Arterial elasticity in obese subjects with coronary slow flow phenomenon.

BACKGROUND: Coronary slow flow phenomenon (CSFP) is a functional and structural disease that is diagnosed by coronary angiogram. OBJECTIVES: To evaluate the possible association between CSFP and small artery elasticity in an effort to understand the pathogenesis of CSFP. METHODS: The study population comprised 12 patients with normal coronary arteries and CSFP and 12 with normal coronary arteries without CSFP. We measured conjugated diene formation at 234 nm during low density lipoprotein (LDL) oxidation, as well as platelet aggregation. We estimated, noninvasively, arterial elasticity parameters. Mann-Whitney nonparametric test was used to compare differences between the groups. Data are presented as mean +/- standard deviation. RESULTS: Waist circumference was 99.2 +/- 8.8 cm and 114.9 +/- 10.5 cm in the normal flow and CSFP groups, respectively (P = 0.003). Four patients in the CSFP group and one in the normal flow group had type 2 diabetes. Area under the curve in the oral glucose tolerance test was 22% higher in the CSFP than in the normal group (P = 0.04). There was no difference in systolic and diastolic blood pressure, plasma concentrations of total cholesterol, triglycerides, high density lipoprotein, LDL and platelet aggregation parameters between the groups. Lag time required until initiation of LDL oxidation in the presence of CuSO4 was 17% longer (P = 0.02) and homocysteine fasting plasma concentration was 81% lower (P = 0.05) in the normal flow group. Large artery elasticity was the same in both groups. Small artery elasticity was 5 +/- 1.5 ml/mmHg x 100 in normal flow subjects and 6.1 +/- 1.9 ml/mmHg x 100 in the CSFP patients (P = 0.02). CONCLUSIONS: Patients with CSFP had more metabolic derangements. Arterial stiffness was not increased in CSFP.

Renal artery stenting with two simultaneous protection devices.

PURPOSE: To describe a new technique for distal protection during stenting of a bifurcated renal artery using two simultaneous filter devices. CASE REPORT: A 70-year-old patient underwent angiography of a single functional kidney. Severe proximal, nonostial narrowing of an early bifurcated renal artery was found. Two AngioGuard filter protection devices were placed, one in each branch. A balloon mounted stent was advanced over both wires simultaneously till they reached divergence point, expanded fully, and the protection devices were retrieved. No complications were observed and the final result was good. CONCLUSION: The concomitant use of two protection devices is feasible in a particular anatomy context.

Short- and long-term outcomes of the titanium-NO stent registry.

BACKGROUND: Five to 15% of the population have allergy to nickel, chromium, or molybdenum, which is a potential cause for in-stent restenosis. The Titan stent is made of stainless steel and is coated with titanium-nitride oxide (TiNOX), which completely prevents the discharge of metal elements. We performed a real-life multicenter registry to assess the short- and long-term characteristics of the Titan stent. METHODS AND RESULTS: A total of 103 Titan stents was implanted in 100 patients. Patients were 61.4+/-12.6 years old (81 men). Risk factors included hypercholesterolemia (63%), hypertension (53%), diabetes mellitus (DM; 35%), and current smoking (23%). Indications for PCI (percutaneous coronary intervention) were acute coronary syndromes (ACS) in 68% [acute ST elevation myocardial infarction (MI) in 8%], stable AP (angina pectoris) in 25%, and silent ischemia in 7% of the patients. Fifty-two percent of the treated lesions were of Type B2 or C. Lesion length was 14.3+/-2.9 mm and stent diameter was 3.06+/-0.36 mm. Indications for stenting were prevention of restenosis in 66%, residual stenosis in 33%, dissection in 13%, acute MI in 13%, and in-stent restenosis in 7% of the patients. Procedural success was 100%, with no complications. At 30 days, there were no major adverse cardiac events (MACE), including death, MI, and revascularization. At 180 days, only three patients had TVR (target vessel revascularization); two had TLR (target lesion revascularization) (one PCI and one CABG [coronary artery bypass grafting]), and one patient had a new narrowing proximal to the stent and underwent CABG due to multivessel disease. CONCLUSIONS: The Titan stent has a remarkable safety profile in high-risk patients and complex coronary lesions and excellent short- and long-term outcome with a very low clinical TLR rate.

The Titanium-NO Stent:results of a multicenter registry.

BACKGROUND: Contemporary stents discharge nickel, chromium and molybdenum which might contribute to restenosis. The Titan stent is coated with titanium nitride-oxide that prevents completely discharge of metal elements. AIMS: To assess short and long term outcome of the Titan in a multi-centre registry. METHODS: Included were all patients except those in cardiogenic shock. Titan stents were 2.0-5.0 mm in diameter and 7-28 mm in length. Clinical follow-up was performed at 30 days and 6 months. RESULTS: Total of 333 Titan stents were implanted in 296 patients (age 68.8+/-11.8 years, 81% men). Risk factors included hypercholesterolaemia (61.3%), hypertension (51.3%), diabetes mellitus (DM) (36.6%) and current smoking (27.6%). Eighty-one percent of patients had Acute Coronary Syndrome (ACS). Sixty two percent of treated lesions were B2/C type. Lesion length was 17.5+/-14.8 mm and stent diameter was 3.0+/-2.12 mm.Procedural success was 99.7%. At 180 days, 6.3% of patients had a total of 7.6% MACE including 5.4% TLR, 0.7% MI, 0.7% stent thrombosis and 0.7% death. CONCLUSION: The Titan stent has a remarkable safety profile. Notwithstanding the highly complicated lesion and case mix, the short- and long-term results of this registry approach those of drug-eluting stents.