[show abstract][hide abstract] ABSTRACT: Background
Nonagenarians are mostly denied from different therapeutic strategies due to high comorbidity index and risk-benefit calculation. We present the results of nonagenarians with high comorbidity index not eligible for conventional aortic valve surgery undergoing transcatheter aortic valve implantation (TAVI) with the CoreValve system.
Our retrospective analysis include baseline parameters, procedural characteristics, morbidity, mortality as well as twelve-lead surface ECG and echocardiographic parameters which were revealed preinterventionally, at hospital discharge and at 30-day follow-up. Clinical follow-up was performed 6 months after TAVI.
Out of 158 patients 11 nonagenarians with a mean age of 92.6 ± 1.3 years suffering from severe aortic valve stenosis and elevated comorbidity index (logistic EuroSCORE of 32.0 ± 9.5%, STS score 25.3 ± 9.7%) underwent TAVI between January 2008 and January 2011 using the third-generation percutaneous self-expanding CoreValve prosthesis. Baseline transthoracic echocardiography reported a mean aortic valve area (AVA) of 0.6 ± 0.2 cm2 with a mean and peak pressure gradient of 60.2 ± 13.1mmHg and 91.0 ± 27.4mmHg, respectively. The 30-day follow up all cause and cardiovascular mortality was 27.3% and 9.1%, respectively. One major stroke (9.1%), 2 pulmonary embolisms (18.2%), 1 periprocedural (9.1%) and 1 (9.1%) spontaneous myocardial infarction occured. Life-threatening or disabling bleeding occurred in 2 cases (18.2%), and minor bleeding in 7 cases (63.6%). Mean severity of heart failure according to NYHA functional class improved from 3.2 ± 0.8 to 1.36 ± 0.5 while mean AVA increased from 0.6 ± 0.2cm2 to 1.8 ± 0.2cm2. At 6-months follow-up 8 patients (72.7%) were alive without any additional myocardial infarction, pulmonary embolism, bleeding, or stroke as compared to 30-day follow-up.
Our case series demonstrate that even with elevated comorbidity index, clinical endpoints and valve-associated results are relatively favorable in nonagenarians treated with CoreValve.
[show abstract][hide abstract] ABSTRACT: This study sought to evaluate long-term survival in type B aortic dissection patients treated with thoracic endovascular aortic repair (TEVAR) therapy.
Historical data have supported medical therapy in type B acute aortic dissection (TBAAD) patients. Recent advances in TEVAR appear to improve in-hospital mortality.
We examined 1,129 consecutive patients with TBAAD enrolled in IRAD (International Registry of Acute Aortic Dissection) between 1995 and 2012 who received medical (n = 853, 75.6%) or TEVAR (n = 276, 24.4%) therapy.
Clinical history was similar between groups. TEVAR patients were more likely to present with a pulse deficit (28.3% vs. 13.4%, p < 0.001) and lower extremity ischemia (16.8% vs. 3.6%, p < 0.001), and to characterize their pain as the "worst pain ever" (27.5% vs. 15.7%, p < 0.001). TEVAR patients were also most likely to present with complicated acute aortic dissection, defined as shock, periaortic hematoma, signs of malperfusion, stroke, spinal cord ischemia, mesenteric ischemia, and/or renal failure (61.7% vs. 37.2%). In-hospital mortality was similar in patients managed with endovascular repair (10.9 % vs. 8.7%, p = 0.273) compared with medically managed patients. One-year mortality was also similar in both groups (8.1% endovascular vs. 9.8% medical, p = 0.604). Among adverse events during follow-up, aortic growth/new aneurysm was most common, occurring in 73.3% of patients with medical therapy and in 62.7% of patients after TEVAR, based on 5-year Kaplan-Meier estimates. Kaplan-Meier survival estimates showed that patients undergoing TEVAR had a lower death rate (15.5% vs. 29.0%, p = 0.018) at 5 years.
Results from IRAD show that TEVAR is associated with lower mortality over a 5-year period than medical therapy for TBAAD. Further randomized trials with long-term follow-up are needed.
[show abstract][hide abstract] ABSTRACT: This study analyzed the outcome of a combined endovascular and debranching procedure for hybrid aortic arch repair (HAR) in patients with complicated type B aortic dissection.
