Search

Background The radial approach for cardiac catheterization and coronary angioplasty is well established. The prevalence of radial artery occlusion and its determining factors still raises debate. The objective of this study was to analyze the incidence of radial artery occlusion after cardiac procedures using the radial approach, comparing hemostasis done by elastic compression dressing or hemostatic wristband. Methods A randomized clinical trial comparing the incidence of radial artery occlusion as established by palpation and vascular Doppler, upon discharge and [...]

A úlcera aterosclerótica penetrante de aorta é uma patologia subdiagnosticada que apresenta altas taxas de morbimortalidade. Relatamos dois casos de pacientes com dor torácica intensa sem características isquêmicas que foram submetidos a angiotomografia de tórax e apresentaram ulceração na parede da aorta com penetração de contraste na camada média. Em razão da falha no tratamento clínico, foram submetidos a implante percutâneo de endoprótese aórtica com resolução completa dos sintomas.

We report the case of a female patient with obstructive lesions in the right and left carotid, right renal, left subclavian and left common iliac arteries which were percutaneously treated.

We report the case of a 16-year-old pregnant patient with severe aortic stenosis and pulmonary congestion clinically uncontrolled, in whom percutaneous balloon aortic valvuloplasty was used as the first choice of treatment in an emergency procedure. The clinical findings, pathophysiology, diagnostic features, and indications for percutaneous treatment are reported. Severe congenital aortic stenosis is rare in children and young individuals. Bicuspid aortic valve occurs in 3% to 6% of patients with congenital heart disease; when associated with commissural fusion, significant stenosis may be present in childhood. The association of severe congenital aortic stenosis and pregnancy is difficult to control clinically, carrying a high risk of maternal and fetal mortality, mainly when manifested with symptoms of pulmonary congestion 1,2.

INTRODUÇÃO: A eficácia e a segurança do stent farmacológico (SF) de segunda geração liberador de everolimus XienceTM V (Abbott Vascular, Santa Clara, Estados Unidos) já foram estabelecidas no tratamento de pacientes selecionados com lesões coronárias. No entanto, o impacto do stent XienceTM V em populações da prática clínica com lesões complexas ainda não está totalmente definido. MÉTODOS: O Registro BRAVO foi um estudo prospectivo, não-randomizado, multicêntrico, que avaliou os resultados clínicos tardios de pacientes minimamente selecionados tratados com o SF XienceTM V na prática diária brasileira. No total, foram incluídos 535 pacientes em 25 centros clínicos entre setembro de 2008 e setembro de 2010. Eventos cardíacos adversos maiores (ECAM) foram definidos como morte cardíaca, infarto agudo do miocárdio (IAM) e revascularização do vaso-alvo (RVA). RESULTADOS: A média de idade dos pacientes era de 62,7 ± 11,1 anos, 40% dos quais tinham diabetes, 24,9% apresentavam IAM prévio e 41,9% apresentaram-se com síndrome coronária aguda. Cerca de dois terços dos pacientes tinham lesões tipo B2/C e 46,1% trataram a artéria descendente anterior. Implante de múltiplos stents ocorreu em 13,8% dos casos, e o sucesso angiográfico foi > 99%. Na fase intra-hospitalar, a taxa de IAM periprocedimento foi de 1,9%. Já no seguimento de 6 meses, as taxas cumulativas de óbito cardíaco, IAM e RVA foram de 1,1%, 2,2% e 1,3%, respectivamente (taxa de ECAM de 4,3%). Com relação à trombose de stent (definida de acordo com os critérios do Academic Research Consortium ARC), foram reportados 4 casos até 6 meses, representando taxa de evento de 0,75% (0,4% definitiva/provável). CONCLUSÕES: Neste Registro, que incluiu pacientes e lesões complexos tratados em múltiplos centros nacionais, o SF de segunda geração XienceTM V demonstrou excelentes resultados imediatos e efetividade clínica e segurança sustentadas até o seguimento a médio prazo (6 meses). Os resultados do seguimento a longo prazo são aguardados. BACKGROUND: The XienceTM V everolimus-eluting stent (Abbott Vascular, Santa Clara, USA), a second-generation drug-eluting stent (DES) has demonstrated sustained efficacy and safety in the treatment of selected patients with coronary lesions. However, the impact of the XienceTM V stent in populations from daily clinical practice with complex lesions has not yet been fully determined. METHODS: The BRAVO Registry was a prospective, non-randomized, multicenter study that evaluated the late clinical outcomes of minimally selected patients treated with XienceTM V DES in the Brazilian daily clinical practice. Overall, 535 patients were included in 25 clinical sites between September/2008 and September/2010. Major adverse cardiac events (MACE) were defined as cardiac death, acute myocardial infarction (AMI) and target vessel revascularization (TVR). RESULTS: Mean age was 62.7 + 11.1 years, 40% had diabetes, 24.9% had a previous AMI and 41.9% presented with acute coronary syndrome. About two thirds of the patients had type B2/C lesions and 46.1% treated the left anterior descending artery. Multiple stenting procedures were performed in 13.8% of cases and angiographic success was > 99%. During hospitalization, periprocedural AMI rate was 1.9%. At the 6-month follow-up, cumulative rates of cardiac death, AMI and TVR were 1.1%, 2.2% and 1.3%, respectively (MACE rate: 4.3%). There were 4 cases of stent thrombosis (defined according to the Academic Research Consortium ARC) reported within 6 months, representing an event rate of 0.75% (0.4% definite/probable). CONCLUSIONS: In this Registry including complex patients and lesions treated at multiple sites in Brazil, the XienceTM V second generation DES demonstrated excellent immediate results and sustained clinical efficacy and safety at mid-term follow-up (6 months). Long-term results are expected.

