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

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)

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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…

Studio in Gb su 46 milioni di individui prima e dopo i vaccini

In Reply In the AGENT IDE trial, treatment of in-stent restenosis with a coronary paclitaxel-coated balloon significantly reduced the rate of the primary end point of 1-year target lesion failure compared with conventional balloon angioplasty. Among the components of the primary end point, target lesion revascularization was required to be adjudicated as ischemia-driven by an independent clinical events committee. Absolute rates of this end point may potentially be influenced by operator practice patterns; however, differences in rates between treatment groups are attributable to the effectiveness of the device at preventing recurrent restenosis. Importantly, the rate of target vessel–related myocardial infarction was also significantly lower in the paclitaxel-coated vs uncoated balloon group. The occurrence of this end point is neither subjective nor dependent on operator decisions.

To the Editor We write to express our concern with the conclusion of the AGENT IDE (A Clinical Trial to Assess the Agent Paclitaxel Coated PTCA Balloon Catheter for the Treatment of Subjects With In-Stent Restenosis) study, which reported drug-coated balloons to be superior to uncoated balloons based on a composite end point of 1-year target lesion failure—defined as the composite of ischemia-driven target lesion revascularization, target vessel–related myocardial infarction, or cardiac death. This composite end point was driven by the first 2 subjective and operator-dependent outcomes; however, the objective component, rate of cardiac death, was twice as high in the paclitaxel group as the control group, raising concerns for serious adverse events related to this coated balloon. Previous studies have raised concern about coated balloons, and their use remains controversial. A study comparing the AGENT drug-coated balloon with the older SeQuent drug-coated balloon reported a 1-year mortality rate of 3.1% and 1.7%, respectively.

Objectives
This study aimed to assess whether the national centralised volume-based procurement policy and the Shanghai government’s supportive measures (coronary stent policies) implemented in Shanghai, China, on 20 January 2021 affected the cost-effectiveness of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) in the year after surgery.

Design
A retrospective cohort study based on real-world data and propensity score (PS)-matched data was conducted to compare the cost-effectiveness of PCI before and after policy implementation.

Patients and setting
Patients with ACS who had undergone first-time PCI over 1 year previously in hospitals in Shanghai and were discharged between 1 March 2019 and 30 April 2022 were included in the study.

Outcome measures
In the present study, cost was defined as total direct medical expenses, and effectiveness was defined as the prevention of major adverse cardiac events (MACEs). Incremental cost-effectiveness ratios (ICERs) were used to measure the cost-effectiveness of PCI in patients with ACS 1 year after surgery.

Results
The study included 31 760 patients. According to real-world and PS-matched data, the implementation of coronary stent policies in Shanghai reduced the total medical cost of patients with ACS 1 year after PCI by 24.39% (p

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.