A novel ultrafast-low-dose computed tomography protocol allows concomitant coronary artery evaluation and lung cancer screening.

BACKGROUND: Cardiac computed tomography (CT) is often performed in patients who are at high risk for lung cancer in whom screening is currently recommended. We tested diagnostic ability and radiation exposure of a novel ultra-low-dose CT protocol that allows concomitant coronary artery evaluation and lung screening. METHODS: We studied 30 current or former heavy smoker subjects with suspected or known coronary artery disease who underwent CT assessment of both coronary arteries and thoracic area (Revolution CT, General Electric). A new ultrafast-low-dose single protocol was used for ECG-gated helical acquisition of the heart and the whole chest. A single IV iodine bolus (70-90 ml) was used. All patients with CT evidence of coronary stenosis underwent also invasive coronary angiography. RESULTS: All the coronary segments were assessable in 28/30 (93%) patients. Only 8 coronary segments were not assessable in 2 patients due to motion artefacts (assessability: 98%; 477/485 segments). In the assessable segments, 20/21 significant stenoses (> 70% reduction of vessel diameter) were correctly diagnosed. Pulmonary nodules were detected in 5 patients, thus requiring to schedule follow-up surveillance CT thorax. Effective dose was 1.3 ± 0.9 mSv (range: 0.8-3.2 mSv). Noteworthy, no contrast or radiation dose increment was required with the new protocol as compared to conventional coronary CT protocol. CONCLUSIONS: The novel ultrafast-low-dose CT protocol allows lung cancer screening at time of coronary artery evaluation. The new approach might enhance the cost-effectiveness of coronary CT in heavy smokers with suspected or known coronary artery disease.

The Last Broken Barrier: Retrograde Radial Artery Recanalization Prior to Transradial Coronary Interventions.

Transradial access has become the default vascular access for coronary procedures, since it has shown to reduce major bleeding, adverse cardiac events and mortality compared with transfemoral access. However, radial artery occlusion has been historically considered a formal contraindication for transradial coronary procedures. In this investigation, we report the feasibility and outcomes of radial artery occlusion recanalization from distal radial access prior to transradial angiography and intervention.

[Feasibility and safety of same-day discharge after elective transcatheter interventions: experience of a high-volume center]. / Fattibilità e sicurezza della dimissione in giornata per procedure elettive di cardiologia interventistica in un centro ad alto volume.

BACKGROUND: Safety of same-day discharge (SSD) after percutaneous coronary interventions (PCI) has been demonstrated in several studies. However, SDD is rarely adopted in Italy, with a potential waste of resources and decrease of patient satisfaction. METHODS: In 2019 we implemented a strategy of SDD for all elective coronary procedures admitted to our Radial Unit. Patients were excluded from SDD in case of contraindications for radial access, known contrast allergy, known left main disease based on previous angiogram or coronary computed tomography scan, chronic total occlusions considered as target of revascularization. We assessed the feasibility and safety of this approach in consecutive patients treated at Humanitas Research Center. RESULTS: Out of 366 patients who were admitted electively to our Radial Unit, 152 (41.5%) underwent only diagnostic coronary angiography, while 214 underwent PCI. As expected, radial access was used in the vast majority of cases (361; 98.6%). Patients were mostly discharged in the same day (268; 73%), both after diagnostic (96.7%) and interventional (56.5%) procedures. Patients that were hospitalized at least for one night were older, had a higher cardiovascular risk profile and had a more complex coronary anatomy (left main or proximal left anterior descending artery disease, bifurcations, total occlusions). There were no significant differences between patients discharged and those who were admitted overnight with regards to 7- and 30-day hospital readmission. CONCLUSIONS: SSD is safe and feasible in the majority of patients after elective coronary procedures (both diagnostic angiography and PCI), and is not associated with increased hospital readmission at 7 and 30 days. On the basis of the current study, a wider SDD program will be implemented in 2020.

[Successful embolization of a distal coronary artery perforation using the "block and deliver" technique]. / Efficace embolizzazione di una perforazione coronarica distale mediante la tecnica "block and deliver".

Coronary perforation is a rare but potentially lethal complication of percutaneous coronary intervention and it is associated with an increased risk of adverse outcomes. There are no standardized techniques to achieve prompt and effective perforation sealing and treatment is left to the operator's preference and expertise. We report a case of successful embolization of a distal coronary artery perforation using the "block and deliver" technique. The technique is relatively simple and safe, it was effective, and we are strongly convinced that it may be helpful to all interventional cardiologists in their daily practice.

[Acute coronary syndrome in a patient with a residual aortic dissection flap after supracoronary aortic replacement: the role of intravascular ultrasound]. / Sindrome coronarica acuta in paziente con flap residuo di dissezione aortica dopo intervento di sostituzione dell'aorta ascendente sopracoronarica: ruolo dell'ecografia intravascolare.

Acute chest pain caused by aortic dissection (AD) or acute myocardial infarction (AMI) is one of the most serious medical emergencies and requires a very quick differential diagnosis to choose the best timing for treatment. AD and AMI are often manifested with similar symptoms, making it difficult to differentially diagnose these two conditions. After supracoronary aortic repair for type A AD, small intimal flap could remain in the anastomosis area. Aortic intramural hematoma could extend to the coronary ostia causing an extrinsic compression. Intravascular ultrasound is a safe and effective methodology to distinguish an atherosclerotic plaque from an extrinsic compression. We present the case of a 68-year-old man, with a recent surgical correction of a type A AD, referred to our emergency department for an acute coronary syndrome.

The Cre8 amphilimus-eluting stent for the treatment of coronary artery disease: safety and efficacy profile.

Introduction: Polymer-free drug-eluting stents are designed with stent surface modifications and drug-matrix formulations in order to release antiproliferative agents without the need of a polymer coating. Polymer-free technologies have the potential to overcome complications due to polymer persistence over time, such as local inflammatory reactions, delayed arterial healing, neoatherosclerosis, and subsequent ischemic adverse events.Areas covered: The Cre8 polymer-free amphilimus-eluting stent received CE mark in 2011 and was conceived with the aim of addressing the safety and efficacy limitations of early generation drug-eluting stents based on permanent polymer coatings. Besides the absence of polymer, the main features of the Cre8 stent include the abluminal reservoirs, the passive carbon film coating, and the antiproliferative agent formulation based on sirolimus mixed with free-fatty acid chain - namely amphilimus. This review will focus on the Cre8 development, technical characteristics, preclinical evidence, clinical efficacy and safety, and future perspectives.Expert opinion: The Cre8 stent has shown favorable angiographic and clinical outcomes at short and medium-term follow-up. This technology might provide a benefit in patients with diabetes. Further randomized evidence is required to provide an adequate clinical evaluation of this promising technology in patients with and without diabetes.

Ultra-Deep Guide Catheter Intubation for Direct Thromboaspiration in Acute Myocardial Infarction.

Thrombus burden remains an important mortality risk factor during primary percutaneous coronary interventions (PCI), especially when associated with distal embolization of atheromatous debris (Sharma et al., 2016; Ibanez et al., 2018 [1,2]). Although routine thrombus aspiration during primary PCI in acute coronary syndrome (ACS) is not recommended (Sharma et al., 2016 [1]), some procedures become very challenging when thrombus removal and vessel reperfusion is not achieved with conventional dedicated devices. We describe a case of a 60-year old man with a late-comer infero-lateral ST-segment elevation myocardial infarction (STEMI) undergoing right coronary artery primary PCI. A high thrombotic burden was shown requiring an ultra-deep guide catheter intubation to perform a successful thromboaspiration and stenting.