Victor Lim

Tomografía de coherencia óptica en la evaluación de las endoprótesis coronarias con capacidad de liberación de fármacos

Rev Esp Cardiol. 2005;58(12):1469 1469 La tomografía de coherencia óptica (OCT, optical coherence tomography) es una nueva modalidad de imagen intracoronaria que ofrece imágenes con una resolución 10 veces mayor que la que proporciona la ecografía intravascular (EIV). Dado que las ondas de luz casi infrarroja que se utilizan en la OCT no pueden atravesar la sangre, para obtener las imágenes se crea un campo sin sangre mediante la oclusión transitoria del vaso proximal a la lesión. Para ello se utiliza un catéter de balón especial de presión baja seguido de la infusión de suero salino. Esta mayor capacidad de visualización puede ser útil para evaluar la eficacia y el comportamiento durante el seguimiento de los stents con capacidad de liberación de fármacos. En este estudio se presenta una serie de imágenes OCT en las que se demuestran algunas características cuya visualización sería difícil con la EIV. La figura 1 muestra la implantación primaria de un stent liberador de sirolimus Cypher sobre una reestenosis intra-stent en la arteria coronaria descendente anterior (DA); tras la implantación de la endoprótesis se observa claramente una lenIM Á G E N E S E N CA R D I O L O G Í A

Comparison of novel 6.5 Fr sheathless guiding catheters versus 5 Fr guiding catheters for transradial coronary intervention.

AIMS To assess the safety and efficacy of a novel sheathless (SH) 6.5 Fr (French) hydrophilic-coated guiding catheter (GC) compared to the standard 5 Fr GCs in transradial coronary interventions (TRI). METHODS AND RESULTS Patients undergoing TRI with 6.5 Fr SH or 5 Fr GCs were included. Baseline characteristics and in-hospital outcomes were recorded. Primary endpoints were procedural success and presence of radial pulse at discharge. Secondary endpoints were successful GC support, in-hospital adverse events, access-site complications, procedural duration and contrast load. There were 269 patients with 146 procedures in each group. The SH GC group had more non-ST elevation MI, in-stent restenosis, high-risk and bifurcation lesions. Procedural success in both arms was 95.2%. One patient in each group (0.7%) experienced radial artery occlusion (RAO) after TRI, without clinical sequelae. One access-site haematoma and one minor stroke occurred in the 5 Fr group (none in the SH group, both p=ns). Mean procedure time (52±21 vs. 45±21 minutes, p=0.004) and contrast load (160±45 ml vs. 140±45 ml, p=0.003) were greater in the SH group. CONCLUSIONS Both 6.5 Fr SH GCs and 5 Fr GCs achieved high procedural TRI success with low RAO rates. The SH GC eliminated the disadvantages of the 5 Fr GC whilst maintaining the advantage of low RAO rates, and may become the GC of choice in TRI.

Use of Taxus polymer-coated paclitaxel-eluting stents for treatment of in-stent restenosis in real world patients: results of clinical and angiographic follow-up at six months in a single-center registry.

Objective:To evaluate the safety and efficacy of Taxus paclitaxel‐eluting stents in a real world group of unselected patients with coronary in‐stent restenosis (ISR) lesions. Methods: This is a prospective single‐center registry of a consecutive series of 94 patients with 104 ISR lesions, without previous brachytherapy, over a period of 1 year. Quantitative coronary angiographic analyses were performed at baseline and at 6‐month angiographic follow‐up. Clinical follow‐up were obtained at 6 months. Results:Pre‐intervention mean reference vessel diameter was 2.62 ± 0.50 mm and mean lesion length was 13.95 ± 6.78 mm. Baseline ISR patterns were mostly either Type I focal (32.7%) or Type II diffuse intrastent (48.1%). At 6‐month angiographic follow‐up, the in‐stent and in‐segment binary restenosis was 3.8% (4/105) and 7.6% (8/105) respectively, and the in‐stent and in‐segment late loss was 0.30 ± 0.50 mm and 0.57 ± 0.54 mm, respectively. Seven of these eight restenosed lesions had a diffuse or proliferative ISR pattern prior to intervention. Lesions that restenosed had longer mean stent length per lesion (37.3 mm vs. 22.5 mm in nonrestenosed group; P = 0.001) and more likely to have had a pattern of total occlusion pre‐intervention (25.0% vs. 3.1% in nonrestenosed group; P = 0.046). At 6‐month clinical follow‐up, the MACE rate was 8.5% and target lesion revascularization rate was 7.4%. There was no death but subacute stent thrombosis occurred in 1 patient (1.1%) at 3 days after intervention. Conclusions: Paclitaxel‐eluting Taxus stent for the treatment of ISR effectively suppresses recurrent neointimal proliferation, and was safe and efficacious at 6‐month follow‐up.

