Diretriz Da Sociedade Brasileira De Cardiologia E Da Sociedade Brasileira De Hemodinâmica E Cardiologia Intervencionista Sobre Intervenção Coronária Percutânea

Feres, Fausto; Costa, Ricardo A.; Siqueira, Dimytri; Costa, J. Ribamar; Chamié, Daniel; Staico, Rodolfo; Chaves, Áurea J.; Abizaid, Alexandre; Marin-Neto, José Antônio; Rassi, Anis; Botelho, Roberto; Alves, Cláudia Maria Rodrigues; Saad, Jamil Abdalla; Mangione, José Armando; Lemos, Pedro A.; Quadros, Alexandre Schaan de; Queiroga, M. A.; Cantarelli, Marcelo J. C.; Figueira, Hélio Roque

doi:10.5935/abc.20170111

Cited by 48 publications

(110 citation statements)

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“…In the case of ACS, the minimum predicted DAPT duration was 12 months (class I recommendation), regardless of the type of stent implanted. 1,2 Bare-metal stents until not long ago were preferred to drug-eluting stents in patients at high risk of bleeding, especially in the elderly, since they enabled shorter duration of DAPT.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that patients undergoing percutaneous coronary intervention (PCI), either for the treatment of acute coronary syndrome (ACS) or stable coronary artery disease (CAD), tend to have multiple risk factors for both ischemic events and bleeding complications. 1 Determining the duration of DAPT becomes, therefore, more complex, and should be individualized, calculating the risk and benefit of prolonging the therapy, by use of scores considering the possibility of hemorrhagic or ischemic complications ( PRECISE-DAPT and DAPT scores, for example).¹ , ² In addition to the management of DAPT, other strategies may be used when dealing with a patient with a clinical profile of high risk of bleeding, such as choosing the appropriate vascular access and using adjunctive intravascular imaging methods, to optimize results or invasive functional assessment that enables a more rational, ischemia-guided intervention.² The objective of this report was to describe and discuss strategies used in a specific case of high risk of bleeding.…”

mentioning

confidence: 99%

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High risk of bleeding in elderly patient with coronary artery disease

Santo¹,

Galindo²,

Almeida³

et al. 2020

J Transcat Intervent

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Individuals at high risk of bleeding comprise a significant portion of patients submitted to coronary angioplasty. The optimal duration of dual antiplatelet therapy for these patients remains uncertain, and the use of risk stratification scores for hemorrhagic and ischemic complications, such as PRECISE-DAPT and DAPT, help in the decision-making process. We report the case of an octogenarian patient with known high risk of bleeding (PRECISE-DAPT = 65; DAPT = 0) diagnosed with two chronic subdural hematomas, 4 weeks after angioplasty with placement of drug-eluting stent to treat coronary artery disease. Based on the latest evidence from the literature on the management of antiplatelet agents for this group of patients, the decision was for early discontinuation of clopidogrel on the 31 st day after angioplasty. The clinical course was successful over 24-month follow-up.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

High risk of bleeding in elderly patient with coronary artery disease

Santo¹,

Galindo²,

Almeida³

et al. 2020

J Transcat Intervent

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“…6,9,[13][14][15] TRA currently features in the latest guidelines as the preferred vascular approach, particularly in ACS. [16][17][18][19][20] The use of the Ikari® Left 3.5 (Terumo Corporation, Tokyo, Japan) ( Figure 1), a universal transradial catheter (with one single format for the right and left coronary arteries) for both diagnostic and therapeutic procedures, has been previously studied, 21 even in patients with ST-elevation acute myocardial infarction (STEMI) 22 Continuous variables were expressed as mean and standard deviation, and categorical variables, as frequency and percentage. Clinical and procedural characteristics were compared between the groups using Pearson's chi-square test and Student's t test.…”

Section: Introductionmentioning

confidence: 99%

Comparing single-catheter transradial approach and transfemoral approach in acute coronary syndromes

Lopes¹,

Lemos²,

Medeiros³

et al. 2020

J Transcat Intervent

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Background: The transradial approach is currently the first option for percutaneous coronary procedures, whether diagnostic or therapeutic, particularly in patients with acute coronary syndromes. However, there is limited data in the literature comparing the use of a universal catheter from a radial approach versus the transfemoral approach. The purpose of this study was to demonstrate the feasibility of the single-catheter radial approach compared with the transfemoral approach. Methods: A retrospective assessment of cases of acute coronary syndrome undergoing invasive risk stratification and ad hoc percutaneous coronary intervention by transradial or transfemoral approach. In the transradial group, we selected cases in which one single guiding catheter was used in the procedure. Results: Between November 2011 and January 2013, we investigated 198 patients who met the selection criteria. Except for the higher mean age observed in the transradial group (63.5 vs. 59.2; p=0.002), there were no differences in clinical characteristics. In addition, there were no differences in clinical presentation, culprit vessel, number and size of the stents used, or final angiographic success rate. The number of vascular complications was higher, particularly hematomas <5cm, in the transfemoral group. Conclusion: The use of single-catheter transradial approach is feasible, safe and effective in managing patients with acute coronary syndrome.

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“…In ad hoc PCI, patients are subjected to higher radiation exposure in the same procedure, greater contrast volume, and, consequently, greater chance of developing contrast-induced nephropathy, longer procedure duration, difficulty in obtaining informed consent for the procedure, and a faster decision-making process, compromising the heart team concept. [1][2][3][4][5] Almost all data available in the literature on ad hoc PCI are from real-world registries, showing a reduction in puncture site-related vascular complications, no increase in the incidence of procedure-related complications, including mortality, and no significant changes in the immediate success rate of the procedure. 1 The use of radial access for coronary angiography and PCI has increased significantly in recent years.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] Almost all data available in the literature on ad hoc PCI are from real-world registries, showing a reduction in puncture site-related vascular complications, no increase in the incidence of procedure-related complications, including mortality, and no significant changes in the immediate success rate of the procedure. 1 The use of radial access for coronary angiography and PCI has increased significantly in recent years. The advantages of this approach include lower bleeding and vascular complication rates, and greater patient comfort, with a significant reduction in hospital costs and length of stay.…”

Section: Introductionmentioning

confidence: 99%