Valor del estudio de la reserva de flujo fraccional para guiar la indicación de angioplastia percutánea en las lesiones coronarias intermedias previamente evaluadas mediante ecocardiografía intracoronaria

Falta palabras claveLa enfermedad coronaria supone casi la mitad de las muertes en Europa lo que conlleva un alto coste economico; dentro de la cardiopatia isquemica estable es importante identificar a los pacientes de mayor riesgo que son, a su vez, los que se benefician de la revascularizacion coronaria. Para ello disponemos de tecnicas de imagen (ecocardiografia intracoronaria y la tomografia de coherencia optica) y el estudio funcional de las lesiones coronarias (estudios de medicina nuclear y la reserva de flujo coronario). En la literatura existen varios estudios comparando la ecocardiografia intracoronaria y la reserva de flujo fraccional para detectar aquellas lesiones coronarias que producen isquemia miocardica proponiendose diferentes puntos de corte del area luminal minima medida por ecocardiografia intracoronaria que detecta una reserva de flujo fraccional positivo, pero no existe ningun estudio aleatorizado comparando ambas tecnicas con un seguimiento clinico. El tratamiento percutaneo de lesiones coronarias intermedias evaluadas por angiografia (lesiones con estenosis entre el 50-70%) cuya severidad ha sido confirmada por la ecocardiografia intracoronaria guiado por la reserva de flujo fraccional es al menos igual de seguro y eficaz que el guiado unicamente por ecocardiografia intracoronaria cuando se utilizan stents farmacoactivos. Objetivo principal: Establecer la eficacia a medio plazo en terminos clinicos del tratamiento guiado con la reserva de flujo fraccional en comparacion con la realizacion de angioplastia coronaria directa para aquellas lesiones coronarias intermedias por angiografia en las que se determina la severidad por ecocardiografia intracoronaria. Objetivos secundarios: Establecer la eficacia en terminos de tiempo de procedimiento, cantidad de contraste usado y coste economico del tratamiento guiado por la reserva de flujo fraccional en comparacion con la realizacion de la angioplastia directa para aquellas lesiones coronarias intermedias por angiografia en las que se determina la severidad por ecocardiografia intracoronaria. Valor del estudio de la reserva de flujo fraccional para guiar la indicación de angioplastia percutánea en las lesiones coronarias intermedias previamente evaluadas medianteecocardiografía intracoronaria

Subclavian angioplasty during coronary interventions using radial approach.

In the past years, the percentage of percutaneous coronary angiography and coronary interventions using radial access had significantly increased due to its higher safety, lower risk of major bleeding, and hence lower cardiovascular mortality. Subclavian artery stenosis is one of the challenges that may be met during transradial coronary interventions, which may necessitate femoral access crossover or conversion. To evaluate the feasibility and safety of performing subclavian angioplasty via radial access during complex coronary interventions using the forearm approach. A series of patients with complex radial approach due to subclavian stenosis received subclavian angioplasty during the procedure. We included 48 patients out of 22 500 procedures performed from February 2009 to February 2020. All patients did not have alternative vascular access due to extensive peripheral arterial disease (previous history of iliac stenting or distal aortic occlusion, which makes femoral access crossover difficult; also the contralateral radial/ulnar artery was very faint or not detectable at all). Mean age was 72 (10) years and 67% of patients were males. Subclavian angioplasty was successfully done in all patients via ipsilateral radial access; 44 patients (91.7%) required subclavian stenting, and 4 patients were treated by subclavian angioplasty without stenting. Coronary angiography or intervention was perfectly achieved through the revascularized subclavian artery; coronary stenting was successfully done in 36 patients as indicated. It can be concluded that percutaneous subclavian artery angioplasty can be done safely and effectively to facilitate complex transradial coronary procedures with an acceptable immediate technical success, especially in patients without alternative vascular access. Also, we may conclude that subclavian angioplasty may be successfully performed in patients with symptomatic upper limb ischemia, via the radial approach

Subclavian angioplasty during coronary interventions using radial approach

BACKGROUND: In the past years, the percentage of percutaneous coronary angiography and interventions using the radial access had significantly increased due to its higher safety, lower risk of major bleeding and hence lower cardiovascular mortality. Subclavian artery stenosis is one of the challenges that may be met during transradial coronary interventions, which may necessitate femoral access crossover or conversion. AIMS: To evaluate the feasibility and safety of performing subclavian angioplasty via the radial access, during complex coronary interventions using forearm approach. METHODS: A series of patients with complex radial approach due to subclavian stenosis, for which subclavian angioplasty was performed during the procedure. Forty-eight patients out of 22 500 procedures performed, from February 2009 to February 2020, were included. All patients did not have alternative vascular access due to extensive peripheral arterial disease (previous history of iliac stenting or distal aortic occlusion which makes femoral access crossover difficult, also the contralateral radial/ulnar artery was very faint or not felt at all). RESULTS: Mean age was 72 (10) years and 67% were males. Subclavian angioplasty was successfully done in all patients via the ipsilateral radial access; 91.7% (44 patients) required subclavian stenting and 4 patients were treated by subclavian angioplasty without stenting. Coronary angiography or intervention was perfectly done through the revascularized subclavian artery; coronary stenting was successfully done in 36 patients as indicated. CONCLUSIONS: It can be concluded that percutaneous subclavian artery angioplasty can be done safely and effectively to facilitate complex transradial coronary procedures, with an acceptable immediate technical success, especially in patients without alternative vascular access. Also, we may conclude that subclavian angioplasty may be successfully performed in patients with symptomatic upper limb ischemia, via the radial approac