Revista Brasileira de Cardiologia Invasiva (English Edition)最新文献

{"title":"Early and late clinical outcomes after saphenous vein graft treatment with MGuardTM stents vs. drug-eluting stents","authors":"Danillo Taiguara da Silva ,&nbsp;J. Ribamar da Costa Jr. ,&nbsp;Antonio de Castro Filho ,&nbsp;Rodolfo Staico ,&nbsp;Ricardo A. Costa ,&nbsp;Adriana Moreira ,&nbsp;Dimytri Siqueira ,&nbsp;Daniel Chamié ,&nbsp;Marinella Centemero ,&nbsp;Galo Maldonado ,&nbsp;Manoel Cano ,&nbsp;Luiz Fernando Tanajura ,&nbsp;Áurea J. Chaves ,&nbsp;Fausto Feres ,&nbsp;Alexandre Abizaid ,&nbsp;Amanda Sousa ,&nbsp;J. Eduardo Sousa","doi":"10.1016/j.rbciev.2017.02.007","DOIUrl":"10.1016/j.rbciev.2017.02.007","url":null,"abstract":"<div><h3>Background</h3><p>The MGuard^TM stent, which has a microscopic polymer mesh coating, is intended to reduce the distal embolization of fragments during percutaneous coronary intervention (PCI) in saphenous vein grafts (SVG). This study evaluated the early and late clinical outcomes of patients undergoing PCI in SVG with MGuard^TM stents vs. drug-eluting stents (DES).</p></div><div><h3>Methods</h3><p>Observational, retrospective study conducted at two tertiary centers, involving a cohort of patients with SVG lesions submitted to elective or emergency treatment with MGuard^TM stents or DES.</p></div><div><h3>Results</h3><p>A total of 271 patients were included, of whom 220 were treated with DES. The MGuard^TM group had a higher proportion of women (25.5% vs. 10.5%; <em>p</em> = 0.01), with a mean age of 65.0 ± 13.9 years vs. 69.0 ± 9.6 years (<em>p</em> = 0.06). The DES group more frequently used distal protection filter (5.8% vs. 10.0%; <em>p</em> = 0.001). Angiographic success was attained in most cases (96.2% vs. 98.0%; <em>p</em> = 0.22). The MGuard^TM group had lower rates of early major adverse cardiovascular events (MACE) than the DES group (1.9% vs. 13.6%; <em>p</em> = 0.01), due solely to the lower incidence of periprocedural infarction. However, the MACE rate at 1 year was higher in the MGuard^TM group (14.3% vs. 4.4%; <em>p</em> = 0.01) at the expense of a higher rate of target lesion revascularization (7.1% vs. 1.3%; <em>p</em> = 0.048).</p></div><div><h3>Conclusions</h3><p>The use of the MGuard^TM stent resulted in a reduction of events during hospitalization; however, in the long term the DES were superior in reducing major outcomes, mainly the need for target lesion revascularization.</p></div><div><h3>Introdução</h3><p>O stent MGuard^TM, revestido por malha polimérica microscópica, tem a finalidade de reduzir a embolização distal de fragmentos durante a intervenção coronária percutânea (ICP) em enxertos de veia safena (EVS). Avaliamos os desfechos clínicos precoces e tardios de pacientes submetidos à ICP de EVS com stents MGuard™ vs. stents farmacológicos (SF).</p></div><div><h3>Métodos</h3><p>Estudo observacional, retrospectivo, realizado em dois centros terciários, envolvendo uma coorte de pacientes com lesões em EVS, tratados de forma eletiva ou de emergência com stents MGuard™ ou SF.</p></div><div><h3>Resultados</h3><p>Foram incluídos 271 pacientes, sendo 220 tratados com SF. O Grupo MGuard™ apresentou maior proporção de mulheres (25,5% vs. 10,5%; p=0,01), com média de idades de 65,0 ± 13,9 anos vs. 69,0 ± 9,6 anos (<em>p</em> = 0,06). O Grupo SF utilizou com maior frequência filtro de proteção distal (5,8% vs. 10,0%; <em>p</em> = 0,001). Sucesso angiográfico foi obtido na maioria dos casos (96,2% vs. 98,0%; <em>p</em> = 0,22). O Grupo MGuard™ teve menores taxas de eventos cardiovasculares adversos maiores (ECAM) na fase hospitalar que o Grup","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 251-255"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"100973394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second-generation drug-eluting stent treatment for isolated proximal left anterior descending artery stenoses. The SAFIRA Registry data","authors":"Fernanda Marinho Mangione ,&nbsp;Maria Fernanda Zulliani Mauro ,&nbsp;Paulo Vasconcelos Silva ,&nbsp;Nádia Mendonça Carnieto ,&nbsp;Salvador André Bavaresco Cristóvão ,&nbsp;Adnan Ali