Stress shielding following radial head arthroplasty: the impact of preoperative bone quality.

INTRODUCTION: We sought to assess if the medullary diameter to cortical width ratio (MD:CW), canal flair index (CFI), and canal fill (CF) of the proximal radius were associated with the presence of Stress shielding (SS) after a MoPyC radial head arthroplasty (RHA). MATERIAL & METHOD: We conducted a retrospective, international, multicenter (4 centers) study. A total of 100 radial head arthroplasties in 64 women and 36 men with a mean age of 58.40 years ±14.90 (range, 25.00; 91.00) were included. Radiographic measurements, including MD:CW, CFI, CF, and postoperative SS were captured at a mean follow-up of 3.9 years ±2.8 (range, 0.5-11). RESULTS: Stress shielding was identified in 60 patients. Mean preoperative MD:CW, CFI, and CF were 0.55 ±0.09, 1.05 ±0.18 and 0.79±0.11, respectively. The presence of SS was significantly associated with MD:CW (aOR=13.66; p=0.001), and expansion of the stem (aOR=3.78; p=0.001). The amount of the SS was significantly correlated with expansion of the stem (aß 4.58; p<0.001). CONCLUSIONS: Our study found that MD:CW was an independent risk factor of SS after Mopyc RHA. Patients with longer and larger diameter (auto-expansion) Mopyc stems were also at significantly increased risk of SS. Further studies involving multiple implants designs are needed to confirm the preliminary observations presented in the current study.

Comparison of outcomes in patients with or without ARC-HBR criteria undergoing PCI with polymer-free biolimus coated stents: The BioFreedom France study.

BACKGROUND: The polymer-free biolimus coated stent (BioFreedom) was shown to be superior to bare metal stents in the LEADERS FREE randomized trial in high bleeding risk (HBR) patients treated with 1-month dual antiplatelet therapy (DAPT). However, there is limited outcome data with this device in an all-comers' population. METHODS: We conducted a prospective single-arm study of patients undergoing percutaneous coronary intervention with the polymer-free biolimus coated stent in 25 centers in France with wide inclusion criteria including multivessel disease, complex lesions, and acute coronary syndromes. The primary endpoint was the incidence of target lesion failure (TLF), a composite of cardiac death or target-vessel myocardial infarction (MI) or clinically indicated target lesion revascularization (ci-TLR) at 1-year. The patient population was classified according to the presence (or not) of HBR criteria according to the recent ARC-HBR definition. RESULTS: Between April 2019 and April 2020, 1497 patients were enrolled. TLF occurred in 101 (6.9%) patients, including cardiac death in 35 (2.4%), target vessel MI in 20 (1.4%) and ci-TLR in 65 (4.5%) of them. There were 491 HBR patients (32.8%) and 1006 non-HBR patients. The median duration of DAPT was 74 days in the HBR group versus 348 days in the non-HBR group (p < 0.0001). TLF occurred in 44 (9.2%) of the HBR group and in 57 (5.8%) of the non-HBR group (relative risk 1.62 [95% confidence interval: 1.10-2.41], p = 0015). Compared to the non-HBR group, HBR patients had higher rates of cardiac death (4.4% vs. 1.4%, p = 0.0005) and target vessel MI (2.9% vs. 0.6%, p = 0.0003), but similar rates of ci-TLR. BARC 3-5 bleeding occurred in 6.2% of the HBR group versus 1.4% of the non-HBR group (p < 0.0001). CONCLUSION: In this multicenter all-comers study, HBR patients treated with a polymer-free biolimus coated stent had, compared to non-HBR patients, an increased risk of cardiac death and MI, and despite a shorter duration of DAPT, continued to have higher rates of BARC 3-5 bleeding.

Use and outcomes of the PK Papyrus covered stent in France: SOS PK Papyrus Registry.

OBJECTIVES: To evaluate the rate of procedural success and long-term outcomes of the PK Papyrus (PKP) covered stent (CS). BACKGROUND: CS are essential in the treatment of coronary artery perforation (CAP). They have also been used to treat coronary artery aneurysms. Limited evidence is available on clinical outcomes with the PKP. METHODS: This was a multicenter, observational, retrospective, and prospective study. Consecutive patients undergoing intentional PKP implantation in 22 centers in France were included. The primary endpoint was the rate of procedural success. Secondary endpoints included rates of death, myocardial infarction (MI), target lesion revascularization (TLR), in-stent restenosis (ISR), and stent thrombosis (ST). RESULTS: Data from 130 patients were analyzed (mean age 72.5 ± 10.5 years; 71% men). The main indication for PKP was CAP, in 84 patients (65%). Delivery success was achieved in 95% and procedural success in 91%. During the in-hospital stay, 15 patients died (12%) and 7 (5%) presented with ST. Data from 127 patients were available at 19.2 ± 12.8 month follow-up. Thirty-three patients died (26%), 15 (12%) had an MI and 21 (17%) presented with TLR. TLR was due to ISR in 12 patients (9%), 10 had definite ST (8%) and 1 patient for stent under-expansion. CONCLUSIONS: The principal indication for PKP was CAP. PKP had high rates of delivery and procedural success. At long-term follow-up, there was a high rate of TLR, mainly due to ISR and ST. These results are consistent with previously reported data in these clinical settings.