Between February 2006 and August 2012, HAR was performed in 75 consecutive patients, with retrospective analysis of a subgroup of 45 patients who underwent HAR with complicated acute (n = 10), subacute (n = 7), or chronic (n = 28) type B dissection as the underlying disease. Descriptive statistics were computed for continuous and categoric variables. The interval to death or last follow-up was estimated using the Kaplan-Meier method.
The patients were a mean age of 59.9 ± 10.7 years (median, 59.2; range, 35-78 years). Complete supra-aortic debranching was performed in six (13%) in zone 0 (procedure time, 200 minutes; range, 185-365 minutes) and partial debranching in 39 (87%), comprising 16 (36%) in zone 1 (procedure time, 120 minutes; range, 75-250 minutes) and 23 (51%) in zone 2 (procedure time, 91 minutes; range, 70-210 minutes). Technical success was achieved in 86.7% (39 of 45). Thirty-day mortality was 4.4% (two of 45), with an in-hospital mortality of 11.1% (five of 45) as a result of three additional deaths after days 33, 35, and 111. Comparing HAR for type B dissection after complete debranching in six and partial debranching in 39, the overall in-hospital mortality was 67% (four of six) and 2.6% (one of 39), respectively. After a median follow-up of 20.8 months (range, 0.3-70 months), the overall mortality was 13.3% (six of 45), with Kaplan-Meier survival estimate of 85% at 1 year. Stroke rate was 8.8% (four of 45). Paraplegia developed in one patient (2.2%), with complete recovery after spinal drainage. Cardiac complications occurred in three patients (6.7%), pulmonary complications in 10 (22.2%), and renal insufficiency requiring dialysis developed in five (11%). Retrograde dissection occurred in one patient (2.2%) 14 days after complete debranching and zone 0 thoracic endovascular aortic repair, with fatal outcome. No bypass dysfunction was seen during follow-up. The overall early and late endoleak rates were 27% (12 of 44) and 43% (13 of 30), respectively. Eight patients (18%) required reintervention, with freedom of reintervention in 91% at 1 year and 81% at 2 years.
HAR in zone 1 and 2 appears a viable alternative to conventional aortic arch surgery in patients with complicated type B dissection. Stroke and endoleaks remain complications that need to be addressed. Treatment of type B aortic dissection with complete supra-aortic debranching and thoracic endovascular aortic repair in zone 0, however, is associated with high mortality, which might be reduced by improved technology using branched stent grafts.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 07/2013; · 3.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: Aims: The haemodynamic effect of mitral valve (MV) repair using multiple MitraClips® (MC) has not been investigated. The aim of the study was to evaluate the stress performance of MV repair with MC. Methods and results: Twenty consecutive patients (77±7 years, 13 men [65%]) after implantation of >2 MitraClips® were subsequently evaluated with dobutamine stress echocardiography (DSE). After MC implantation, mean transmitral pressure gradient (TPG) (3.3±0.8 mmHg vs. 4.0±0.6 mmHg; p<0.001) and mitral valve orifice area (2.9±0.3 cm2 vs. 3.9±0.4 cm2; p<0.001) were significantly increased during DSE showing a physiological behaviour effect of the MV. LVEF (41±18% vs. 46±21%; p<0.001) and systolic pulmonary artery pressure (42±11 mmHg vs. 44±12 mmHg; p=0.014) increased significantly. The degree of MR was stable during stress (p=0.68). At linear regression, only baseline peak TPG was related to stress mean TPG (p<0.001; Beta 0.816; 95% CI: 0.368-0.918). Conclusions: MV repair using MitraClips® should be performed with the aim of maximal reduction of MR degree. MV repair using MC may not lead to pathological degrees of MV stenosis. Although the TPG is significantly increased during stress, it never reaches pathological levels and is always accompanied by a significant increase in MVOA. The degree of residual MR remains unchanged during maximal pharmacological stress.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 01/2013; · 3.17 Impact Factor
[show abstract][hide abstract] ABSTRACT: Beyond their originally sole mechanical function, current drug-eluting stents (DES) implement the concept of local drug delivery for the re-opening of stenotic arterial vessels, and for prevention of in-stent restenosis as one of the major limitations of conventional bare metal stents (BMS). Current DES consist of a permanent metallic stent platform and an active agent being released from a drug-incorporated polymer coating or a porous stent surface. Although DES have impressively demonstrated their capability of reducing in-stent restenosis, their safety remains under debate due to potential risks, such as delayed healing, late thrombosis and hypersensitivity demanding further development. Current advancements in the stent design address the stent platform, the pharmacologically active substance and/or the drug carrier. For instance, novel biocompatible absorbable stent platforms and drug carriers are developed and novel drugs with a differential effect on vascular endothelial and smooth muscle cells, providing efficient inhibition of muscle cells without altering the endothelial cell function, are identified. Moreover, biofunctionalization of the stent's surface with capture molecules for endothelial progenitor cells are under investigation in order to achieve an in situ endothelialization of the implant. In this context, this review paper discusses the current advances in coronary stent technology with a special focus on novel stent platforms, drugs and stent coatings for the prevention of restenosis and improvement of biocompatibility.
