Repozycjonowanie lewej elektrody komorowej z fiksacją stentem bioresorbowalnym

83-year-old man was referred to a clinic due to exacerbation of chronic heart failure. CRT-D interrogation revealed lack of efficient left ventricular pacing. Patient was qualified to the left ventricular lead reposition. Due to anatomical conditions and technical limitations it was decided to stabilize the lead with the bioresorbable vascular scaffold.Mężczyzna, 83-letni, został skierowany do kliniki z powodu zaostrzenia przewlekłej niewydolności serca. Interrogacja CRT-D wykazała brak skutecznej stymulacji lewej komory, a pacjent został zakwalifikowany do repozycjonowania lewej elektrody. Ze względu na trudne warunki anatomiczne i techniczne ograniczenia, podjęto decyzję o wykonaniu stabilizacji przy użyciu rusztowania bioresorbowalnego

Alternative methods for functional assessment of intermediate coronary lesions

Wire-based fractional flow reserve (FFR) is a diagnostic tool used to evaluate the ischemic burden of coronary lesions. Large-scale studies have shown that FFR-guided revascularization is associated with better clinical outcomes. However, wide adoption of this technology is limited due to the considerable cost, additional time needed for set-up and performance of the measurement as well as the invasiveness of the procedure which requires pressure wire placement across the lesion into the distal segment of the coronary artery. To overcome these limitations new, promising, and less-/non-invasive methods were developed. These methods are based on computational fluid dynamics analysis and three-dimensional lumen reconstruction. The aim of this paper is to review scientific evidence supporting the clinical safety and efficacy of these techniques, such as instantaneous wave-free ratio, quantitative flow ratio and FFR calculated from computed tomographic angiography

Tissue coverage of paclitaxel and sirolimus eluting stents in long term follow-up: Optical coherence tomography study

Background: Implantation of drug eluting stents (DES) has become a standard treatment ofpatients undergoing percutaneous coronary intervention (PCI). Incomplete strut coverage isa potential risk factor for late stent thrombosis. Optical coherence tomography (OCT) enablesin vivo identification of incomplete neointimal coverage.Methods: Study included 62 patients after sirolimus eluting stents (SES) or paclitaxel elutingstents (PES) implantation. OCT examination was performed at least 24 months after theinitial procedure (35.4± 9.4 months). In cross-sectional still frames selected from each 1 mm ofanalyzed stents a total number of visible struts and number of struts with or without completeneointimal coverage was assessed. Measurements of neointimal coverage, presented as a meanthickness of tissue, were performed. Patients were followed up for 3 years and the frequency ofmajor adverse cardiac events was recorded.Results: In the analyzed 28 SES and 37 PES 9998 struts were identified. Complete neointimalcoverage was observed in 83.5% and 79.2% of SES and PES struts respectively (p = 0.48).There was no difference in incidence of not covered or malapposed struts between SES and PES groups. Mean thickness of the tissue covering SES struts was 0.165 ± 0.095 mm, and 0.157 ± 0.121 mm for PES. The mean neointimal thickness difference (SES vs. PES) was notstatistically significant. In a 36 months follow-up 1 death was observed — potentially attributedto stent thrombosis.Conclusions: A long term OCT follow-up after DES implantation shows high incidence ofuncovered struts regardless of the stent type. Clinical significance of this finding remains questionableand requires further large scale trials

Bioresorbable everolimus-eluting vascular scaffold in patients with ST-segment elevation myocardial infarction: Optical coherence tomography evaluation and clinical outcomes

Background: Bioresorbable vascular scaffold (BVS) implantation is a new, promising treat­ment method of coronary artery disease. Preliminary data in patients with stable angina are encouraging. However, the utility of BVS was not sufficiently evaluated in the setting of acute thrombotic lesions. The aim of this study was an optical coherence tomography (OCT) assessment of acute procedural result of the everolimus-eluting BVS implantation in patients with ST segment elevation myocardial infarction (STEMI) and evaluation of mid-term clinical outcomes. Methods: OCT examination was conducted in 23 STEMI patients who underwent primary angioplasty with BVS implantation. Off-line qualitative and quantitative coronary angiography and OCT analyses were performed by an independent core laboratory. Results: Successful procedural and clinical results were achieved in 95.7% of patients, and device success was observed in all patients. In OCT evaluation, most of the struts (95.4 ± ± 7.96%) were well apposed, 4.6 ± 5.71% were classified as malapposed. The final minimum lumen diameter was 2.6 ± 0.35 mm, minimum scaffold area was 6.9 ± 1.54 mm2 and final residual stenosis was 8.8 ± 24.37%. Edge dissections were found in 3 (7.7%) lesions. Median follow-up period was 229 (interquartile range 199–248) days. One myocardial infarction, due to sub-acute stent thrombosis, occurred in a patient who discontinued pharmacotherapy. Conclusions: The study shows that everolimus-eluting BVS implantation in STEMI is safe and feasible. The OCT evaluation confirmed excellent acute performance with appropriate scaffold expansion and low rate of malapposition.  

Wieloczynnikowe podłoże dolegliwości bólowych w klatce piersiowej

W niniejszej pracy przedstawiono przypadek 66-letniego mężczyzny z ostrym zespołem wieńcowym o złożonej patogenezie (spazm tętnicy wieńcowej, miażdżyca, czynnościowe zawężenie drogi odpływu lewej komory), jednocześnie wskazując nietypowość obrazu dysfunkcji tętnic wieńcowych w badaniach dodatkowych. Za dominującą przyczynę dolegliwości uznano postać naczynioskurczową dławicy piersiowej, uwzględniając trudności w sformułowaniu jednoznacznych wniosków

Wieloczynnikowe podłoże dolegliwości bólowych w klatce piersiowej

W niniejszej pracy przedstawiono przypadek 66-letniego mężczyzny z ostrym zespołem wieńcowym o złożonej patogenezie (spazm tętnicy wieńcowej, miażdżyca, czynnościowe zawężenie drogi odpływu lewej komory), jednocześnie wskazując nietypowość obrazu dysfunkcji tętnic wieńcowych w badaniach dodatkowych. Za dominującą przyczynę dolegliwości uznano postać naczynioskurczową dławicy piersiowej, uwzględniając trudności w sformułowaniu jednoznacznych wniosków