Δευτέρα, 14 Δεκεμβρίου 2015

Οι εργασίες μας στο διεθνές συνέδριο στεφανιαίας νόσου στη Φλωρεντία - Ιταλία, 2015

Είχα την τιμή να συμμετάσχω στις εργασίες που παρουσιάσθηκαν στο 11th International Congress on CORONARY ARTERY DISEASE, Florence, Italy (Διεθνές Συνέδριο σχετικό με τη ΣΤΕΦΑΝΙΑΙΑ ΝΟΣΟ). Το οποίο διεξήχθη στη Φλωρεντία - Ιταλία, από 29/11 έως και 02/12/2015. Οι δύο εργασίες, στις οποίες συμμετείχα, αφορούσαν:
  • η πρώτη στον επιπολασμό, στη θεραπευτική αντιμετώπιση και στη μεσοπρόθεσμη πρόγνωση του αυτόματου διαχωρισμού των στεφανιαίων αγγείων. Αποτέλεσμα που προέκυψε από μια βάση δεδομένων 5350 ασθενών.
  • η δεύτερη σε οξύ στεφανιαίο σύνδρομο σε έναν ασθενή, στον οποίο συνυπήρχαν δύο ξεχωριστές μορφές συγγενούς δυσπλασίας: η μονήρης στεφανιαία αρτηρία και ο διπλός πρόσθιος κατιών κλάδος, ένα εξαιρετικά σπάνιο περιστατικό συγγενούς ανωμαλίας των στεφανιαίων αρτηριών.



























Abstract: 028

PREVALENCE, THERAPEUTIC MANAGEMENT AND MEDIUM-TERM PROGNOSIS OF SPONTANEOUS CORONARY ARTERY DISSECTION: RESULTS FROM A DATABASE OF 5350 PATIENTS

Aims


To assess the prevalence, clinical presentation, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection (SCAD).

Method

A retrospective single-center cohort study. Over a 7-year period in 5350 coronary angiographies study identified 9 patients with angiographically confirmed SCAD (0.17%). Mean age was 42.6 years and 88,9% were female. Most patients presented with an acute myocardial infarction (8 pts). SCD had a diffuse angiographic pattern in most cases.

Results

Coronary angiography revealed involvement of coronary vessel distribution: LAD in 7 cases (77,8%), RCA in one case(11,1%) and LM in another (11,1%). 8 cases were treated with coronary stenting and 1 patient underwent coronary artery bypass grafting. The mortality rate was 0% during hospitalization. In one patient we dealt with retrograde extension of the dissection to the left main as an complication. He was treated with PCI in day 5 of his hospitalization. During follow-up no cases of repeated SCAD were recorded and 1 case of repeat percutaneous coronary intervention due to restenosis.

Conclusion

SCAD affects a young, predominantly female population, frequently presenting as ST elevation myocardial infarction ECG pattern. Revascularisation of SCAD patients might be challenging, with no guidelines yet in place. In the case where PCI is required, the potential benefits and use of bioabsorbable stent should be considered.Especially in cases of extensive or distally located dissection.

Co-authors

C. Graidis1, D. Dimitriadis1, G. Dimitriadis1, G. Tsonis2, V. Karasavvidis1, T. Bitsis1, E. Argyropoulou1, A. Antoniou3, G. Karakostas4.

1Euromedica Kyanous Stavros General Hospital, Interventional Cardiology, Thessaloniki, Greece.
2Euromedica Kyanous Stavros General Hospital, Cardiothoracic Department, Thessaloniki, Greece.
3General Hospital of Serres, Cardiology Department, Serres, Greece.
4General Hospital of Kilkis, Cardiology Department, Kilkis, Greece.




Abstract: 031

ACS IN A PATIENT WITH A SINGLE CORONARY ARTERY AND THE PRESENCE OF A DOUBLE LAD, AN EXTREMELY RARE CASE OF CONGENITAL ANOMALY OF CORONARIES

Aims


Congenital coronary anomalies are uncommon with an incidence 35 ranging from 0.17% in autopsy cases to 1.2% in angiographically evaluated cases. The recent development of ECG–gated multi–detector row computed tomography (MDCT) coronary angiography allows accurate and noninvasive depiction of coronary artery anomalies. We present a unique case of a patient that was admitted to our department with acute coronary syndrome and his coronary angiography revealed an extremely rare congenital coronary artery anomaly.

Method

In this case the patient underwent coronary angiography that revealed the coexistence of a two distinct coronary artery anomalies, the presence of a single coronary artery (SCA type R/3/P) together with the existence of a double left anterior descending artery (double LAD type IV). Subsequently a 64 multi slice CT coronary angiography with injection of 80 ml nonionic contrast medium. Retrospective gating technique was used to synchronize data reconstruction with the ECG signal. Maximum intensity projection, multi-planar reformatted, and volume rendering images were derived from axial scans.

Results

The results of this study support the use MDCT coronary angiography as a safe and effective noninvasive imaging modality for defining CAAs in an appropriate clinical setting, providing detailed three-dimensional anatomic information that may be difficult to obtain with invasive angiography. 







Conclusion
It’s of great importance the diagnostic approach to cases like that, in order to properly design the conservative, surgical or percutaneus treatment. To our knowledge the above coronary artery variation has not described in the literature yet.

Co-authors


C. Graidis1, D. Dimitriadis1, A. Mavrogianni2, G. Dimitriadis2, V. Karasavvidis1, T. Bitsis1, A. Tsiakou1, I. Bostanitis2, I. Zarifis2.

1Euromedica Kyanous Stavros General Hospital, Interventional Cardiology Department, Thessaloniki, Greece.
2Papanikolaou General Hospital, Interventional Cardiology Department, Thessaloniki, Greece.