Current pharmaceutical biotechnology 10/2012; · 3.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been established as a treatment option for inoperable patients with symptomatic aortic valve stenosis. However, patients suffer frequently from conduction disturbances after TAVI. METHODS: Baseline, procedural as well as surface and intracardiac ECG parameters were evaluated for patients treated with TAVI and a comparison between patients requiring pacemaker with those not suffering from relevant conduction disorders were done. RESULTS: TAVI was successfully in all patients (n=45). Baseline surface and intracardiac ECG recording revealed longer PQ (197.1+/-51.2 msec versus 154.1+/-32.1 msec; p<0.001), longer AH (153.6+/-43.4 msec versus 116.1+/-31.2 msec; p<0.001) and HV interval (81.7+/-17.8 msec versus 56.8+/-8.5 msec; p<0.001) in patients with need for a pacemaker (n=23) versus control group (n=22); furthermore, 7-day follow-up analysis showed a higher prevalence of new left bundle branch block (LBBB) (87.0% versus 31.9%; p<0.001). Multivariate analysis revealed that only new LBBB, QRS duration >120 msec and a PQ interval >200 msec immediately (within 60 minutes) after implantation of the aortic valve were predictors for high-grade (type II second-degree and third-degree) AV block. Other clinical parameters as well as baseline electrocardiographic parameters had no impact on critical conduction delay. CONCLUSION: Cardiac conduction disturbances are common after TAVI. The need for pacing after TAVI is predictable by surface ECG evaluation immediately (within 60 minutes) after the procedure.
[show abstract][hide abstract] ABSTRACT: Aims: Compare mid-term outcomes after MitraClip® implantation for severe mitral regurgitation (MR) in patients categorised in different logistic EuroSCORE (LES) groups. Methods and results: MitraClip was implanted in 85 patients (78±6 years, 48 men [56.5%]) with severe symptomatic MR. Baseline characteristics, perioperative results, mid-term survival, major adverse cerebrovascular and cardiac events (MACCE), and re-hospitalisation were compared in patients with LES <20% (n=30) and ≥20% (n=55). Overall LES was 24±12 (range 2.5-56.3) and STS-score 12±7 (range 1.2-31.2). Overall procedural success rate was 96.5% with an in-hospital mortality rate of 3.5%. Echocardiographic and clinical follow-up confirmed similar mean transmitral pressure gradient (p=0.13), MR degree (p=0.48), and NYHA Class (p=0.93). Estimated six-month survival and freedom from composite endpoint was 80.7%/77.1% in LES ≥ 20% and 90.8/86.6% in LES<20% group, respectively (p= 0.014; p=0.018). Multivariate analysis determined LES ≥20% (OR=8.1; 95% CI 1.002-65.186), mean transmitral gradient after intervention (OR 2.5; 95% CI 1.267-5.131) and residual MR (OR=5.1; 95% CI 1.464-17.946) as predictors for overall mortality. Conclusions: LES is a good predictor of perioperative results, and follow-up adverse outcomes after MitraClip implantation are significantly influenced by the preoperative risk profile. The presence of residual MR immediately after MitraClip therapy can exacerbate the occurrence of MACCE.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2012; 8(5):571-8. · 3.17 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: The objective of this study was to compare outcomes of surgical repair (SR) vs MitraClip (MC) implantation for severe mitral regurgitation (MR). METHODS: A retrospective analysis of patients treated within a single institution was performed. Patients had EuroSCORE [European System for Cardiac Operative Risk Evaluation] < 20%, left ventricular ejection fraction ≥45%, and grade 3+/4+ MR. RESULTS: Fifty patients (24 [48%] MC group, 26 [52%] SR group) with EuroSCORE 7.9 ± 5.6 were included. The MC group included 24 (48%) and the SR group 26 (52%) patients. Patients in the MC group had a significantly more complex comorbid profile (P < 0.001). Successful MC placement was in 22 patients (91.7%) and SR in 26 (100%). At discharge, no patient had grade 3+/4+ MR. There were no in hospital or 30-day deaths. At follow-up (mean 526 ± 398 days), further mitral valve surgery was necessary in 1 (3.8%) patient in the SR group and in 2 (8.3%) patients in the MC group (P = 0.26). One-year freedom from composite end point (death, stroke, myocardial infarction, major bleeding, cardiac rehospitalization) was 75.5% (SR 83% vs MC 67%; P = 0.18). Degree of residual MR Degree of residual MR immediately after the procedure was equally distributed in both groups (P = 0.13) and the sole independent determinant for composite outcome (odds ratio, 16.9; P = 0.024). CONCLUSIONS: MC in nonsurgical candidates and SR in surgical patients showed similar perioperative and follow-up outcomes at an institution experienced with both techniques. Neither MC nor SR were independently related to outcome whenever similar degrees of acute correction with minimal residual MR were achieved. However, these findings should be interpreted within the selection biases and the numerical limitations of the present study.
The Canadian journal of cardiology 08/2012; · 3.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: The results of the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) II trial have demonstrated that percutaneous mitral valve repair using the MitraClip in high-risk patients was associated favourable outcomes. However, commonly accepted contraindications for the standard MitraClip procedure include extensively prolapsed valves and flail leaflets. We report on the management of a patient not amenable to standard interventional procedure.
The Canadian journal of cardiology 07/2012; · 3.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: Hintergrund:
Eine Aortenklappeninsuffizienz, unterteilbar in eine akute
sowie eine chronische Form, kann unterschiedlicher Genese sein. Während
bei der akuten Form häufig eine Endokarditis, eine Typ-A-Aortendissektion
sowie Traumata eine Rolle spielen, kann die chronische Form u.a. durch
eine angeborene Klappenanomalie bedingt sein. Hierbei stellt die quadrikuspide
Aortenklappe die weitaus seltenste Form dar. Die Diagnose wird meist
zufällig während der echokardiographischen Untersuchung, im Rahmen von
kardiochirurgischen Eingriffen oder postmortal gestellt.
Berichtet wird über eine 44-jährige Patientin mit seit
2 Jahren bestehender progredienter Belastungsdyspnoe. In der klinischen
Untersuchung fand sich ein lautes Diastolikum im zweiten Interkostalraum
rechts bei einem Blutdruck von 170/60 mmHg. Die echokardiographische
Untersuchung ergab die Diagnose einer Aortenklappeninsuffizienz III° bei
angeborener quadrikuspider Aortenklappe. Nach operativem Aortenklappenersatz
nach Bentall und anschließender oraler Antikoagulation wurde die
Patientin im weiteren Verlauf beschwerdefrei.
Das Auftreten einer quadrikuspiden Aortenklappe, häufig
assoziiert mit einer Aortenklappeninsuffizienz, ist sehr selten. Bei klinischem
Verdacht sollte eine echokardiographische Untersuchung veranlasst werden.
Die spezielle Therapie kann anhand der klinischen Beschwerden und der
objektiven Parameter festgelegt werden. Bei geringer Aortenklappeninsuffizienz
und leichten klinischen Beschwerden ist ein medikamentös-konservatives
Vorgehen gerechtfertigt. Bei Auftreten einer höhergradigen Aortenklappeninsuffizienz
sowie klinischen Zeichen einer kardialen Dekompensation wird
eine chirurgische Therapie empfohlen.
