ABSTRACT: Sirolimus-eluting stents (SES) have already demonstrated their long-term effectiveness in suppressing neointimal hyperplasia in non-high risk patients. The long-term follow up of diabetic patients treated with SES has not been yet evaluated.
Quantitative coronary angiography and intravascular ultrasound analysis were performed in 35 diabetic patients treated with a SES at short- (6.0 +/- 1.0 months) and long-term (18.5 +/- 4.9 months) follow up. There were no significant changes in the in-stent minimum lumen diameter (MLD) between short- and long-term follow up (2.69 +/- 0.46 vs. 2.61 +/- 0.44 mm; p = 0.5), as well as in the in-lesion MLD (2.38 +/- 0.54 vs. 2.30 +/- 0.62 mm; p = 0.6). None of the patients reached binary restenosis (diameter stenosis > 50%) at either follow-up periods. Stent obstruction volume by 3-D IVUS was very small at short-term follow up and has remained virtually the same at long-term follow up (3.4% vs. 3.5%; p = 0.8). There were no aneurysm formations, late stent strut malappositions or late stent thromboses.
The present study demonstrates the 18-month efficacy and safety of SES for the treatment of diabetic patients without the so-called late catch-up phenomenon.
The Journal of invasive cardiology 04/2006; 18(4):142-6. · 1.84 Impact Factor
ABSTRACT: We report one-year angiographic and intravascular ultrasound (IVUS) outcomes of in-stent restenosis (ISR) patients treated with intravascular brachytherapy (IVBT). The benefit of IVBT for treating ISR is well documented. However, few data exist on significant angiographic and intravascular ultrasonic in-stent lumen deterioration beyond the habitual 6-month analysis after the index radiation procedure or so-called late catch-up process in the treatment of ISR. Twenty-five consecutive patients with ISR were treated with IVBT using the Beta-Cath System (a 40 mm 90 Sr per 90 gamma source). Quantitative angiographic and IVUS analysis was performed in all of them at 6 and 12 months. IVBT was successful in all patients. Four patients (16%) developed recurrent angiographic binary restenosis at 6-month follow-up, all located within the adjacent reference segments, with 2 being associated with geographical miss. An additional 4 patients (16%) presented with recurrent ISR at 12-month follow-up, all within the stented segment. Significant in-stent lumen loss (0.16 +/- 0.42 mm to 0.34 +/- 0.46 mm; p = 0.008) and in-stent intimal hyperplasia growth (+11.2 +/- 0.48 mm3; p = 0.03) was observed between 6 and 12 months. Intracoronary beta-radiation for the treatment of ISR was associated with significant luminal deterioration (late catch-up) within the stents between 6 and 12 months due to an important late progression of in-stent intimal hyperplasia.
The Journal of invasive cardiology 10/2005; 17(9):473-7. · 1.84 Impact Factor
ABSTRACT: The use of blood or blood products is routine in cardiac surgery, but is associated with various complications. Aware of this, we have always tried to avoid the use of blood products whenever possible. In this study we sought to evaluate the results of this policy.
The records of 1505 adult patients who underwent coronary (732) or valve (773) surgery under cardiopulmonary bypass (CPB) in 2002 and 2003 were reviewed retrospectively. Of these, 1058 were male (70.3%) and the mean age was 62.1+/-11.4 years. Mean weight was 68.5+/-10.2 kg and body surface area was 1.7+/-0.2 m2, corresponding to a blood volume of 4119.9+/-593.6 ml. Preoperative hematocrit (Hct) was 40.6+/-4.2% and the prothrombin index was 87.0+/-17.4%. A bloodless prime of the bypass circuit was used for all patients with Hct > or =36%. The prime volume was reduced to the minimum possible. Plasma was used when coagulation was deficient. All blood remaining in the CPB circuit was reinfused at the end of the procedure, either in the operating room or in the ICU. Shed mediastinal blood was retransfused in the first 6 hours in the ICU.
Operative mortality was 0.7% for coronary and 0.5% for valve patients. Blood or blood products were not used in 77.3% of the patients (88.7% of coronary and 66.5% of valve patients). Blood and/or plasma was initially added to the prime in 18.2% of cases and during CPB in 11%. Hct was 28.9+/-4.0% after initiation and 28.8+/-3.9% after discontinuation of CPB. The number of units (300 cc) of blood used was 0.25.57 per patient (1.09+/-0.73 per patient transfused). The number of units (300 cc) of plasma used was 0.24+/-0.72. Reoperation for bleeding was required in 2.4% of the patients.
This blood-sparing policy is simple, effective and safe, resulting in low mortality and morbidity rates. More than three quarters of the patients did not require blood or blood products. Additional measures are possible to further decrease the use of blood products.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 05/2005; 24(5):647-54.