Risultati per: Utilizzo degli stent-retriever nell’ictus ischemico acuto

Circulation, Volume 150, Issue Suppl_1, Page A4141302-A4141302, November 12, 2024. Background:After percutaneous coronary intervention (PCI), 5-10% of patients experience in-stent restenosis (ISR), and among these, 10-20% develop recurrent in-stent restenosis (RISR). Proteins could be encapsulated into exosomes and participate in intercellular signaling, affecting various progression of cardiovascular diseases. However, the effect of exosome-derived proteins on RISR progression needs further exploration.Aims:Vascular endothelial injury initiates restenosis post-PCI, with the excessive proliferation and migration of vascular smooth muscle cells (VSMCs) playing a central role. To elucidate the mechanisms by which exosomes derived from endothelial cells influence the proliferation and migration of VSMCs, thereby contributing to the exacerbation of RISR.Methods:Firstly, coronary plasma was collected from 8 RISR patients and 8 healthy controls. Exosomes were isolated using ultracentrifugation techniques. Protein components in exosomes were sequenced by four-dimensional data-independent acquisition (4D-DIA) quantitative proteomics. Exosomes with high TGF-β1 were co-cultured with primary VSMCs to assess their functional impact on cell behavior. After 24 hours of serum starvation to synchronize cell cycles, the cells were treated with PKH67-labeled exosomes. Subsequent confocal microscopy analysis to evalulate the presence of PKH67-labeled exosomes in VSMCs. Next, we performed cell proliferation assays (CCK-8) and migration assays (wound healing and transwell migration) to evaluate the effects of exosomal transfer on VSMC activity. The expression of TGF-β1, MYH9 and Smad2/3 pathway with their phosphorylation status in exosome-treated VSMCs were tested using WB assays.Results:Exosomes from RISR patients, with high TGF-β1 expression, were originated from endothelial cells and could be internalized by VSMCs. TGF-β1 activated Smad2/3 pathway and then promoted MYH9 expression. In addition, overexpression of TGF-β1 boosted the expression of MYH9, while the knockdown of TGF-β1 has the opposite effect. The functional rescue experiment validated that TGF-β1 can regulate downstream MYH9, and participates in the proliferation and migration of VSMCs via Smad2/3 pathway.Conclusion:Our study suggests that exosome-derived, endothelial cell-originated TGF-β1 is essential to VSMCs proliferation and migration. This process is mediated via TGF-β1- Smad2/3-MYH9 axis.

Circulation, Volume 150, Issue Suppl_1, Page A4147346-A4147346, November 12, 2024. Background:Although recent studies have suggested the advantages of utilizing optical coherence tomography (OCT) for image guidance during percutaneous coronary intervention (PCI) with drug-eluting stent implantation over conventional angiography, the specific impact on post-procedural lesion complications has remained uncertain. To address this gap, we conducted an updated systematic review and meta-analysis focusing on post-procedural lesion complications associated with OCT-guided versus angiography-guided procedures in lesions undergoing PCI with drug-eluting stent implementation.Methods:We searched systematically through Pubmed, Embase, and Cochrane for randomized controlled trials(RCTs), which included lesions undergoing PCI and drug-stent deployment guided by OCTversus angiography. Our primary outcome of interest was (1) stent malposition under OCT analysis. We also included the following secondary outcome: (2) dissections under OCT analysis. We excluded studies that did not use OCT imaging to analyze post-procedure lesions. Risk Ratios(RRs) with 95% confidence interval (CI) were pooled across studies using a random effect model.Results:Five RCTs comprising 3,266 lesions undergoing OCT or Angio PCI-guided and drug stent implementation were included, of whom 1,549(48,34%) underwent OCT. The number of moderate-severe calcified lesions was 370 (11.33%). Our results show a significant association with decreased stent malposition risk in the OCT group, showed a significant decrease in post-procedure risk regarding stent malpositioning ( RR: 0.80; 95% CI: 0.75-0.84; P

