Nihon rinsho. Japanese journal of clinical medicine
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Several treatments for coronary artery disease have been developed. Current techniques for both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have improved the outcomes after procedures. ⋯ Several randomized controlled clinical trials demonstrated the superiority of CABG regarding major adverse cardiac and cerebral events to PCI. The selection of these two invasive therapies including hybrid approach should be done by both patients' clinical condition and anatomical characteristics of coronary artery.
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Diabetes mellitus (DM) is increasing in the world wide and a risk factor for the progression of coronary artery disease (CAD). CAD is the major cause of mortality in patients with DM. In the case of combination CAD with DM becomes a great threatening of their lifes. ⋯ Furthermore, patients with diabetes undergoing revascularization have worse mortality than non-diabetic patients. Optimal revascularization for CAD in the diabetic patients remains controversial, with availability of drug eluting stents and bypass surgery. Because of the worse prognosis in diabetic patients, making an effort toward an early diagnosis and aggressive medical treatment is necessary and a first step to improve their prognosis.
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Atherosclerosis accounts for 90% of the cases of renal artery stenosis. It is an important cause of secondary arterial hypertension by means of inducing the renin-angiotensin system, volume expansion, and sympathetic activation. ⋯ The accurate predictors identify the good indication for renal artery stenting is clinically needed. Currently, the presence of hemodynamically critical stenosis causing renal ischemia, the presence of symptoms with undoubtedly benefit from revascularization, and the assessment of procedural risk are key factors for decision making about indication of renal artery stenting.
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Thrombolysis is generally accepted in patients with acute massive pulmonary embolism, however, thrombolytic agents could not be fully administrated for cases with a high risk of bleeding. On the other hand, catheter intervention is an optimal treatment for massive pulmonary embolism patients having contraindications for thrombolysis, and is a minimally invasive alternative to surgical embolectomy. It can be performed with a minimum dose of thrombolytic agents or without, and can be combined various procedures including catheter fragmentation or embolectomy in accordance with the extent of thrombus on pulmonary angiogram. Hybrid catheter intervention for massive pulmonary embolism can reduce rapidly heart rate and pulmonary artery pressure, and can improve the gas exchange indices and outcomes.