the left anterior descending artery. The primary treatment of the anomalous origin of RCA from the pulmonary artery is surgical technique. Our surgeons opted for coronary reimplantation; 6-month follow-up has shown very good results, with complete disappearance of symptoms.
Osteopetrosis is a heterogeneous group of heritable conditions in which there is a defect in bone resorption by osteoclasts. It is associated with an increased skeletal mass due to abnormally dense, ...but brittle, bones. Osteopetrosis varies greatly in severity, and fracture treatment remains a matter of controversy due to altered responses to fixation and the risk of osteomyelitis. The fate of sternotomy in this condition is unknown, and osteopetrosis could represent a situation of 'hostile chest'. Here, the case is described of a patient with osteopetrosis and concomitant symptomatic aortic valve stenosis and coronary artery disease.
Mitroflow aortic prosthesis dysfunction in case of complex vascular disease is considered a challenging scenario. Because of the high risk for surgical reoperation and the presence of chronic aortic ...dissection originated from a calcified Kommerel diverticulum, we considered to perform a transapical valve-in-valve transcatheter aortic valve implantation (TAVI) procedure. Myocardial ischemia is a dreadful complication reported in valve-in-valve TAVI procedures, mainly in patients with degenerated Mitroflow aortic bioprostheses. Because of the narrow shape of Valsalva sinuses and the short distance between Mitroflow annulus and left coronary ostium, to overcome the risk of possible Mitroflow leaflets displacement during TAVI expansion thus overlapping coronary ostia, we performed a preventive angioplasty. Then, we implanted a bare metal stent on the left main protruding in the aortic root. At 3 years follow-up the patient was in good clinical conditions.
We describe a 74-year-old female patient with unstable angina. The coronary angiogram showed the presence of a single coronary artery arising from the right sinus of Valsalva, which is a very ...uncommon congenital anomaly, with subocclusive atherosclerotic plaques at the proximal and distal right coronary artery. The stenoses were treated through percutaneous coronary angioplasty and insertion of taxol-eluting stents, with complete relief of symptoms and without evidence of myocardial ischemia at 6-months follow up. Single coronary artery is a rare congenital coronary anomaly, which may be asymptomatic and occasionally detected in patients with myocardial ischemia due to atherosclerotic coronary artery disease. In these cases, percutaneous coronary angioplasty with stent insertion may be a successful therapeutic option; however, accurate morphologic identification of anomalous arteries is mandatory before planning these interventions, in order to recognize other possible mechanisms of myocardial ischemia (e.g. vascular compression) and to choose the most appropriate type of pharmacological, percutaneous or surgical intervention.
An inverse relation between the degree of heparin anticoagulation and the subsequent risk of postprocedural thrombotic complications was observed in the era of conventional balloon angioplasty, but ...the optimal dose of heparin during percutaneous coronary intervention (PCI) using newer interventional equipment and glycoprotein IIb/IIIa receptor inhibition has not been clearly defined. Previous studies did not assess the increased risk of adverse cardiac events with an activated clotting time of <200 s using strategies of routine stent placement and glycoprotein IIb/IIIa receptor inhibition. We hypothesised that the efficacy and safety of PCI would be maintained, if not improved, especially when performed in conjunction with glycoprotein IIb/IIIa receptor inhibitors (abciximab, tirofiban or eptifibatide as a bolus plus infusion for 12-18 h) and oral antiplatelet therapy (clopidogrel 75 mg plus aspirin 325 mg/day) associated with low doses (5000-10 000 U) of unfractionated heparin using a target activated clotting time of </=200 s during PCI. In this way, the sheath could be immediately removed at the end of the procedure.
We evaluated the outcome at 30 days and at one year of 2552 consecutive patients who underwent PCI and stenting; most of them were treated with PCI and selective administration of glycoprotein IIb/IIIa inhibitors in high-risk cases (61%).
By design, the activated clotting time was 184 +/- 39 s. The incidence of access site complications and of in-hospital major adverse cardiac events during the first 48 h following PCI was 3.7% and 3.3%, respectively. The incidence of major adverse cardiac events was 4.5% at 30 days and 7.6% at one year.
This study shows the safety and efficacy of this therapeutic strategy in the era of frequent stent implantation and aggressive intravenous and oral platelet inhibition. Additional research is warranted to determine whether these results can be extrapolated routinely to patients with acute myocardial infarction or undergoing PCI without stent implantation.
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