Salman ,&nbsp;Gustavo Alexandre Dutra ,&nbsp;Bernardo Monteiro de Aguillar Giordano ,&nbsp;Fabio Musa Mustafa Dessiyeh ,&nbsp;Marcelo P. Gomes ,&nbsp;Tanas Jatene ,&nbsp;José Armando Mangione","doi":"10.1016/j.rbciev.2017.02.011","DOIUrl":"10.1016/j.rbciev.2017.02.011","url":null,"abstract":"<div><h3>Background</h3><p>Severe stenosis of the proximal left anterior descending artery (LAD) is classified as a high-risk lesion, as it may affect a large part of the left ventricular myocardium. Second-generation drug-eluting stents (DES) have been shown to be more effective and safer when compared to bare-metal or first-generation ones. There are few reports in the literature on the use of these devices for the treatment of isolated lesions in the proximal LAD.</p></div><div><h3>Methods</h3><p>Observational and prospective study, which included single-vessel patients with <em>de novo</em> lesions in the proximal LAD, electively treated with second-generation DES. In-hospital and late clinical outcomes were evaluated.</p></div><div><h3>Results</h3><p>Seventy patients were included, most of them males (70%), with a mean age of 65.4 ± 11.2 years and a high prevalence of diabetes (37%). The most common clinical presentation was stable angina (57.1%) and half of the lesions were type B2 or C. A total of 70 lesions were treated with 71 stents, with 100% angiographic success. The primary endpoint, consisting of cardiac death, nonfatal infarction, or target-vessel revascularization during the 2.5-year clinical follow-up, occurred in 3% of the patients. Cardiac death was 1.5%, and target-lesion revascularization was required in only 1.5% of the patients.</p></div><div><h3>Conclusions</h3><p>Elective treatment with second-generation DES seems to be a safe option in single-vessel patients with <em>de novo</em> lesions in the proximal LAD, with low rates of adverse cardiac events or need for additional revascularization procedure.</p></div><div><h3>Introdução</h3><p>A estenose grave do terço proximal da artéria descendente anterior (ADA) é classificada como lesão de alto risco, visto que pode comprometer grande parte do miocárdio ventricular esquerdo. Os stents farmacológicos (SF) de segunda geração têm demonstrado maior eficácia e segurança quando comparados aos não farmacológicos ou aos de primeira geração. São escassos os relatos na literatura do emprego desses dispositivos para o tratamento de lesões isoladas do terço proximal da ADA.</p></div><div><h3>Métodos</h3><p>Estudo observacional e prospectivo, que incluiu pacientes uniarteriais, portadores de lesão <em>de novo</em> no terço proximal da ADA, tratados eletivamente com SF de segunda geração. Avaliamos os desfechos clínicos hospitalares e tardios.</p></div><div><h3>Resultados</h3><p>Foram incluídos 70 pacientes, sendo a maioria do sexo masculino (70%), com média de idades de 65,4 ± 11,2 anos e com alta prevalência de diabetes (37%). O quadro clínico mais frequente foi angina estável (57,1%) e metade das lesões era do tipo B2 ou C. Foram tratadas 70 lesões com 71 stents, com sucesso angiográfico de 100%. O desfecho primário composto por óbito cardíaco, infarto não fatal ou revascularização do vaso alvo no seguimento clínico de 2,5 anos ocorreu em 3% dos pacientes. A mortalidade cardíaca foi de ","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 256-260"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"108031173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally-invasive strategy for transcatheter implantation of second-generation Lotus™ aortic valve system","authors":"Marden André Tebet ,&nbsp;Vinicius Borges Cardoso Esteves ,&nbsp;Sergio Kreimer ,&nbsp;Cleverson Zukowski ,&nbsp;Felipe Maia ,&nbsp;Maurício Oliveira ,&nbsp;Jorge Lorena ,&nbsp;Pedro Beraldo de Andrade ,&nbsp;Luiz Alberto Piva e Mattos","doi":"10.1016/j.rbciev.2017.02.015","DOIUrl":"10.1016/j.rbciev.2017.02.015","url":null,"abstract":"<div><p>Transcatheter aortic valve implantation is a well-established therapy in patients with severe aortic stenosis. There has been a progressive improvement in device technology associated with increased experience of the interventionists, resulting in safer procedures with better outcomes. The first second-generation device approved in Brazil, Lotus™ Valve System (Boston Scientific Corporation, Natick, USA), incorporates several of these new characteristics. This report describes the first two cases, both successfully performed in the country, carried out under local anesthesia and conscious sedation.