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RESUMEN Introducción. Se presenta el tercer reporte general del registro continuo de infarto ARGEN- IAM-ST. Objetivos. Evaluar los principales marcadores de atención y las complicaciones del infarto agudo de miocardio (IAM) con elevación del segmento ST en el registro continuo de infarto ARGEN-IAM-ST. Conocer la evolución de la terapia de reperfusión y la mortalidad en los últimos 8 años. Material y métodos. Estudio prospectivo multicéntrico, con alcance nacional. Se incluyeron pacientes con IAM con elevación del segmento ST de hasta 36 horas de evolución. Resultados. Se incluyeron 6765 pacientes, con una edad media de 61 ± 12 años, 65 % de género masculino. Se observó una importante carga de factores de riesgo cardiovascular: hipertensión arterial 58 %, diabetes 23 %, dislipidemia 42 %, tabaquismo activo 37 % y antecedentes familiares de enfermedad cardiovascular 17 %. El 13,5 % presentó antecedente de enfermedad coronaria; al ingreso un 49 % presentó IAM de cara anterior y el 23 % falla cardíaca. La mediana de tiempo de dolor a la consulta fue de 120 minutos (rango intercuartílico, RIC, 60-285), el tiempo puerta-aguja fue de 50 minutos (RIC 25-110) y el tiempo puerta balón fue de 100 minutos (RIC 58-190). La mortalidad general intrahospitalaria fue del 8,8 %. Se realizó un análisis exploratorio y descriptivo para observar la variación de la reperfusión y mortalidad durante 8 años donde no se muestran cambios acentuados en la mortalidad a pesar de las altas tasas de reperfusión. Conclusión. En los últimos 8 años la mortalidad registrada en el registro ARGEN IAM-ST se ha mantenido en valores elevados a pesar de las altas tasas de reporte de reperfusión.

ABSTRACT Background. The continuous Argentine ST-segment Elevation Acute Myocardial Infarction (ARGEN-IAM-ST) registry presents its third general report. Objectives. The aim of this study was to evaluate the main ST-segment elevation myocardial infarction (STEMI) markers of care and its complications in the continuous ARGEN-IAM-ST registry, and assess the outcome of reperfusion therapy and mortality in the last 8 years. Methods. This was a national, prospective, multicenter study, including STEMI patients with up to 36-hour evolution. Results. A total of 6765 patients, mean age 61±12 years, 65 % male , were included in the study. A significant burden of cardiovascular risk factors was observed: 58 % of patients had hypertension, 23 % diabetes, 42 % dyslipidemia, 37 % were active smokers, and 17 % had a family history of cardiovascular disease. In 13.5 % of cases, patients had prior history of coronary heart disease. On admission, 49 % presented with anterior AMI and 23 % with heart failure. Median (interquartile range, IQR) pain-consultation time was 120 minutes (IQR 60-285), door-to-needle time 50 minutes (IQR 25-110) and door-to-balloon time 100 minutes (IQR 58-190) Overall in-hospital mortality was 8.8 %. An exploratory and descriptive analysis was performed to assess the variation in reperfusion and mortality over 8 years, showing no marked changes in mortality despite high reperfusion rates. Conclusion. In the last 8 years, the mortality recorded in the ARGEN-IAM-ST registry has remained at high values despite the high reperfusion rates reported.

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Background: The silk + flow-diverter stent is increasingly used to treat complex intracranial aneurysms including wide-neck and fusiform aneurysms. Balloon angioplasty has been used to better appose the flow diverter (FD) to the vessel wall and, thus, improve aneurysm occlusion rates and decrease periprocedural complications. Sparse data are available concerning the results of this technique. We report our experience with silk + FD associated with balloon angioplasty for the treatment of intracranial aneurysms. Methods: A retrospective study was conducted on all patients treated by the silk + FD. Clinical charts, procedural data, and angiographic results were reviewed and compared between those treated with balloon angioplasty. A multivariate analysis was conducted to identify predictors of complications, occlusion, and outcome. Results: Between July 2014 and May 2016, we identified 209 patients with 223 intracranial aneurysms. There were 176 (84.2%) women and 33 (15.8%) men. The most common stent size used was 4.5 mm in 101 patients (46.1%), followed by 4 mm in 57 patients (26%). Univariate analysis observed that stent diameter was significantly related to aneurysm occlusion (P < 0.05). Patients with more than 1 aneurysm treated with silk + stent have a 9.07 times greater chance of having complications in the procedure than patients with only 01 aneurysm (OR = 9.07; P = 0.0008). Patients who had angioplasty without the use of a balloon have a 13.69-times-higher risk of complications (OR = 13.69; P = 0.0003). Older age, larger aneurysms, and the use of more than 1 FD device were predictors of recanalization. Conclusion: Endovascular treatment of intracranial aneurysms with the silk + FD associated with balloon angioplasty is a safe and effective therapeutic option. Balloon angioplasty in combination with FD lowers the risk of complications. Higher complication rates and worse outcomes are associated with older age and large aneurysms.

