RESUMEN
We report treatment of a lesion with coronary stent underexpansion due to heavily calcified plaque. Conventional balloon angioplasty was attempted for in-stent restenosis, but the lesion was undilatable despite 25-atm inflation pressure. Intravascular ultrasound (IVUS) revealed stent underexpansion due to heavily calcified plaque. Rotational atherectomy was performed using a stepped burr approach, after which repeat IVUS revealed marked ablation of the stent-calcium complex. Adjunctive balloon angioplasty then easily resulted in full balloon and stent expansion, with an excellent angiographic and IVUS result. The patient's hospital course was uneventful.
Asunto(s)
Aterectomía Coronaria/métodos , Enfermedad Coronaria/terapia , Stents , Anciano , Angioplastia Coronaria con Balón , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Humanos , Masculino , Ultrasonografía IntervencionalAsunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/terapia , Stents/efectos adversos , Angioplastia Coronaria con Balón/métodos , Angiografía Coronaria , Femenino , Humanos , Incidencia , Masculino , Probabilidad , Pronóstico , Recurrencia , Medición de Riesgo , Resistencia VascularRESUMEN
The MULTI-LINK (ML) stent is a novel second generation coronary stent. The ACS MultiLink Stent Clinical Equivalence in De Novo Lesions Trial (ASCENT) randomized 1,040 patients with single, de novo native vessel lesions to treatment with the ML stent or the benchmark Palmaz-Schatz (PS) stent, to demonstrate that the ML stent was not inferior to (i.e., equivalent or better than) the PS stent in terms of target vessel failure by 9 months. Successful stent delivery was achieved in 98.8% versus 96.9% of patients, with a slightly lower postprocedural diameter stenosis (8% vs 10%, p = 0.04), and no difference in 30-day major adverse cardiac events (5.0% vs 6.5%) for the ML stent versus the PS stent. The primary end point of target vessel failure at 9 months was seen in 15.1% of ML-treated patients versus 16.7% of PS-treated patients, with the ML proving to be equal or superior to the PS stent (p <0.001 by test for equivalency). In a prespecified subset, angiographic restudy showed a nonsignificant trend for reduced ML restenosis (16.0% vs 22.1%). Thus, the ML stent showed excellent deliverability and acute results, with 9-month clinical and 6-month angiographic outcomes that were equivalent or better than the PS stent.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Stents , Anciano , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Análisis de Regresión , Análisis de Supervivencia , Resultado del TratamientoAsunto(s)
Anticuerpos Monoclonales/uso terapéutico , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/terapia , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Stents , Abciximab , Humanos , Recurrencia , Estudios RetrospectivosRESUMEN
The cumulative experience of 4 clinical trials using the MULTI-LINK coronary stent design was analyzed. Multivariable logistic regression identified postprocedure in-stent minimum lumen diameter (p = 0.0001), stent length (p = 0.0038), smoking (p = 0.0105). and diabetes (p = 0.0803) as the most important predictors of in-stent restenosis at late (6- to 9-month) angiographic follow-up.
Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Enfermedad Coronaria/terapia , Stents , Adulto , Anciano , Ensayos Clínicos como Asunto , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Falla de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , RecurrenciaAsunto(s)
Enfermedad Coronaria/terapia , Stents , Falla de Equipo , Estudios de Seguimiento , Humanos , Metales , Factores de TiempoRESUMEN
Cocaine-induced myocardial infarction has been well reported. Likewise, there are numerous reports of patients with cocaine-induced myocardial infarction being treated conservatively with nitroglycerin, verapamil, and thrombolytics. However, based on a Medline search from 1977 to 1998 (with the keywords cocaine and angioplasty), there have been no reports in English of cocaine-induced myocardial infarction being treated with catheter-based intervention. We report such a case, as well as review what is known about the pathophysiology of cocaine-induced coronary arteriopathy and myocardial infarction.
Asunto(s)
Angioplastia Coronaria con Balón , Cocaína/efectos adversos , Infarto del Miocardio/inducido químicamente , Stents , Vasoconstrictores/efectos adversos , Adulto , Angiografía Coronaria , Electrocardiografía/efectos de los fármacos , Humanos , Masculino , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/terapia , Resultado del TratamientoRESUMEN
Palmaz-Schatz stents were implanted in 79 lesions in 76 patients, and serially expanded at 12, 15, and 18 atm of pressure using noncompliant balloons. By core lab analysis, intravascular ultrasound demonstrated marked stent expansion as pressure was raised, which was not apparent by angiography.
Asunto(s)
Enfermedad Coronaria/terapia , Stents , Anciano , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presión , Estudios Prospectivos , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
We report 3 cases of fatal neutropenia and thrombocytopenia associated with ticlopidine after coronary stenting. Patients should be counseled about the early signs of infection and bleeding and to have regularly scheduled complete blood counts.