</p></div><div><p>O implante percutâneo de bioprótese aórtica é a terapia estabelecida em pacientes com estenose aórtica grave. Houve um progressivo aperfeiçoamento na tecnologia dos dispositivos que, associada a maior experiência dos operadores, resultou em procedimentos mais seguros e com melhores resultados. O primeiro dispositivo de segunda geração aprovado no Brasil, o sistema de válvula Lotus™ (Boston Scientific Corporation, Natick, EUA), incorpora várias dessas novas características. Descrevemos aqui os dois primeiros casos realizados no país, conduzidos sob anestesia local e sedação consciente, ambos com sucesso.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 285-287"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"111085900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New generation devices for transcatheter aortic valve replacement","authors":"Áurea J. Chaves","doi":"10.1016/j.rbciev.2017.02.002","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.02.002","url":null,"abstract":"","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Page 233"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72204878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous aortic valve implantation – an experience with the LotusTM repositionable device","authors":"Vinicius Esteves ,&nbsp;Julio F. Marchini ,&nbsp;Guilherme Bernardi ,&nbsp;Marden A. Tebet ,&nbsp;Fernando Bernardi ,&nbsp;Sérgio Kreimer ,&nbsp;Paulo Prates ,&nbsp;José Mariani Jr. ,&nbsp;Rogério Sarmento-Leite ,&nbsp;Luiz Alberto Mattos ,&nbsp;Eberhard Grube ,&nbsp;Pedro A. Lemos","doi":"10.1016/j.rbciev.2017.02.005","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.02.005","url":null,"abstract":"<div><h3>Background</h3><p>The second-generation Lotus^TM transcatheter aortic valve was designed to provide the interventional cardiologist with complete control of its release during the procedure. This study presents the initial experience and in-hospital outcomes of patients treated with this prosthesis in Brazil.</p></div><div><h3>Methods</h3><p>This observational and retrospective study included patients with symptomatic severe aortic stenosis considered at high surgical risk, treated in seven centers.</p></div><div><h3>Results</h3><p>The device was used in 31 patients, 61.3% female, aged 82.9 ± 6.9 years, and with STS score of 6.5 ± 4.1%. The aortic valve area was 0.73 ± 0.18<!--> <!-->cm² and the mean gradient was 51.7 ± 13.9<!--> <!-->mmHg. All procedures were performed by the transfemoral access route, and pre-dilation was necessary in 65% of cases. The success rate of the procedure was 96.7%. There were no vascular complications requiring surgical intervention nor cases of stroke. The mean gradient after the procedure was 10.5 ± 5.8<!--> <!-->mmHg; no cases of moderate to severe aortic regurgitation were observed. The rate of permanent pacemaker implantation was 38.7%, and mean in-hospital length of stay was 8.5 ± 4.8 days.</p></div><div><h3>Conclusions</h3><p>In the initial experience with the use of the Lotus^TM aortic valve, in-hospital results demonstrated the safety and efficacy of the device; no cases of significant aortic regurgitation were observed.</p></div><div><h3>Introdução</h3><p>A válvula aórtica transcateter de segunda geração Lotus^TM foi desenhada para proporcionar ao intervencionista o controle completo de sua liberação durante o procedimento. O presente estudo apresenta a experiência inicial e os desfechos hospitalares de pacientes tratados com essa prótese no Brasil.</p></div><div><h3>Métodos</h3><p>Registro observacional, retrospectivo, que incluiu pacientes com estenose aórtica grave sintomáticos, considerados de alto risco cirúrgico, tratados em sete centros.