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Journal of Cardiology Cases Jun 2020The patient was a 19-year-old woman who had experienced headache for 1 year. Soon after birth, ventricular septal defects were diagnosed, the size of which were small,...
The patient was a 19-year-old woman who had experienced headache for 1 year. Soon after birth, ventricular septal defects were diagnosed, the size of which were small, therefore not requiring surgical repair. She also noticed hypertension, with up to 184/110 mmHg of blood pressure. Her physical examination revealed a difference in blood pressure between her upper and lower limbs (160/108 and 92/65 mmHg, respectively). A cardiac computed tomography image clearly demonstrated the narrowing of the aortic isthmus. Coarctation of the aorta (CoA) was definitively diagnosed and was the cause of the upper limb hypertension and headache. Cardiac catheterization revealed 3.8 mm of the aortic isthmus and 65 mmHg of the peak-to-peak pressure gradient across the CoA. The patient was offered endovascular therapy of the CoA. A non-covered stent implantation was successfully performed and the pressure gradient across the aortic isthmus disappeared. Her upper limb hypertension also improved. Aortic angioscopy revealed a yellow plaque on the aortic intima, located proximal to the coarctation site, which was exposed owing to high blood pressure. Our case highlights that an atherosclerotic change can develop even in young patients with hypertension. <: An aortic angioscope can detect an early atherosclerotic change of aorta, which other imaging modalities such as computed tomography and intravascular ultrasonography cannot show. An early atherosclerosis can develop even in a young patient with hypertension; therefore, coarctation of the aorta should be diagnosed and treated appropriately as soon as possible.>.
PubMed: 32547662
DOI: 10.1016/j.jccase.2020.03.001 -
Journal of Cardiology Oct 2020The advantage of using bioresorbable-polymer drug-eluting stent (BP-DES) compared with second-generation durable-polymer drug-eluting stent (2G DP-DES) still remains...
Impact of different coronary angioscopic findings on arterial healing one year after bioresorbable-polymer and second-generation durable-polymer drug-eluting stent implantation.
BACKGROUND
The advantage of using bioresorbable-polymer drug-eluting stent (BP-DES) compared with second-generation durable-polymer drug-eluting stent (2G DP-DES) still remains controversial in clinical situations. The purpose of this study to evaluate the degree of re-endothelialization and the prevalence of high-grade yellow-colored plaque (YCP), which might concern arterial healing after BP-DES and 2G DP-DES implantation using a high-resolution coronary angioscopy (CAS).
METHODS
In total, 104 DESs (52: 2G DP-DES and 52: BP-DES) were prospectively observed using CAS 12±1 months after coronary intervention. The grade of neointimal coverage (NIC) over the stent was scored on a 4-point scale from 0 (no coverage) to 3 (complete coverage). YCP grade was also scored on a 4-point scale as 0 (white) to 3 (intensive yellow). High-grade YCP was defined as maximum grade ≥2. Moreover, the prevalence of high-grade YCP and the incidence of thrombus were investigated.
RESULTS
BP-DES revealed better dominant NIC grade and less NIC heterogeneity than 2G DP-DES (p=0.0001 and p=0.015, respectively). The prevalence of high-grade YCP was lower for BP-DES than for 2G DP-DES (p=0.05). However, the incidence of thrombus was not significantly different (p=0.41). Multivariate analysis identified that low-density lipoprotein cholesterol levels [odds ratio (OR), 1.03; 95% Confidence Interval (CI): 1.01-1.06, p=0.01] and the usage of BP-DES [OR, 0.36; 95% CI: 0.14-0.91, p=0.03] as independent predictors of high-grade YCP.
CONCLUSIONS
Compared with 2G DP-DES, BP-DES was less heterogeneous and well-covered NIC and less prevalence of the high-grade YCP implying optimal arterial healing.
Topics: Absorbable Implants; Aged; Aged, 80 and over; Angioscopy; Cholesterol, LDL; Coronary Vessels; Drug-Eluting Stents; Female; Humans; Male; Plaque, Atherosclerotic; Polymers; Treatment Outcome
PubMed: 32423653
DOI: 10.1016/j.jjcc.2020.03.016 -
Journal of Cardiology Cases Aug 2020We evaluated Viabahn stent-graft (W.L. Gore & Associates, Flagstaff, AZ, USA) implanted in the superficial femoral artery at 6 months and one year after implantation...
We evaluated Viabahn stent-graft (W.L. Gore & Associates, Flagstaff, AZ, USA) implanted in the superficial femoral artery at 6 months and one year after implantation because the patient felt claudication due to repeated restenosis of bare nitinol stent which was implanted just proximal to the site of Viabahn stent-graft. At 6 months, angioscopy showed severe thrombosis in the stent-graft while the stent-graft was entirely patent. However, at one year, angioscopic evaluation revealed no thrombosis in the stent-graft. She received the same dual antiplatelet therapy. < We report a case with Viabahn stent-graft in whom an angioscopy revealed severe thrombosis at 6 months but no thrombosis at one year during the same dual antiplatelet therapy (DAPT). It might be necessary to continue DAPT after Viabahn stent-graft implantation at least over one year to prevent thrombosis.>.
PubMed: 32774521
DOI: 10.1016/j.jccase.2020.05.003 -
Journal of Cardiology Cases Jan 2021Vascular complications associated with vascular closure device use is uncommon; however, it sometimes occurs in transfemoral transcatheter aortic valve implantation...
