Introduction:There are inconclusive data about the potential delay of procedure time in emergent percutaneous coronary intervention (PCI) by radial compared with femoral approach in patients with ST-segment elevation myocardial infarction (STEMI).Aims:The purpose of the current study is to conduct a comprehensive meta-analysis of controlled randomized trials (CRTs) comparing the procedure time in STEMI patients undergoing emergent PCI with radial versus femoral access.Methods:Formal search of CRTs through electronic databases (Medline and PubMed) was performed from January 1990 to October 2014 without language restrictions. Mean difference (MD) of procedure time was evaluated as overall effect.Results:Twelve studies were included with 2052 and 2121 patients in radial and femoral group, respectively. Variability in the definition of procedure time was found with unavailability of a precise definition in 41.6% of studies. When all studies were included, no significant longer procedure time in radial approach was detected (MD [95% confidence interval [CI] = 1.6 min [−0.10, 3.3], P = 0.07, P het = 0.56). After deleting RIVAL trial, procedure time was significantly longer in radial group (MD [95% CI] = 1.5 min [0.71, 2.3], P < 0.001, P het = 0.20). Meta-analysis of three studies with similar definition of procedure time showed (MD [95% CI] = 1.26 min [−0.43, 2.95], P = 0.14, P het = 0.85).Conclusions:Although the procedure time in STEMI patients undergoing emergent PCI by radial access is generally comparable with femoral approach, there is an absence of uniformity in its definition, which leads to divergent results. A standardized definition of procedure time is required to elucidate this relevant matter.
We present a case of an accidentally crushed stent due to an unnoticed passage of a guidewire through a lateral stent strut with subsequent stent compression after balloon dilatation, during a planned percutaneous coronary intervention on the left main. The crushed stent segment was reconstructed with step-by-step balloon dilation, guided by intravascular ultrasound.
Objectives:Crank test and the radiological Sulcus sign are described as reliable parameters of shoulder instability. Our objective is to establish by these methods, the clinical and x- ray stability outcome in patients with arthroscopic Bankart repair.Methods:We studied 30 patients, 21 males and 9 female, average age 31 years (17-45), with ISIS average of 3.5 (2-5), all the cases presented Bankart lesion. All patients were treated on by the same team, all the surgeries were did by the same arthroscopic technique. Average follow up 21 months (6 - 36). The radiological and clinic assessment was done by the same surgeon to the 3, 6, 12 and 24 months postoperatively.Results:We found In 25 patients a negative result of clinical - x ray evaluation, 4 patients had crank test positive,1 patient presented both, Crank test and positive Sulcus sign.Discussion:These clinical and radiological tests are a practical tool that reproduced the gleno humeral postsurgical instability; In addition, it was found that the positive cases of instability coincide with a 6 points preoperative ISIS evaluation.Conclusion:We can infer that both, Crank test as Sulcus sign are reliable parameters for evaluate postoperative instability. We know that the success of the surgical outcome is the preoperative screening of the patient.
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