Circulation, Volume 150, Issue Suppl_1, Page A4114293-A4114293, November 12, 2024. Background:Stent length has been considered an important predictor of adverse events in stable patients undergoing percutaneous coronary intervention (PCI). However, there are few data in acute myocardial infarction (AMI) patients treated with very long drug-eluting stents (DES). We conducted this study to evaluate the impact of stent length on the long-term clinical outcomes.Method:The study included a total of 9,021 AMI patients who underwent PCI with 2ndgeneration DESs. The patients were categorized into 3 groups according to the stent length: group A (

Circulation, Volume 150, Issue Suppl_1, Page A4139718-A4139718, November 12, 2024. Background:Paclitaxel-coated balloon (PCB) has been used for the treatment of coronary artery disease in the small native coronary artery and its safety and efficacy have been reported in clinical trials.Research Questions:The real-word long-term outcomes after intravascular imaging device-guided percutaneous coronary intervention (PCI) with PCB have not fully elucidated.Aims:To elucidate the long-term outcome after PCB treatment.Methods:This was a single-center, retrospective and observational study. We enrolled 1226 lesions from 713 patients which were treated by intravascular imaging device-guided PCI with PCB (342 lesions from 211 patients) or durable-polymer everolimus-eluting stent (DP-EES, 784 lesions from 502 patients) which diameter was less than 3.0 mm in the native coronary arteries. Long-term clinical outcomes were compared between PCB and DP-EES. Primary outcome was major adverse cardiac event (MACE) defined as a composite of cardiac death (CD), myocardial infarction (MI), target vessel revascularization (TVR) and device thrombosis. Secondary outcomes were all-cause death, CD, MI, target lesion revascularization (TLR), TVR and device thrombosis. Cumulative incidences of clinical outcomes were estimated by the Kaplan-Meier method and compared by the log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) of PCB relative to DP-EES for MACE were estimated through a multivariable Cox model and an inverse probability weighted (IPW).Results:Cumulative 5-year incidence of MACE was similar between PCB and DP-EES (18.5% vs. 20.7%, P=0.78, Figure). Cumulative 5-year incidences of all-cause death (23.2% vs. 16.8%, P=0.12), CD (8.0% vs. 7.0%, P=0.81), MI (2.2% vs. 2.5%, P=0.97), TLR (5.9% vs. 8.9%, P=0.35), TVR (12.6% vs. 14.4%, P=0.90) and device thrombosis (0% vs. 0.6%, P=0.20) were also similar between PCB and DP-EES. Even after adjustment for baseline characteristics, cumulative 5-year incidence of MACE was similar between PCB and DP-EES (multivariate and IPW adjusted HRs 0.72 [95% CI: 0.37-1.39], P=0.33 and 0.67 [95% CI: 0.21-2.07], P=0.48, respectively).Conclusion:PCB demonstrated comparable 5-year clinical outcomes with intravascular imaging device-guided PCI compared to DP-EES.

Circulation, Volume 150, Issue Suppl_1, Page A4146986-A4146986, November 12, 2024. Case Description and Procedural Technique:86 year old female with a prior history of coronary artery bypass grafting presented with non-ST elevation MI underwent subtotal occlusion of vein graft supplying the large obtuse marginal artery.The left coronary bypass catheter was used to cannulate the vein graft, supplying the obtuse marginal artery. Balanced middleweight universal wire (BMW) was used to cross the lesion. Given the critical nature of the lesion, it was pre-dilated using a 2 mm balloon. Bare wire and emboshield NAV6 (2.5-4.8mm) embolic protection was then used for distal protection. Due to hemodynamically intolerance, direct stenting was opted for, and a 3.5 x 16 mm synergy stent was deployed over the BMW wire with accidental entrapment of the bare wire and embossed filter protection system behind the stent frame.We have then placed an un-inflated 2.5 mm balloon inside the stent frame over the BMW wire. A 1 mm sapphire balloon was advanced over the bare wire, and its distal tip was placed behind the proximal edge of the stent. It was then inflated at 8 atmospheres. Serial inflations behind the stent frame were done with slow advancement of the balloon, covering the entire length of the stent. The balloon was then upsized to 2 mm, and serial inflations were performed behind the stent frame. After creating enough lumen, the filter was pulled back and re-captured. The 2.5 mm balloon was then inflated inside the stent frame. The balloon was upsized to 3.5 mm for the good apposition of the stent frame. TIMI III flow was obtained without any complications.Discussion:Distal embolic protection with intravascular filters is often used during percutaneous intervention of saphenous venous grafts. Accidental entrapment of emboshield filter systems can occur behind the stent in emergent situations when buddy wire technique is used in the vein graft. Our technique describes removal of the entrapped filter in a safe manner keeping the stent frame in place without surgical intervention. A few similar cases have been reported in the literature with surgical removal of wire.

