Three-months optical coherence tomography analysis of a biodegradable polymer, sirolimus-eluting stent.

Objective: We aimed to assess early neointimal healing by optical coherence tomography (OCT) 3 months after implantation of the ultrathin Orsiro® sirolimus-eluting stent with biodegradable polymer.

Background: New generations of drug-eluting stents with biodegradable polymer have been developed to avoid the continued vascular irritation of durable polymers.

Methods: In this prospective, open-label study, 34 patients received an Orsiro® sirolimus-eluting stent with biodegradable polymer.

A randomized trial of bifurcation stenting technique in chronic total occlusions percutaneous coronary intervention.

Background: The optimal strategy to treat bifurcation lesions (BFLs) in a percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remains unknown.

Aims: We sought to assess whether T-provisional or mini-crush is appropriate for BFLs within CTO vessels.

Patients And Methods: From January 2011 to December 2013, patients who underwent successful CTO guidewire crossing and with a BFL within the CTO target vessel were enrolled prospectively and assigned randomly to either T-provisional stenting or the mini-crush technique for BFL treatment.

Mid-term outcome of biolimus-eluting stents with biodegradable polymer: results from a multinational prospective 'all-comers' registry.

Background: The Nobori biolimus-eluting stent (BES) is a biodegradable polymer drug-eluting stent (DES). Several studies have shown its noninferiority in comparison with durable polymer DES.

Aim: We sought to investigate the efficacy and the safety of Nobori BES in an all-comer population undergoing a percutaneous coronary intervention.

Incidence of atrial fibrillation after percutaneous closure of patent foramen ovale and small atrial septal defects in patients presenting with cryptogenic stroke.

Objective: The occurrence of atrial fibrillation after percutaneous closure of a patent foramen ovale for cryptogenic stroke has been reported in a variable percentage of patients. However, its precise incidence and mechanism are presently unclear and remain to be elucidated.

Design: Prospective follow-up study.

The role of the sizing balloon in selection of the patent foramen ovale closure device size.

Objectives: To find a correlation between the patent foramen ovale (PFO) size measured by the sizing balloon and the appropriate closure device size.

Methods: The PFO of 57 patients was closed using a sizing balloon. A mathematical model was introduced to relate the PFO balloon waist diameter to the closure device size based on the PFO transformation from a slit-like to a circular form during balloon inflation.

Aberrant right coronary artery occlusion during the percutaneous pulmonary trunk stenting in a patient with tetralogy of Fallot.

Aberrant coronary arteries are frequently observed in patients presenting with Fallot's tetralogy (TOF). Before the complete surgical repair of the TOF, the percutaneously performed pulmonary trunk (PT) angioplasty is often performed in order to temporarily increase the pulmonary circulation, thus increasing the pulmonary vessel size, finally improving surgical outcome. This case reports a 12-year-old boy with a TOF insufficiently improved by surgical correction, in whom a PT angioplasty with stent implantation was complicated by an extrinsic compression of an aberrant right coronary artery (RCA) causing a myocardial ischemia with severe hypotension.

Differentiated analysis of an everolimus-eluting stent and a paclitaxel-eluting stent among higher risk subgroups for restenosis: results from the SPIRIT II trial.

Aims: Restenosis is higher among certain subpopulations when subjected to percutaneous coronary interventions even when using drug-eluting stents. The randomised SPIRIT II trial demonstrated the superiority of the XIENCE V Everolimus Eluting Coronary Stent System over the TAXUS Paclitaxel-Eluting Stent System in terms of in-stent late loss at six months among 300 patients treated for de novo native coronary artery lesions.

Methods And Results: In this post-hoc analysis of SPIRIT II we focused on six-month angiographic outcomes of diabetic patients (n=69), left anterior descending arteries (n=149), long lesions >20 mm (n=43), small vessels <3.

Coronary myocardial bridge: an innocent bystander?

Myocardial bridge (MB) or tunneled coronary artery is an inborn abnormality, which implicates a systolic vessel compression with a persistent mid-late diastolic diameter reduction. Myocardial bridges are often observed during coronary angiography with an incidence of 0.5%-5.

Feasibility of the PCI through 6F diagnostic catheters.

Background: The choice of guiding catheter for optimal back-up support is critical in order to achieve a successful PCI. Diagnostic 6 French (F) catheters have an internal lumen diameter as large as 5F guiding catheters. The aim of this study was to demonstrate for the first time the feasibility of performing PCI with Cordis 6F diagnostic catheters in selected coronary lesions.

Interatrial septum rupture during balloon measurement of a patent foramen ovale in a young patient presenting cryptogenic stroke.

We report the case of a 36-year-old woman admitted for cryptogenic stroke, in whom the Patent Foramen Ovale (PFO) diameter measurement, with a purpose built sizing balloon, performed before the closure procedure, was complicated with the rupture of the inter-atrial septum generating an Atrial Septal Defect (ASD) with a significant left-to-right shunt. This kind of complication may not be easy to handle, changing the initial procedural strategy from PFO to ASD closure technique requiring specific material and operator's technical skill.