Vascular complications associated with vascular closure device use is uncommon; however, it sometimes occurs in transfemoral transcatheter aortic valve implantation (TF-TAVI). We present a case of ProGlide (Abbott Vascular, Santa Clara, CA, USA)-related right femoral occlusion following TF-TAVI. An 83-year-old woman, who underwent TF-TAVI using double ProGlide pre-closure technique, presented with right claudication three days after TAVI. Computed tomography showed femoral occlusion of the puncture site. Recanalization without pressure gradient between the proximal and distal sites of the lesion was achieved by balloon angioplasty (BA) with a 4.0 mm balloon; however, early re-occlusion of the lesion occurred the next day after BA. Repeated BA was performed for the re-occlusion site 30 days after TAVI because of persistent claudication. Serial angioscopic images of the lesion revealed that the intima, which was injured at the first BA, had healed at the second BA, indicating that BA with larger balloons could be safely performed. We performed BA with a 6.0-mm balloon without stent implantation. The patency of the lesion was maintained during the 6-month follow-up period. The serial angioscopic findings, which revealed the healing process of the intima injury, were useful in determining a suitable endovascular therapy strategy for ProGlide-related occlusion. < ProGlide-related femoral occlusion can occur in arteries without stenosis, calcification, and vessel branching, suggesting that ProGlide should be carefully used with echo-guidance to avoid the occlusion of a puncture site. If endovascular therapy is performed for the lesion to avoid surgical repair, sufficient expansion is required to maintain patency. Angioscopy may be useful for determining a suitable endovascular therapy strategy for the lesion by evaluating the properties of the intima.>.
PubMed: 33437341
DOI: 10.1016/j.jccase.2020.09.006 -
Indian Journal of Thoracic and... Jan 2022Rarely pulmonary embolectomy has also been used as a salvage procedure for acute right ventricle (RV) dysfunction following acute pulmonary embolism (APE). Complete...
Rarely pulmonary embolectomy has also been used as a salvage procedure for acute right ventricle (RV) dysfunction following acute pulmonary embolism (APE). Complete surgical removal of thromboembolus in acute pulmonary thromboembolism is an essential pre-requisite for good outcome. Complete clearance of thromboembolic load from pulmonary arterial tree is difficult to assess intraoperatively. We hereby describe the use of flexible fibre optic bronchoscope (FFB) as angioscope to visualise the pulmonary arterial tree intraoperatively. Angioscopy ascertains the complete clearance up to subsegmental level after thromboembolectomy and aids in the removal of residual thrombus or embolus. Herein, we describe a case series of two patients, where FFB was used as angioscope during surgery for APE.
PubMed: 34898892
DOI: 10.1007/s12055-021-01276-0 -
Circulation Journal : Official Journal... Nov 2020
Topics: Angioscopy; Atherectomy, Coronary; Coronary Angiography; Coronary Vessels; Humans; Male; Middle Aged; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 33055473
DOI: 10.1253/circj.CJ-20-0610 -
JACC. Cardiovascular Interventions Aug 2020
Topics: Alloys; Angioscopy; Endovascular Procedures; Femoral Artery; Humans; Male; Middle Aged; Peripheral Arterial Disease; Popliteal Artery; Predictive Value of Tests; Prosthesis Design; Stents; Time Factors; Treatment Outcome
PubMed: 32739298
DOI: 10.1016/j.jcin.2020.05.015 -
The Journal of International Medical... Jan 2020The drug-coated balloon (DCB) angioplasty is considered a standard therapeutic option for in-stent restenosis. In the present case, we observed high-intensity spots on...
Serial optical coherence tomography and angioscopic assessments of 10-year in-stent restenosis of Cypher sirolimus-eluting stent treated with drug-coated balloon angioplasty.
The drug-coated balloon (DCB) angioplasty is considered a standard therapeutic option for in-stent restenosis. In the present case, we observed high-intensity spots on optical coherence tomography (OCT) and bright spots on coronary angioplasty (CAS) immediately after DCB angioplasty. The superficial high-intensity area on OCT presumably corresponded with the bright spots on CAS. The high-intensity superficial regions were thought to represent an iopromide/paclitaxel mixture. The present serial observation demonstrated that the eluted drugs remained for at least 2 months but disappeared within 6 months. At the site where we observed the drugs, neointimal growth was successfully inhibited and stabilized at the 6-month follow-up. The association of eluted drugs after DCB angioplasty with consequent neointimal growth is of scientific interest. Further prospective imaging studies with a large sample size are warranted to clarify this association.
Topics: Aged; Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Restenosis; Drug-Eluting Stents; Humans; Immunosuppressive Agents; Male; Sirolimus; Tomography, Optical Coherence; Treatment Outcome
PubMed: 30938569
DOI: 10.1177/0300060519837445 -
Circulation Journal : Official Journal... Sep 2020
Topics: Aged; Angioscopy; Anticoagulants; Catheterization, Peripheral; Catheters; Female; Fibrinolytic Agents; Humans; Thrombolytic Therapy; Treatment Outcome; Venous Thrombosis
PubMed: 32848120
DOI: 10.1253/circj.CJ-20-0461 -
Circulation Journal : Official Journal... Nov 2020
Topics: Adult; Angioplasty, Balloon; Catheters; Female; Fibrinolytic Agents; Humans; Iliac Vein; Thrombolytic Therapy; Treatment Outcome; Venous Thrombosis
PubMed: 33055457
DOI: 10.1253/circj.CJ-20-0530