</p></div><div><h3>Resultados</h3><p>Receberam o dispositivo 31 pacientes, sendo 61,3% do sexo feminino, com idade de 82,9 ± 6,9 anos e escore STS de 6,5 ± 4,1%. A área valvar aórtica foi de 0,73 ± 0,18<!--> <!-->cm² e o gradiente médio de 51,7 ± 13,9<!--> <!-->mmHg. Todos os procedimentos foram realizados pela via transfemoral, e a pré-dilatação foi necessária em 65% dos casos. A taxa de sucesso do procedimento foi de 96,7%. Não houve complicação vascular com necessidade de intervenção cirúrgica e nem casos de acidente vascular cerebral. O gradiente médio após o procedimento foi de 10,5 ± 5,8<!--> <!-->mmHg e não foram observadas regurgitações aórticas de graus moderado/importante. A taxa de implante de marca-passo definitivo foi de 38,7%, e a permanência hospitalar de 8,5 ± 4,8 dias.</p></div><div><h3>Conclusões</h3><p>Na experiência inicial com o implante da válvula aórtica Lotus^TM, os resultad","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 238-241"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72236358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial artery avulsion - a rare complication of radial access","authors":"Gilberto Guilherme Ajjar Marchiori,&nbsp;George César Ximenes Meireles,&nbsp;Sérgio Kreimer,&nbsp;Micheli Zanoti Galon,&nbsp;Carlos Vinicius Abreu do Espírito Santo","doi":"10.1016/j.rbciev.2017.02.009","DOIUrl":"10.1016/j.rbciev.2017.02.009","url":null,"abstract":"<div><p>The radial access is widely used for cardiac catheterization and angioplasty, with advantages such as decreased risk of bleeding and vascular complications. This case reports on a rare complication during cardiac catheterization by radial access: radial artery endothelial tissue avulsion through the catheter and its embolization to the left anterior descending artery, which was resolved by manual aspiration of the embolized fragment. This complication may be related to the specific anatomical characteristics of the patient's radial artery.</p></div><div><p>A via radial é amplamente utilizada para a realização de cateterismo cardíaco e angioplastia, com vantagens como a diminuição do risco de sangramento e de complicações vasculares. O presente caso relata uma complicação rara durante o cateterismo cardíaco por via radial: a avulsão de tecido endotelial da artéria radial pelo cateter e sua embolização para a artéria descendente anterior, a qual foi resolvida pela aspiração manual do fragmento embolizado. Tal complicação pode ter relação com as características anatômicas específicas da artéria radial do paciente.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 282-284"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"105644519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of conventional compressive dressings vs. wristband devices after catheterization by radial approach","authors":"Said Assaf Neto ,&nbsp;João Orávio de Freitas Jr. ,&nbsp;Sérgio Luis Berti ,&nbsp;J. Ribamar Costa Jr. ,&nbsp;Jorge Augusto L. Zbeid","doi":"10.1016/j.rbciev.2017.02.014","DOIUrl":"10.1016/j.rbciev.2017.02.014","url":null,"abstract":"<div><h3>Background</h3><p>Wristband devices used in the compression of the radial puncture site add cost to the procedure and have not been adequately compared with conventional compressive dressings. This study evaluated the effectiveness and safety of both forms of hemostasis in patients undergoing coronary angiography and/or percutaneous coronary intervention in daily practice.</p></div><div><h3>Methods</h3><p>A prospective, multicenter, nonrandomized study, which included consecutive patients who underwent procedures through radial access. The type of compression was at the interventionist's discretion and the availability of wristband devices. The main objective was to compare the patency of the radial artery on the 7^th day after the procedure, measured by Doppler. Secondarily, the authors evaluated the occurrence of bleeding/hematoma at the puncture site during compression, after removal of the device and on the 7^th day after the procedure.