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RESUMEN Introducción: El tratamiento de reperfusión es la terapéutica de mayor eficacia para reducir la mortalidad del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) , y su efectividad es inversamente proporcional al tiempo total de isquemia. El mayor desafío es instrumentar su aplicación en la vida real y corregir en forma continua los desvíos o las barreras que se presentan en la práctica cotidiana. Objetivos: Evaluar la mortalidad con las diferentes modalidades de reperfusión, su relación con el tiempo de tratamiento y su efectividad en un registro prospectivo multicéntrico del mundo real de Argentina. Material y Métodos: estudio prospectivo, multicéntrico de carácter nacional, incluidos los pacientes con IAMCEST hasta las 36 h del comienzo de los síntomas (ARGEN-IAM-ST registro continuo). Resultados: participaron 2464 pacientes de 78 centros entre 2015 y 2019. El 88,5% recibió tratamiento de reperfusión. La mortalidad fue de 8,68%. Los pacientes tratados con reperfusión tuvieron una mortalidad de 7,81% versus 15,38% sin tratamiento (p <0,001). La mortalidad con angioplastia primaria fue 7,51%, con trombolíticos 9,03%, con estrategia farmacoinvasiva 2,99% y con angioplastia de rescate 9,40%, sin diferencia estadísticamente significativa entre angioplastia primaria y trombolíticos (OR 0,81 IC 95% 0,56-1,18, p = ns). Los pacientes fallecidos fueron de mayor edad, con mayor proporción de mujeres e insuficiencia cardíaca. El tratamiento de reperfusión e ingreso a la institución dentro de 3 horas del comienzo de los síntomas se asoció a menor mortalidad. Los pacientes fallecidos con angioplastia primaria tuvieron mayor tiempo total de isquemia (378 minutos versus 285 minutos, p < 0,001). Conclusiones: La mortalidad por IAMCEST se relacionó con el acceso a la reperfusión y su precocidad. Fue mucho mayor en los pacientes no reperfundidos, y menor cuando la reperfusión se efectuó en forma precoz dentro de las primeras tres horas del comienzo de los síntomas. En los pacientes tratados con angioplastia primaria la mortalidad se incrementó con mayor tiempo total de isquemia. Este registro de la práctica real del tratamiento del IAMCEST refuerza la necesidad de una mejor articulación del sistema de atención para bajar los tiempos y utilizar la estrategia mejor y más oportuna.

ABSTRACT Background: reperfusion treatment is the most effective therapy in reducing mortality from acute ST elevation myocardial infarction and its effectiveness is inversely proportional to the total time of ischemia. The greatest challenge is to implement its application in real life and continuously correct the deviations or barriers that arise in daily practice. Objectives: to evaluate mortality with the different reperfusion modalities, its relationship with treatment time and to evaluate its effectiveness. Methods: a prospective, multicenter national study, including patients with STEMI up to 36 h after symptoms began (ARGENAMI-ST continuous registry). Results: 2464 patients were included from 2015 to 2019 in 78 centers. 88.5% received reperfusion treatment. Mortality was 8.68%. The patients treated with reperfusion had a mortality of 7.81% versus 15.38% without treatment (p <0.001). Mortality with primary angioplasty was 7.51%, thrombolytics 9.03%, pharmacoinvasive strategy 2.99%, and rescue angioplasty 9.40%, with no statistically significant difference between primary angioplasty and thrombolytics (OR 0.81; 95% CI 0.56-1.18, p = ns). The deceased patients were older, a higher proportion of women, and heart failure. Reperfusion treatment and admission to the institution within 3 hours of starting symptoms were associated with lower mortality. Patients who died with primary angioplasty had a longer total ischemia time (378 minutes versus 285 minutes, p <0.001). Conclusions: mortality from STEMI was related to access to reperfusion and its earliness. It was much higher in non-reperfused patients, and lower when reperfusion was carried out early within the first three hours of the onset of symptoms. In patients treated with primary angioplasty, mortality increased with a longer total ischemia time. This record of the actual practice of the treatment of infarction reinforces the need for a better articulation of the care system to reduce times and use the best timely strategy.

