131,008 research outputs found
Images in cardiovascular interventions endovascular treatment of two pseudoaneurysms of the superficial femoral artery with the Hemobahn graft-stent
No full textLate occlusive in-stent restenosis of a bare-metal stent presenting with ST-elevation anterior MI : is restenosis better than a late stent thrombosis?
No full textIn-stent restenosis (ISR) occurs in 20% to 40% of de novo coronary lesions treated with bare-metal stents (BMS), depending on lesion and patient-related factors. Drug-eluting stents coated with antiproliferative agents, represent a valid rationale for treatment and prevention of recurrent ISR, with low MACE rates. However, case reports and observational studies reported a definite increase in the incidence of late stent thrombosis after drug-eluting stents use, particularly in off-label cases and after clopidogrel withdrawal. The case we present shows target vessel occlusion occurring at the site of a previously implanted BMS, suggesting that in-stent restenosis was the main pathological mechanism leading to abrupt thrombotic vessel closure and acute myocardial infarction
Contemporary antithrombotic strategies in patients undergoing coronary stent implantation
No full textThe number of annual stenting procedures has been increasing at a rapid pace since coronary stents were first used in clinical practice just over a decade ago. Subacute stent thrombosis, which usually has serious clinical consequences, plagued the stent early experience despite intense anticoagulation therapy. The reduction of stent thrombosis was among the factors that contributed to stent growth and widespread acceptance in recent years. This was the result of improved implantation techniques, advances in adjunctive pharmacotherapy and evolution in stent designs, delivery systems and non-thrombogenic coatings. However, novel designs and materials customized for particular lesion types and newer anti-restenotic treatments could influence stent thrombogenicity. Intravascular brachytherapy and drug-eluting stents have been shown to reduce the incidence of in-stent restenosis preventing cellular proliferation. However, by interfering with the re-endothelization process they may also increase the risk of stent thrombosis. To prevent a recrudescence of this feared complication, future research direction must focus on the hemocompatibility aspects of new technologies, along with further refinement of stent-deployment techniques and antithrombotic strategies
Markers for atherosclerosis
No full textA method for the diagnosis, prognosis or identification of a predisposition towards atherosclerosis and the susceptibility to the development of atherosclerotic plaques and/or vascular obstruction is described, the method comprising analysing a sample to determine the percentage frequency of multiple sub-populations of T-lymphocytes and comparing the data obtained against comparative and/or control dat
Comparison of the Effectiveness of Percutaneous Intervention of the Left-Main Coronary Artery With Everolimus-Eluting Stents in Women -Vs- Men
No full textEverolimus-eluting stents are largely used for left main (LM) percutaneous coronary interventions (PCI) . Long-term follow-up of patients undergoing LM PCI in a real world clinical setting, in particular women, have been scarcely reported. Consecutive patients undergoing unprotected LM PCI with EES at a single Institution from December 2006 to April 2016 were included. Main outcome assessed was the occurrence of major adverse cardiovascular events (MACE) as a composite of death, myocardial infarction or target lesion revascularization at follow-up. Overall, 589 patients (20.8% women), were included in the present analysis. Women were older, had lower BMI and more frequently hypertensive compared to men. Main clinical presentation was stable CAD; unstable angina was more frequently observed in women compared to men, whereas STEMI was less frequent. After 69.7 ± 28.3 months of follow-up, 47 patients overall experienced MACE (1.43 per 100*patients/year). MACE rate was higher in female compared to male patients, with a rate of 2.49 and 1.17 per 100*patients/year, respectively (P=0.015). The difference was driven mainly by higher mortality in women (0.89 vs. 0.15 per 100*patients/years, P=0.002). At multivariable Cox regression, female gender was independently associated with an increased risk of MACE at follow-up (HR 2.21, 95% CI 1.20 – 4.08, P=0.011). In conclusion, EES can be safely and effectively adopted for LM PC
Xience stent single-center registry
No full textABSTRACT
Background: Safety and effectiveness of the everolimus-eluting stent (EES) have been previously demonstrated.
Aims: To assess very long-term performance and outcomes of the EES in a real-world population. Methods: This single-center registry prospectively enrolled 6,893 patients (mean age 66±9.7 years, 81.4% men) undergoing elective coronary intervention with the EES over a decade. Clinical follow-up (FU) was performed at 1 year and then yearly.
Results: Multiple risk factors were present in 34%. Stable angina was the main stenting indication (78.1%), followed by unstable angina (5.3%) and positive stress test (16.6%) for 1- (44%) or 2/3-VD (56%). Multiple stents (stent/patient ratio: 2.1±0.8) in >1vessel were implanted in 36.9% (mean stent length=43±31.3 mm). At 1 year, 80% of patients were on dual antiplatelet therapy, while 3% only at 2 years. A low (5%) 1-year MACE rate was observed; ST occurred in 19 (0.3%) patients with a prevalence of early (9) over late (4) and very late (6) (0.08%) events. Clinically driven TLR/TVR occurred in 3.3% at 1-year follow-up. Long-term FU (3 years) completed in 6210 (90%) patients showed a 5.9% MACE rate, while very long-term (>5 years and up to 10 years) follow-up, available in 3550 out of 4635 exposed patients (72%), showed an 8.6% MACE rate. Independent MACE predictors were stented segment length (OR: 2.1; 95% CI:1.57-2.82), small vessel stenting (OR: 1.34;95% CI: 1.08-1.68) and multivessel disease (2VD, OR:1.59; 95% CI: 1.21-2.08; 3VD, OR: 2.26; 95% CI: 1.72-2.97).
Conclusions: This large prospective registry confirms the very long-term safety and efficacy of the EES in unselected real world and complex coronary lesions
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