</p></div><div><h3>Results</h3><p>This study evaluated 528 patients, 416 using conventional compressive dressings and 112 using wristband devices. When the sheath was removed and soon after its removal, a higher incidence of bleeding in the conventional compressive dressings group was observed (13.4% vs. 0%; <em>p</em> &lt; 0.001). All bleeding events were small (type I or type II) and did not require further actions. At 7 days, there were only small hematomas at the puncture site in 7.1% of cases that used the wristband device. There was no difference in the patency rates of the radial artery (3.8% vs. 7.1%; <em>p</em> = 0.20).</p></div><div><h3>Conclusions</h3><p>The use of wristband devices for radial artery hemostasis did not result in higher rates of late arterial patency when compared to conventional compressive dressings.</p></div><div><h3>Introdução</h3><p>Dispositivos dedicados à compressão do sítio de punção radial adicionam custo ao procedimento e não foram adequadamente comparados aos curativos compressivos. Avaliamos a efetividade e a segurança de ambas as formas de hemostasia em pacientes submetidos à cinecoronariografia e/ou intervenção coronária percutânea na prática diária.</p></div><div><h3>Métodos</h3><p>Estudo prospectivo, multicêntrico e não randomizado, que incluiu pacientes consecutivamente submetidos a procedimentos por via radial. A modalidade de compressão ficou a critério do operador e da disponibilidade das pulseiras hemostáticas. O objetivo primário foi a comparação da patência da artéria radial no sétimo dia pós-procedimento, aferida por meio do Doppler. Secundariamente, avaliamos a ocorrência de hemorragia/hematoma no sítio de punção durante a compressão, após a retirada do dispositivo e no sétimo dia pós-procedimento.</p></div><div><h3>Resultados</h3><p>Foram avaliados 528 pacientes, 416 que usaram o curativo compressivo e 112 que usaram a pulseira hemostática. Na fase da retirada do introdutor e logo após sua remoção, notou-se uma incidência maior de","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 271-275"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"111215022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for vascular access-related complications in patients undergoing early invasive strategy","authors":"Pedro Beraldo de Andrade ,&nbsp;Fábio Salerno Rinaldi ,&nbsp;Igor Ribeiro de Castro Bienert ,&nbsp;Robson Alves Barbosa ,&nbsp;Marcos Henriques Bergonso ,&nbsp;Milena Paiva Brasil de Matos ,&nbsp;Caio Fraga Barreto de Matos Ferreira ,&nbsp;Ederlon Ferreira Nogueira ,&nbsp;André Labrunie ,&nbsp;Sérgio Kreimer ,&nbsp;Vinícius Cardozo Esteves ,&nbsp;Marden André Tebet ,&nbsp;Luiz Alberto Piva e Mattos ,&nbsp;Amanda G.M.R. Sousa","doi":"10.1016/j.rbciev.2017.02.006","DOIUrl":"10.1016/j.rbciev.2017.02.006","url":null,"abstract":"<div><h3>Background</h3><p>The knowledge of risk factors related to vascular access complications in patients undergoing early invasive strategy allows the adoption of methods to minimize them.</p></div><div><h3>Methods</h3><p>We performed a subanalysis of the ARISE study, aiming to identify predictors of vascular complications in patients randomized to the radial or femoral techniques with the use of vascular closure device (VCD).</p></div><div><h3>Results</h3><p>A total of 240 patients with a mean age of 63.0 ± 10.7 years were included, with 30.8% of diabetics. Except for a higher prevalence of women in the radial group, there were no clinical differences between the groups. Percutaneous coronary intervention was performed in 86.7% of the cases. The rate of vascular complications after 30 days was 13.3% in the radial group, due to hematoma &gt; 5<!--> <!-->cm (6.7%) and asymptomatic artery occlusion (5.8%), and 12.5% in femoral group, due to hematoma &gt; 5<!--> <!-->cm, without significant difference. The following were identified as risk factors for vascular access complications: body mass index (BMI), previous stroke, longer duration of the procedure, and VCD failure. At the stratified analysis, female gender and high or very high-risk CRUSADE score were predictors of complications only for the femoral group. In the multivariate model, the factors that remained significant were BMI and VCD failure.