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RESUMEN Introducción: A través del Registro Nacional de Infarto Agudo de Miocardio (IAM) con Elevación del ST (ARGEN IAM-ST) realizado en 2015 se conocieron datos de la realidad del IAM en Argentina; en esta ocasión, se presenta un reporte actual. Material y métodos: Estudio prospectivo multicéntrico, con alcance nacional. Luego de la primera fase de la encuesta ARGEN-IAM-ST, se invitó a los centros a continuar con el registro de IAM. Se incluyeron pacientes con IAM con elevación del segmento ST en el electrocardiograma de hasta 36 horas de evolución. Resultados: La población analizada abarcó 2464 pacientes asistidos en 78 centros. La media de edad fue 60 ± 12 años y el 80% fue de sexo masculino. Los factores de riesgo prevenibles se distribuyeron del siguiente modo: tabaquismo 45%, hipertensión arterial 58%, diabetes 24% y dislipidemia 41%. El 11% tuvo antecedente de enfermedad coronaria. El 88% recibió reperfusión; el 21% de estos pacientes recibieron trombolíticos y al 89% se le realizó angioplastia. La demora desde el inicio de los síntomas hasta la admisión fue de 130 minutos (RIC 25-75: 60-305); los médicos reportaron demoras hasta el tratamiento en el 49% de los casos, con impacto en los tiempos totales de isquemia (TTI). La mortalidad intrahospitalaria fue del 8,7%. En el análisis multivariado, ser tratado en un centro con hemodinamia no se asoció de forma independiente con la supervivencia. Conclusiones: Los datos actuales del registro continuo de IAM en la Argentina son similares a los que mostró la encuesta de 2015. Las demoras hasta el tratamiento son importantes, especialmente por el tiempo de demora en la consulta de los pacientes, lo que impacta en gran medida en los TTI.

ABSTRACT Background: The National ST-segment elevation Acute Myocardial Infarction (ARGEN-AMI-ST) registry carried out in 2015 provided data on the reality of AMI in Argentina. Objective: The aim of this study was to present an updated report of the ARGEN-AMI-ST registry. Methods: This was a national, prospective, multicenter study. After the first phase of the ARGEN-AMI-ST survey, centers were invited to continue with the AMI registry including patients with up to 36-hour electrocardiographic STEMI evolution. Results: The analyzed population comprised 2,464 patients assisted in 78 centers. Mean age was 60±12 years and 80% were men. Preventable risk factors were: 45% smoking, 58% hypertension, 24% diabetes, 41% dyslipidemia and 11% history of coronary heart disease. Eighty-eight percent of patients underwent reperfusion, and among them, 21% received thrombolytics and 89% percutaneous coronary intervention. The delay from onset of symptoms to admission was 130 minutes (IQR 25-75: 60-305); physicians reported delays to treatment in 49% of cases, with an impact on total ischemic times (TIT). In-hospital mortality was 8.7%. In the multivariate analysis, being treated in a center with hemodynamic availability was not independently associated with survival. Conclusions: Current data from the continuous AMI registry in Argentina are similar to those shown in the 2015 survey. Delays to treatment are important, especially due to the delay in patient consultation, which greatly impacts on TIT.

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The development of venous intimal hyperplasia (VIH) has not been fully studied. At present, there are no drugs approved for VIH inhibition; to investigate such alternatives, we aimed to compare paclitaxel with cilostazol in VIH early inhibition in a preliminary experimental model of balloon angioplasty. Twenty-eight male New Zealand rabbits were randomly divided into two groups: cilostazol (A) and paclitaxel (B), which underwent femoral vein barotrauma by a 4 mm balloon angioplasty. The VIH model was previously tested in controls obtaining an 80% increase of subintimal area (SIA) compared with veins without injury (from 0.12 mm2 [standard deviation (SD), 0.05] to 0.86 mm2 [SD, 0.08]). Group A received 20 mg/kg twice daily; group B angioplasty was performed with a single-dose paclitaxel-coated balloon. Seven days later rabbits were euthanized, and vein tissue samples were taken for histological analysis. The primary end point was SIA measure expressed in mm2, and the anticipated difference between treatments was 0.21 mm2. Other measurements were immunohistochemistry expression of hypoxia inducible factor-1 alpha, platelet derived growth factor, and smooth muscle actin, as surrogates of cell migration and oxidative stress. SIA of group A was 0.33 mm2 (SD, 0.15; 95% CI, 0.24-0.42 mm2), and that of group B was 0.31 mm2 (SD, 0.14; 95% CI, 0.22-0.40 mm2). Both drugs showed a reduction of 61% and 63%, respectively, in SIA, compared with controls. The difference between both drugs was 0.0193 mm2 (95% CI, -0.1175 to 0.156 mm2); the statistical difference was found in hypoxia inducible factor-1 alpha expression between both groups. CLINICAL RELEVANCE: Although veins have a thinner middle layer compared with arteries, smooth muscle cells appear to play an important role in venous stenosis after angioplasty. The study of smooth muscle cell response after barotrauma may have clinical applications in the endovascular treatment of venous stenosis, because at the moment, there is no medication indicated to prolong patency after venous endovascular procedures, for example in May Thurner syndrome. Paclitaxel and cilostazol seem to have a promising role. Finally, the present study could inspire a research line to reduce stent placement and increase patency after venous angioplasty.