Penetrating aortic atherosclerotic ulcer is an underdiagnosed condition that presents high rates of morbidity and mortality. We report two cases of patients with severe chest pain, with no ischemic features, who underwent chest angiotomography and showed an ulceration of the aortic wall, with contrast penetration into the middle layer. Due to the failure of the medical treatment, the patients underwent percutaneous aortic stent implantation with complete resolution of symptoms.

INTRODUÇÃO: Aproximadamente 90% dos pacientes submetidos a cirurgia de revascularização do miocárdio (CRM) recebem enxerto de artéria torácica interna esquerda. A ocorrência de estenose da artéria subclávia esquerda pode resultar em falência do enxerto por limitação de fluxo coronário. A prevalência de estenose da artéria subclávia esquerda em pacientes com aterosclerose coronária grave, considerados candidatos a CRM, não é conhecida. OBJETIVO: Determinar a prevalência e a eficácia da avaliação clínica para diagnosticar a estenose da artéria subclávia esquerda em candidatos a CRM. MÉTODO: Em um registro multicêntrico, realizouse angiografia seletiva da artéria subclávia esquerda em pacientes com indicação de CRM na ocasião da cinecoronariografia. Estenoses maiores ou iguais a 50% antes da origem da artéria torácica interna foram consideradas significativas. RESULTADOS: Dos 205 pacientes estudados, 16 (7,8%) apresentavam estenose significativa da artéria subclávia esquerda. A medida da pressão arterial não-invasiva diferencial entre os membros superiores > 10 mmHg teve baixa sensibilidade (37,5%) e baixo valor preditivo positivo (13,3%) para a identificação da estenose. Não foram identificados preditores clínicos de estenose da artéria subclávia pela análise univariada. CONCLUSÃO: Estenose da artéria subclávia esquerda não é incomum em pacientes com indicação de CRM. O gradiente de pressão entre os membros superiores é um método diagnóstico insuficiente. Portanto, em pacientes candidatos a CRM, a realização de arteriografia seletiva da artéria subclávia esquerda deve ser considerada, pelo risco de comprometimento de fluxo e síndrome do roubo coronário-subclávio em pacientes com estenose da subclávia não diagnosticada que recebem enxerto de artéria torácica interna esquerda. BACKGROUND: Approximately 90% of the patients submitted to coronary artery bypass graft surgery (CABG) receive a left internal thoracic artery (LITA) graft. Stenosis of the left subclavian artery can result in graft failure due to restricted coronary flow. The prevalence of stenosis of the left subclavian artery in patients with severe coronary atherosclerosis, deemed candidates to CABG, is not known. OBJECTIVE: To assess the prevalence of stenosis of left subclavian artery in CABG candidates, as well as the diagnostic effectiveness of clinical evaluation. METHODS: In a multicenter registry, selective angiography of the left subclavian artery was carried out in patients considered candidates to CABG during coronary cineangiography. Stenoses > 50% proximal to the origin of the LITA were considered significant. RESULTS: A total of 205 patients were included. Significant stenosis of the left subclavian artery was observed in 16 (7.8%) patients. Noninvasive differential arterial blood pressure measurement > 10 mmHg between both arms showed low sensitivity (37.5%) and low positive predictive value (13.3%) for stenosis identification. No clinical predictors of significant stenosis were identified by univariate analysis. CONCLUSION: Stenosis of the left subclavian artery is not uncommon in CABG candidates. Noninvasive blood pressure gradient between both arms has low diagnostic accuracy. Therefore, in patients candidates to CABG, selective angiography of the left subclavian artery should be considered, because of the risk of reduced flow and coronary-subclavian steal syndrome in patients with non-diagnosed stenosis of the subclavian artery who receive a LITA graft.