Polymer-free Drug-Coated Coronary Stents in Patients at High Bleeding Risk.

BACKGROUND: Patients at high risk for bleeding who undergo percutaneous coronary intervention (PCI) often receive bare-metal stents followed by 1 month of dual antiplatelet therapy. We studied a polymer-free and carrier-free drug-coated stent that transfers umirolimus (also known as biolimus A9), a highly lipophilic sirolimus analogue, into the vessel wall over a period of 1 month. METHODS: In a randomized, double-blind trial, we compared the drug-coated stent with a very similar bare-metal stent in patients with a high risk of bleeding who underwent PCI. All patients received 1 month of dual antiplatelet therapy. The primary safety end point, tested for both noninferiority and superiority, was a composite of cardiac death, myocardial infarction, or stent thrombosis. The primary efficacy end point was clinically driven target-lesion revascularization. RESULTS: We enrolled 2466 patients. At 390 days, the primary safety end point had occurred in 112 patients (9.4%) in the drug-coated-stent group and in 154 patients (12.9%) in the bare-metal-stent group (risk difference, -3.6 percentage points; 95% confidence interval [CI], -6.1 to -1.0; hazard ratio, 0.71; 95% CI, 0.56 to 0.91; P<0.001 for noninferiority and P=0.005 for superiority). During the same time period, clinically driven target-lesion revascularization was needed in 59 patients (5.1%) in the drug-coated-stent group and in 113 patients (9.8%) in the bare-metal-stent group (risk difference, -4.8 percentage points; 95% CI, -6.9 to -2.6; hazard ratio, 0.50; 95% CI, 0.37 to 0.69; P<0.001). CONCLUSIONS: Among patients at high risk for bleeding who underwent PCI, a polymer-free umirolimus-coated stent was superior to a bare-metal stent with respect to the primary safety and efficacy end points when used with a 1-month course of dual antiplatelet therapy. (Funded by Biosensors Europe; LEADERS FREE ClinicalTrials.gov number, NCT01623180.).

Rapid pacing using the left ventricular guidewire: Reviving an old technique to simplify BAV and TAVI procedures.

OBJECTIVES: We sought to demonstrate the safety and efficacy of rapid left ventricular (LV) pacing through the guidewire during balloon aortic valvuloplasty (BAV) and Transaortic valve implantation (TAVI). BACKGROUND: Right ventricular temporary pacing during TAVI and BAV is time-consuming and associated with vascular and pericardial complications. METHODS: Rapid left ventricular pacing was provided via the back-up 0.035″ guidewire. The cathode of an external pacemaker was placed on the tip of the 0.035″ wire and the anode on a needle inserted into the groin. Insulation was ensured by the balloon or TAVI catheter. RESULTS: 38 BAV and 87 TAVI procedures were performed in 113 consecutive patients in three centers with one for one pacing (160-200 bpm) in all patients. A significant reduction in blood pressure was achieved with a mean systolic pressure of 44 mm Hg during stimulation. Mean procedural time was 49.7 ± 31 min for BAV and 68.7 ± 30.9 for TAVI. A temporary venous pacemaker was required in 12 patients; only 12% of TAVI patients had a femoral central venous catheter. Femoral venous puncture was not performed in BAV patients. No venous vascular complications were observed. One case of successfully treated tamponade (0.8%) occurred 8 hr post procedure. In-hospital mortality rates were 4.6% and 2.6% in the TAVI and BAV groups, respectively. CONCLUSIONS: Use of the LV guidewire for rapid pacing during BAV and TAVI was shown to be simple, reproducible, and prevented complications associated with RV temporary leads thus potentially simplifying TAVI and enhancing its safety. © 2016 Wiley Periodicals, Inc.

Intra-abdominal abscess from dropped gallstone: A case report.

Dropped gallstones are a common complication during a laparoscopic cholecystectomy. The formation of an abdominal abscess related to the dropped gallstones is rare because the majority of these calculi do not cause complications. Ultrasound is a usually used first-line imaging modality to detect gallstones in the abscess. CT scan may be used to confirm the diagnosis of abscess and for topographic analysis. We report the case of a lady presented to the emergency department 2 months after laparoscopic cholecystectomy; for acute cholecystitis; with acute abdomen and fever. Laboratory values revealed an elevated white blood cell count (WBC) and C-reactive protein concentration (CRP). The diagnosis of intra-abdominal abscess was evoked by ultrasound and contrast-enhanced CT, and confirmed by laparoscopy. The purpose of this paper is to illustrate the importance of searching and recognizing dropped gallstone within collection, particularly in the context of previous laparoscopic cholecystectomy.

