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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A thrombus was observed in the left anterior descending coronary artery in a 47 year-old woman who presented with acute anterior myocardial infarction. On a coronary angiogram in the right oblique cranial position, the thrombus appeared as an eccentric, solid and homogeneous mass with a 22 mm maximal length and 1.9 mm maximal diameter. The thrombotic segment and the rest of the coronary tree was free of atherosclerosis. Due to the inappropriate coronary structure and length of the thrombus, coronary angioplasty and/or stent procedures were not performed. The patient refused coronary artery by-pass. She was given the glycoprotein IIb/IIIa inhibitor tirofiban 0.4 microg x kg(-1) x min(-1) bolus over 30 minutes followed by 0.1 microg x kg(-1) x min(-1) for 24 hours, orally acetylsalicylic acid 300 mg per day, nytroglicerin 40 mg per day and warfarine with INR being in a range of 2-2.5 times. A control coronary angiography performed two months later showed total dissolution of the coronary thrombus and clearance of the culprit vessel.
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PMID:Resolution of a spontaneous coronary artery thrombus with a new antiplatelet agent. 1157 60

The hemostasis is a complex regulated system. It can be subdivided into the coagulation cascade, the fibrinolytic system, thrombocytes and cellular hemostasis. In atherosclerosis there are several systemic changes of the hemostasis and fibrinolysis, especially in diabetics. These alterations are markedly pronounced in patients with acute complications like acute coronary syndromes. The alterations in these patients constitute a prothrombotic state. To treat this procoagulant situation several drugs like antithrombins, antiplatelet drugs including glycoprotein IIb/IIIa-receptor antagonists, and others are used. This therapy itself can cause perioperative hemostatic disorders. Therefore, a close communication between cardiologist and cardiac surgeon is necessary to handle this complex situation.
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PMID:[Overview of the relevant aspects of the blood coagulation system--focus and cardiovascular hemostasis]. 1182 17

Percutaneous coronary intervention represents an established method to obtain revascularization in patients suffering from obstructive coronary artery disease. Despite the predictability of procedural results and the favorable clinical outcome shown in large series, there are still areas in which the clinical benefits of intervention are less impressive and a lot remains to be done to improve both procedural and clinical outcomes. Among these areas, one may well include the subgroup of patients with previous bypass surgery, who have been consistently shown to be affected by a high rate of periprocedural complications as well as late recurrence. The risk profile of these patients is examined under two main perspectives: the burden of more severe baseline clinical conditions (age, ventricular function, severity of coronary disease) and the negative impact of graft atherosclerosis. The basic assumption of this article is that a variable combination of these characteristics identifies subsets with increasing risk of complications and/or recurrence. For this reason, results of percutaneous revascularization in these patients may still represent a technical as well as a clinical challenge. In particular, the long debated relationship between composition of atherosclerotic plaque in saphenous vein graft, distal embolization, periprocedural myocardial damage and early and late adverse events represents a negative sequence that currently available pharmacologic and interventional resources cannot consistently antagonize. Added to this, are the unresolved issues of diffuse degeneration and chronic total occlusion of saphenous vein grafts, in which no therapeutic approach, alone or in combination, has substantially modified the poor outcome of these lesions. The use of glycoprotein IIb/IIIa receptor antagonists is also discussed, in the light of available data derived from large clinical trials, casting doubts on the efficacy of these otherwise essential pharmacologic agents. Lastly, the setting of acute myocardial infarction represents the clinical scenario in which the adverse effects of the combination of clinical and angiographic characteristics are clearly appreciated. Both coronary intervention and cardiac surgery represent fields of rapidly growing knowledge and technology. It is likely that in the near future we will witness major changes in the clinical management of these patients, thanks to the increasing utilization of arterial conduits, the widespread use of local drug delivery, the availability of new percutaneous devices, and the development of integrated pharmacologic and mechanical revascularization strategies.
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PMID:[Coronary angioplasty in subgroups at risk: patients treated with bypass]. 1189 71