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ABSTRACT Vascular accesses for hemodialysis are considered the patient's lifeline and their maintenance is essential for treatment continuity. Following the example of institutions in other countries affected by the Covid-19 pandemic, the Brazilian Society of Nephrology developed these guidelines for healthcare services, elaborating on the importance of carrying out procedures for the preparation and preservation of vascular accesses. Creating definitive accesses for hemodialysis, grafts and arteriovenous fistulas are non-elective procedures, as well as the transition from the use of non-tunneled catheters to tunneled catheters, which cause less morbidity. In the case of patients with suspected or confirmed coronavirus infection, one may postpone the procedures for the quarantine period, to avoid spreading the disease.

RESUMO Os acessos vasculares para hemodiálise são considerados a linha da vida do paciente, e sua manutenção é essencial para o seguimento do tratamento. A exemplo de instituições de outros países atingidos pela pandemia da Covid-19, a Sociedade Brasileira de Nefrologia elaborou estas orientações para os serviços de saúde, esclarecendo a importância da realização dos procedimentos de confecção e preservação de acessos vasculares. Consideramos como não eletivos os procedimentos de confecção de acessos definitivos para hemodiálise, próteses e fístulas arteriovenosas, bem como a transição do uso de cateteres não tunelizados para cateteres tunelizados, os quais acarretam menor morbidade. Nos casos de pacientes com infecção suspeita ou confirmada por coronavírus, é aceitável o adiamento dos procedimentos pelo período de quarentena, para evitar disseminação da doença.

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Resumo Contexto A reestenose intra-stent por hiperplasia miointimal pós-angioplastia é uma intercorrência frequente e que limita a perviedade do procedimento a longo prazo. A terapia com balões revestidos de droga com ação antiproliferativa pode ser uma alternativa no tratamento dessa complicação. Objetivos Demonstrar eficácia e as complicações (óbito, grandes amputações, etc.) do balão farmacológico no tratamento da reestenose intra-stent de segmento femoropoplíteo. Métodos Estudo de coorte retrospectivo de 32 pacientes consecutivos tratados entre os anos de 2012 e 2016, submetidos a terapia de reestenose intra-stent de segmento femoropoplíteo com angioplastia com balão farmacológico revestido com paclitaxel. A taxa de sucesso foi mensurada pela ocorrência de sucesso do procedimento e reestenose inferior a 50% em avaliação por eco-Doppler colorido 30, 90 e 180 dias após o procedimento. Resultados Quatro pacientes (12,5%) apresentaram reestenose superior a 50%, sendo um (3,1%) após 90 dias e três (9,4%) após 180 dias, conferindo uma taxa de sucesso de 87,5% ao procedimento. Após 180 dias, todos os pacientes referiam melhora ou cessação dos sinais e/ou sintomas apresentados antes do procedimento. Não houve óbitos, e complicações ocorreram apenas em dois casos, no pós-operatório imediato. Conclusões Os resultados a curto prazo da terapia com balão farmacológico são promissores, com redução na taxa de reestenose e baixo índice de complicações. Ainda precisam ser apresentados estudos demonstrando os efeitos a longo prazo dessa terapia, assim como seu impacto econômico quando comparada a outros procedimentos.

Abstract Background In-stent restenosis due to myointimal hyperplasia after angioplasty is common and limits long-term patency. Treatments using balloons coated with antiproliferative drugs may offer an alternative option for this pathology. Objectives To demonstrate the efficacy and complications (death, major amputations, etc.) of drug-coated balloons for treatment of in-stent restenosis in femoropopliteal segments. Methods This was a retrospective cohort study of 32 consecutive patients treated between 2012 and 2016 who underwent treatment to correct in-stent restenosis in the femoropopliteal segment using paclitaxel-coated balloons. The success rate was measured in terms of technical success and restenosis of less than 50% on Doppler ultrasonography at 30, 90, and 180 days after the procedure. Results Four patients (12.5%) exhibited restenosis greater than 50%, one (3.1%) after 90 days and three (9.4%) after 180 days, equating to a success rate of 87.5% of procedures, and by 180 days all patients experienced improvement or cessation of the signs and/or symptoms they had presented prior to the procedure. There were no deaths and complications occurred in just 2 cases in the immediate postoperative period. Conclusions Short-term results are promising, with reductions in the magnitude of restenosis and a low rate of complications. Further studies are needed that can demonstrate the long-term effects and the economic impacts in comparison to other procedures.