Direct wire pacing during measurement of fractional flow reserve: A randomized proof-of-concept noninferiority crossover trial.

Background: Adenosine administration for fractional flow reserve (FFR) measurement may induce heart pauses. Aims: To assess the accuracy and tolerability of direct wire pacing (DWP) during measurement of FFR. Methods: Adults with at least one intermediate coronary artery stenosis (40%-80%) were consecutively enrolled between June 2021 and February 2022 in this randomized, noninferiority, crossover trial (NCT04970082) carried out in France. DWP was applied (DWP) or not (standard method) through the pressure guidewire used for FFR measurement during adenosine-induced maximal hyperaemia. Subjects were randomly assigned to the allocation sequence (DWP first or standard first). A 2-minute washout period was observed between the two FFR measurements performed for each stenosis. The primary endpoint was the reproducibility of FFR measurements between methods. Results: A total of 150 focal lesions, presented by 94 subjects, were randomized (ratio: 1:1). The FFR values obtained with each method were nearly identical (R = 0.98, p = 0.005). The mean FFR difference of 0.00054 (95% confidence interval: 0.004 to 0.003) showed the noninferiority of FFR measurement with DWP vs. that with the standard method. Higher levels of chest discomfort were reported with DWP than with the standard method (0.61 ± 0.84 vs. 1.05 ± 0.89, p < 0.001), and a correlation was observed between the electrical sensations reported with DWP and chest discomfort (p < 0.001). Pauses (n = 20/148 lesions) were observed with the standard method, but did not correlate with chest discomfort (p = 0.21). No pauses were observed with DWP. Conclusions: DWP during FFR measurement resulted in accurate and reproducible FFR values, and eliminated the pauses induced by adenosine.

A direct wire pacing device for transcatheter heart valve and coronary interventions: a first-in-human, multicentre study of the Electroducer Sleeve.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) and complex percutaneous coronary interventions (PCI) may require cardiac pacing during device delivery, generally requiring the insertion of a temporary pacing lead via an additional venous access site. The purpose-built Electroducer Sleeve device provides direct wire pacing without the need for a temporary venous pacemaker. AIMS: This study assessed the safety of temporary cardiac pacing using the novel sleeve device during PCI. METHODS: This was a multicentre, non-randomised, prospective, first-in-human, single-arm, pilot study. The primary endpoint was analysis of a safety outcome, defined as the occurrence of haematomas or bleeding complications at the device vascular access site. Secondary endpoints included analyses of effectiveness and qualitative outcomes. RESULTS: Sixty patients (mean age: 77.9±9.6 years) from 4 centres in France were included: 39 (65%) underwent TAVI, and 21 (35%) underwent PCI. Procedures were performed using the sleeve with access through the radial (32 patients; 53.3%) or femoral arteries (26; 43.3%), or the femoral vein (2; 3.3%). Primary endpoint analysis revealed that 2 patients (3.3%) developed EArly Discharge After Transradial Stenting of CoronarY Arteries Study (EASY) grade I/Bleeding Academic Research Consortium (BARC) type I haematomas at the device access site. As a measure of effectiveness, a haemodynamic effect was observed after each spike delivery in 54 patients (90%). Analyses of other secondary endpoints showed that 2 patients (6.3%) presented asymptomatic radial artery occlusion. No allergies were reported. CONCLUSIONS: This first-in-human trial using the Electroducer Sleeve indicated that this novel, purpose-built, temporary pacing device was safe and effective. Larger prospective studies are required to confirm these findings.

Safety of conservative management for non-stenotic culprit lesions in STEMI patients treated with a two-step reperfusion strategy: a SUPER-MIMI sub-study.

Background: In the observational SUPER-MIMI study, a minimalist immediate mechanical intervention (MIMI) technique-which involves restoring blood flow in the acute phase and postponing stenting-was shown to be safe and effective among patients with a high thrombotic burden after ST-segment elevation myocardial infarction (STEMI). We aim to assess whether a non-stenting strategy after a SUPER-MIMI strategy was safe at 4-year follow-up in patients enrolled in the SUPER-MIMI study who were not stented. Methods: This prospective cohort study assessed the long-term outcomes of a subgroup of patients included in the SUPER-MIMI study. Results: Among the 155 patients enrolled in the SUPER-MIMI study, 57 patients (36.8%) benefited from a conservative management (without stenting or balloon angioplasty) and were included in the current substudy. The mean duration of follow-up was 4.1±1.0 years. Four patients (7.0%) presented definite culprit lesion re-thrombosis, all of which occurred in the right coronary artery. The re-thrombosis rate appeared to be higher among patients with larger vessels: 2.9%, 8.3%, and 28.6% in arteries with diameters of 3-<4, 4-<5, and ≥5 mm, respectively. The overall rate of target lesion revascularization was 10.5%. There was one cardiac death and three rehospitalizations for heart failure. Overall, 82.5% of patients remained event free at a mean of 4.1±1.0 years. Conclusions: Conservative management of non-stenotic culprit lesions after a SUPER-MIMI strategy was associated with a high rate of re-thrombosis, particularly in patients with large coronary arteries.

