Coronary stent fracture in an octogenarian patient: from bad to worse.
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ABSTRACT:
SUBMITTER: Triantafyllis AS
PROVIDER: S-EPMC8648541 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: Not available
| S-EPMC3066831 | biostudies-literature
Project description:Background Reported evidence of coronary stent fracture (CSF) has increased in recent years. The purpose of this study was to determine reliable estimates of the overall incidence of CSF. Methods and results The MEDLINE, Embase and Cochrane databases were searched until March 18, 2022. Pooled estimates were acquired using random effects models. Meta-regression and subgroup analysis were used to explore sources of heterogeneity, and publication bias was evaluated by visual assessment of funnel plots and Egger’s test. Overall, 46 articles were included in this study. Estimates of CSF incidence were 5.5% [95% confidence interval (CI): 3.7–7.7%] among 39,953 patients based on 36 studies, 4.8% (95% CI: 3.1–6.8%) among 39,945 lesions based on 29 studies and 4.9% (95% CI: 2.5–9.4%) among 19,252 stents based on 8 studies. There has been an obvious increase in the incidence of CSF over the past two decades, and it seems that the duration of stent placement after stent implantation has no impact on incidence estimation. Conclusion The incidence of CSF was 5.5% among patients, 4.8% for lesions and 4.9% for stents and increased over the past 20 years. The duration of stent placement after stent implantation was found to have no impact on the incidence of CSF, but drug-eluting stent (DES) types and right coronary artery (RCA) lesions influenced the pooled incidence. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022311995], identifier [CRD42022311995].
| S-EPMC9445981 | biostudies-literature
Project description:Over the past four decades, percutaneous coronary intervention (PCI) safety and efficacy have significantly improved, particularly with the advent of the drug-eluting stent (DES). First-generation DESs reduced in-stent restenosis rates and targeted lesion revascularization; however, safety issues emerged, due to high incidences of stent thrombosis (ST) linked to death, myocardial infarction, and repeat revascularization. Second-generation DESs were developed to overcome these issues, reducing late-thrombotic-event risk while maintaining anti-restenosis efficacy. Nevertheless, ST still occurs with second-generation DES use. Stent thrombosis etiology is multifaceted, encompassing lesion-, patient-, procedural-, and stent-related factors. Overall, most early-stent-thrombosis cases are linked to procedural and patient-related aspects. Factors like premature discontinuation of dual antiplatelet therapy, resistance to clopidogrel, smoking, diabetes mellitus, malignancy, reduced ejection fraction or undertaking coronary angioplasty for an acute coronary syndrome can increase the risk of stent thrombosis. The aim of this study is to assess patient-related factors that potentially heighten the risk of stent thrombosis, with the objective of pinpointing and addressing modifiable contributors to this risk. By focusing on both patient- and procedure-related factors, a multifaceted approach to coronary revascularization can help minimize complications and maximize long-term benefits in managing ST.
| S-EPMC10707589 | biostudies-literature
Project description:An 85-year-old man was admitted to the emergency department with chest pain. His electrocardiogram showed a right bundle branch block as well as increased voltages suggesting left ventricular hypertrophy and t-wave inversions consistent with a strain pattern (versus ischemia). He underwent echocardiography which showed regional noncompaction and associated hypokinesis. These findings led to coronary angiography which revealed multiple coronary-cameral fistulae involving all three coronary arteries. He was initially treated for acute coronary syndrome but after his diagnostic procedures this was narrowed to a beta blocker, to reduce myocardial oxygen demand, and an angiotensin-converting enzyme inhibitor due to the cardiomyopathy. Although the fistulae may have caused the patient's chest pain, intervention was not possible due to the diffuse nature of the fistulae. He did well in follow-up without the development of heart failure symptoms or continued angina. <Learning objective: Noncompaction cardiomyopathy and coronary cameral fistulae are two rare disorders that have even more rarely been described in a single patient. They may be a part of a spectrum of a single disease that results from arrest of the normal sequence of embryologic development of the heart. The management of the two conditions includes aspects of standard heart failure care as well as medical and possibly interventional therapy for coronary ischemia (angina) related to fistulae.>.
| S-EPMC7283295 | biostudies-literature
Project description:A 59-year-old man with acute cholangitis was referred to us because of a coronary artery aneurysm that was incidentally detected on contrast-enhanced computed tomography. Intravascular ultrasonography showed a loss of vascular layers and complete stent fracture, which was suggestive of a pseudoaneurysm. After some management protocols, such as observation, covered stent implantation, and surgical treatment, had failed, we treated the pseudoaneurysm successfully using coil embolization and a vascular plug. There were no complications during the perioperative period. We suggest that, if conventional management fails, treatment with coil embolization and a vascular plug should be considered.Learning objectiveA rare complication of percutaneous coronary intervention resulting from stent fracture is a coronary artery aneurysm. Here, we discuss the chronic complications of stent implantation and discuss the optimal management strategy for coronary pseudoaneurysms. Further, we discuss the strengths and weaknesses of each strategy.
| S-EPMC9995659 | biostudies-literature
Project description:Patients with idiopathic pulmonary fibrosis have a significantly increased risk for the development of lung cancer. The morbidity and mortality of this disease combination are substantial, and, unfortunately, there are currently few data to help guide clinicians in its diagnosis and treatment. In a recent issue of this journal, Hwang et al presented one of the first studies to evaluate lung cancer in patients with idiopathic pulmonary fibrosis at the molecular level. They demonstrate variants in regulators of the cell cycle, which are known to be important in malignant transformation and may also be important in the pathogenesis of idiopathic pulmonary fibrosis. Further understanding of the pathogenic overlap between lung cancer and idiopathic pulmonary fibrosis could help point the direction to specific diagnostic modalities and targeted treatment of both conditions in the future. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
| S-EPMC6491351 | biostudies-literature
Project description:This report describes a rare asymptomatic case of complete stent fracture, coronary arterial transection, and pseudoaneurysm formation in response to repeated stenting. The proximal and distal ends of transected coronary artery were closed, and distal bypass was performed. Coronary arterial transection can occur in patients with repeated stenting as a long-term adverse event.
| S-EPMC4620260 | biostudies-literature
Project description:Percutaneous transluminal coronary angioplasty with metal stent placement has become a well-developed treatment modality for coronary stenotic lesions. Although infection involving implanted stents is rare, it can, however, occur with high morbidity and mortality. We describe herein a case of an inserted coronary stent that was infected and complicated with recurrent stent thrombosis, pseudoaneurysm formation and severe sepsis. Despite repeated intervention and bypass surgery, the patient died from severe sepsis.
| S-EPMC5290029 | biostudies-literature
Project description:Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is key for secondary prevention of recurrent coronary ischemic events and stent thrombosis. For this purpose, DAPT showed superior efficacy compared to aspirin alone, but it is also associated with an increased risk of major, and potentially fatal, bleeding. Hence, while secondary prevention with aspirin monotherapy is generally maintained for an indefinite period, the duration of DAPT after the index event is still debated. Multiple trials have challenged the guideline recommended standard of care of 12 months of DAPT duration. These studies tested on one side a treatment reduction to 6 or 3 months, and on the other side an extension of treatment beyond 12 months in order to define the optimal DAPT duration maximizing the anti-ischemic protection and minimizing bleeding. In this document we sought to summarize the existing evidence from more than 18 randomized controlled trials in the field, and discuss the benefit and risks of prolonging/shortening DAPT duration. In addition, a specific focus on treatment individualization will outline the current, evidence-based, decision-making process for optimal DAPT duration selection after coronary stenting.
| S-EPMC6232356 | biostudies-literature