RESUMEN
Venous thromboembolism is the third vascular disease in morbidity and mortality. The new oral anticoagulants are presented as an effective and safe alternative to conventional antithrombotic therapy. Apixaban has been recently approved to use for the treatment of deep vein thrombosis. A case of an elderly patient, with high risk of bleeding, a history of cancer, and recent pacemaker implant, who consulted for superficial venous thrombosis of the ipsilateral arm to the implant, which was successfully treated with apixaban is here presented.
Asunto(s)
Inhibidores del Factor Xa/uso terapéutico , Marcapaso Artificial/efectos adversos , Pirazoles/uso terapéutico , Piridonas/uso terapéutico , Trombosis de la Vena/tratamiento farmacológico , Anciano de 80 o más Años , Humanos , Masculino , Factores de Riesgo , Ultrasonografía Doppler de Pulso , Trombosis de la Vena/etiologíaRESUMEN
INTRODUCTION: Sudden death (SD) is in most cases due to cardiac causes, mainly secondary to ischemic heart disease. However, the angiographic characteristics in SD survivors in the context of an acute coronary syndrome (ACS) remain controversial. The aim of this study was to evaluate the clinical and angiographic characteristics of patients who suffered cardiac arrest during an ACS. METHODS: We evaluated 46 patients with SD related to ACS, who were divided into two groups according to their presentation: an ST-elevation myocardial infarction (SD-STEMI) group and a non ST-elevation myocardial infarction (SD-NSTEMI) group. Consecutive STEMI patients without SD served as a double size-matched control group. We compared the clinical and angiographic characteristics and the in-hospital mortality between groups. RESULTS: Patients in the SD-NSTEMI group (n=13) were older and had a higher incidence of hypertension. The left anterior descending coronary artery was the most frequent culprit vessel in all groups. SD-STEMI patients (n=33) had a higher prevalence of proximal coronary culprit segment involvement than did the nonSD STEMI group (75% vs. 36.3%, p<0.001). The SD-NSTEMI group was characterized by multivessel and multi-segment disease. Outcomes were similar for both SD groups. CONCLUSION: SD in patients with NSTEMI occurred in patients who were older, with more cardiovascular risk factors, diffuse and multivessel coronary disease, complex coronary lesions, and a lower rate of angioplasty success as compared with the STEMI group. SD STEMI patients had a significant higher association with proximal coronary acute occlusion than STEMI patients without SD.
Asunto(s)
Síndrome Coronario Agudo , Muerte Súbita Cardíaca , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/terapia , Factores de Edad , Anciano , Angioplastia Coronaria con Balón/estadística & datos numéricos , Angiografía Coronaria/métodos , Vasos Coronarios/patología , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Muerte Súbita Cardíaca/patología , Femenino , Mortalidad Hospitalaria , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , España/epidemiologíaAsunto(s)
Angioplastia Coronaria con Balón/instrumentación , Enfermedad de la Arteria Coronaria/terapia , Trombosis Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Stents Liberadores de Fármacos , Tomografía de Coherencia Óptica , Ultrasonografía Intervencional , Calcificación Vascular/terapia , Angioplastia Coronaria con Balón/efectos adversos , Fármacos Cardiovasculares/administración & dosificación , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/etiología , Trombosis Coronaria/patología , Everolimus/administración & dosificación , Humanos , Valor Predictivo de las Pruebas , Diseño de Prótesis , Factores de Riesgo , Índice de Severidad de la Enfermedad , Calcificación Vascular/complicaciones , Calcificación Vascular/diagnósticoRESUMEN
Clinical trials have shown that functional assessment of coronary stenosis by fractional flow reserve (FFR) improves clinical outcomes. Intravascular ultrasound (IVUS) complements conventional angiography, and is a powerful tool to assess atherosclerotic plaques and to guide percutaneous coronary intervention (PCI). Computational fluid dynamics (CFD) simulation represents a novel method for the functional assessment of coronary flow. A CFD simulation can be calculated from the data normally acquired by IVUS images. A case of coronary heart disease studied with FFR and IVUS, before and after PCI, is presented. A three-dimensional model was constructed based on IVUS images, to which CFD was applied. A discussion of the literature concerning the clinical utility of CFD simulation is provided.
Asunto(s)
Simulación por Computador , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Hidrodinámica , Ultrasonografía Intervencional , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We report a case of very late bare-metal stent restenosis, in which assessment by two intracoronary imaging techniques (intravascular ultrasound and optical coherence tomography) revealed the underlying mechanism (neoatherosclerosis) and facilitated percutaneous treatment (direct bare-metal stent-in-stent). We also take the opportunity to briefly describe the advantages and limitations of both techniques in this pathology.
