IJCS | Volume 32, Nº2, May/June 2019

300 Falcão et al. Coronary angioplasty with bleeding Int J Cardiovasc Sci. 2019;32(3)297-301 Case Report endothelization of the stent struts occurs. Discontinuation of the therapy before this process increases the risk of stent thrombosis. Although the mechanism of thrombosis has not been fully elucidated, the design of the stent platform, toxicity of antiproliferative drugs and the type of the stent polymer (biodegradable vs. durable polymers) are important factors. In general, antiplatelet therapy should be continued for at least 30 days in a case of conventional stents, and for one year if drug-eluting stents are used. 5 Hemorrhagic complications in patients undergoing PTCAhave been associatedwith increased risk of adverse events, such as acute infarction, stroke, stent thrombosis and death in patients with acute coronary syndromes and in patients with chronic diseases. Although the exact mechanism of this association is unknown, it may be related to discontinuation of therapies known to increase survival (antiplatelet drugs, beta-blockers), direct effects of blood transfusion, high prevalence of comorbidities of these patients, and deleterious effects of anemia. Thus, the anti-ischemic benefit of any therapy should always be weighed against the risk of bleeding. 6-10 Advanced age, female sex, chronic renal dysfunction and anemia are clinical predictors of bleeding after percutaneous procedures. The use of bleeding risk scores such as the CRUSADE and the HAS-BLED canmake this assessment more effective. 11 Early failure of arterial graft is not common. Early and long-termpatency of the LITA, when anastomosed to the LAD, is of 95% and 85-90%, respectively. Only 1% of the patients at the immediate postoperative of myocardial revascularization involving the LITA have symptoms of angina. The most common causes of early graft failure are related to technical issues, such as the anastomosis, since progression of the atherosclerosis in a short time period is unlikely. 12,13 In our patient, there was occlusion of the medial third of the LITA. Hypotension caused by vaginal bleeding created favorable conditions to occlusion of the LITA. As LITA failure is confirmed, the target of percutaneous revascularization may be the LITA or native coronary bed, depending on atherosclerosis severity. A second surgical approach should be indicated with caution in patients whose anatomy is unfavorable for interventionist procedure. 2 Uterine leiomyomas, the most common pelvic tumor in women, are benign tumors originating from smooth muscle cells in the myometrium that cause pelvic pain, infertility and vaginal bleeding. Therapeutic options are hormone therapy, surgery (hysterectomy or myomectomy), or interventional procedures (uterine arterial embolization). Less aggressive therapies (myomectomy and embolization) are the therapies of choice for patients who want to get pregnant. Uterine arterial embolization allows reduced hospitalization time and early return to daily activities as comparedwith surgical procedures. 14 The case reported exemplifies the combination of two common diseases in female patients that may be successfully treated by percutaneous procedures, with low risk of complications. Control of active bleeding by embolization procedures can be used for patients in need of coronary angioplasty and antiplatelet therapy. Author contributions Acquisition of data: Baião AH, Rivera M, Monteiro V, Oliveira FRA. Analysis and interpretation of the data: Cantarelli FL. Writing of the manuscript: Falcão FJA. Critical revision of themanuscript for intellectual content: Falcão FJA, Oliveira FRA. Potential conflict of interest The authors declare that they have no potential conflict of interest. Sources of funding This study did not have any source of funding. Study association This study has no relationship with any thesis or dissertation. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Instituto de Medicina Integral Prof. Fernando Figueira under the protocol number 4643. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study.