</p></div><div><h3>Conclusions</h3><p>The radial and femoral techniques, with the use of VCD, shared variables that were predictors of complications. Risk factors, such as female gender and high-risk CRUSADE score, were attenuated by the use of the radial technique.</p></div><div><h3>Introdução</h3><p>O conhecimento dos fatores de risco relacionados às complicações do acesso vascular em pacientes submetidos à estratégia invasiva precoce permite adotar estratégias capazes de minimizá-las.</p></div><div><h3>Métodos</h3><p>Realizamos subanálise do estudo ARISE, com o objetivo de identificar preditores de complicações vasculares em pacientes randomizados para as técnicas radial ou femoral com emprego de dispositivo de oclusão vascular (DOV).</p></div><div><h3>Resultados</h3><p>Foram incluídos 240 pacientes, com média de idade de 63,0 ± 10,7 anos, sendo 30,8% diabéticos e, exceto pela maior prevalência de mulheres no grupo radial, não foram observadas diferenças clínicas entre os grupos. Intervenção coronária percutânea foi realizada em 86,7% dos casos. A taxa de complicações vasculares aos 30 dias foi de 13,3% no grupo radial, à custa de hematomas &gt; 5<!--> <!-->cm (6,7%) e oclusão arterial assintomática (5,8%), e de 12,5% no grupo femoral, à custa de hematomas &gt; 5<!--> <!-->cm, sem diferença significativa. Foram identificados como fatores de risco para complicações do acesso vascular o índice de massa corporal (IMC), o acidente vascular encefálico prévio, a maior duração do procedimento e o insucesso do DOV. Pela análise estratificada, o sexo fem","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 242-246"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"98027939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensive spontaneous coronary dissection with favorable evolution maintained under conservative treatment","authors":"Marcos Danillo Peixoto Oliveira,&nbsp;Breno Alencar Falcão,&nbsp;José Mariani Jr.,&nbsp;Carlos M. Campos,&nbsp;Expedito E. Ribeiro,&nbsp;Pedro Alves Lemos","doi":"10.1016/j.rbciev.2017.02.010","DOIUrl":"10.1016/j.rbciev.2017.02.010","url":null,"abstract":"<div><p>Spontaneous coronary dissection is a rare entity and, therefore, its etiology, pathophysiology, and treatment are not yet established. It affects mainly young women without the classic cardiovascular risk factors, commonly during the pregnancy-childbirth cycle. Several factors influence the treatment strategy, such as clinical presentation, hemodynamic status, topography, number of affected arteries, and distal coronary flow. As in the reported case, in stable patients with well-defined dissections and mainly when the coronary flow has been re-established, one can choose a conservative approach, due to the high incidence of spontaneous resolution and low incidence of long-term adverse events.</p></div><div><p>A dissecção coronária espontânea é uma entidade rara e, por conseguinte, de etiologia, fisiopatologia e tratamento ainda não estabelecidos. Acomete, em geral, mulheres jovens, sem os clássicos fatores de risco cardiovascular, comumente ao longo do ciclo gravídico-puerperal. Vários fatores influenciam na estratégia de tratamento, como quadro clínico, status hemodinâmico, topografia da dissecção, número de artérias afetadas e fluxo coronário distal. Como no caso relatado, em pacientes estáveis, com dissecções bem delimitadas e, sobremodo, quando o fluxo coronário é reestabelecido, pode-se optar por uma abordagem conservadora, em razão da alta incidência de resolução espontânea e da baixa incidência de eventos adversos a longo prazo.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 279-281"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"104397414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The repositionable LotusTM valve system","authors":"Seyrani Yücel ,&nbsp;Ulrich Gerckens","doi":"10.1016/j.rbciev.2017.02.003","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.02.003","url":null,"abstract":"","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 234-235"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72204879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}