Asunto(s)
Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/cirugía , Stents , Tomografía de Coherencia Óptica , Ultrasonografía Intervencional , Anciano , Humanos , MasculinoRESUMEN
Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are imaging methods used in the diagnosis of coronary lesions. IVUS is widely used in interventional cardiology laboratories, but OCT is now increasingly used. Conventional coronary angiography can identify different types of coronary lesions but sometimes is unable to diagnose them correctly. Both intravascular imaging methods are useful for better interpretation of these lesions, and can accurately diagnose ruptured plaques, thrombosis, stent restenosis and hazy images. However, the resolution of OCT is ten times higher than IVUS, and so an accurate diagnosis cannot always be achieved with ultrasound imaging. We present three cases in which IVUS was unable to identify the lesion causing the condition and OCT was required to obtain clearer images that helped to confirm the diagnosis. The advantages and disadvantages of each method are then discussed.
Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico , Tomografía de Coherencia Óptica , Ultrasonografía Intervencional , Adulto , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Trombosis/complicaciones , Trombosis/diagnóstico , Tomografía de Coherencia Óptica/métodos , Angioplastia/métodos , Angioplastia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Trombosis/fisiopatología , Trombosis , Tomografía de Coherencia Óptica/tendencias , Tomografía de Coherencia Óptica , Stents Liberadores de FármacosRESUMEN
Introducción y objetivos. El derrame pericárdico tumoral presenta una elevada tasa de recurrencia tras la pericardiocentesis. Se busca confirmar la eficacia de la pericardiotomía percutánea con balón como tratamiento inicial de elección de estos derrames. Métodos. Análisis retrospectivo de las características clínicas, ecocardiográficas y evolutivas de una serie monocéntrica y consecutiva de pericardiotomías percutáneas con balón en pacientes con enfermedad oncológica avanzada. Resultados. Se han realizado 17 pericardiotomías percutáneas con balón en 16 pacientes (media de edad, 66,2 ± 15,2 años); 14 pacientes tenían confirmación anatomopatológica de enfermedad neoplásica metastásica; 3 habían requerido una pericardiocentesis previa, mientras que en los restantes la pericardiotomía percutánea con balón fue la primera intervención sobre el derrame. Todos los casos presentaban derrame circunferencial grave, y la mayoría tenían datos ecocardiográficos de compromiso hemodinámico. El éxito inicial se logró sin complicaciones agudas y con buena tolerancia en un primer intento. Durante el seguimiento (mediana, 44 [intervalo intercuartílico, 36-225] días) tampoco hubo complicaciones infecciosas. En 1 paciente se demostró la aparición de un derrame pleural significativo, que no precisó tratamiento. Fue necesario realizar una reintervención sobre el pericardio en 3 pacientes: dos ventanas pericárdicas quirúrgicas programadas y una segunda pericardiotomía percutánea con balón. Conclusiones. La pericardiotomía percutánea con balón es un técnica sencilla y segura que puede resultar eficaz en un gran número de pacientes con derrame pericárdico tumoral grave para evitar que recurra. Por sus características, resultaría de especial utilidad en este grupo de pacientes para evitar abordajes más agresivos y peor tolerados (AU)
Introduction and objectives. Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy of percutaneous balloon pericardiotomy as the initial treatment of choice for these effusions. Methods. Retrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of percutaneous balloon pericardiotomies carried out in a single center in patients with advanced cancer. Results. Seventeen percutaneous balloon pericardiotomies were performed in 16 patients with a mean age of 66.2 (15.2) years. Fourteen patients had pathologically confirmed metastatic neoplastic disease, 3 had previously required pericardiocentesis, and in the remaining patients percutaneous balloon pericardiotomy was the first treatment for the effusion. All patients had a severe circumferential effusion, and most presented evidence of hemodynamic compromise on echocardiography. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up (median, 44 [interquartile range, 36-225] days). One patient developed a large pleural effusion that did not require treatment. Three patients needed a new pericardial procedure: 2 had elective pericardial window surgeries and 1 had a second percutaneous balloon pericardiotomy. Conclusions. Percutaneous balloon pericardiotomy is a simple, safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches (AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Pericardiectomía/métodos , Derrame Pericárdico/complicaciones , Derrame Pericárdico/diagnóstico , Pericardiocentesis/métodos , Cuidados Paliativos/métodos , Cuidados Paliativos , Midazolam/uso terapéutico , Radiografía Torácica , Derrame Pericárdico/fisiopatología , Derrame Pericárdico , Estudios Retrospectivos , Ecocardiografía/tendencias , Ecocardiografía , Derrame Pleural/complicaciones , Derrame Pleural/diagnóstico , Fluoroscopía , PericardiectomíaRESUMEN
Although its use in daily practice is not common, optical coherence tomography (OCT) is a powerful research tool in invasive cardiology. This report describes a hazy angiography image after percutaneous coronary intervention that has been assessed using OCT. Based on the results of the OCT, the patient underwent an elective coronary angioplasty with standard anticoagulation. After implantation of the stent, an intracoronary hazy image was seen on angiography. The use of OCT permitted a correct diagnosis and a successful treatment. This paper provides a discussion of the advantages and disadvantages of OCT, and a comparison with intravascular ultrasound.
