Comparison of intravascular ultrasound-guided with angiography-guided double kissing crush stenting for patients with complex coronary bifurcation lesions: Rationale and design of a prospective, randomized, and multicenter DKCRUSH VIII trial.

BACKGROUND: Double kissing (DK) crush approach for patients with coronary bifurcation lesions, particularly localized at distal left main or lesions with increased complexity, is associated with significant reduction in clinical events when compared with provisional stenting. Recently, randomized clinical trial has demonstrated the net clinical benefits by intravascular ultrasound (IVUS)-guided implantation of drug-eluting stent in all-comers. However, the improvement in clinical outcome after DK crush treatment guided by IVUS over angiography guidance for patients with complex bifurcation lesions have never been studied in a randomized fashion. TRIAL DESIGN: DKCRUSH VIII study is a prospective, multicenter, randomized controlled trial designed to assess superiority of IVUS-guided vs angiography-guided DK crush stenting in patients with complex bifurcation lesions according to DEFINITION criteria. A total of 556 patients with complex bifurcation lesions will be randomly (1:1 of ratio) assigned to IVUS-guided or angiography-guided DK crush stenting group. The primary end point is the rate of 12-month target vessel failure, including cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization. The secondary end points consist of the individual component of primary end point, all-cause death, myocardial infarction, and in-stent restenosis. The safety end point is the incidence of definite or probable stent thrombosis. An angiographic follow-up will be performed for all patients at 13 months and clinical follow-up will be continued annually until 3 years after the index procedure. CONCLUSIONS: DKCRUSH VIII trial is the first study designed to evaluate the differences in efficacy and safety between IVUS-guided and angiography-guided DK crush stenting in patients with complex true bifurcation lesions. This study will also provide IVUS-derived criteria to define optimal DK crush stenting for bifurcation lesions at higher complexity.

[Feasibility and outcome of rotational atherectomy for treating resistant chronic total occlusions].

OBJECTIVE: To assess the application of rotational atherectomy to improving the success rate and outcome of percutaneous recanalization of resistant chronic total occlusion (CTO), i.e. the guidewire could cross the lesion but it is impossible to advance any device over the wire through the occluded segment. METHODS: From August 2008 to December 2012, 26 consecutive patients with 27 resistant CTO lesions were additionally treated by high-speed rotational atherectomy (rotational atherectomy group). The control group included 751 non-resistant CTO lesions. Drug-eluting stents were implanted in two groups after the balloon catheter crossed the CTO lesions. The successful rate of rotational atherectomy and in hospital major adverse cardiovascular events (including cardiac death, interventional treatment related myocardial infarction and target vessel revascularization) were observed. RESULTS: The rate of heavily calcified coronary lesions was significantly higher in rotational atherectomy group than in the control group[63.0% (17/27) vs. 21.2% (159/751), P < 0.05] according to pre-procedural coronary angiography. Rotational atherectomy was successful in 25 out of 27 resistant CTO lesions (92.6 %). The rate of cardiac death [0 vs. 0.5% (4/751), P > 0.05], interventional treatment related myocardial infarction [38.5% (10/26) vs. 22.2% (167/751), P > 0.05] and target vessel revascularization [0 vs. 1.2% (9/751), P > 0.05] were similar between the rotational atherectomy group and the control group. CONCLUSION: Rotational atherectomy is a safe and helpful technique to overcome the inability of balloon catheter to cross a resistant CTO.

Optimal dosages of fluoxetine in the treatment of hypoxic brain injury induced by 3-nitropropionic acid: implications for the adjunctive treatment of patients after acute ischemic stroke.

AIM: The serotonin selective reuptake inhibitor fluoxetine (Flx) has tried to treat patients suffered acute ischemic stroke because of its possible neuroprotective actions. However, besides the neuroprotective effect, Flx at high concentration also induces some actions in contradiction to neuroprotection in the brain. The purpose of this study was to investigate whether Flx presents neuroprotective effect against 3-nitropropionic acid (3-NP)-induced hypoxic brain injury, and what is the most suitable dosage of Flx. METHODS: Mouse model was established by subacute systemic administration of 3-NP. Rotarod and pole tests were used to evaluate motor deficit. The oxidative stress and oxidative DNA damage were assessed respectively by measuring malondialdehyde and 8-hydroxydeoxyguanosine content in brain homogenates. RESULTS: According to measurements in the rotarod test, 7 days pretreatment plus 5 days treatment of Flx at low (2.5 mg/kg/day) and, to a lesser degree, medium (5 mg/kg/day) doses exerted a rapid and strong protection against the neurotoxicity induced by 3-NP, whereas Flx at high dose (10mg/kg/day) showed a much late and light effect. Similarly, in the pole test, Flx at 2.5 mg/kg/day had the strongest protective effects. Again, only Flx administration at 2.5 mg/kg/day canceled out the enhancement of malondialdehyde and 8-hydroxydeoxyguanosine in striatum following 3-NP neurotoxication. CONCLUSIONS: Flx attenuated the motor deficits induced by 3-NP in a dose-dependent manner. In contrary to the high dose, Flx at the lower doses had a more remarkable effect against 3-NP insult, similar to acute ischemic stroke.