RESUMEN
BACKGROUND: no-reflow can complicate up to 25% of pPCI and is associated with significant morbidity and mortality. We aimed to compare the outcomes of intracoronary epinephrine and verapamil with intracoronary adenosine in the treatment of no-reflow after primary percutaneous coronary intervention (pPCI). METHODS: 108 STEMI patients had no-reflow during pPCI were assigned into four groups. Group 1, in which epinephrine and verapamil were injected through a well-cannulated guiding catheter. Group 2, in which same drugs were injected in the distal coronary bed through a microcatheter or perfusion catheter. Group 3, in which adenosine was injected through a guiding catheter. Group 4, in which adenosine was injected in distal coronary bed. Primary end point was the achievement of TIMI III flow and MBG II or III. Secondary end point was major adverse cardiovascular and cerebrovascular events (MACCEs) during hospital stay. RESULTS: The study groups did not differ in their baseline characteristics. Primary end point was achieved in 15 (27.8%) patients in the guide-delivery arm compared with 34 (63%) patients in the local-delivery arm, p < 0.01. However, the primary end point did not differ between the epinephrine/verapamil group and the adenosine group (27 (50%) vs 22 (40.7%), p = 0.334). The secondary end points were similar between the study groups. CONCLUSION: Local delivery of epinephrine, verapamil and adenosine in the distal coronary bed is more effective in achieving TIMI III flow with MBG II or III compared with their guide-delivery in patients who suffered no-reflow during pPCI. There was no difference between epinephrine/verapamil Vs. adenosine.
Asunto(s)
Adenosina , Epinefrina , Fenómeno de no Reflujo , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Verapamilo , Humanos , Verapamilo/administración & dosificación , Masculino , Femenino , Adenosina/administración & dosificación , Epinefrina/administración & dosificación , Persona de Mediana Edad , Intervención Coronaria Percutánea/métodos , Fenómeno de no Reflujo/etiología , Fenómeno de no Reflujo/tratamiento farmacológico , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/cirugía , Anciano , Vasodilatadores/administración & dosificación , Resultado del Tratamiento , Estudios ProspectivosRESUMEN
BACKGROUND: This in vitro study aims to compare rotary files (Fanta and Zuanba) with manual K files according to the amount of dentin removed and canal transportation in primary mandibular second molars by CBCT images. METHODS: This experimental study was conducted on 60 extracted human second primary molars. That were divided into three groups according to root canal preparation group "I" instrumented with manual K-files, group "II" instrumented with rotary Fanta files, and group "III" instrumented with rotary Zuanba files. After root canal preparation, teeth were scanned before and after mechanical preparation with CBCT scanner. Then the amount of dentin removed was determined at three levels, including the coronal, middle and apical levels. Data were statically analysed using the Kruskal-Wallis test. RESULT: No statistically significant difference in the amount of dentin removed were noted between the manual and the rotary groups at the coronal and apical RC levels (P = 0.420) and (P = 0.819) respectively but significant difference was noted at the middle third (P = 0.043). Regarding RC transportation, no significant difference was noted among the three groups with the exception of the apical RC level (P = 0.043). CONCLUSION: Although no significant differences were noted between rotary and manual files, the rotary files showed better performance.
Asunto(s)
Cavidad Pulpar , Preparación del Conducto Radicular , Niño , Tomografía Computarizada de Haz Cónico , Instrumentos Dentales/efectos adversos , Cavidad Pulpar/diagnóstico por imagen , Dentina/diagnóstico por imagen , HumanosRESUMEN
OBJECTIVES: The current study was carried out to (1) evaluate premixed bioceramic (BC) and mineral trioxide aggregate (MTA) sealing properties in a laboratory and (2) compare the performance of these two materials in repairing an immediate iatrogenic furcal perforation of primary molars both clinically and radiographically. MATERIALS AND METHODS: In vitro sections including eighty mandibular second primary molars were sorted into 4 equal groups: (1) an intact furcation area group, (2) an artificial perforation group (unrepaired), (3) an artificial perforation group repaired with MTA, and (4) an artificial perforation group repaired with premixed BC. The dye extraction method was used to assess the sealing ability of the material. Clinically, the study was designed as an equivalent parallel randomized controlled trial. Seventy-six mandibular second primary molars with immediate furcal perforation were sealed with MTA and premixed BC. Teeth were evaluated clinically and radiographically at 3, 6, and 12 months. RESULTS: Although the difference was statistically insignificant (p = 0.058), the premixed BC group had better sealing ability than the MTA group [mean difference = 0.020; 95% CI (-0.001, 0.040)]. Clinically and radiographically, the two materials had an equivalent success rate in the first 3 months [ARR = 0.05; 95% CI (-0.07, 0.17)] but inequivalent success rates at 6 and 12 months with premixed BC performing better than MTA. CONCLUSIONS: The present findings confirm that premixed BC is a promising material that can be used to repair a furcal perforation of primary molars. Premixed BC has better sealing properties and better performance at the clinical and radiographic levels than MTA. CLINICAL RELEVANCE: (1) Accidental furcal perforation in primary molars is one of the worst problems that results in diminishing the lifetime expectancy of primary teeth if not properly treated. Though new BC repair materials have been introduced to enhance healing and tissue inductive properties, there is an obvious shortage in clinical trials covering this area. The present study is a premier study that assesses a recently introduced premixed BC material in the furcal perforation of primary teeth and compares its outcomes with those of the widely used MTA. TRIAL REGISTRATION: ClinicalTrials.gov PRS reference #NCT04137861.
