Renal denervation for resistant hypertension: acute results and long-term follow-up.

Introduction: Renal sympathetic hyperactivity is vital for the maintenance and progression of essential hypertension. Catheter-based renal denervation is an evolving concept with favourable results regarding the control of hypertension; however, clinical experience is still limited.

Methods: We enrolled 15 patients with resistant hypertension who underwent percutaneous, catheter-based radiofrequency treatment for renal artery denervation.

Spot drug-eluting stenting for long coronary stenoses: long-term results of a randomized clinical study.

Background: Preliminary results of a randomized trial have suggested that total lesion coverage with drug-eluting stents (DES) is not necessary in the presence of diffuse disease of nonuniform severity. In the present study, we report long-term results of this trial.

Methods: Consecutive, consenting patients with a long (>20 mm) coronary lesion of nonuniform severity and indication for percutaneous coronary intervention were randomized to full stent coverage of the atherosclerotic lesion with multiple, overlapping (full DES group, n = 90) or spot stenting of the hemodynamically significant parts of the lesion only (defined as diameter stenosis > 50%) (spot DES group, n = 89).

Ruptured versus stable plaques in human coronary arteries.

Objective: To derive a model for the identification of left anterior descending (LAD) coronary artery stenoses predisposed to plaque rupture and thrombosis.

Methods: Coronary angiograms of 186 consecutive patients (original sample) with an anterior ST elevation myocardial infarction (STEMI) and a recanalized LAD were reconstructed in the three-dimensional space. Culprit lesions were compared with 293 stable LAD coronary stenoses on the same patients.

Autonomic neural control of cerebral hemodynamics.

Despite the rich innervation of the cerebral vasculature by both sympathetic and parasympathetic nerves, the role of autonomic control in cerebral circulation and, particularly, cerebral hemodynamics is not entirely clear. Previous animal studies have reported inconsistent results regarding the effects of electrical stimulation or denervation on cerebral blood flow (CBF), cerebral pressure-flow relationship, and cerebral vessel response to metabolic stimuli. Moreover, with the advance of transcranial Doppler ultrasound (TCD), which yields accurate measurements of CBF velocity (CBFV) with high time resolution, it has been found that in humans CBFV in the middle cerebral artery decreased substantially during lower body negative pressure (LBNP) and head-up tilt in the absence of systemic hypotension, which suggests the presence of cerebral vasoconstriction associated with augmented sympathetic nerve activity during orthostatic stress.

Comparison of long versus short ("spot") drug-eluting stenting for long coronary stenoses.

We compared spot drug-eluting stenting (DES) to full stent coverage for treatment of long coronary stenoses. Consecutive, consenting patients with a long (>20 mm) coronary lesion of nonuniform severity and indication for percutaneous coronary intervention were randomized to full stent coverage of the atherosclerotic lesion with multiple, overlapping stenting (full DES group, n = 90) or spot stenting of hemodynamically significant parts of the lesion only (defined as diameter stenosis >50%; spot DES group, n = 89). At 1-year follow-up, 14 patients with full DES (15.

Three-dimensional analysis of vulnerable segments in the left anterior descending artery.

Objectives: Analysis of conventional angiograms has suggested that specific anatomic parameters of particular segments of a coronary artery render them prone to vulnerable plaque development, plaque rupture, and consequent thrombosis. This study aimed at performing a three-dimensional analysis of recanalized left anterior descending (LAD) coronary arteries in patients who had suffered an anterior ST-elevation myocardial infarction (STEMI).

Methods: Coronary angiograms of 76 consecutive patients with an anterior STEMI and a recanalized LAD were reconstructed in the three-dimensional space, and compared with angiograms of 76 patients with stable coronary artery disease (SCAD) and significant LAD stenosis.

Three-dimensional analysis of the left anterior descending coronary artery: comparison with conventional coronary angiograms.

Objective: This study aimed at comparing three-dimensional (3-D) reconstruction with two-dimensional coronary angiograms with respect to anatomical parameters that might affect plaque formation and rupture.

Methods: Sixty patients with stable left anterior descending (LAD) lesions and 60 patients with an anteroseptal myocardial infarction and recanalized LAD were studied.

Results: Conventional angiography significantly underestimated the distance of the stenosis from the ostium of the LAD, 29.

Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis.

Aims: To perform a comprehensive analysis of all aspects of patient and in-room personnel radiation dosimetry in interventional electrophysiology.

Methods And Results: Measurements were performed during 19 diagnostic electrophysiology studies and 24 catheter ablations. Kerma-area product and exposure time values were 48.

Handgrip-enhanced myocardial fractional flow reserve for assessment of coronary artery stenoses.

Background: Fractional flow reserve (FFR) may yield false-negative results in up to 12% of lesions tested, and there is a zone of uncertainty at borderline values.

Methods: Forty-eight patients were investigated by means of dobutamine stress echocardiography (DSE), coronary angiography, and FFR assessment of 48 coronary lesions before, during, and immediately after handgrip exercise.

Results: Mean FFR values were lower during and immediately after handgrip exercise as compared with baseline (0.

Patient dosimetry during coronary interventions: a comprehensive analysis.

Background: We performed a detailed analysis of patient radiation during coronary interventions, comparing dose measurements to established dose reference levels, assessing coronary artery doses, and estimating total radiation risk of fatal cancer.

Methods: We prospectively examined 281 patients who were subjected to 307 percutaneous coronary interventions.

Results: The mean kerma area product (KAP) per procedure was 82.

Medical personnel and patient dosimetry during coronary angiography and intervention.

Percutaneous coronary interventions are associated with increased radiation exposure compared to most radiological examinations. This prospective study aimed at (1) measuring entrance doses for all in-room personnel, (2) performing an assessment of patient effective dose and intracoronary doses, (3) investigating the contribution of each projection to kerma-area product (KAP) and irradiation time, (4) comparing results with established DRL values in this clinical setting and (5) estimating the risk for fatal cancer to patients and operators. Measurements were performed during 40 consecutive procedures of coronary angiography (CA), half of which were followed by ad hoc coronary angioplasty (PTCA).