Hemodynamic and Metabolic Observations Associated with Intracoronary Stenting for Acute Closure Following Percutaneous Transluminal Coronary Angioplasty

Emergency stent implantation appears to be an effective method for restoring antegrade flow in case of an abrupt coronary occlusion during percutaneous transluminal coronary angioplasty (PTCA). In this case report, hemodynamic and metabolic changes throughout abrupt coronary closure and stent implantation were followed in order to study the efficacy of this bail out technique in restoring metabolic and hemodynamic disturbances due to acute coronary occlusion. Copyrigh

The importance of adequate anticoagulation to prevent early thrombosis after stenting of stenosed venous bypass grafts

Stent implantation in native coronary arteries may be complicated by acute thrombosis, despite the use of stringent anticoagulation. Thrombotic occlusion of stented venous grafts may occur less frequently, possibly because of the larger caliber of these grafts. We report our experience with 46 stents (Wallstent, Medinvent, Lausanne, Switzerland) implanted in 35 lesions of 24 consecutive patients (mean age 64 years, range 43 to 75). Two overlapping stents were implanted in seven patients, and three overlapping stents were positioned in two. After implantation, activated partial thromboplastin time was maintained at two to three times the control level by intravenous administration of heparin (160 to 550 mg daily) until thrombotest values were reduced 5% to 10% by acenocoumarol. Impending thrombotic occlusion was recognized in two suboptimally anticoagulated patients: patient A after implantation of four stents and patient B after anticoagulation therapy was discontinued because of acute upper gastrointestinal bleeding. Coronary artery bypass grafting was performed successfully in both patients. A third patient had a myocardial infarction on day 7 after stent implantation, in spite of adequate anticoagulation and optimal medical drug therapy. It is concluded that stringent anticoagulation therapy appears mandatory to maintain graft patency after stent implantation

Stenting of venous bypass grafts: A new treatment modality for patients who are poor candidates for reintervention

Abstract During a 2-year period, 136 self-expanding Wall-stents were implanted in saphenous vein bypass grafts in 69 patients with end-stage coronary artery disease. All patients had severe symptoms and the majority were poor candidates for either repeat surgery or conventional bypass coronary angioplasty because of unfavorable native anatomy, impaired left ventricular function, or a high-risk bypass lesion anatomy for coronary angioplasty. All procedures were technically successful without major complications and a need for emergency bypass surgery. However, during the hospital stay acute thrombotic complications occurred in seven patients (10%) resulting in one death and acute myocardial infarction in five patients and necessitating emergency repeat PTCA in two patients and repeat CABG in four. Twenty-three patients had serious hemorrhagic complications directly related to the rigorous anticoagulation schedule. Two patients died of fatal cerebral bleeding. During follow-up, another five patients died accounting for a total mortality rate of 12%. At late angiographic follow-up (4.9 ± 3.4 months, n = 53), 25 patients (47%) had a restenosis (≥50% DS) within or immediately adjacent to the stent, necessitating reintervention in 19 patients (PTCA, n = 12; repeat CABG, n = 7). In the group without stent-related restenosis (n = 28), 15 patients had progression of disease in either the native or bypass vessels leading to recurrence of major anginal symptoms within 1 to 24 months. Ten of these patients required further intervention (stent, n = 6; PTCA, n = 3; repeat CABG, n = 1). Stenting in saphenous coronary bypass grafts can be performed safely with excellent immediate angiographic and clinical results. Early occlusion, late restenosis, and bleeding complications associated with the aggressive anticoagulant treatment remain significant limitations. Reintervention as a result of restenosis or progression of disease in other lesions is common. Stenting of diseased bypass grafts in symptomatic patients with end-stage coronary artery disease (who are at high risk for conventional angioplasty or surgical reintervention) may be useful as palliative therapy

Homeworking Heaven or Hell During the COVID-19 Pandemic?:Lessons for the Job Demands-Resources Model in the Context of Homeworking

During the COVID-19 pandemic, public servants in many countries were required to work from home. In this study, we explore Dutch public servants’ experiences of mandatory homeworking by conducting a template analysis. Based on an in-depth examination of 985 written accounts, we inductively expand an a priori template derived from the Job Demands-Resources (JD-R) framework, to understand and analyze public servants’ experiences of this new situation. We found homeworking in general had positive effects on public servants’ individual performance and health-related well-being but a predominantly negative impact on happiness well-being. Furthermore, we found that the impact of homeworking on the job demands and job resources seems to depend on the specific clusters of these job demands and resources. Our findings are translated into propositions that extend the JD-R framework