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Fundamentos: A doença arterial coronariana (DAC) apresenta alta morbimortalidade. A angioplastia coronariana e antiagregação com ácido acetilsalicílico (AAS) são fundamentais no tratamento desses pacientes. No contexto da angioplastia eletiva, carece estudos referentes aos fatores associados à resistência ao AAS.Objetivo: Avaliar a prevalência e os fatores relacionados à resistência ao AAS em pacientes submetidos àangioplastia eletiva. Métodos: Coorte retrospectiva de 198 pacientes submetidos à angioplastia eletiva, avaliados quanto à resistência ao AAS pela agregometria óptica com ácido araquidônico como agonista.Resultados: Observou-se resistência ao AAS em 6,56% da coorte (13/198). Os níveis de proteína C-reativa (PCR-t)mostraram associação com a resistência ao AAS (p=0,02). Conclusões: A prevalência da resistência ao AAS observada nos pacientes submetidos à angioplastia eletiva é baixa e os níveis elevados de proteína C-reativa relacionaram-se com maior chance de ocorrência dessa resistência.

Background: Coronary artery disease (CAD) has high morbidity and mortality rates. Coronary angioplasty and antiplatelet therapy with acetylsalicylic acid (ASA) are critical in treating CAD patients. Elective angioplasty lacks studies on the factors associatedwith resistance to ASA. Objective: To evaluate the prevalence and ASA resistance related factors in patients undergoing elective angioplasty.Methods: Retrospective cohort study of 198 patients undergoing elective angioplasty, evaluated for resistance to ASA by optical aggregometry with arachidonic acid as agonist. Results: Resistance to ASA in 6.56% of the cohort (13/198). C-reactive protein (CRP) levels indicated association with resistance to ASA (p=0.02).Conclusions: Low prevalence of ASA resistance in patients undergoing elective angioplasty; C-reactive protein high levels are related to greater frequency of this resistance.

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O remodelamento vascular é um determinante fundamental do lúmen em doenças vasculares, porém os mecanismos envolvidos não estão completamente elucidados. Nós investigamos o papel da chaperona redox residente do retículo endoplasmático Dissulfeto Isomerase Proteica (PDI) e sua fração localizada na superfície celular (peri/epicelular=pecPDI) no calibre e arquitetura vascular durante reparação à lesão. Em artérias ilíacas de coelho submetidas à lesão in vivo, houve importante aumento do mRNA e expressão proteica (~25x aumento 14 dias pós-lesão vs. controle) da PDI. O silenciamento da PDI por siRNA (cultura de órgãos) acentuou o estresse do retículo e apoptose, diferentemente da inibição da pecPDI com anticorpo neutralizante (PDI Ab). Bloqueio in vivo da pecPDI por aplicação de gel perivascular contendo PDI Ab no 12° dia após lesão, com análise após 48 h, promoveu ca.25% redução no calibre vascular analisado por arteriografia e diminuição similar na área total do vaso detectada por tomografia de coerência óptica. Neste processo, não ocorreu alteração no tamanho da neoíntima, indicando assim, que PDI Ab acentuou remodelamento constrictivo. Neutralização da pecPDI promoveu importantes alterações na arquitetura da matriz de colágeno e citoesqueleto, resultando em fibras com orientação invertida e desorganizadas. Diminuição na produção de espécies reativas de oxigênio e óxidos de nitrogênio também ocorreu. Análise de propriedades viscoelásticas nas artérias indicou redução na ductilidade vascular, evidenciada pela menor distância para ruptura. As alterações subcelulares no citoesqueleto observadas in vivo após PDI Ab foram recapituladas em um modelo de estiramento cíclico em células musculares lisas vasculares, com importante redução na formação das fibras de estresse. Em modelo de migração randômica de células musculares lisas, a exposição a PDI Ab reduziu a resiliência de regulação da polaridade. Embora a neutralização da pecPDI não tenha afetado a atividade...

