Minerva cardioangiologica
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Minerva cardioangiologica · Feb 2009
ReviewUpdate on the management of atherosclerotic renal artery disease.
Typically involving the renal artery ostium or proximal segment of the renal artery, atherosclerosis is the major cause of renal artery stenosis. While commonly without direct clinical consequences, the presence of renal artery atherosclerosis is associated with atherosclerotic disease in other vascular beds and in some subjects may give rise to systemic hypertension, progressive renal dysfunction and/or heart failure. ⋯ The role for concomitant renal artery revascularization remains unclear and the decision should be individualized depending on patient preferences, co-morbidities, institutional expertise, and carefully weighed risks and benefits. Ongoing trials including CORAL and ASTRAL will hopefully provide critical evidence for or against this additive invasive strategy.
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Minerva cardioangiologica · Feb 2009
Comparative StudyLong term results of unprotected left main percutaneous coronary intervention with DES versus BMS.
Stenosis in the unprotected left main coronary artery (ULMCA) is considered a standard indication for surgical revascularization. Some studies have demonstrated that stenting of the ULMCA is safe and feasible in selected patients. Drug eluting stents (DES) have been shown to be superior to bare metal stents (BMS) in reducing restenosis and major adverse cardiac events (MACE) both in-hospital and at follow-up after treatment of ULMCA disease. Several studies showed that the mid-term prognosis of patients with left main stenting is good, but most of them are limited by small populations and the availability of mid-term results. Thus, we sought to evaluate the very long term impact of DES vs BMS in a large cohort of patients undergoing stent implantation for ULMCA disease in our center. ⋯ Patients presenting with ULMCA disease, who are treated with DES have a significant reduction in the rate of target lesion revascularization with no increased risk of death or myocardial infarction.