Fábio Augusto Pinton

Inflation time in stent deployment: How long is enough?

Coronary stents are commonly deployed using high pressure. However, the duration time of balloon inflation during deployment is still to be determined. Vallurupalli and coworkers, in this issue of CCI, show that the stent system takes an average of 33 sec to “accommodate” its pressure during in vitro deployment. In patients, the mean stent inflation time to achieve pressure stability was 104 seconds, ranging from 30 to 380 sec. These results challenge a rapid inflation/deflation approach for stent deployment. It is suggested that the duration of the inflation might be individualized, in a case‐by‐case approach. However, the findings must be interpreted with caution, as they cannot be directly extrapolated to more diverse clinical, angiographic, and interventional scenarios.

Clinical performance of a novel ultrathin strut, low-dose, sirolimus-eluting stent with abluminal-only biodegradable polymeric coating for patients undergoing percutaneous coronary intervention in the daily practice

BACKGROUND The present study aimed to evaluate the clinical performance, in the daily practice of a busy catheterization laboratory, of a novel drug-eluting stent (DES) built with an ultra-thin-strut metallic platform, eluting sirolimus at low doses, abluminal coated with biodegradable polymers, and mounted in a low-compliant delivery system. METHODS Prospective, single-arm study, comprising all consecutive patients undergoing percutaneous coronary intervention (PCI) with the Inspiron™ sirolimus-eluting stent (SES) (Scitech, Aparecida de Goiania, Brazil). The primary endpoint was the occurrence of major adverse cardiac events (MACE) [cardiac death, non-PCI related myocardial infarction (MI), or target vessel revascularization (TVR)]. RESULTS A total of 470 patients were included, from which 51.3% were diabetics, 33.8% had triple-vessel disease, 15.3% had heart failure, 38.9% had at least one bifurcation treated, 19.8% were treated for a bare metal stent restenosis, and 61.9% had at least one type C lesion; one or more of these features were found in 96.0%. At 300 days, the rate target lesion revascularization was 5.4% and the rate of MACE was 8.1%. The incidence of definite or probable stent thrombosis was 0.4%, with no cases between 30 and 300 days. CONCLUSIONS The novel stent is associated with excellent short and mid-term clinical outcomes in patients treated with PCI in the daily practice.

Injeção de trombina guiada por ultrassom no tratamento de pseudoaneurisma da artéria femoral após procedimento percutâneo em pacientes com síndrome coronária aguda

BACKGROUND: Ultrasound-guided thrombin injection (TI) is an option for the treatment of femoral artery pseudoaneurysm. Nevertheless, the result of this technique in patients with acute coronary syndrome (ACS) may be compromised by the use of antithrombotic drugs. In addition, thrombin extravasation to systemic circulation could potentially cause an increase in thromboembolic events. METHODS: Patients admitted with ACS who developed femoral artery pseudoaneurysm after a percutaneous procedure and treated by TI between January 2007 and July 2011 were included. Clinical and laboratory characteristics, treatment results and complications were evaluated. RESULTS: We evaluated 23 patients with mean age of 67.1 ± 14.2 years, 60.9% were women, with body mass index of 28.4 ± 4.7 kg/m² and 52.2% were diabetics. At presentation, 87% had non-ST elevation ACS and the remaining had ST elevation myocardial infarction. Of the evaluated patients, 70% were submitted to percutaneous coronary intervention. All patients were receiving aspirin, 78.3% used P2Y12 inhibitors and 39.1% used glycoprotein IIb/IIIa inhibitors. TI was successful in occluding the pseudoaneurysm in 100% of cases (96.7% after the first injection), without distal embolization, local infection or need of surgical correction. There were no cases of myocardial infarction, stroke or unscheduled revascularization. There was one death due to cardiogenic shock 22 days after TI, on the second post-operative day after an elective coronary artery bypass graft surgery. CONCLUSIONS: Treatment of femoral artery pseudoaneurysm by TI is a safe and effective procedure in patients with ACS.

Coronary fractional flow reserve derived from intravascular ultrasound imaging: Validation of a new computational method of fusion between anatomy and physiology: Coronary fractional flow reserve derived from intravascular ultrasound imaging: Validation of a new computational method of fusion between anatomy and

To evaluate the diagnostic performance of a novel computational algorithm based on three‐dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUSFR), compared to gold‐standard invasive measurements (FFRINVAS).