Giornata mondiale,con prevenzione evitabili fino al 90% dei casi

L’Italian Stroke Association lancia un piano d’azione

Objective
We evaluated the clinical safety and performance of the ultrathin strut biodegradable polymer-coated Supraflex Cruz (Sahajanand Medical TechnologiesLtd., Surat, India) sirolimus-eluting stent (SES) in an all-comer patient population requiring coronary stent implantation.

Study design
The study was a prospective, observational, multicentre, single-arm registry.

Study settings
The study was conducted at 19 NHS Hospitals across the UK, from March 2020 to September 2021.

Study participants
A total of 1904 patients with symptomatic coronary artery disease (age ≥18 years) who underwent percutaneous coronary intervention with at least one Supraflex Cruz SES were enrolled.

Primary and secondary outcomes measure
The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (TV-MI) and clinically indicated target lesion revascularisation (CI-TLR), at 12 months. Safety endpoints were stent thrombosis, all-cause death and any MI. Prespecified subgroups analysis included patients with diabetes mellitus, bifurcation lesion, type B2/C lesion defined as per ACC/AHA (American College of Cardiology/American Heart Association) lesion classification and long coronary lesions ( >20 mm).

Results
A total of 2973 Supraflex Cruz SES were implanted in 1835 patients (mean age: 65.20±11.03 years). Of these, 404 patients had diabetes mellitus (491 lesions), 271 had bifurcation lesions (293 lesions), 1541 had type B2/C lesions (1832 lesions) and 985 had long coronary lesions ( >20 mm, 1139 lesions). Among the overall population, device success was achieved in 98.2% of lesions. TLF occurred in 12 (0.7%) patients (0.3% cardiac death, 0.2% TV-MI, 0.2% CI-TLR) at 30 days and in 43 (2.3%) patients (0.8% cardiac death, 0.8% TV-MI, 0.8% CI-TLR) at 12 months follow-up. The rate of definite stent thrombosis was 0.3% in the overall population at 12 months. The incidence of TLF and stent thrombosis was 6.2% and 1% in the diabetic, 1.8% and none in bifurcation lesion, 2.5% and 0.3% in type B2/C lesion, and 2.7% and 0.3% in long coronary lesions ( >20 mm) subgroups, respectively. at 12 months follow-up.

Conclusion
The S-FLEX UK-II registry confirms the clinical safety and performance of the ultrathin Supraflex Cruz SES in an all-comer population with complex coronary artery disease, demonstrating low rates of TLF and stent thrombosis.

Trial registration number
ISRCTN39751665 (https://doi.org/10.1186/ISRCTN39751665)

Studio, già una perdita peso del 3% migliora controllo diabete

In patients who underwent PCI for stable coronary artery disease, a once-a-day oral inorganic nitrate treatment was associated with a significant decrease in both in-stent and in-segment LLL.

Il 19 ottobre castello Aymavilles colorato per Giornata afasia

Cardiologia, al via ad Ancona guidato da professor Dello Russo

Minore multimorbidità cardiometabolica

We were delighted to read the article by Jarosova et al, which presents the results of a randomised controlled trial investigating the efficacy of endobiliary radiofrequency ablation (eRFA).1 The authors should be commended for conducting this large trial not only in pancreatic cancer but also, much rarer, perihilar cholangiocarcinoma (pCCA) patients. Endobiliary RFA uses high frequency current to generate heat, which results in coagulation and local tumour necrosis, possibly leading to delayed tumour growth. Theoretically, the potential benefit of eRFA is larger in tumours that originate from the bile duct itself rather than compressing the bile duct, such as pancreatic cancer. The safety and feasibility have been shown in multiple studies, but the efficacy has not been sufficiently studied in randomised trials yet.2–4 Unfortunately, current trial has not been able to show the superiority of eRFA prior to stent placement over…