Whole-vessel remodeling is a critical lumen caliber determinant in vascular disease, but underlying mechanisms are poorly understood. We investigated the role of endoplasmic reticulum chaperone Protein Disulfide Isomerase(PDI) and cell-surface PDI(peri/epicellular=pecPDI) pool in vascular caliber and architecture during vascular repair after injury(AI). After rabbit iliac artery balloon injury, there was marked increase in PDI mRNA and protein (25-fold vs. basal at day 14AI), with increase in both intracellular and pecPDI. Silencing PDI by siRNA (organ culture) induced ER stress augmentation and apoptosis, contrarily to pecPDI neutralization with PDI-antibody(PDI Ab). PecPDI neutralization in vivo with PDIAb-containing perivascular gel from days 12-14AI promoted ca.25% decrease in vascular caliber at arteriography and similar decreases in total vessel circumference at optical coherence tomography, without changing neointima, indicating increased constrictive remodeling. PecPDI neutralization promoted marked changes in collagen and cytoskeleton architecture, with inverted fiber orientation and disorganization. Decreased ROS and nitrogen oxide production also occurred. Viscoelastic artery properties assessment showed decreased ductility, evidenced by decreased distance to rupture. Subcellular cytoskeletal disruption by PDI Ab was recapitulated in vascular smooth muscle cell stretch model, with marked decrease in stress fiber buildup. Also, PDI Ab incubation promoted decreased regulation resilience of vascular smooth muscle migration properties. While pecPDI neutralization did not affect global RhoA activity, there was altered RhoA redistribution to the cell surface and association with caveolin-containing clusters, which mislocalized after stretch. In human coronary atheromas, PDI expression inversely correlated with constrictive remodeling. Thus, strongly-expressed PDI after injury reshapes matrix and cytoskeleton architecture to support an...

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Experiencia local en la técnica de angioplastía con catéter-balón, realizada en siete pacientes con edad que oscila entre 1 mes a 27 años, siendo 5 varones y 2 mujeres, con diagnostico de coartación aórtica nativa. Una vez realizada la sedación, se colocó un introductor en la arteria femoral y se procedió al avance de guías y catéteres hasta la aorta transversa, con el objetivo de obtener imágenes angiografícas y medir presiones invasivas en todos los segmentos. El gradiente de presión pre intervención fue de 41.5mmHg en promedio (rango:21-69mmHg) disminuyó post intervención a 10mmHg en promedio (rango:0-20mmHg). El diámetro de la coartación pre dilatación en promedio fue de 4.3mm (rango: 2.3 a 9.4mm) y aumentó post dilatación a 8.4 mm (rango: 5.5 a 13.5mm). El resultado final fue satisfactorio, pues disminuyó significativamente el gradiente de presión, el diámetro aórtico coartado aumentó y los pulsos en las cuatro extremidades se tornaron simétricos. Se alcanzó estabilidad clínica y el procedimiento se demostró como favorable en todos los pacientes. Los controles postintervención hasta un año después mostraron que el gradiente se mantiene en el tiempo, salvo en el caso de la niña de un mes, que desarrolló recoartación aórtica y fue operada en condiciones electivas, como es usual para este grupo de edad.

Local experience in the technique of balloon catheter angioplasty, performed in seven patients aged between 1 month and 27 years, 5 males and 2 females, diagnosed with native aortic coarctation. After the sedation, the introducer was collocated in the femoral artery, and guide wires and catheters were pushed forward until the transverse aorta in order to obtain angiographic images and to measure invasive pressures in all the segments. The mean pressure gradient before the intervention was 41.5mmHg (range:21-69mmHg) and decreased post intervention to 10mmHg (range:0-20mmHg). The mean diameter of the coarctation pre dilatation was 4.3mm (range:2.3-9.4mm) and increased post dilation to 8.4mm(range:5.5-13.5mm). The final result was satisfactory because the pressure gradient was significantly reduced, the aortic diameter increased and the pulses in all four extremities symmetrical. Clinical stability was achieved and the procedure proved to be favorable for all the patients. Controls until one year post intervention showed that the gradient did not change over the time, except in the case of a one month old girl, who developed recoarctation and was operated in elective conditions, as it is usual for this group of age.

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Síndrome da aorta média (SAM) é uma condição clínica caracterizada por estenose segmentar ou difusa da aorta, hipertensão arterial e claudicação de membros inferiores. A principal causa da SAM é a arterite de Takayasu. A estenose segmentar pode estar localizada na aorta suprarrenal, renal ou infrarrenal e com alta propensão de lesões estenóticas concomitantes das artérias renais e viscerais. A gravidade da hipertensão arterial é a principal indicação para o tratamento. A técnica endovascular para o tratamento da síndrome da aorta média tem bons resultados e é a menos invasiva. No presente artigo, é descrito o tratamento com sucesso de uma estenose da aorta toracoabdominal com recanalização da artéria mesentérica superior através de angioplastia em uma mulher de 34 anos portadora de arterite de Takayasu e hipertensão arterial grave.

Middle aortic syndrome (MAS) is a clinical condition characterized by segmental or diffuse narrowing of the aorta, hypertension, and lower limb claudication. The main cause of MAS is Takayasu's arteritis. Segmental aortic stenosis may be located at the suprarenal, renal or infrarenal aorta with high tendency to concomitant stenosis in both the renal and visceral arteries. Severity of hypertension is the primary indication for intervention. Endovascular therapy is a minimally invasive treatment for MAS and may provide good results. In the present report, we describe a successful endovascular treatment of stenosis of the thoracoabdominal aorta with recanalization of the superior mesenteric artery using angioplasty in a 34-year-old woman with Takaysu's arteritis and severe hypertension.

