Dataset Information

Successful Treatment of a Stenotic Pulmonary Vein to Left Atrium Conduit With a Drug-Eluting Stent.

ABSTRACT: Partial anomaly of the pulmonary venous return is a rare congenital condition treated with surgical redirection of the blood flow through the creation of a conduit to the left atrium. We report the case of a stenotic pulmonary vein to left atrium conduit successfully treated with the implantation of a drug-eluting stent. Pulmonary vein or conduit stenosis is generally treated with balloon dilation or bare-metal stent but is often met with underwhelming outcomes. Given the successful outcome of the case presented, drug-eluting stents may represent an attractive treatment option in suitable anatomies.

SUBMITTER: Bastiany A

PROVIDER: S-EPMC7063610 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Successful Treatment of a Stenotic Pulmonary Vein to Left Atrium Conduit With a Drug-Eluting Stent.

Bastiany Alexandra A Kasongo-Mukombula Adolphe A Chartrand-Lefebvre Carl C Potvin Jeannot J Masson Jean-Bernard JB

CJC open 20190315 3

Partial anomaly of the pulmonary venous return is a rare congenital condition treated with surgical redirection of the blood flow through the creation of a conduit to the left atrium. We report the case of a stenotic pulmonary vein to left atrium conduit successfully treated with the implantation of a drug-eluting stent. Pulmonary vein or conduit stenosis is generally treated with balloon dilation or bare-metal stent but is often met with underwhelming outcomes. Given the successful outcome of t ...[more]

PMID: 32159098

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Project description:BackgroundSaphenous vein grafts develop an aggressive atherosclerotic process and the efficacy of drug eluting stents (DES) in treating saphenous vein graft (SVG) lesions has not been convincingly demonstrated. The aim of this study was to review and analyze the current literature for controlled studies comparing DES versus bare metal stents (BMS) for treatment of SVG stenoses.Methodology/principal findingsWe searched several scientific databases and conference proceedings up to March 15, 2010 for controlled studies comparing target vessel revascularization (TVR) between DES and BMS. Summary odds ratios (OR) for the primary endpoint TVR and secondary endpoints infarction, stent thrombosis and death were calculated using random-effect models. A total of 29 studies (3 randomized controlled trials RCT) involving 7549 (202 in RCT) patients were included. The need for target vessel revascularization in the DES group tended to be lower compared to BMS for the 3 RCT (OR 0.50 [0.24-1.00]; p = 0.051) and for observational studies (0.62 [0.49-0.79]; p<0.001). There was no significant difference in the risk for myocardial infarction in the RCT (OR 1.25 [0.22-6.99]; p = 0.250) but a lower risk for DES based on the observational studies 0.68 [0.49-0.95]; p = 0.023. The risk for stent thrombosis was found to be non-different in the RCT (OR 0.78 [0.03-21.73], p = 0.885) while it was in favor of DES in the observational studies (0.58 [0.38 - 0.84]; p<0.001). The mortality was not significantly different between DES and BMS in the RCT's (OR 2.22 [0.17 - 29.50]; p = 0.546) while the observation studies showed a decreased mortality in the DES group (0.69 [0.55-0.85]; p<0.001).ConclusionDES may decrease TVR rate in treatment of SVG stenoses. No differences in reinfarction rate, stent thrombosis or mortality was found between the DES and BMS groups in the RCT's while the observational data showed lower risk for myocardial infarction, stent thrombosis and death in the DES group. This may be a result of patient selection bias in the observational studies or represent a true finding that was not the detected in the RCT analysis due to limited statistical power.

Project description:AimsIn-stent chronic total occlusion (IS-CTO) represents a unique challenge for percutaneous coronary intervention. Whether the optimal treatment for IS-CTO is angioplasty with paclitaxel-coated balloons (PCBs) or repeat stenting with drug-eluting stents (DESs) is unclear. We aimed to evaluate the long-term clinical outcome of PCB angioplasty and DES repeat stenting for DES IS-CTO.MethodsWe retrospectively included patients with DES IS-CTO who underwent successful PCB angioplasty or DES repeat stenting from January 2016 to December 2019. The primary endpoints were major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, and target lesion revascularization (TLR). Cox proportional hazards model was performed to compare the risk of MACEs between PCB angioplasty and DES repeat stenting, and to further explore the prognostic factors of patients with DES IS-CTO.ResultsA total of 214 patients with DES IS-CTO were enrolled: 78 patients (36.4%) treated with PCB and 136 patients (63.6%) treated with DES respectively. The median follow-up was 1160 days, and MACEs were observed in 28.2% of patients with PCB angioplasty versus 26.5% of patients with DES repeat stenting (P = 0.784), mainly driven by TLR (21.8% vs. 19.9%, P = 0.735). There was no significant difference in the risk of MACEs between the PCB group and the DES group (hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.64-2.46, P = 0.512). Multivariate Cox analysis revealed that chronic kidney disease and ≥ 3 stent layers in the lesion were independent predictors of MACEs, while switching to another antiproliferative drug was an independent protective factor (all P < 0.05).ConclusionsPCB angioplasty was an effective alternative treatment strategy for DES IS-CTO, which had similar long-term outcomes to DES repeat stenting in contemporary practice, but both were accompanied by a high rate of long-term MACEs. Improving the poor prognosis of patients with DES IS-CTO remains a challenge.

Dataset Information

Successful Treatment of a Stenotic Pulmonary Vein to Left Atrium Conduit With a Drug-Eluting Stent.

Publications

Successful Treatment of a Stenotic Pulmonary Vein to Left Atrium Conduit With a Drug-Eluting Stent.

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