SummaryObjective: To compare restenosis and major cardiac event rates at one and six months after DLC-coated stent implantation with those of uncoated stents. Méthods

Este estudo foi apresentado no XXVII Congresso da Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista e no XI Congresso da Sociedad Latinoamericana de Cardiologia Intervencionista. 42 ResumoObjetivo: Comparar os resultados da retirada de introdutor arterial pelo enfermeiro especializado em Unidade de Hemodinâmica e pelo médico residente em Cardiologia Intervencionista em pacientes submetidos à intervenção coronária percutânea.Métodos: Trata-se de registro prospectivo em 100 pacientes submetidos à intervenção coronária percutânea, no período de setembro a outubro de 2004, divididos em dois grupos: Grupo A (GA) -enfermeiro (n = 48 pacientes) -e Grupo B (GB) -médico residente (n = 52 pacientes). Hematoma pequeno foi definido como inchaço palpável no local da punção menor que 2 cm; hematoma moderado, com 2 a 6 cm de diâmetro; e hematoma grande, maior que 6 cm de diâmetro. A dose de heparina foi de 100 UI/kg. Os introdutores foram retirados após controle do tempo de coagulação ativado (TCA < 180 segundos), e foi realizada compressão manual por 15 minutos.Resultados: A idade dos pacientes foi de 59,54 ± 11,1 anos (GA) e 61,7 ± 10,4 anos (GB), com predomínio do sexo masculino (GA = 75% e GB = 58%). Os introdutores foram 7 French. O tempo de compressão manual foi de 19,4 ± 3,1 minutos no GA e 19,6 ± 3,1 minutos no GB (P = 0,76). Ocorreram oito hematomas no GA (sete pequenos e um moderado) e nove hematomas no GB (sete pequenos e dois moderados), P = não-significante. Os hematomas foram tratados clinicamente, sem complicações.Conclusão: A retirada de introdutor arterial, após intervenções coronárias percutâneas, pode ser realizada pelo enfermeiro especializado em Unidade de Hemodinâmica ou pelo médico residente em Cardiologia Intervencionista com segurança e sem complicações maiores. Palavras-chave:Angioplastia transluminal percutânea coronária, enfermagem, capacitação. AbstractObjective: To compare the results of sheath removal by the catheterization lab specialist nurse and by the interventional cardiology resident in patients submitted to a percutaneous coronary intervention.

A 52-year-old man with diagnosis of post-infarction unstable angina. Coronary angiography revealed 90% luminal obstruction in the middle third of the right coronary artery and 90% in the marginal branch of the circumflex artery. After the administration of clopidogrel 300 mg associated with acetylsalicylic acid, the patient underwent the implantation of a sirolimus-eluting stent Randomized studies with the use of drug-eluting stents have demonstrated an inhibition of neointimal hyperplasia in the majority of patients 1,2 . With the increasing use of these stents, information on their long-term effect is extremely important. The presence of a coronary aneurysm one year and five months after the implantation of a sirolimus-eluting stent is of utmost interest due to the lack of previously reported case reports. CASE REPORTThe patient was a 52-year-old male admitted with a history of very intense oppressive precordial pain at rest. He presented risk factors for coronary disease, systemic arterial hypertension and was a smoker; he also used captopril 12.5 mg twice a day. An electrocardiogram and enzyme measurements were carried out and an acute myocardial infarction was diagnosed, with no upper unleveling of the ST segment. During hospital stay, he presented precordial pain and post-infarction angina was diagnosed. At the physical examination he presented arterial pressure of 120/70 mmHg and cardiac frequency of 80 bpm. Cardiopulmonary auscultation was normal.The electrocardiogram showed a sinusal rhythm, with no abnormalities. Thorax X-ray showed a cardiothoracic index of 0.5, elongated aorta and normal pleuropulmonary fields.The patient underwent a coronary angiography by the Sones technique, which disclosed a luminal obstruction of 90% in the middle third of the right coronary artery (RCA) and 90% in the first marginal branch (MG) ( fig. 1) of the circumflex artery (CA). The venticulography showed a slight lower lateral hypocontractility.The patient was medicated with clopidogrel 300 mg and acetylsalicylic acid (AAS) 200 mg on the same day the angiography was carried out, and on the following day, after a pre-dilation with a Wordpass balloon-catheter (Johnson&Johnson-Cordis) 2.0 x 20 mm, he underwent the implantation of a sirolimus-eluting stent (CYPHER; Johnson&Johnson-Cordis) 2.5 x 18 mm in the lesion at the MG branch with success ( fig. 2). The stent was released with a 12 ATM pressure and the right femoral artery (RFA) was the access via used.The use of the Philips System for the quantitative angiographic analysis of the measurements of the left marginal branch disclosed, at the pre-implantation assessment, a reference diameter of 2.50 mm, a percent Case Report Case Report Case Report Case Report Case Report Case Report (CYPHER; Johnson & Johnson -Cordis) 2.5 x 1.8 mm in the lesion located at the left marginal branch. One year and five months after the CYPHER stent implantation, a new angiography showed intrastent coronary aneurysm at the left marginal branch. This case report suggests that the implantation of...

A male 39 year-old patient with post-infarction angina. The coronary angiography showed total proximal obstruction of right coronary artery (RCA), obstructive lesions of 95% of the anterior descending artery (ADA), 80% of the second left marginal branch (LM2), and 95% of the circumflex artery (CXA). The patient was successfully implanted with a Taxus 3.0 x 24 mm stent and an Express 2.75 x 24 mm stent in the proximal and distal thirds of the RCA, respectively, and with an Infinnium 3.0 x 24 mm stent in the ADA. After seven months, the patient had an anterior acute myocardial infarct (AMI) due to thrombosis of the Infinnium stent and restenosis of the Taxus stent, with no loss of results in the conventional stents.