Chronic long-segment iliac artery occlusion represents a relatively rare and particularly severe form of iliac artery disease,often associated with complex anatomical challenges.When symptomatic,these patients are typ...Chronic long-segment iliac artery occlusion represents a relatively rare and particularly severe form of iliac artery disease,often associated with complex anatomical challenges.When symptomatic,these patients are typically candidates for surgical revascularization.展开更多
It is generally believed that serious events are unlikely to result from atherosclerotic disease of a non-dominant hypoplastic right coronary artery (RCA). Left dominant coronary artery system are usually associated w...It is generally believed that serious events are unlikely to result from atherosclerotic disease of a non-dominant hypoplastic right coronary artery (RCA). Left dominant coronary artery system are usually associated with higher in-hospital mortality among patients undergoing percutaneous coronary intervention.[1,2] Nevertheless, clinical series or reports of right ventricle infarction, malignat arrhythmias and sudden death correlated to non-dominant RCA have been reported in the literature in the past years.[3,4] The specific contribute of non-dominant RCA disease on long-term follow-up in patients aged over 65 years has not been yet clarified.展开更多
Complex bifurcations have been suggested to be better approached by a planned double stent technique; however, recent randomized trials have shown better outcomes of provisional compared to planned twostent strategy, ...Complex bifurcations have been suggested to be better approached by a planned double stent technique; however, recent randomized trials have shown better outcomes of provisional compared to planned twostent strategy, in terms of both short-term efficacy and safety. In left main(LM) bifurcations, double kissing(DK)-Crush has demonstrated its superiority over Culotte and provisional-T in terms of restenosis and stent thrombosis, gaining respect as one of the most performant techniques for bifurcations stenting. On the other hand, the Nano-Crush technique has recently become part of the repertoire of double stenting techniques, providing evidence that the use of ultrathin strut stents and very minimal crush would be beneficial for both the physiological and rheological properties of the complex bifurcations, even in LM scenario, leading to a lower rate of thrombosis and restenosis at both side branch and true carina. Finally, the newest generation of ultrathin strut stents are gaining a reputation for its safe and effective use in LM treatment thanks to improved design with increased expansion rate capable of LM treatment up to 5-6 mm diameter. The modern crush techniques, such as DK-Crush and Nano-Crush, are providing excellent results on mid and long-term follow up, suggesting that minimal crushing obtained using ultra-thin stents is a good way to obtain surgical-like outcomes in the treatment of complex LM bifurcation disease.展开更多
Objective To evaluate the impact of run-off vessels number on the outcomes of Supera stent(Abbott Vascular,Santa Clara,Calif,USA)for treatment of femoropopliteal occlusive disease.Methods We retrospectively evaluated ...Objective To evaluate the impact of run-off vessels number on the outcomes of Supera stent(Abbott Vascular,Santa Clara,Calif,USA)for treatment of femoropopliteal occlusive disease.Methods We retrospectively evaluated the medical records of 188 consecutive patients(mean age 68.2±9.6 years,100 males)undergone angiography and woven mesh stent implantation in femoral or popliteal arteries or both arterial segments,in our institution between January 12014 and January 12018.Target lesion revascularization and major adverse limb events at 12-month were evaluated comparing patients with 1-,2-or 3-run-off vessels in the foot.Results Interventional success was achieved in 100%.Stent implantation involved in the femoral site in 56 patients(30.3%),the femoropopliteal in 92 patients(48.9%)and the popliteal site in 40 patients(21.3%).A significant improvement of ankle-brachial index(0.29±0.6 vs.0.88±0.3,P<0.001)and Rutherford class(5.3±0.8 vs.0.7±1.9,P<0.01)were observed before discharge.The median follow-up duration was 12.3 months(inter quartile range:11.0 to 13.9).During the follow-up period,52 patients(27.6%)had clinical events.Primary patency at 12 months was 72.4%.The primary patency significantly increased when the runoff status.Comparing the number of events among patients with different number of run-off vessels,a significant difference(P<0.001)was observed for patients having one(24.0%)and two run-off vessels(15.0%).Conclusions The outcomes of Supera stent in femoropopliteal occlusive disease depend strictly on the number of run-off vessels.展开更多
