RESUMEN
Partial malposition of a PFO closure device occurred, probably due to a right atrial ligamentous structure. Despite absence of residual shunt and uneventful postprocedural course, elective surgical removal was performed. Indications, procedural and anatomical aspects are discussed.
Asunto(s)
Implantación de Prótesis Vascular , Remoción de Dispositivos , Ecocardiografía Transesofágica , Defectos del Tabique Interatrial/cirugía , Complicaciones Posoperatorias/cirugía , Falla de Prótesis , Adulto , Cateterismo Cardíaco , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Ligamentos/diagnóstico por imagen , Ligamentos/cirugía , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Diseño de Prótesis , ReoperaciónRESUMEN
The increasing limitation of resources has stimulated the discussion of the reuse of medical devices labelled for "single use" by the manufacturer. The prerequisites for employment of reprocessing measures are patient safety and cost saving potential. Although reprocessing of single use medical devices has been general practice by many institutions, health care providers and authorities have remained insecure as to hygienic and functional risks, liability and legal aspects. Changes in legislation (German Medical Device Act), guidelines of the Robert Koch Institute (and position of the FDA) and the high quality guaranteed by innovative reprocessing technology have now created the basis for expanded but controlled use of reprocessing techniques for medical devices as a contribution to cost containment. A significant cost saving potential is calculated for the cost-intensive field of interventional cardiology.
Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Cateterismo Cardíaco/instrumentación , Equipos Desechables/economía , Equipo Reutilizado/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Esterilización/legislación & jurisprudencia , Angioplastia Coronaria con Balón/economía , Cateterismo Cardíaco/economía , Control de Costos/legislación & jurisprudencia , Equipos Desechables/normas , Equipo Reutilizado/economía , Alemania , Humanos , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/economía , Garantía de la Calidad de Atención de Salud/normas , Esterilización/economía , Esterilización/normasRESUMEN
Dedicated catheter and stent systems for use in the carotid circulation have only been developed recently. Almost exclusively, self-expandable metallic stents are being used. Longitudinal flexibility, contourability of the luminal configuration, sufficient radial resistive force, narrow meshwork for sealing of the diseased vessel wall, low profile of the constraint stent, and compatibility of the devices with routine angioplasty techniques are the premier requirements. Most of the current experience is based on the longitudinal wire mesh design (Carotid Wallstent). The narrow meshwork has excellent sealing capacity but the inherent (yet manageable) problem of foreshortening with expansion needs attention. The segmented ring designs of the more recent Nitinol stents permit more precise positioning and contouring of the luminal surface, yet their capacity to seal a complex or thrombotic lesion and their clinical safety needs further evaluation. As more distinct features of dedicated carotid stents are being developed and as their differential importance gets recognized, a more meaningful and individual stent selection for the carotid anatomy may further improve clinical outcome.
Asunto(s)
Arterias Carótidas/cirugía , Estenosis Carotídea/cirugía , Stents , HumanosRESUMEN
The increase in minimum lumen diameter achieved by coronary stent placement can be further enhanced by reducing the immediate recoil that occurs after stent deployment. The effect of various stent designs-flexible coils, slotted tubes, and a locking stent-on minimization of postdilation stent recoil was evaluated using an in vitro model of circumferential compression. The stents were expanded to 7 atm (3.82 +/- 0.02 mm); as pressure was reduced, lumen diameter and cross-sectional area (CSA) were determined by on-line intravascular ultrasound imaging (30 MHz) positioned inside the dilating balloon (n = 10-15 inflation-deflation cycles). Stent recoil was assessed by calculation of percent change in CSA from 7 atm to negative balloon pressure: -33.1 +/- 5.6% (GR-II) and -22.4 +/- 3.8% (Wiktor) in the coil stents; -20.0 +/- 4.2% (JJIS coronary), -8.4 +/- 2.6% (JJIS biliary), and -6.9 +/- 1.5% (Multilink) in the slotted tube stents; and -1.9 +/- 3.2% in the Navius ZR1 locking stent (P < 0.05 vs. Multilink, P < 0.0001 vs. others). A range of resistances to recoil is demonstrated by this model, with coil stent designs undergoing greater elastic recoil than slotted tube stent designs. The locking stent design demonstrated the greatest radial strength and the most reduction in elastic recoil.
Asunto(s)
Cateterismo , Stents , Ultrasonografía Intervencional , Angioplastia Coronaria con Balón , Artefactos , Elasticidad , Estudios de Evaluación como Asunto , Humanos , Diseño de PrótesisRESUMEN
Although the use of coronary stents has virtually abolished the threat of periprocedural obstructive dissection, subacute and acute intracoronary thrombosis and late restenosis remain a major problem with catheter-guided transluminal coronary interventions, despite significant technical advances over the last 10 years. Acute stent thrombosis emerged as a new problem with the introduction of metallic coronary prostheses (stents), which unfortunately represent an ideal stimulus for platelet deposition. Recently, dramatic progress has been achieved by focusing on the inhibition of thrombin and platelets, before and during interventional procedures. This has stimulated the search for powerful and well-tolerated antithrombotic agents-platelet inhibitors and antithrombins-so that long-term (oral) administration may become possible, if necessary. The current roles of unfractionated and low-molecular-weight heparins (LMWHs), direct thrombin inhibitors (such as hirulog and hirudin), antiplatelet agents (such as aspirin, clopidogrel, and ticlopidine) and the potential of the glycoprotein IIb/IIa receptor blockers are reviewed and put into perspective with respect to their acute and long-term clinical value.