It has been estimated that 15-25% of patients who undergo percutaneous or surgical coronary angioplasty are diabetics. The indications for coronary revascularization and initial results of the procedure do not differ substantially between patients with diabetes mellitus and non-diabetics. However, the long-term results of both percutaneous and surgical coronary angioplasty are less favorable in diabetics in terms of mortality and the need for new revascularization procedures. The development and widespread use of stents and glycoprotein IIb/IIIa receptor inhibiting drugs have improved the clinical evolution of diabetics treated with angioplasty. Currently available data show that the administration of glycoprotein IIb/IIIa inhibitors to patients undergoing coronary angioplasty is especially useful in diabetics and improves short-term and long-term results, decreasing one-year mortality by 45%. There seem to be indications for the routine use of glycoprotein IIb/IIIa inhibitors in diabetics treated with angioplasty. While the use of stents has improved long-term and short-term results in diabetics, the success rates of angioplasty in diabetics are still lower than in non-diabetics. Diabetes is still an independent predictor of restenosis and long-term events after stenting interventions. Analysis of the studies comparing percutaneous and surgical revascularization in diabetic patients with multivessel disease shows that surgery is superior in terms of long-term mortality and need for new revascularization procedures. Stenting has improved, but not substantially, the results of multivessel angioplasty in diabetics. Therefore, the indications for angioplasty in multivessel diabetics should be evaluated individually. Factors that contribute to the less favorable post-angioplasty evolution of diabetic patients are more rapid progression of atherosclerosis and, especially, a higher rate of restenosis. New angioplasty techniques, such as brachytherapy and drug-eluting stents, are likely to significantly improve the results of percutaneous interventions in diabetics, thus allowing the indications for angioplasty in diabetics to be extended even further in the near future.
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PMID:[Coronary angioplasty in diabetic patients. Current and future perspectives]. 1242 76

Acute coronary syndrome (ACS) is often associated with the rupture of vulnerable atherosclerotic plaque, coronary thrombus formation, and abrupt limitation of blood flow, leading to adverse outcomes. Passivation of vulnerable plaque represents a therapeutic concept that has the potential to prevent or limit the magnitude of a new rupture in order to reduce the recurrence or severity of events. Plaque passivation can be defined as a process by which the structure or content of the atherosclerotic plaque is changed to reduce the risk of subsequent rupture and thrombosis. This may be achieved by using strategies that address different components of the plaque or the endothelium. The following factors can affect the susceptibility of plaque to rupture: macrophage infiltration; accumulation of inflammatory cells; paracrine secretion of enzymes that may cause degradation of the fibrous cap of coronary plaque; shear stress; circadian rhythm variation in stress hormone release; and infectious agents. The use of pharmacologic agents to reduce plaque vulnerability by passivation has been explored. Clinical studies demonstrate that lipid-modifying agents (e.g., statins), antiplatelet agents (acetylsalicylic acid, thienopyridines, thianopyridines, glycoprotein IIb/IIIa inhibitors), and antithrombotic agents (unfractionated heparin and low-molecular-weight heparin) can reduce the occurrence of acute coronary events in ACS patients. In addition, angiographic studies suggest that statins may also promote regression of atherosclerosis. Angiotensin-converting enzyme inhibitors, niacin, and calcium antagonists may also contribute to plaque passivation. This article reviews atherosclerotic plaque development and vulnerability and discusses some clinical studies highlighting the role of plaque passivation in the management of ACS patients.
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PMID:Pharmacologic plaque passivation for the reduction of recurrent cardiac events in acute coronary syndromes. 1264 37

Conventional therapy for non-ST-segment elevation acute coronary syndrome (ACS) has traditionally employed an "ischemia-guided" strategy. In this approach, diagnostic cardiac catheterization and revascularization are only used in patients with objective evidence of myocardial ischemia as identified by recurrent symptoms or provocative stress testing. More recent studies, however, have demonstrated improved clinical outcomes with the use of an "early invasive" approach, employing routine coronary angiography early in the patient's hospital course, followed by percutaneous intervention or bypass surgery where appropriate. Improved clinical outcomes associated with an "early invasive" strategy may have evolved as a consequence of recent advances in both adjunctive pharmacotherapy and revascularization technique. In particular, use of glycoprotein IIb/IIIa inhibitors and/or low-molecular-weight heparin before catheterization have been shown to reduce clinical events in patients with ACS, and may reduce the risk of an invasive approach by plaque passivation before interventional therapy. Perhaps more importantly, the combined use of glycoprotein IIb/IIIa inhibitors and intracoronary stenting may reduce the potential early hazard of an invasive approach by specifically decreasing the incidence of death and nonfatal myocardial infarction associated with percutaneous intervention. In spite of the benefits of this synergistic combination of pharmacology and mechanical revascularization, risk stratification remains important in identifying high-risk individuals most likely to benefit from an "early invasive" approach. In addition, angiography with possible percutaneous coronary intervention of "culprit" lesions should always be used in combination with aggressive medical therapy to treat the widespread coronary atherosclerosis commonly seen in patients with ACS.
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PMID:"Ischemia-guided" versus "early invasive" strategies in the management of acute coronary syndrome/non-ST-segment elevation myocardial infarction: the interventionalist's perspective. 1264 47