RESUMEN
INTRODUCTION AND OBJECTIVES: Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy of percutaneous balloon pericardiotomy as the initial treatment of choice for these effusions. METHODS: Retrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of percutaneous balloon pericardiotomies carried out in a single center in patients with advanced cancer. RESULTS: Seventeen percutaneous balloon pericardiotomies were performed in 16 patients with a mean age of 66.2 (15.2) years. Fourteen patients had pathologically confirmed metastatic neoplastic disease, 3 had previously required pericardiocentesis, and in the remaining patients percutaneous balloon pericardiotomy was the first treatment for the effusion. All patients had a severe circumferential effusion, and most presented evidence of hemodynamic compromise on echocardiography. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up (median, 44 [interquartile range, 36-225] days). One patient developed a large pleural effusion that did not require treatment. Three patients needed a new pericardial procedure: 2 had elective pericardial window surgeries and 1 had a second percutaneous balloon pericardiotomy. CONCLUSIONS: Percutaneous balloon pericardiotomy is a simple, safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches.
Asunto(s)
Derrame Pericárdico/cirugía , Pericardiectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Derrame Pericárdico/etiología , Pericardiectomía/instrumentación , Estudios RetrospectivosRESUMEN
The no-reflow phenomenon (NRP) is defined as the lack of adequate myocardial tissue perfusion despite a patent epicardial coronary artery. The incidence of NRP varies between 2-5% of elective percutaneous coronary interventions (PCI) and 30% in primary PCI. Clinically, it is an independent predictor of myocardial infarction, in-hospital mortality, and long-term mortality. It may be categorized in interventional (after PCI, especially in saphenous venous grafts) or reperfusion NRP (after re-opening of a totally occluded coronary artery, usually during primary PCI or thrombolysis). There are many physiopathological factors implicated: distal microembolization, interstitial and intracellular edema, coronary spasm and capillary plugging. Although reperfusion and no reflow is a field of intense research, no single mechanical or pharmacological therapy has demonstrated a clear efficacy against NRP, probably due to its multifactorial nature. Once established, the treatment of NRP is based on vasodilators like adenosine, verapamil, nitroprusside or nicorandil. However, the efficacy of these measures is poor, so every effort should be made to prevent the apparition of NRP. The objective of this report is to provide an update of the pharmacological armamentarium available for the prevention and treatment of NRP, and suggest a systematic approach of the management of NRP according to the different possible clinical scenarios.
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Fármacos Cardiovasculares/uso terapéutico , Química Farmacéutica/tendencias , Fenómeno de no Reflujo/tratamiento farmacológico , Humanos , Fenómeno de no Reflujo/fisiopatologíaRESUMEN
Coronary pseudo-aneurysm is an extremely rare entity. Its natural history is scarcely known and its treatment is controversial. We report a case of pseudo-aneurysm of the left main coronary artery associated with an antero-apical infarct of the left ventricle diagnosed five years after a cardiac arrest following a non-penetrating thoracic trauma. The patient was treated conservatively because percutaneous or surgical correction were not considered suitable for this lesion. A multidetector computed tomography coronary angiogram performed 10 years after the initial event showed no evidence of progression.
Asunto(s)
Aneurisma Falso/etiología , Aneurisma Coronario/etiología , Vasos Coronarios , Heridas Penetrantes/complicaciones , Adulto , Aneurisma Falso/diagnóstico por imagen , Aneurisma Coronario/diagnóstico por imagen , Angiografía Coronaria , Vasos Coronarios/lesiones , Humanos , Masculino , Tomografía Computarizada MultidetectorRESUMEN
El pseudo-aneurisma de arteria coronaria es extremadamente raro. Su historia natural es poco conocida y su tratamiento discutido. Se presenta el caso de un paciente con pseudo-aneurisma de tronco de la coronaria izquierda e infarto antero-apical del ventrículo izquierdo cinco años después de un paro cardíaco secundario a un traumatismo no penetrante de tórax. Se consideró entonces que la lesión no era pasible de corrección percutánea o quirúrgica por lo que se optó por tratamiento médico conservador. Una angiografía coronaria por tomografía computarizada multicorte realizada 10 años después del evento inicial mostró ausencia de progresión de la lesión.
Coronary pseudo-aneurysm is an extremely rare entity. Its natural history is scarcely known and its treatment is controversial. We report a case of pseudo-aneurysm of the left main coronary artery associated with an antero-apical infarct of the left ventricle diagnosed five years after a cardiac arrest following a non-penetrating thoracic trauma. The patient was treated conservatively because percutaneous or surgical correction were not considered suitable for this lesion. A multidetector computed tomography coronary angiogram performed 10 years after the initial event showed no evidence of progression.