A 68-year-old man presented to the emergency depart-ment due to recurrent episodes of syncope and shortness ofbreath during the previous two days. Her medical historyincluded arterial hypertension and diabetes. She wa...A 68-year-old man presented to the emergency depart-ment due to recurrent episodes of syncope and shortness ofbreath during the previous two days. Her medical historyincluded arterial hypertension and diabetes. She was nottaking any negative chronotropic drugs but she referred afhmilial history of fhtal pulmonary embolism and suddencardiac death. At admission, blood pressure, pulse rate andperipheral oxygen saturation were 88/60 mmHg.展开更多
1Introducfion Peripheral arterial disease (PAD)is the consequence of atherosclerosis in the arteries of carotid,vertebral,abdominal mesenteric,renal,and extremity arteries with a prevalence increasing with.Carotid Occ...1Introducfion Peripheral arterial disease (PAD)is the consequence of atherosclerosis in the arteries of carotid,vertebral,abdominal mesenteric,renal,and extremity arteries with a prevalence increasing with.Carotid Occlusive disease is one of the most common site for atherosclerosis development:Endoatherec- tomy and Carotid artery stenting (CAS)have been shown to achieve similar outcomes and costst[1,2]especially in high-risk patients as very often elderly patients with multiple athero- sclerotic localizations are.The performance of supraaortic diagnostic and interventional procedures via the radial artery (RA)is growing all over the world thanks to lower risk of access site complications,lower chance to embolizing de- bries by touching the aortic arch,lower costs,and increased patient comfort compared to the traditional transfemoral approach (TFA).[3,4]The aim of this paper is to describe the potentiality the TRA can offer in the peripheral interventions of supra-aortic arteries in the elderly.展开更多
Over the years, the use of transradial approach （TRA） for carotid artery stenting （CAS） with distal embolic protection has been recognized as a valid alternative to the conventional femoral approach, improving the...Over the years, the use of transradial approach （TRA） for carotid artery stenting （CAS） with distal embolic protection has been recognized as a valid alternative to the conventional femoral approach, improving the outcomes compared to carotid endoatherectomy.0-33 Indeed, despite the femoral artery remains the conventional access site for the endovascular treatment of supraoartic vessels, concomitant anatomical variations and/or peripheral vascular disease could complicate the cannulation of such arteries. Moreover, the TRA has been related with a lower incidence of bleeding complications and a shorter bed rest after the interventional procedure.展开更多
A82-year-old man,with a previous history of ischemic heart disease due to 3-vessel disease with left main(LM)involvement.Twenty years before he underwent a double coronary artery bypass graft(left internal mammary art...A82-year-old man,with a previous history of ischemic heart disease due to 3-vessel disease with left main(LM)involvement.Twenty years before he underwent a double coronary artery bypass graft(left internal mammary artery(LIMA)to left anterior descending coronary artery(LAD)and saphein graft to Posterior Descending coronary artery(PDA));subsequent follow-up was uneventful.He was admitted to our hospital due to an acute coronary syndrome with ST segment abnormalities in the lateral and inferior leads on baseline EKG.展开更多
Over the latest years,both randomized controlled trials(RCTs)and observational studies have provided solid basis for percutaneous coronary intervention as a treatment option for unprotected left main(LM)bifurcation co...Over the latest years,both randomized controlled trials(RCTs)and observational studies have provided solid basis for percutaneous coronary intervention as a treatment option for unprotected left main(LM)bifurcation coronary artery disease.A recent meta-analysis comparing the long-term outcome between LM bifurcation disease one-stent technique versus twostent technique,the study has demonstrated that one-stent strategy resulted associated with both major adverse cardiac events and target lesion revascularizations(TLRs)lower rates but resulted equivalent to two-stent strategy in terms of cardiovascular mortality,target lesion failure and stent thrombosis(ST)even at one-year and three-year follow-up.[1]展开更多
Coronary artery anomalies can reach easily nowadays elderly age, causing troubles at both diagnostic and thera- peutic levels. A 80-year-old hypertensive man underwent coronary artery angiography because of a doubtful...Coronary artery anomalies can reach easily nowadays elderly age, causing troubles at both diagnostic and thera- peutic levels. A 80-year-old hypertensive man underwent coronary artery angiography because of a doubtful ergomettic test for atypical thoracic discomfort.展开更多