Asunto(s)
Materiales de Obturación del Conducto Radicular , Compuestos de Aluminio/uso terapéutico , Compuestos de Calcio/uso terapéutico , Combinación de Medicamentos , Humanos , Diente Molar/diagnóstico por imagen , Diente Molar/cirugía , Óxidos/uso terapéutico , Materiales de Obturación del Conducto Radicular/uso terapéutico , Silicatos/uso terapéutico , Diente PrimarioRESUMEN
BACKGROUND: The incidence of contrast-induced acute kidney injury is strongly related to the amount of the given contrast. Our objectives were to evaluate the efficacy and safety of coronary sinus aspiration (CSA) procedure to reduce the volume of the given contrast and attenuate the risk of contrast-induced acute kidney injury. METHODS AND RESULTS: The study included 43 patients with type 2 diabetes mellitus and renal impairment (creatinine 1.5-3 mg/dL) who were candidates for coronary angiography. Eighteen patients were subjected to CSA procedure during coronary angiography (CSA group), and 25 patients served as a control group. Periprocedural standard care was given. In CSA group, the coronary sinus was cannulated via subclavian or femoral venous approaches, and aspiration was done directly from a transseptal sheath (8 patients) or through a balloon occlusion catheter placed through the sheath (10 patients) simultaneously during each coronary injection. Estimated volume of aspirated contrast was calculated based on the percentage reduction in hematocrit value of the aspirate in relation to the patient's baseline hematocrit. Fraction of aspirated contrast was calculated by dividing estimated volume of aspirated contrast over the volume of injected contrast×100. Both study groups were matched in clinical and laboratory data, as well as volume of injected contrast. In CSA group, mean fraction of aspirated contrast was 39.35±10.47%. One patient in the CSA group, compared with 9 patients in the control group, developed contrast-induced acute kidney injury (P=0.028). CONCLUSIONS: CSA during coronary angiography could effectively remove more than one third of the given contrast and may reduce the incidence of contrast-induced acute kidney injury in selected patients.
Asunto(s)
Lesión Renal Aguda/prevención & control , Cateterismo Cardíaco , Medios de Contraste/efectos adversos , Angiografía Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Seno Coronario/diagnóstico por imagen , Nefropatías Diabéticas/complicaciones , Succión , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/diagnóstico , Anciano , Cateterismo Cardíaco/efectos adversos , Estudios de Casos y Controles , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/terapia , Nefropatías Diabéticas/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Succión/efectos adversos , Resultado del TratamientoRESUMEN
OBJECTIVE: The aortic distensibility index, as a measure of vascular function, can serve as a marker of coronary artery disease severity. This study explores the feasibility of using the non-invasively measured index as an indicator of severity of coronary stenosis. METHODS: One hundred patients with normal left ventricular systolic function were prospectively enrolled. They were subjected to assessment of aortic distensibility using computed tomographic angiography and transthoracic echocardiography. Coronary artery disease severity and coronary artery calcium score were assessed. RESULTS: The mean age of the whole study cohort was 58 +/- 9 years, 63 (63%) being males. A significant inverse correlation was found between aortic distensibility measured using computed tomographic angiography and patients' age, systolic blood pressure, coronary artery calcium score and severity of coronary artery disease (percent luminal stenosis). However, there was no statistical correlation with the number of diseased coronary arteries. A strong direct correlation was recorded upon comparing aortic distensibility index values obtained using computed tomographic angiography and transthoracic echocardiography (r=0.325, P=0.004). Receiver operating characteristic curve analysis revealed that an echocardiography-derived aortic distensibility index value of 6.65% is associated with significant (50% luminal stenosis) coronary artery disease with a sensitivity of 83%, specificity of 93%, positive predictive value of 97% and negative predictive value of 65%. CONCLUSION: Non-invasive assessment of aortic distensibility indices is a feasible procedure to predict significant atherosclerotic coronary artery disease. Lower values are associated with significant obstructive coronary artery disease and high coronary artery calcium score.
Asunto(s)
Aorta , Estenosis Coronaria , Vasos Coronarios , Diagnóstico por Imagen de Elasticidad/métodos , Anciano , Aorta/patología , Aorta/fisiopatología , Presión Arterial/fisiología , Calcinosis/patología , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/fisiopatología , Vasos Coronarios/patología , Vasos Coronarios/fisiopatología , Ecocardiografía/métodos , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodosRESUMEN
Unstable coronary syndromes usually involve platelet activation and thrombus formation at the site of atherosclerotic plaque. P-selectin in platelets and endothelial cells mediates adhesive interaction with leucocytes to form thrombi. The aim of this study was to asses the level of soluble P-selectin (CD62P) as a non invasive marker of coronary plaque destabilization in unstable angina (U.A.). Serum samples were collected from 23 male patients with UA, 20 male patients with stable angina (SA) and 13 healthy controls. Soluble P-selectin (sP-selectin) level was measured by ELISA technique. The mean sP-selectin level was significantly higher in patients with UA (87.6+/-30.10 ng/ml) than SA (36.2 +/-13.8 ng/ml) and control subjects (16.7+/-8.6 ng/ml). In conclusion, s-Pslectin level could be used as a marker of plaque destabilization in unstable angina.