Atherosclerosis, with its thromboembolic complications (including sudden cardiac death, myocardial infarction, and other ischemic organ damage such as stroke and ischemic renovascular disease), represents by far the major cause of death, morbidity, and disability for industrialized countries, and is rapidly spreading worldwide. Atherosclerosis is also a paradigm for complex, multifactorial disorders that affect humans in an age-dependent fashion. Atherosclerosis has usually been studied in a descriptive framework of biological and clinical data gathered over more than a century. As such, it is a chronic inflammatory process that selectively affects arterial vessels, and is, at least in part, genetically predetermined. Despite spectacular progress in the cardiovascular discipline, with the development of therapeutic strategies that have substantially improved the outcome of affected patients, several key questions remain unanswered: Why is aging such a powerful risk for coronary artery disease? What is the triggering mechanism for atherosclerotic inflammation? Also, in the context of this and accompanying reviews, do we modify coronary inflammation with glycoprotein IIb/IIIa blockers? Recent progress in our understanding of the underlying process of atherosclerosis has provided us with the opportunity to refine the answers to some of these questions.
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PMID:Inflammation, platelets, and glycoprotein IIb/IIIa inhibitors. 1266 59

Platelet inhibiting drugs are mainly used to prevent arterial thrombosis complicating atherosclerosis. Numerous clinical trials have delineated their clinical indications and precise guidelines are internationally available. The mechanism of action of aspirin is well understood: inhibition of platelet synthesis of thromboxane, and there is a pretty good relationship between pharmacology at the molecular and cellular levels and clinical results. The recently available drugs are the following. Clopidogrel is a thienopyridine, which irreversibly inhibits platelet activation by ADP interacting with the recently cloned P2Y12 receptor. There are also inhibitors of the fibrinogen binding to its platelet receptor, the glycoprotein IIb/IIIa complex, which is the key mechanism of platelet aggregation. These new drugs are widely used in patients with active coronary artery disease, on top of aspirin.
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PMID:[Platelet inhibitors: old and new]. 1269 52

The cardiovascular continuum describes the way from risk factors to atherosclerosis, acute cardiovascular events (unstable angina and myocardial infarction), and development of terminal heart failure and its complications. Following this way, advances are reported in the prevention of cardiovascular disease, in noninvasive diagnostics and revascularization of coronary artery disease, and in new therapeutic options of acute myocardial infarction. The following issues are reported in detail: (1) significance of statins, inhibition of platelet aggregation and vitamins in primary and secondary prevention of cardiovascular disease, (2) comparison of the angiotensin receptor blocker losartan and the beta-blocker atenolol in hypertension (LIFE study), (3) magnetic resonance angiography for the detection of coronary stenoses, (4) advantages and disadvantages of operative and interventional coronary revascularization considering elderly patients and sirolimus-eluting stents, and (5) efficacy of glycoprotein IIb/IIIa inhibition and low molecular weight heparin in acute myocardial infarction.
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PMID:[From risk factors to symptomatic coronary artery disease. Update cardiology 2001/2002--part I]. 1271 45

The cardiovascular continuum describes the way from risk factors to atherosclerosis, acute cardiovascular events (unstable angina and myocardial infarction), and development of terminal heart failure and its complications. Following this way, advances are reported in the therapy of acute coronary syndrome, heart failure, ventricular and supraventricular tachyarrhythmias, and stroke in patients with patent foramen ovale. The following issues are reported in detail: (1) significance of statins and statin withdrawal, glycoprotein IIb/IIIa receptor blocker, acute coronary interventions, aspirin and clopidogrel in unstable coronary syndromes, (2) pathogenesis of acute pulmonary edema associated with hypertension, (3) cardiac regeneration capability after transplantation and myocardial infarction, (4) beta-blocker therapy, efficacy of additional angiotensin receptor blocker therapy and multisite biventricular pacing in symptomatic (advanced) heart failure, (5) prognosis after ablation of the atrioventricular node in patients with atrial fibrillation, (6) primary prevention with an implantable defibrillator and resumption of driving after implantation, and (7) therapeutic options after cryptogenic stroke and patent foramen ovale.
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PMID:[Update cardiology 2001/2002-part II. From unstable coronary syndrome to terminal heart failure]. 1281 17


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