Both, acute and chronic aortic insufficiency, can be caused
by various conditions. While the acute form is often associated with an endocarditis,
type A aortic dissection and trauma, one possible cause of chronic
aortic insufficiency is a congenital malformation of the aortic valve. Among
these malformations, the quadricuspid aortic valve is the most rare form. The
diagnosis is often made by Doppler echocardiography, during cardiac surgery,
A 44-year-old female patient presented with a 2-year history
of increasing dyspnea on exertion. The physical examination revealed
a diastolic heart murmur in the second right intercostal space and a blood
pressure of 170/60 mmHg. Transthoracic and transesophageal Doppler
echocardiography disclosed a quadricuspid aortic valve with severe aortic
insufficiency. After implantation of a mechanical aortic valve, the patient was
Quadricuspid aortic valve, often associated with aortic insufficiency,
is a rare condition. The diagnosis can be made by Doppler echocardiography.
The special treatment should be based on objective and subjective
findings. In the absence of severe aortic regurgitation or clinical signs, a medical
treatment with close follow-up is justified. In case of severe aortic regurgitation
or clinical signs of cardiac decompensation, surgical treatment is recommended.
[show abstract][hide abstract] ABSTRACT: Die erfolgreiche Therapie des akuten Myokardinfarkts (STEMI [ST-Hebungsinfarkt]) erfordert eine schnellstmögliche und komplette
Revaskularisation, da die Prognose des Infarktpatienten vom Zeitintervall zwischen Gefäßverschluss und Wiedereröffnung mit
resultierendem normalem Fluss der Infarktarterie abhängt. Die zeitgerechte primäre perkutane Koronarintervention (PPCI) durch
ein erfahrenes Team ist selbst der prähospitalen Thrombolysetherapie überlegen und wurde von nationalen und internationalen
Fachgesellschaften zur Therapie der ersten Wahl erklärt.
Zur flächenhaften Durchsetzung der PPCI wird die Einrichtung von Netzwerken mit direktem Transport des Infarktpatienten in
ein geeignetes Herzkatheterlabor, auch unter Umgehung eines näher gelegenen „nichtinvasiven“ Krankenhauses, empfohlen. Mittels
Netzwerklogistik und eines standardisierten Therapiepfads können die prognostisch relevanten Therapiezeitintervalle eingehalten
werden. Im PCI-Zentrum sind hierzu die Bereithaltung aller notwendigen logistischen, apparativen und personellen Voraussetzungen,
insbesondere die ständige Bereitschaft eines erfahrenen interventionellen Teams, sowie eine einfache Patientenanmeldung via
Im Drip&Ship-Netzwerk Rostock wurden innerhalb von 5 Jahren 1 022 Patienten mit STEMI interventionell behandelt, von denen
490 Patienten aus einem peripheren Krankenhaus transferiert und 532 Patienten direkt im PCI-Zentrum vorgestellt wurden. Exakt
95,1% aller transferierten und 94,8% aller direkt aufgenommenen Patienten wurden einer sofortigen PCI unterzogen, in deren
Ergebnis ein normalisierter Koronarfluss in 96% beider Gruppen erzielt wurde. In der 12-Monats-Nachbeobachtung unterschieden
sich die Patienten beider Gruppen weder hinsichtlich des Ausmaßes der Myokardnekrose noch bezüglich Mortalität, NYHA-Stadium
und linksventrikulärer Ejektionsfraktion. Die effiziente PCI-Netzwerklogistik sichert somit den Patienten mit STEMI in ländlichen
Regionen dieselbe Prognose wie bei innerstädtischer Versorgung.
Management of acute ST elevation myocardial infarction (STEMI) demands rapid and complete reperfusion of the infarct-related
artery (IRA). With postinfarction prognosis depending on time delay from onset of symptoms to complete reperfusion (TIMI 3
flow) of the IRA, primary percutaneous coronary intervention (PPCI) performed by an experienced team has been shown to be
superior to thrombolytic therapy with lower mortality, less frequent occurrence of nonfatal reinfarction and stroke, and thus
represents the preferred treatment strategy according to the national and international guidelines.
For regional implementation of PPCI, particularly in rural areas, information and transfer logistics within networks of care
and direct transport of an infarction patient to a PCI hospital rather than to the closest hospital are a challenge. With
successful implementation of network logistics and standardized therapeutic pathways, current guidelines and requested timelines
versus thrombolysis could be met. The implemented logistics comprised 24 h/7 days stand-by services of an experienced PCI
team, direct telephone hotline contact between rescue service/emergency physician and interventional cardiologist on call,
and direct open access to a catheterization laboratory at any time.