Obstructions of the upper venous system may be due to spontaneous thrombosis or the presence of hemodialysis or chemotherapy catheters, or even the presence of extrinsic compression due to intra-thoracic tumors. The use of endoprosthesis for the treatment of these obstructions has become common practice, and its indications include situations of risk for pulmonary embolism, superior vena cava syndrome, and loss of vascular access. Within this context, the use of intracardiac ultrasound may be useful in evaluating the extension and severity of the obstructive lesion, besides providing important information about the mural and intraluminal morphology of the venous system. The authors report the case of a patient with superior vena cava syndrome caused by thrombosis at the entry pathway of the right atrium, besides discussing the subject by means of literature review.

SUMMARYIndication and Results of PercutaneousInterventions in Carotid Arteries In this article, the authors discuss the epidemiological impor-tance of carotid occlusive disease, highlighting the clinicalpresentation and the main methods for its diagnosis, bothinvasive and non-invasive. Additionally, the authors discussthe chief studies available in the literature, comparing theresults of carotid endarterectomy to percutaneous interventions. DESCRIPTORS: Carotid stenosis, terapy. Carotid stenosis,surgery. Endarterectomy, carotid. Carotid artery diseases. RESUMO Neste artigo, os autores discutem a importância epidemiologicada doenca oclusiva das arterias carotidas, destacando aapresentacao clinica e os principais metodos para o seudiagnostico, invasivos ou nao. Alem disso, discutem osprincipais estudos disponiveis na literatura comparando osresultados da endarterectomia carotidea aos das intervencoespercutâneas. DESCRITORES: Estenose das carotidas, terapia. Estenosedas carotidas, cirurgia. Endarterectomia das carotidas. Doen-cas das arterias carotidas.

OBJETIVO: Determinar a prevalência de estenose da artéria renal (EAR) em pacientes submetidos a cineangiocoronariografia. MÉTODOS: Estudo prospectivo, considerando 1.656 cinean-giocoronariografias seguidas de aortografia, entre janeiro/2002 e fevereiro/2004, de pacientes encaminhados à cineangiocoronariografia diagnóstica com história ou não de hipertensão arterial sistêmica (HAS). RESULTADOS: Dos 1.656 pacientes, a idade média foi de 61,6 ± 11,8 anos, 53,8% eram do sexo masculino, 10,2% eram diabéticos, 63,8% apresentavam coronariopatia obstrutiva. A presença de EAR maior que 50% foi observada em 228 (13,8%) pacientes, e em 25 (1,5%) destes, ocorreu bilateralmente. A coronariopatia obstrutiva foi definida como estenose que causa redução do lúmen do vaso em 50% ou mais, em um, dois ou três vasos principais, denominados uniarterial, biarterial ou triarterial, respectivamente.A quantificação era realizada através da análise visual da angiografia. Comparando os grupos com e sem EAR > 50%, observou-se diferença estatisticamente significativa quanto a gênero, idade, ocorrência de diabete melito, PA e função ventricular esquerda. Não houve diferença significativa, no entanto, quanto à ocorrência de obstrução coronariana > 50%. Quando, porém, a EAR considerada é > 70%, observa-se diferença significativa quanto a PA, associação à obstrução coronariana > 50% e à disfunção ventricular esquerda, maiores no grupo com EAR. CONCLUSÃO: A prevalência de EAR neste estudo foi comparável àquela das grandes casuísticas da literatura e, em razão de sua importância pela associação com HAS e doença renal terminal (DRT) e suas seqüelas, devemos estar atentos para seu diagnóstico angiográfico. OBJECTIVE: To determine the prevalence of renal artery stenosis (RAS) in patients who have undergone cineangiocoronariography. METHODS: Prospective study of cineangiocoronariography and aortography examinations conducted between January 2002 and February 2004 on 1,656 hypertensive and normotensive patients who underwent the examinations to confirm the diagnosis of obstructive coronary artery disease or valve disease. RESULTS: The average age of the 1,656 patients was 61.6 ± 11.8 years. Eight hundred and ninety-one (53.8%) were male, 169 (10.2%) were diabetic and 1,054 (63.8%) presented obstructive coronary artery disease. Renal stenosis greater than 50% was observed in 228 (13.8%) patients, and 25 (1.5%) had bilateral stenosis. Obstructive coronary artery disease was defined as stenosis greater than or equal to 50% of the vessel lumen, in one, two or three main arteries, classified as single, double or triple vessels, respectively. Quantification was conducted using visual analysis of the angiography. Comparison of the groups with and without renal artery obstruction > 50%, revealed significant statistical differences in relation to gender, age, diabetes mellitus, blood pressure and left ventricular function. However, no statistical difference was noted in relation to the occurrence of coronary artery obstructions > 50%. Nevertheless, renal artery obstructions > 70%, revealed significant differences in relation to blood pressure, coronary artery obstructions > 50% and left ventricular function, which were all higher in the renal artery obstruction group. CONCLUSION: The prevalence of RAS found in our study was comparable to that reported by major medical literature case studies. RAS is associated with systemic hypertension (SH), end-stage renal disease (ESRD) and its sequelae, emphasizing how important it is that we are aware of possible candidates for angiographic diagnosis of this disease.

