RESUMEN
This is a report of a new modification of the "kissing balloon" technique for complex multivessel angioplasty. Based on a series of five consecutive cases, we describe a representative case in which a single guide catheter and two over-the-wire balloon catheters were utilized in association with a single inflation device. This approach could have significant advantages over the two-inflation-device approach, based primarily on its lower cost without compromise of the effectiveness and safety of the technique.
Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Angioplastia Coronaria con Balón/métodos , Oclusión de Injerto Vascular/terapia , Cateterismo Cardíaco , Angiografía Coronaria , Puente de Arteria Coronaria , Diseño de Equipo , Oclusión de Injerto Vascular/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Vena Safena/trasplanteRESUMEN
The timing and mechanisms of early (30 day) mortality in 330 consecutive patients treated with direct angioplasty less than 12 hr after onset of myocardial infarction without antecedent thrombolysis were studied. There were 38 deaths (11.5% of pts), with a majority being due to cardiogenic shock (76%). Other causes included acute closure (11%), death after emergency bypass surgery (5%), ventricular arrhythmias (5%), and respiratory failure (3%). No deaths from stroke or cardiac rupture were seen, in contrast to trials of thrombolytic agents. Most deaths were seen early, with 47% occurring within 1 day, 35% from days 2-7, and 18% from days 8-30. Death from cardiogenic shock was the most common cause of death throughout this period: 83% of deaths in days 0-3, 88% of deaths in days 4-6, and 43% of deaths in days 8-30. Significant predictors of early death included older age (P < .0001), multi-vessel disease (P < .05), direct angioplasty failure (P < .05), reduced ejection fraction (P < .0001), and anterior myocardial infarction (P < .0005). Gender, prior myocardial infarction, and prior bypass surgery did not affect mortality. Cardiogenic shock is the most common cause of early death after direct angioplasty for myocardial infarction. Patients with one or more risk factors for early death may benefit from additional myocardial salvage or revascularization efforts in the early post-infarct period. Certain causes of death after direct angioplasty (cardiac, rupture, stroke) appear to be less common than data reported for lytic therapy for myocardial infarction.
Asunto(s)
Angioplastia Coronaria con Balón/mortalidad , Infarto del Miocardio/terapia , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/fisiopatología , Pronóstico , Factores de Riesgo , Choque Cardiogénico/mortalidad , Volumen Sistólico , Factores de TiempoRESUMEN
Currently, percutaneous revascularization techniques are recommended for peripheral arterial disease only when limiting or disabling symptoms are present. However, the cost of these procedures is less than that of surgery and the risk is much lower. Additional prospective, randomized studies are needed for better definition of the role of percutaneous techniques in clinical practice. In the future, as techniques evolve and outcomes become better defined, this role may be expanded.
Asunto(s)
Angioplastia de Balón , Claudicación Intermitente/terapia , Angioplastia de Balón/estadística & datos numéricos , Humanos , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/epidemiología , Claudicación Intermitente/cirugía , Complicaciones Posoperatorias , Factores Socioeconómicos , Estados Unidos/epidemiologíaRESUMEN
A 72-year-old woman was admitted to the hospital with "flash" pulmonary edema, preceded by chest pain, requiring intubation. Her medical history included coronary artery disease with previous myocardial infarctions, hypertension, and diabetes mellitus. A history of angioedema secondary to lisinopril therapy was elicited. Current medications did not include angiotensin-converting enzyme inhibitors or beta-blockers. She had no previous beta-blocking drug exposure. During the first day of hospitalization (while intubated), intravenous metoprolol was given, resulting in severe angioedema. The angioedema resolved after therapy with intravenous steroids and diphenhydramine hydrochloride.