Feasibility and safety of intra-coronary Beta irradiation with 144Ce/Pr for prevention of restenosis after percutaneous transluminal coronary angioplasty of in-stent restenotic lesions.

Background: Endovascular brachytherapy is a proven and efficacious treatment of coronary in-stent restenosis with established long-term benefit. Owing to its complexity and logistic inconveniences, brachytherapy did not find wide acceptance, especially in the current drug-eluting stents era. We conducted a single center, non-randomized pilot trial with 144Ce/Pr, utilizing a new high-energy Beta emitting source, for prevention of restenosis after percutaneous treatment of in-stent restenotic lesions.

Late cardiac tamponade after percutaneous closure of a patent foramen ovale.

We report the case of a 35-year-old man who had a transient ischemic cerebral attack and then underwent a percutaneous closure of the patent foramen ovale (PFO) with a Cardiastar device. One year later, the patient developed a cardiac tamponade due to an important hemorrhagic pericardial effusion. Transoesophageal echocardiography showed that one of the struts had impinged on the aortic root in the region adjacent to the transverse pericardial sinus.

High-risk left main coronary stenting supported by percutaneous left ventricular assist device.

Percutaneous left ventricular assist devices could nowadays offer a valid support to percutaneous coronary interventions even in very high risk patients. This case illustrates a successful distal left main coronary artery V-stenting supported by the Tandem Heart in a patient with severe left ventricular dysfunction, severe aortic stenosis, and refractory myocardial ischemia.

Biological aspects of radiation and drug-eluting stents for the prevention of restenosis.

Based on recent advances, this article aims to review the biological basis for the use of either radiation or drug-eluting stents for the prevention of restenosis, and to elucidate the complementary role that they may play in the future. Vascular restenosis is a multifactorial process primarily driven by the remodeling of the arterial wall, as well as by the hyperproliferation of smooth muscle cells (SMC). These pathophysiological features are the target of therapeutic strategies aimed at inhibiting constrictive remodeling as well as inhibiting SMC proliferation.

A case of renal artery brachytherapy for in-stent restenosis: four-year follow-up.

Renal artery stent implantation is associated with high rates of restenosis, particularly in vessels less than 4.5 mm in diameter. We describe 4-year follow-up results in the first patient to receive renal artery brachytherapy for this indication.

A morphological-mechanical explanation of edge restenosis in lesions treated with vascular brachytherapy.

Purpose: Edge restenosis in stenotic lesions treated by implantation of a conventional stent followed (or preceded) by a catheter-based brachytherapy is often attributed to "geographic miss" (GM). We propose a complementary (or, possibly, alternative) explanation based on the concept that a clear postprocedural mismatch between the in-stent lumen and the normal (undilated) lumens of the proximal and/or distal vessel segments results in an excessive, damageable increase of axial wall stress in these segments.

Methods: The possible poststenting situations at both margins of a stent are examined, and based on the presence or absence of an increase in axial wall stress, predictions are made about the lesion evolution.

In-hospital complications of percutaneous intraaortic balloon counterpulsation.

Complications related to intraaortic balloon counterpulsation pumping (IABP) remain a problem despite the development of small caliber balloon catheter shafts and introducer sheaths. The authors report their experience in counterpulsation-related complications of 201 consecutive patients who underwent 212 percutaneous counterpulsation balloon insertions from June 1989 to June 1996 by use of balloons with 8-9.5 French shafts.

Time savings with prehospital thrombolysis in an urban area.

The aim of this study was to evaluate the time saved by prehospital thrombolysis compared with the usual inhospital reperfusion strategies in Geneva, Switzerland, a moderate-sized urban area with short transportation times (median time 4 min). Patients with acute myocardial infarction, diagnosed clinically and by means of a 12-lead electrocardiogram in a mobile intensive care unit, without contraindications to thrombolysis, were randomly assigned either to 'prehospital thrombolysis' or to 'usual hospital care', i.e.

Heterogeneity of smooth muscle cell populations cultured from pig coronary artery.

Objective: Heterogeneous smooth muscle cell (SMC) populations have been described in the arteries of several species. We have investigated whether SMC heterogeneity is present in the porcine coronary artery, which is widely used as a model of restenosis.

Methods And Results: By using 2 isolation methods, distinct medial populations were identified: spindle-shaped SMCs (S-SMCs) after enzymatic digestion, with a "hill-and-valley" growth pattern, and rhomboid SMCs (R-SMCs) after explantation, which grow as a monolayer.

Gamma-irradiation markedly inhibits the hydrated collagen gel contradiction by arterial smooth muscle cells.

Background: Vessel wall responses to percutaneous transluminal coronary angioplasty include neointimal proliferation and arterial remodeling. The contraction of a collagen gel is a good in vitro model of wound repair and vascular remodeling. Because irradiation is an important new therapeutic modality capable of preventing restenosis, the purpose of this study was to evaluate the effect of irradiation on the contraction of a collagen gel by smooth muscle cells (SMCs), on SMCs viability, and on DNA synthesis.