Obstructions of the upper venous system may be due to spontaneous thrombosis or the presence of hemodialysis or chemotherapy catheters, or even the presence of extrinsic compression due to intra-thoracic tumors. The use of endoprosthesis for the treatment of these obstructions has become common practice, and its indications include situations of risk for pulmonary embolism, superior vena cava syndrome, and loss of vascular access. Within this context, the use of intracardiac ultrasound may be useful in evaluating the extension and severity of the obstructive lesion, besides providing important information about the mural and intraluminal morphology of the venous system. The authors report the case of a patient with superior vena cava syndrome caused by thrombosis at the entry pathway of the right atrium, besides discussing the subject by means of literature review.

We report the case of a female patient with obstructive lesions in the right and left carotid, right renal, left subclavian and left common iliac arteries which were percutaneously treated.

To determine the prevalence of renal artery stenosis (RAS) in patients who have undergone cineangiocoronariography.Prospective study of cineangiocoronariography and aortography examinations conducted between January 2002 and February 2004 on 1,656 hypertensive and normotensive patients who underwent the examinations to confirm the diagnosis of obstructive coronary artery disease or valve disease.The average age of the 1,656 patients was 61.6 +/- 11.8 years. Eight hundred and ninety-one (53.8%) were male, 169 (10.2%) were diabetic and 1,054 (63.8%) presented obstructive coronary artery disease. Renal stenosis greater than 50% was observed in 228 (13.8%) patients, and 25 (1.5%) had bilateral stenosis. Obstructive coronary artery disease was defined as stenosis greater than or equal to 50% of the vessel lumen, in one, two or three main arteries, classified as single, double or triple vessels, respectively. Quantification was conducted using visual analysis of the angiography. Comparison of the groups with and without renal artery obstructionor = 50%, revealed significant statistical differences in relation to gender, age, diabetes mellitus, blood pressure and left ventricular function. However, no statistical difference was noted in relation to the occurrence of coronary artery obstructionsor = 50%. Nevertheless, renal artery obstructionsor = 70%, revealed significant differences in relation to blood pressure, coronary artery obstructionsor = 50% and left ventricular function, which were all higher in the renal artery obstruction group.The prevalence of RAS found in our study was comparable to that reported by major medical literature case studies. RAS is associated with systemic hypertension (SH), end-stage renal disease (ESRD) and its sequelae, emphasizing how important it is that we are aware of possible candidates for angiographic diagnosis of this disease.

This is a case report of a 48-year-old female patient with a compatible history of Kawasaki disease during childhood, who was admitted to the emergency coronary unit with unstable angina pectoris. Coronary angiography identified two coronary aneurysms, one causing right coronary occlusion and the other causing severe obstruction of the left anterior descending coronary artery. Coronary artery bypass surgery was indicated.