A case report of COVID-19-associated acute hand ischaemia in a young professional volleyball player

Several coronavirus disease-19 (COVID-19)-associated complications are being increasingly reported, including arterial and venous thrombo-embolic events that may lead to amputation of the affected limbs. So far, acute upper limb ischaemia (ULI) has been reported only in critically ill patients.Herein, we aimed to present a case of a 29-year-old, otherwise healthy male volleyball player, with acute ischaemic signs in the upper extremity who was diagnosed with COVID-19 1 month before the ischaemic event. It has been shown that volleyball players experience repetitive stress that involves their hands and, in particular, their fingers. Repetitive trauma can lead to local vascular abnormalities, such as reduced capillarization and lower resting blood flow that can lead to pain and cold digits, but never acute ULI.To our knowledge, this is the first case of such a hypercoagulable synergistic mechanism that leads to a high thrombus burden. Intra-arterial local thrombolysis and percutaneous transluminal angioplasty failed to succeed, and percutaneous large-bore embolectomy with the Indigo Aspiration System (Penumbra Inc., CA, USA) was deemed necessary

Gyógyszerkibocsátó stent ismételt restenosisának sikeres kezelése gyógyszerkibocsátó ballonnal = Drug-eluting balloon in the treatment of a recurrent in-stent restenosis of drug-eluting stent

A koszorúér-betegség alapját jelentő atheroscleroticus folyamatok gyógyszeres kezelése mellett a percutan intervenciós módszer szerepe az utóbbi évtizedekben egyre jelentősebb. A stentek elterjedésével a percutan koszorúér-intervenció akut sikerrátája jelentős javulást mutatott, azonban a hagyományos fémstentekben keletkezett instentrestenosis újabb kihívást (és anyagi ráfordítást) jelent az intervenciós kardiológia számára. Az instentrestenosis csökkentése hatékonyan kivitelezhető gyógyszerkibocsátó stentek alkalmazásával, ahol a stent fémvázára felvitt polimerhez citosztatikus anyag kapcsolódik. Az intimaproliferáció gátlásával az instentrestenosis gyakorisága 10% alá csökkenthető. A gyógyszerkibocsátó stentekben megjelenő restenosis kezelése azonban jelenleg megoldatlan probléma. Egyes elméletek szerint az érfal reaktivitását kiváltó/fenntartó fém, illetve polimer kiküszöbölése jelenthet megoldást. A kutatások két irányba folytatódnak ezek alapján: 1. biológiailag lebomló polimer, illetve stent; 2. gyógyszerkibocsátó ballon. Jelen dolgozatukban a szerzők egy tanulságos eset kapcsán adnak áttekintést az utóbbi módszerről. Orv. Hetil., 2010, 37, 1509–1514. | Although medical treatment of atherosclerotic processes as a cause of the coronary artery disease has its own fundamental role, percutaneous coronary interventions showed an impressing development due to the intensive innovation. The use of stents increased the success rate of percutaneous coronary interventions, but in-stent restenosis appeared as a new complication. Drug eluting stents are dedicated to decrease the frequency of intima proliferation facilitating in-stent restenosis. After implantation of a drug-eluting stent, in-stent restenosis occurs in less than 10% of the patients. In spite of the improving results, in-stent restenosis of a drug-eluting stent has been remained unsolved. Besides the biodegradable stents/polymers, drug-eluting balloon may indicate the future technology. In this paper a very exciting, educative case is presented with a summary of the literature of drug-eluting balloon technique. Orv. Hetil., 2010, 37, 1509–1514

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Background: Once occluded, the radial artery becomes unsuitable for repeat interventions and obligates the need for alternative vascular access, such as the femoral approach, which is not encouraged by current guidelines. With the dissemination of distal radial access (DRA), which allows the cannulation of the artery in its distal segment and which remains patent even in the case of radial artery occlusion (RAO), the option to perform angioplasty at this level becomes feasible. Methods: Thirty patients with RAO were enrolled in this pilot study. Recanalization was performed through DRA using hydrophilic guidewires. The feasibility endpoint was procedural success, namely the successful RAO recanalization, the efficacy endpoint was patency of the artery at 30 days, and the safety endpoint was the absence of periprocedural vascular major complications or major adverse cardiac and cerebrovascular events. Results: The mean age of the patients was 63 ± 11 years, and 15 patients (50%) were men. Most patients had asymptomatic RAO (n = 28, 93.3%), and only two (6.6%) reported numbness in their hands. The most common indication for the procedure was PCI (19, 63.2%). Total procedural time was 41 ± 22 min, while the amount of contrast used was 140 ± 28 mL. Procedural success was 100% (n = 30). Moreover, there were no major vascular complications (0%); only two small hematomas were described (10%) and one had an angiographically visible perforation (3%). One case of periprocedural stroke was reported (3%), with onset immediately after the procedure and recovering 24 h later. Twenty-seven radial arteries (90%) remained patent at the one-month follow-up. Conclusions: RAO recanalization is feasible and safe, and by using dedicated hydrophilic guidewires, the success rate is high without significantly increasing procedural time or the amount of used contrast