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Contexto: A terapia endovascular tem avançado muito como tratamento para a doença arterial oclusiva infrainguinal, principalmente com o desenvolvimento dos materiais e dos stents autoexpansíveis de nitinol. Objetivo: Avaliar os resultados e os fatores determinantes da angioplastia fêmoro-poplítea em pacientes portadores de isquemia de membros inferiores. Métodos: Foram tratados, através de angioplastia com ou sem stent, 114 pacientes, e acompanhados por um período médio de 12 meses. A média de idade foi de 66 anos; 53 por cento eram do sexo feminino; 23,7 por cento eram portadores de claudicação incapacitante; 8,8 por cento, de dor isquêmica de repouso; e 67,5 por cento, de lesão trófica. As lesões foram classificadas segundo o TransAtlantic Inter-Society Consensus II em A (53 por cento), B (34 por cento), C (5 por cento) e D (9 por cento). Resultados: A análise angiográfica do leito distal mostrou uma média de 1,4±1,0 artérias infrapoplíteas pérvias. O sucesso inicial foi de 97 por cento. No seguimento de 1, 6, 12 e 24 meses, a perviedade primária foi de 94, 78, 48 e 31 por cento, e a primária assistida, de 94, 84, 73 e 61 por cento, respectivamente (p = 0,005). O leito distal pobre e a presença de diabetes melito foram associados a uma menor perviedade primária (p = 0,01), enquanto a extensão da lesão não influenciou os resultados. As taxas de salvamento de membro em 6, 12 e 24 meses foram de 95, 90 e 90 por cento, respectivamente. Conclusões: A extensão das lesões tratadas não foi um fator determinante em nossa casuística para o menor sucesso da angioplastia, o que pode sugerir que as indicações para o tratamento endovascular possam ser ampliadas para pacientes com lesões TransAtlantic Inter-Society Consensus II C/D.

Background: Endovascular techniques have undergone major advances with regard to the treatment of infrainguinal arterial occlusive disease, mainly as a result of development of new devices and self-expanding nitinol stents. Objective: To evaluate the results and determinant factors of femoropopliteal angioplasty in patients with critical lower limb ischemia. Methods: During the study, 114 patients were submitted to angioplasty or stenting and followed during an average of 12 months. Mean age was 66 years, and 53 percent were female; 23.7 percent presented disabling claudication, 8.8 percent ischemic rest pain and 67.5 percent tissue loss. Lesions were classified as A (53 percent), B (34 percent), C (5 percent) and D (9 percent) according to the TransAtlantic Inter-Society Consensus II. Results: Angiographic run-off analysis showed an average of 1.4±1.0 patent infrapopliteal artery. Initial success rate was 97 percent. At 1, 6, 12 and 24 months of the follow-up period, primary patencies of 94, 78, 48 and 31 percent, and assisted primary patencies of 94, 84, 73 and 61 percent were achieved (p = 0.005). Poor run-off and diabetes mellitus were directly associated with lower primary patency rates (p = 0.01), while angiographic severity of the lesions did not influence results. Limb salvage rates calculated at 6, 12 and 24 months were 95, 90 and 90 percent, respectively. Conclusions: Lesion length was not a determinant factor of lower success rates for angioplasty or stenting, which may suggest that indications for endovascular treatment can be extended to patients with TransAtlantic Inter-Society Consensus II C/D lesions.

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OBJETIVO: Analisar a eficiência da angioplastia primária infra-inguinal como método de salvamento de membros em pacientes portadores de lesões tróficas por isquemia crítica. MATERIAIS E MÉTODOS: Foram analisados 36 pacientes submetidos a angioplastias primárias sem stent. Todos os pacientes apresentavam isquemia crítica com lesão trófica - grau III, categoria 5 de Rutherford -, sendo 17 lesões na artéria femoral superficial, 16 na artéria poplítea e 51 em artérias da perna, totalizando 84 angioplastias. Foram analisadas também as prevalências em relação a sexo, membro afetado, idade e principais comorbidades, sendo tecidas considerações técnicas sobre os procedimentos, assim como os materiais utilizados. RESULTADOS: Considerou-se sucesso quando a lesão trófica que motivou a angioplastia cicatrizou, ou o nível de amputação limitou-se a artelhos ou ao antepé, sem ter havido necessidade de procedimento cirúrgico de reconstituição do fluxo sanguíneo (bypass), independentemente de tempo, drogas associadas e números de desbridamentos realizados. CONCLUSÃO: As angioplastias no segmento femoropoplíteo e infrapoplíteo são procedimentos de elevado sucesso técnico, baixa morbidade e mortalidade, constituindo-se procedimento eficaz em pacientes com isquemia crítica de membro inferior.