A 66-year-old woman with lower limb edema and exertional dyspnea presented to the emergency department.Posteroanterior chest X-ray revealed a Fleischner’s sign in both lungs(Figure 1A)suggesting a pulmonary hypertens...A 66-year-old woman with lower limb edema and exertional dyspnea presented to the emergency department.Posteroanterior chest X-ray revealed a Fleischner’s sign in both lungs(Figure 1A)suggesting a pulmonary hypertension.A subsequent transthoracic echocardiogram revealed a 24 mm diameter secundum atrial septal defect(ASD)(Figure 1B)with a dilated right heart and a mean pulmonary pressure of 68 mmHg.Fleischner’s sign refers to a prominent central pulmonary artery that can be commonly caused either by pulmonary hypertension or acute pulmonary embolism.This radiological finding is very rare in patients with secundum ASD unless the defect remains undiagnosed till the elderly.Chest X-ray remains fundamental in making diagnosis of cardiovascular disease.展开更多
文摘Chronic long-segment iliac artery occlusion represents a relatively rare and particularly severe form of iliac artery disease,often associated with complex anatomical challenges.When symptomatic,these patients are typically candidates for surgical revascularization.
文摘It is generally believed that serious events are unlikely to result from atherosclerotic disease of a non-dominant hypoplastic right coronary artery (RCA). Left dominant coronary artery system are usually associated with higher in-hospital mortality among patients undergoing percutaneous coronary intervention.[1,2] Nevertheless, clinical series or reports of right ventricle infarction, malignat arrhythmias and sudden death correlated to non-dominant RCA have been reported in the literature in the past years.[3,4] The specific contribute of non-dominant RCA disease on long-term follow-up in patients aged over 65 years has not been yet clarified.
文摘Complex bifurcations have been suggested to be better approached by a planned double stent technique; however, recent randomized trials have shown better outcomes of provisional compared to planned twostent strategy, in terms of both short-term efficacy and safety. In left main(LM) bifurcations, double kissing(DK)-Crush has demonstrated its superiority over Culotte and provisional-T in terms of restenosis and stent thrombosis, gaining respect as one of the most performant techniques for bifurcations stenting. On the other hand, the Nano-Crush technique has recently become part of the repertoire of double stenting techniques, providing evidence that the use of ultrathin strut stents and very minimal crush would be beneficial for both the physiological and rheological properties of the complex bifurcations, even in LM scenario, leading to a lower rate of thrombosis and restenosis at both side branch and true carina. Finally, the newest generation of ultrathin strut stents are gaining a reputation for its safe and effective use in LM treatment thanks to improved design with increased expansion rate capable of LM treatment up to 5-6 mm diameter. The modern crush techniques, such as DK-Crush and Nano-Crush, are providing excellent results on mid and long-term follow up, suggesting that minimal crushing obtained using ultra-thin stents is a good way to obtain surgical-like outcomes in the treatment of complex LM bifurcation disease.
文摘Objective To evaluate the impact of run-off vessels number on the outcomes of Supera stent(Abbott Vascular,Santa Clara,Calif,USA)for treatment of femoropopliteal occlusive disease.Methods We retrospectively evaluated the medical records of 188 consecutive patients(mean age 68.2±9.6 years,100 males)undergone angiography and woven mesh stent implantation in femoral or popliteal arteries or both arterial segments,in our institution between January 12014 and January 12018.Target lesion revascularization and major adverse limb events at 12-month were evaluated comparing patients with 1-,2-or 3-run-off vessels in the foot.Results Interventional success was achieved in 100%.Stent implantation involved in the femoral site in 56 patients(30.3%),the femoropopliteal in 92 patients(48.9%)and the popliteal site in 40 patients(21.3%).A significant improvement of ankle-brachial index(0.29±0.6 vs.0.88±0.3,P<0.001)and Rutherford class(5.3±0.8 vs.0.7±1.9,P<0.01)were observed before discharge.The median follow-up duration was 12.3 months(inter quartile range:11.0 to 13.9).During the follow-up period,52 patients(27.6%)had clinical events.Primary patency at 12 months was 72.4%.The primary patency significantly increased when the runoff status.Comparing the number of events among patients with different number of run-off vessels,a significant difference(P<0.001)was observed for patients having one(24.0%)and two run-off vessels(15.0%).Conclusions The outcomes of Supera stent in femoropopliteal occlusive disease depend strictly on the number of run-off vessels.
