Marcelo F. Santos

Análise Ultrassonográfica Tardia do Stent Eluidor de Sirolimus Firebird TM

ABSTRACT Long-Term Ultrasound Analysis ofthe Firebird TM Sirolimus Eluting Stent Background: Drug eluting stents (DES) have improved theclinical outcomes of patients undergoing percutaneouscoronary interventions (PCI). New DES have been developedwith the purpose of overcoming the current limitations ofthe older generation DES. This study aimed to evaluatethe long-term angiographic and intravascular ultrasound(IVUS) findings of the Firebird TM sirolimus eluting stent. Methods: From December 2007 to March 2008, 15 patientswith de novo lesions underwent PCI using the Firebird TM stent. Angiography and IVUS were performed in all patientsat 24 months of follow-up. The primary objective was toassess the late luminal loss by quantitative coronary angio-graphy and in-stent percent volume obstruction by intra-vascular ultrasound (IVUS). Results: Mean age was 57 +7.1 years, 87% were male and 27% were diabetics. The leftanterior descending artery was the most frequently treatedvessel (36%) and most of the lesions were B2/C typelesions (82%). At 24 months, late luminal loss was 0.17 +0.36 mm and target vessel revascularization was 6.6%.In-stent percent volume obstruction was 9.6 + 4.6%. Therewere no cases of death, myocardial infarction or stentthrombosis.

TCT-194 Impact of Intravascular Imaging Methods for Optimal Scaffold Implantation Reducing Thrombosis After Absorb BVS in a Real World Setting: Identification of Probable Factors Related to Stent Failure

Recently, bioresorbable vascular scaffolds (BVS) were related to an unexpected high incidence of thrombosis. The aim of this study was to analyze in a single center experience, the impact of intravascular imaging (intravascular ultrasound-IVUS; optical coherence tomography-OCT) identifying and

CRT-300.05 Impact of Intravascular Imaging Methods for Optimal Scaffold Implantation Reducing Thrombosis After Absorb Bvs in a Real World Setting: Identification of Factors Related to Stent Failure

Recently, bioresorbable vascular scaffolds (BVS) were related to an unexpected high incidence of thrombosis. The aim of this study was to analyze in a single center experience, the impact of intravascular imaging (intravascular ultrasound-IVUS; optical coherence tomography-OCT) identifying and

CRT-700.02 Clinical Outcomes After Implantation of Absorb BVS in a Real World Setting, with pre And post Dilatation, Guided By Intravascular Ultrasound And Optical Coherence Tomography

The safety and performance of the Absorb Bioresorbable Vascular Scaffold (Absorb) has been previously demonstrated with clinical data. However, these trials included patients with simple lesions. Aiming to evaluate clinical outcomes, we analyzed the treatment of real world patients from a single

Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve

Background Functional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR) has become the most widely used. Objective To evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction. Methods Retrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or ≥ 70% in other segments) estimated by quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS). All cases presented ischemia in one of the noninvasive studies. Results All 96 patients presented ischemia (100%) in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values ≤ 0.80. On correlation analysis for FFR ≤ 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed. Conclusion Coronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.

TCTAP A-211 Diagnostic Accuracy of Fractional Flow Reserve to Detect Coronary Ischemic Lesions in Daily Practice

Clinical trials have shown low rates of clinical events in patients undergoing PCI of ischemic lesions only as determined by a fractional flow reserve <0.8. However there is few data showing the diagnostic accuracy of FFR in real world practice. Since 3/11 until 7/13 a total of 324 coronary lesions

Evolução clínica de pacientes com lesões de tronco de coronária esquerda não-protegido submetidos a angioplastia coronária com implante de stents farmacológicos

INTRODUCAO: Recentemente a intervencao coronaria percutânea (ICP) com stents farmacologicos (SFs) tem se mostrado uma opcao viavel em pacientes selecionados com lesao de tronco de coronaria esquerda nao-protegido (TCE-NP). Este estudo teve como objetivo avaliar a efetividade e a seguranca da ICP com SFs em lesoes de TCE-NP da pratica diaria, analisando a ocorrencia combinada de eventos cardiacos adversos maiores (ECAM) a longo prazo. METODOS: Foram tratados 142 pacientes consecutivos, com media de seguimento clinico de 917 ± 743 dias. A decisao de utilizar um ou dois stents e inibidor da glicoproteina IIb/IIIa ficou a criterio do operador. Angiografia coronaria no seguimento nao foi realizada de rotina, mas deixada a criterio clinico. RESULTADOS: A media de idade foi de 67,5 ± 16 anos, tres quartos dos pacientes eram do sexo masculino, 29% eram portadores de diabetes e 39% apresentavam angina instavel. Foram utilizados 2,75 ± 1,25 stents por paciente. Lesoes com comprometimento da bifurcacao foram identificadas em 90,1% e as tecnicas mais frequentemente utilizadas foram o provisional stent em 36% e o small crush em 29% dos pacientes. Ultrassom intracoronario foi realizado em 92,3% dos pacientes, e reintervencao ocorreu em 21,3% dos stents, por apresentarem aposicao incompleta de suas hastes apos o implante. ECAM na evolucao tardia ocorreram em 15,4%, obito cardiaco ocorreu em 3,6%, revascularizacao do vaso-alvo em 11,2% e trombose definitiva/ provavel do stent em 1,4%. CONCLUSOES: A ICP com SFs em lesoes de TCE-NP neste estudo mostrou ser segura e eficaz na evolucao tardia, com baixas taxas de obito cardiaco e de trombose do stent.

Aterectomia rotacional para o tratamento da reestenose intrastent

Relatamos o caso de um paciente com reestenose de stent nao-farmacologico, secundaria a hipoexpansao da protese, decorrente de grave calcificacao da placa aterosclerotica subjacente, a qual nao foi adequadamente reconhecida na angiografia. A utilizacao do ultrassom intracoronario foi de grande importância para reconhecer o mecanismo da reestenose e orientar na escolha da estrategia intervencionista mais adequada. A aterectomia rotacional foi realizada com sucesso para debilitar o calcio peristent, permitindo a expansao posterior da protese com baloes de alta pressao.

Pharmacological stent deployment in the left anterior descending artery: late event indicators

BACKGROUND The efficacy of pharmacological stents in decreasing the incidence of cardiac events is not homogeneous for all lesions or patient subgroups. OBJECTIVE 1) To evaluate the late clinical evolution of patients submitted to pharmacological stent implantation in atherosclerotic lesions of the left anterior descending artery; 2) to identify, among the clinical, angiographic and intravascular ultrasonographic characteristics, the ones predictive of cardiac event risk. METHODS From May 2002 to August 2005, 205 patients were treated with 236 pharmacological stent implants, guided by the intravascular US (IVUS). RESULTS After a mean follow-up period of 711 days, the rate of stent thrombosis was 0.48%, the same observed for acute myocardial infarction or revascularization surgery. The revascularization rate of the treated lesion was 7.31% and the general event rate was 10.24%. The event indicators, according to the multivariate analysis were the implant of more than one stent in the same artery, concentric lesions and the minimal intra-stent area measured by IVUS < 3.88 mm(2). CONCLUSION Based on the data obtained, we conclude that the revascularization of the left anterior descending artery with pharmacological stent implant, chosen and optimized by IVUS, presents a low incidence of late events. The implant of two pharmacological stents for the treatment of long lesions was the main independent factor for the occurrence of late events. The final luminal area > 3.88 mm(2) obtained in the small reference-diameter segments is an independent indicator of event-free evolution.