RESUMO
OBJECTIVES: The purpose of this study was to evaluate the efficacy and long-term outcomes of a novel polymer/carrier-free drug-coated stent (DCS) in patients with de novo coronary lesions.BACKGROUND: The BioFreedom (BFD) DCS incorporates a low-profile, stainless-steel platform, with a surface that has been modified to create a selectively microstructured abluminal surface that allows adhesion and further release of Biolimus A9 (Biosensors Europe SA, Morges, Switzerland). METHODS: A total of 182 patients (183 lesions) were randomized into a 1:1:1 ratio for treatment with BFD "standard dose" (BFD) or BFD "low dose" (BFD-LD) versus first-generation paclitaxel-eluting stents (PES) at 4 sites in Germany.RESULTS: Baseline and procedural characteristics were well matched. At 4-month angiographic follow-up (Cohort 1, n = 75), in-stent late lumen loss (LLL) was significantly lower with BFD and BFD-LD versus PES (0.08 and 0.12 mm vs. 0.37 mm, respectively; p < 0.0001 for BFD vs. PES, and p = 0.002 for BFD-LD vs. PES). At 12 months (Cohort 2, n = 107), in-stent LLL (primary endpoint) was 0.17 mm in BFD versus 0.35 mm in PES (p = 0.001 for noninferiority; p = 0.11 for superiority)...
Assuntos
Doença das Coronárias , Intervenção Coronária Percutânea , Stents , Stents FarmacológicosRESUMO
We report a case of transcatheter aortic valve implantation (TAVI) with the self-expanding Medtronic CoreValve bioprosthesis (Medtronic, Minneapolis, MI) through a diseased left common carotid (LCC) artery. This 81-year-old male patient presented with heart failure due to a severe degenerative aortic valve stenosis. Comorbidities included diabetes, hypertension, and dyslipidemia as well as peripheral and coronary artery disease, resulting in a logistic EuroScore II of 25.9%. Consequently, he was rejected to undergo surgery and a transcatheter approach was planned. Due to severe peripheral vascular disease with iliofemoral lesions, significant calcifications and unfavourable angulations of the innominate artery as well as prior bypass surgery precluding a direct aortic and subclavian approach, none of the established access sites were suitable. Therefore, we considered a left carotid access, which had to be combined with a surgical endarterectomy for treatment of a significant common carotid bifurcation stenosis and left subclavian-LCC permanent tunnel bypass graft. The procedure was successful without cardiac, cerebrovascular, or access complications. This case illustrates a true heart team approach, establishing a unique access for TAVI for patients without regular access options.
Assuntos
Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Endarterectomia das Carótidas , Implante de Prótese de Valva Cardíaca/métodos , Artéria Subclávia/cirurgia , Enxerto Vascular , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Bioprótese , Cateterismo Cardíaco/instrumentação , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico , Artéria Carótida Primitiva/diagnóstico por imagem , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Desenho de Prótese , Radiografia Intervencionista , Artéria Subclávia/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND: Factors influencing the size of target vessels of patients referred for coronary intervention are poorly defined. We aimed to investigate in a large series of patients undergoing percutaneous intervention the relation of constitutional, anatomical, and clinical features with the reference diameter of coronary vessels treated with stenting. METHODS: A total of 4,850 de novo coronary lesions, non-ostial and non-bifurcational, located in native vessels were analyzed. The following pre-specified characteristics were analyzed to reflect the relation between constitutional, anatomical, and clinical features on reference vessel diameter: age, gender, height, weight, proximal location, vessel, diabetes, hypertension, multivessel disease, and clinical presentation. RESULTS: The average reference diameter was 2.66+/-0.50 mm. All pre-specified markers had a significant relation with the vessel reference diameter at univariate analysis, except by hypertension which showed a strong tendency. However, at multivariate analysis, only diabetes, proximal location, multivessel disease, clinical presentation, vessel, weight, and height were identified as independent predictors of reference vessel diameter. CONCLUSION: Reference diameter of coronary vessels at the site of lesions treated by stenting is significantly influenced by a variety of characteristics. We hypothesize that the treated segment size of patients undergoing stenting ultimately reflects the conjoint effect of several different factors, including constitutional, anatomical, and clinical features.