RESUMEN
PURPOSE: To report a complication of stent placement at a bifurcation in the infrapopliteal arteries. CASE REPORT: A 60-year-old man presented with a complex subtotal stenosis in the anterior tibial artery and the tibioperoneal trunk. Two drug-eluting stents were implanted by means of the crush technique, successfully recanalizing the trifurcation. One week later, the patient was readmitted with a thrombotic occlusion of the popliteal artery. Fluoroscopy showed a fracture of the larger stent in the tibioperoneal trunk. After successful local thrombolysis, a stent fragment was located in the popliteal artery and removed with an Amplatz snare. Long-term follow-up was uneventful. CONCLUSION: Fracture may be a more common complication of bifurcation stenting when undertaken in a territory at high risk for this complication.
Asunto(s)
Angioplastia de Balón/efectos adversos , Arteriopatías Oclusivas/terapia , Migración de Cuerpo Extraño/etiología , Arteria Poplítea , Falla de Prótesis , Stents , Trombosis/etiología , Arterias Tibiales , Angioplastia de Balón/métodos , Arteriopatías Oclusivas/diagnóstico por imagen , Constricción Patológica/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Arteria Poplítea/diagnóstico por imagen , Radiografía Intervencional , Trombosis/diagnóstico por imagen , Arterias Tibiales/diagnóstico por imagen , Ultrasonografía Doppler DúplexRESUMEN
BACKGROUND: The purpose of this study was to determine whether implementation of recent guidelines improves in-hospital mortality from acute ST-elevation myocardial infarction (STEMI) in a metropolitan area. METHODS AND RESULTS: We organized a network that consisted of the Viennese Ambulance Systems, which is responsible for diagnosis and triage of patients with acute STEMI, and 5 high-volume interventional cardiology departments to expand the performance of primary percutaneous catheter intervention (PPCI) and to use the fastest available reperfusion strategy in STEMI of short duration (2 to 3 hours from onset of symptoms), either PPCI or thrombolytic therapy (TT; prehospital or in-hospital), respectively. Implementation of guidelines resulted in increased numbers of patients receiving 1 of the 2 reperfusion strategies (from 66% to 86.6%). Accordingly, the proportion of patients not receiving reperfusion therapy dropped from 34% to 13.4%, respectively. PPCI usage increased from 16% to almost 60%, whereas the use of TT decreased from 50.5% to 26.7% in the participating centers. As a consequence, in-hospital mortality decreased from 16% before establishment of the network to 9.5%, including patients not receiving reperfusion therapy. Whereas PPCI and TT demonstrated comparable in-hospital mortality rates when initiated within 2 to 3 hours from onset of symptoms, PPCI was more effective in acute STEMI of >3 but <12 hours' duration. CONCLUSIONS: Implementation of recent guidelines for the treatment of acute STEMI by the organization of a cooperating network within a large metropolitan area was associated with a significant improvement in clinical outcomes.
Asunto(s)
Angioplastia Coronaria con Balón/normas , Infarto del Miocardio/terapia , Reperfusión Miocárdica/normas , Anciano , Austria/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/cirugía , Garantía de la Calidad de Atención de Salud , Sistema de Registros , Estudios Retrospectivos , Choque Cardiogénico/epidemiología , Factores de TiempoRESUMEN
Previous studies have demonstrated that magnesium supplementation improves endothelial function in patients with coronary artery disease (CAD). However, the impact on clinical outcomes, such as exercise-induced chest pain, exercise tolerance, and quality of life, has not been established. In a multicenter, multinational, prospective, randomized, double-blind and placebo-controlled trial, 187 patients with CAD (151 men, 36 women; mean +/- SD age 63 +/- 10 years, range 42 to 83) were randomized to receive either oral magnesium 15 mmol twice daily (Magnosolv-Granulat, total magnesium 365 mg provided as magnesium citrate) (n = 94) or placebo (n = 93) for 6 months. Symptom-limited exercise testing (Bruce protocol) and responses given on quality-of-life questionnaires were the outcomes measured. Magnesium therapy significantly increased intracellular magnesium levels ([Mg]i) in a substudy of 106 patients at 6 months compared with placebo (35.5 +/- 3.7 vs 32.6 +/- 2.9 mEq/L, p = 0.0151). Magnesium treatment significantly increased exercise duration time compared with placebo (8.7 +/- 2.1 vs 7.8 +/- 2.9 minutes, p = 0.0075), and lessened exercise-induced chest pain (8% vs 21%, p = 0.0237). Quality-of-life parameters significantly improved in the magnesium group. These findings suggest that oral magnesium supplementation in patients with CAD for 6 months results in a significant improvement in exercise tolerance, exercise-induced chest pain, and quality of life, suggesting a potential mechanism whereby magnesium could beneficially alter outcomes in patients with CAD.