OBJECTIVE: To evaluate the efficacy of infra-inguinal, primary angioplasty as a method of limb salvage in patients with trophic lesions secondary to critical ischemia. MATERIALS AND METHODS: Thirty-six patients submitted to primary percutaneous transluminal angioplasty without stenting were evaluated. All of them presented critical limb ischemia with trophic lesion (Rutherford grade III, category 5). Eighty-four angioplasties were performed for 17 lesions in superficial femoral artery, 16 lesions in popliteal artery, and 51 lesions in below-knee arteries. Additionally, prevalence in relation to sex, age, limb involved and main comorbidities have been discussed, with technical considerations regarding procedures and materials utilized. RESULTS: Clinical success has been defined as complete healing of the trophic lesion or amputation level limited to toes or forefoot, not requiring bypass surgery, independently from time, drugs utilized and number of debridement procedures performed. CONCLUSION: Femoropopliteal and belowknee angioplasties present high technical success, low mortality and low complications rates and are highly effective in the treatment of patients with critical lower limb ischemia.

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CONTEXT AND OBJECTIVE: Peripheral arterial occlusive disease (PAOD) is a prevalent atherosclerotic disorder characterized by limb pain on exertion, limb loss and a high mortality rate. Because of its chronic nature, it often has a negative impact on patients' quality of life (QOL). This study aimed to assess QOL among patients with PAOD that was treated by endovascular intervention using femoral and popliteal percutaneous transluminal balloon angioplasty (PTBA). DESIGN AND SETTING: This study was local, prospective and longitudinal. It was carried at the Second Department of Internal Medicine of Charles University Hospital in Hradec Kralove, Czech Republic. METHODS: Thirty PAOD patients (20 male and 10 female) were treated by endovascular intervention using femoral and popliteal PTBA. The Czech version of the international generic European Quality of Life Questionnaire (EQ-5D) was applied. RESULTS: The statistical evaluation demonstrated that QOL presented highly significant statistical dependence on femoral and popliteal PTBA (p < 0.0001). CONCLUSION: The results showed that femoral and popliteal PTBA had a highly positive effect on the QOL of patients with PAOD.

CONTEXTO E OBJETIVO: Doença arterial oclusiva periférica (DAOP) é uma desordem aterosclerótica prevalente, caracterizada por dor esforço do membro, perda do membro e alta taxa de mortalidade. Devido à sua natureza crônica, freqüentemente tem impacto negativo na qualidade de vida (QV) dos pacientes. Este estudo objetivou avaliar a QV entre pacientes com DAOP tratada por intervenção endovascular usando angioplastia com balão transluminal femoral e poplítea (ABT). TIPO DE ESTUDO E LOCAL: Este estudo local, prospectivo e longitudinal foi realizado no Segundo Departamento de Medicina Interna do Charles University Hospital em Hradec Kralove, República Checa. MÉTODOS: 30 pacientes com DAOP (20 homens) foram tratados por intervenção endovascular usando ABT femoral e poplítea. A versão checa do Questionário Europeu de Qualidade de Vida (EQ-5D) foi aplicada. RESULTADOS: A avaliação estatística demonstrou que a QV apresentou dependência altamente significativa da ABT femoral e poplítea (p < 0,0001). CONCLUSÃO: Os resultados mostraram que a ABT femoral e poplítea teve efeito altamente positivo na QV dos pacientes com DAOP.

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As técnicas endovasculares para o tratamento da doença obstrutiva carotídea evoluíram substancialmentenos últimos anos. A introdução dos ôstentsõ em vez da simples angioplastia, o início da utilização e o aperfeiçoamento dos dispositivos de proteção cerebral, o incremento do arsenal medicamentoso e a difusão das técnicas e materiais, entre outros, levou a comunidade médica a um imenso interesse na área. O objetivo deste trabalho é demonstrar esta evolução, mostrando o porquê de cada etapa, baseado no nosso primeiro caso de ôstentõ que, sete anos depois, submeteu-se a um novo procedimento na carótida contralateral, permitindo a comparação entre os doisprocedimentos.

The endovascular technique for the treatment of carotid obstructive disease improved substantially in the last years. The addition of stents, the utilization and improvement of cerebral protectiondevices, new drugs and materials, the spread of the techniques and information, among others, bring a great interest in the medical community. Our objective is show this evolution, explaining each step, based on our first stent case which, seven years later, wassubmitted to a new procedure on the other carotid, allowing a beautiful comparison between both procedures.

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