TCT-573 Head-to-head comparison between coronary computed tomography angiography (CCTA) and intravascular ultrasound (IVUS) tridimensional models: a geometric point of view

Tridimensional reconstruction of the coronary arteries have played a major role in the understanding of the onset and progression of atherosclerotic plaque, plaque rupture and its hemodynamics repercussion. Our aim is to validate an automated algorithm that allows obtaining tridimensional model from

TCT-535 Coronary computed tomography angiography (CCTA) blood flow model, how we can improve it? Insights based on comparison with intravascular ultrasound (IVUS) tridimensional model.

RESULTS For deferred lesions, the risk of MACE had significant inverse relationship with FFR (adjusted hazard ratio [aHR], 1.06; 95% confidence interval [CI], 1.05 1.08; P<0.001). However, this relationship was not observed in revascularized lesions (aHR, 1.00; 95% CI, 0.99 1.02; P1⁄40.69). For lesions with FFR of 0.76, the risk of MACE was not significantly different between deferred and revascularized lesions. Conversely, in lesions with FFR of 0.75, the risk of MACE was significantly lower in revascularized lesions than in the deferred lesions (for FFR 0.71 0.75, aHR, 0.47; 95% CI, 0.24 0.89; P1⁄40.021, and for FFR 0.70, aHR 0.47; 95% CI, 0.26 0.84; P1⁄40.012).

Valvuloplastia aórtica por cateter balão na estenose aórtica degenerativa: impacto terapêutico em pacientes em condição clínica in extremis

INTRODUCAO: A valvuloplastia aortica por cateter balao (VAB) e utilizada como estrategia paliativa em pacientes inelegiveis tanto para troca valvar cirurgica quanto para implante valvar aortico transcateter, ou como ponte para essas modalidades de tratamento. Nao se sabe o impacto terapeutico da VAB quando realizada como medida de salvamento para pacientes em condicoes clinicas extremas (in extremis). METODOS: Foram analisados pacientes com estenose aortica grave de etiologia degenerativa submetidos a VAB entre julho de 2008 e janeiro de 2013. Os pacientes foram divididos entre o grupo in extremis (definido pela presenca de duas ou mais das seguintes disfuncoes orgânicas: ventilacao mecânica, instabilidade hemodinâmica, terapia renal dialitica, coagulopatia ou disfuncao hepatica graves) e o grupo controle, que incluiu os demais pacientes. RESULTADOS: Um total de 19 pacientes realizaram VAB no periodo. A condicao clinica in extremis esteve presente em 42,1%. Os pacientes do grupo in extremis tiveram EUROSCORE II mais elevado (41,1 ± 24,7 vs. 15,9 ± 14,0; P = 0,01) e fracao de ejecao do VE mais baixa que o grupo controle (33,9 ± 17,3% vs. 49,0 ± 12,5%; P = 0,04). Nenhum paciente do grupo in extremis sobreviveu ao periodo intra-hospitalar, enquanto que, no grupo controle, a mortalidade foi de 27,3% (P < 0,01). CONCLUSOES: Para o tratamento de pacientes com estenose aortica grave de etiologia degenerativa, a VAB tem resultado desfavoravel quando indicada para pacientes com duas ou mais disfuncoes orgânicas, ou seja, em condicao clinica in extremis.

Balloon aortic valvuloplasty in degenerative aortic stenosis: therapeutic impact on patients in extremis

ABSTRACT Background Balloon aortic valvuloplasty (BAV) is used as a palliative strategy in patients who are not eligible for valve replacement surgery, transcatheter aortic valve implantation, or as a bridge to these treatment modalities. The impact of BAV as a salvage procedure for patients in extreme clinical conditions ( in extremis ) is unknown. Methods Patients with severe degenerative aortic stenosis undergoing BAV between July 2008 and January 2013 were evaluated. Patients were divided into the in - extremis group (defined by the presence of two or more of the following organ dysfunctions: mechanical ventilation, hemodynamic instability, dialysis, coagulopathy or severe hepatic dysfunction) and the control group, which included the remaining patients. Results A total of 19 patients underwent BAV. The clinical condition in - extremis was present in 42.1% of them. Patients from the in - extremis group had a higher EUROSCORE II (41.1 ± 24.7 vs. 15.9 ± 14.0; P = 0.001) and LV ejection fraction lower than the control group (33.9 ± 17.3% vs. 49.0 ± 12.5; P = 0.04). None of the patients in the in - extremis group survived past the hospitalization period, whereas the control group mortality was 27.3% (P Conclusions BAV has an unfavorable result in patients with severe degenerative aortic stenosis with two or more organ dysfunctions, that is, patients in extremis .