Comparative endoluminal visualization of TAXUS crush-stenting at 9 months follow-up by intravascular ultrasound and optical coherence tomography

Wir berichten den Verlauf eines Patienten nach ‘Crush-Stenting’ von Paclitaxel-freisetzenden TAXUS-Stents innerhalb einer LAD/D1-Bifurkationsstenose. Speziell zur Evaluation der neointimalen Antwort des Hauptgefäßes auf diesen Eingriff führten wir nach 9 Monaten eine elektive Re-Angiographie mit intravaskulärer Bildgebung mittels ‘Optical Coherence Tomography (OCT)’, einer neuartigen hochauflösenden Bildgebungstechnik, und IVUS durch. Die Untersuchung zeigte, das die Stents im Hauptgefäß mit einer homogenen neointimalen Schicht überdeckt waren ohne Hinweise auf eine bedeutsame Lumeneinengung oder eine Malapposition. Im Vergleich zu IVUS bestätigte OCT die Einbettung der Stentstreben in die Gefäßwand mit einer deutlich überlegenen Darstellungsqualität und ermöglichte darüber hinaus neue Einsichten in das Stentverhalten innerhalb offener Bifurkationsstellen. We report a case of crush-stenting with Paclitaxeleluting TAXUS stents in a left anterior descending artery (LAD) bifurcation lesion. In order to obtain precise information on the mid-term neointimal response of the main vessel to this approach, we evaluated the patient angiographically 9 months later, including intravascular visualization with optical coherence tomography (OCT), a new high resolution imaging technique, and IVUS. The evaluation revealed that there was a homogeneous neointimal coverage of the main vessel stents without evidence of significant recurrent lumen renarrowing or malappositions. Compared to IVUS, OCT proved the coverage of the stent struts adjacent to the vessel wall with a superior imaging quality and, in addition, provided new insights into the stent performance at the open bifurcation site.

COMPARING UTILIZATION OF TIMI RISK INDEX VERSUS KILLIP CLASS AT PRESENTATION IN DETERMINING THE NEED OF ADMISSION TO CORONARY CARE UNIT FOR ACUTE ST ELEVATION MYOCARDIAL INFARCTION PATIENT AFTER SUCCESSFUL PRIMARY PERCUTANEOUS CORONARY INTERVENTION: SINGLE CENTRE STUDY

Background: With the ever-increasing number of acutely ill patients with cardiac disease that need intensive monitoring and limited resources in coronary care unit (CCU), there is a need to ensure appropriate admission to CCU. Studies have shown that Killip 1 patients who had successful primary percutaneous coronary intervention (PPCI) for ST Elevation Myocardial Infarction (STEMI) can be admitted safely to a step-down unit. However, Killip class was a subjective assessment. We attempt to compare TIMI risk index {TRI = [heart rate X (age/10)2]/systolic blood pressure} versus Killip Class at presentation in determining the need of admission to CCU for STEMI patient after successful PPCI. TRI was a robust predictor (for STEMI patients on irst arrival in hospital) and high discriminatory capacity of in-hospital events in each of the ive risk subgroups.