文摘A 68-year-old man presented to the emergency depart-ment due to recurrent episodes of syncope and shortness ofbreath during the previous two days. Her medical historyincluded arterial hypertension and diabetes. She was nottaking any negative chronotropic drugs but she referred afhmilial history of fhtal pulmonary embolism and suddencardiac death. At admission, blood pressure, pulse rate andperipheral oxygen saturation were 88/60 mmHg.
文摘1Introducfion Peripheral arterial disease (PAD)is the consequence of atherosclerosis in the arteries of carotid,vertebral,abdominal mesenteric,renal,and extremity arteries with a prevalence increasing with.Carotid Occlusive disease is one of the most common site for atherosclerosis development:Endoatherec- tomy and Carotid artery stenting (CAS)have been shown to achieve similar outcomes and costst[1,2]especially in high-risk patients as very often elderly patients with multiple athero- sclerotic localizations are.The performance of supraaortic diagnostic and interventional procedures via the radial artery (RA)is growing all over the world thanks to lower risk of access site complications,lower chance to embolizing de- bries by touching the aortic arch,lower costs,and increased patient comfort compared to the traditional transfemoral approach (TFA).[3,4]The aim of this paper is to describe the potentiality the TRA can offer in the peripheral interventions of supra-aortic arteries in the elderly.
文摘Over the years, the use of transradial approach （TRA） for carotid artery stenting （CAS） with distal embolic protection has been recognized as a valid alternative to the conventional femoral approach, improving the outcomes compared to carotid endoatherectomy.0-33 Indeed, despite the femoral artery remains the conventional access site for the endovascular treatment of supraoartic vessels, concomitant anatomical variations and/or peripheral vascular disease could complicate the cannulation of such arteries. Moreover, the TRA has been related with a lower incidence of bleeding complications and a shorter bed rest after the interventional procedure.
文摘A82-year-old man,with a previous history of ischemic heart disease due to 3-vessel disease with left main(LM)involvement.Twenty years before he underwent a double coronary artery bypass graft(left internal mammary artery(LIMA)to left anterior descending coronary artery(LAD)and saphein graft to Posterior Descending coronary artery(PDA));subsequent follow-up was uneventful.He was admitted to our hospital due to an acute coronary syndrome with ST segment abnormalities in the lateral and inferior leads on baseline EKG.
文摘Over the latest years,both randomized controlled trials(RCTs)and observational studies have provided solid basis for percutaneous coronary intervention as a treatment option for unprotected left main(LM)bifurcation coronary artery disease.A recent meta-analysis comparing the long-term outcome between LM bifurcation disease one-stent technique versus twostent technique,the study has demonstrated that one-stent strategy resulted associated with both major adverse cardiac events and target lesion revascularizations(TLRs)lower rates but resulted equivalent to two-stent strategy in terms of cardiovascular mortality,target lesion failure and stent thrombosis(ST)even at one-year and three-year follow-up.[1]
文摘Coronary artery anomalies can reach easily nowadays elderly age, causing troubles at both diagnostic and thera- peutic levels. A 80-year-old hypertensive man underwent coronary artery angiography because of a doubtful ergomettic test for atypical thoracic discomfort.
文摘A 66-year-old woman with lower limb edema and exertional dyspnea presented to the emergency department.Posteroanterior chest X-ray revealed a Fleischner’s sign in both lungs(Figure 1A)suggesting a pulmonary hypertension.A subsequent transthoracic echocardiogram revealed a 24 mm diameter secundum atrial septal defect(ASD)(Figure 1B)with a dilated right heart and a mean pulmonary pressure of 68 mmHg.Fleischner’s sign refers to a prominent central pulmonary artery that can be commonly caused either by pulmonary hypertension or acute pulmonary embolism.This radiological finding is very rare in patients with secundum ASD unless the defect remains undiagnosed till the elderly.Chest X-ray remains fundamental in making diagnosis of cardiovascular disease.