Within the Drip&Ship network Rostock, to date (July 2007) 1,022 consecutive patients with PCI for STEMI were documented and
analyzed over 5 years; of these, 490 patients were transferred from a community hospital to the PCI center and 532 patients
were admitted directly to the interventional center. In 95.1% of all transferred and in 94.8% of all directly admitted patients,
PCI was successfully accomplished upon arrival. A normalized flow to the IRA after PCI was documented in 96% of both groups,
no patient was subjected to thrombolytic therapy. At 12-month follow-up, there were no differences between both groups with
respect to infarct size and mortality. Moreover, there was no evidence of differences in left ventricular ejection fraction
between groups. Thus, transportation of STEMI patients within an established PCI network did not result in any prognostic
disadvantage. Efficient network logistics with transportation for PPCI in acute STEMI ensure both safety and outcome profiles
similar to patients treated by PCI in metropolitan areas.
[show abstract][hide abstract] ABSTRACT: Calcified coronary lesions are challenging to deal with, as they require optimal lesion preparation. Direct stenting in this scenario is associated with risk of stent-underexpansion, which is related to in-stent restenosis, target lesion revascularization and stent-thrombosis. We report on the interventional management of an underexpanded bare-metal stent not amenable to high-pressure balloon dilation and cutting-balloon. By using rotablation we could abrade the underexpanded stent struts and the calcification with subsequent implantation of a drug-eluting stent. Follow-up of 6 months revealed good results without evidence of significant restenosis. Our clinical experience and case reports in the literature suggest that this strategy might be an option for underexpanded stents not amenable to conventional techniques.
Clinical Medicine Insights. Cardiology. 01/2012; 6:53-6.
[show abstract][hide abstract] ABSTRACT: To evaluate the short-term outcome of patients predominantly at high risk treated with the MitraClip® device for severe mitral valve regurgitation (MR) using one or more clips.
We prospectively analyzed patients with highly symptomatic MR classified as inoperable (logistic EuroSCORE 24.16 ± 13.64%; STS-score 29.9 ± 14.5%) but subject to mitral valve repair with MitraClip® between May 2010 and January 2011. Thirty-three consecutive patients (57.6% male; age 77.8 ± 6.7 years) were enrolled and treated with either 1 (n = 7; 21.2%), 2 (n = 20; 60.6%), 3 (n = 4; 12.1%), or 4 (n = 2, 6.1%) clips. Grading of MR was performed by two-dimensional transesophageal echocardiography (2D-TEE) prior to TEE-guided clipping and before discharge.
MR was classified as functional in 23 (69.7%) and organic in 10 (30.3%) of the patients with MR-grade ≥ 3+ in 32 (97%) and = 4 in 1 patients (3%) before repair. Reduction in MR grade to grade ≤1+ was achieved in 81.7% and to 2 in 12.1% (P = 0.00072). Invasive pulmonary artery systolic pressure (PAPsyst) and pulmonary capillary wedge pressure (PCWP) v-wave decreased from 59.2 ± 18.6 to 46.9 ± 15.3 mmHg (P = 0.00014) and 21.2 ± 6.7 to 8.0 ± 3.3 mmHg (P = 0.0093), respectively, as measured immediately after clipping. Functional NYHA class improved from mean 3 (range 3 [90.9%] to 4 [9.1%]) to 2 in 84.9% (P = 0.00081) as obtained at discharge.
Mitral valve repair with MitraClip® using multiple clips is appropriate and safe in unselected patients resulting in reduced MR with positive impact on short-term functional capacity.
Journal of Interventional Cardiology 12/2011; 25(2):180-9. · 1.50 Impact Factor
[show abstract][hide abstract] ABSTRACT: Drug-eluting stents have changed the practice in interventional cardiology. With the widespread use of these stents important safety concerns regarding stent thrombosis and formation of coronary artery aneurysm have been expressed. While the majority of attention was focused on stent thrombosis, the formation of coronary aneurysm was only described in anecdotal reports. We report on a patient who suffered from very late stent thrombosis in association with coronary artery aneurysm formation secondary to drug-eluting stent but not to bare-metal stent.
Chinese medical journal 10/2011; 124(20):3427-9. · 0.90 Impact Factor