Patent Hemostasis Impact in Clinical Routine: Large Monocentric Echo-Doppler Study of Radial Artery Patency After Coronary Catheterization.

BACKGROUND: Radial access is currently the first line of access in interventional cardiology. Nevertheless, this technique carries a 1%-10% risk of radial artery occlusion (RAO) based on series. METHODS: We conducted a large-scale echo-Doppler evaluation of radial patency including prospectively all patients who underwent coronary angiography and/or angioplasty with radial catheterization at our center in 2018. RESULTS: A total of 1106 patients were enrolled in the cohort. Average patient age was 70 years, 24.5% were females and 75.5% were males, and 28.3% were diabetics. Five Fr and 6 Fr devices were used in 527 procedures and 565 procedures, respectively. Our study highlighted a very low RAO rate (0.99%). These results are mainly due to the high attention given to patent hemostasis, which was achieved in 1091 patients (98.6%). According to the literature, female gender is a multivariate predictive factor of RAO (P<.01). Furthermore, we confirm the protective nature of heparin (P=.04) with an average heparin dose of 69.73 IU/kg. CONCLUSIONS: Our study focused on a large population with 1106 patients who underwent radial catheterization shows that a very low rate of RAO (0.99%) can be achieved. These results are correlated with a high attention to patent hemostasis and a close collaboration between the medical and paramedical staff.

[Mayer-Rokitansky-Küster-Hauser syndrome: a cause of primary amenorrhea: about a case]. / Le syndrome de Mayer-Rokitansky-Küster-Hauser comme cause d'aménorrhée primaire: à propos d'un cas.

Mayer-Rokitansky -Küster -Hauser syndrome (MRKH) is a rare cause of primary amenorrhea. It is defined as congenital aplasia of the uterus and of the upper two thirds of the vagina in women with normal development of secondary sexual characteristics. Diagnosis is essentially based on magnetic resonance imaging (MRI). We here report the case of a 17-year-old girl presenting with primary amenorrhea with well developed secondary sexual characteristics. Laboratory tests revealed normal ovarian function as well as gonadotropic axis. Pelvic ultrasonography and magnetic resonance imaging revealed complete uterine agenesis of the uterus, the upper two-thirds of the vagina and left kidney, allowing to confirm the diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome type II. This study highlights the importance of suspecting MRKH in young patients with well-developed sexual characteristics and any type of primary amenorrhea as well as of performing MRI in order to detect any specific sign of this disorder.

Scrotal leiomyoma: An uncommon cause of chronic scrotal swelling.

Leiomyoma is a benign tumor that arises from smooth muscle. It may be encountered at any part of the body especially the uterus. However, scrotal localization is very uncommon, hence it often requires radiologic and pathology correlation to establish an accurate diagnosis and make optimal decisions for subsequent treatment. We present a case of an 82-years-old male, presenting with a left scrotal mass. Ultrasound and MRI demonstrated a left paratesticular mass. Surgery was then indicated and pathology results were consistent with a scrotal leiomyoma.

Direct Wire Pacing for Challenging Left Main Stenting: An Old Technique Revived.

During stent positioning after predilating with a non-compliant balloon, we observed major motion of our device in the left main coronary artery. Under those conditions, accurate stent placement was uncertain. To remedy this situation, we decided to perform a rapid direct wire pacing with a good final angiographic result.

Tuberculous common bile duct stricture mimicking a cholangiocarcinoma: A case report.

Biliary involvement during abdominal tuberculosis is extremely uncommon and represents a challenging diagnosis that can easily be mistaken for a malignant etiology. We report the case of a 40 years old male who presented with anorexia, chronic abdominal pain, and progressive obstructive jaundice. Abdominal computed tomography demonstrated distal narrowing with wall thickening of the main biliary duct, along with enlarged lymph nodes and signs of portal hypertension. Abdominal magnetic resonance imaging showed a long distal biliary stricture, suggestive of malignancy, with dilated intrahepatic radicles. The diagnosis of cholangiocarcinoma was initially suggested. However, given his young age and other imaging findings, the patient underwent laparoscopic biopsy which revealed epithelioid cell granuloma with caseating necrosis consistent with tuberculous origin.

Polymer-free drug-coated vs. bare-metal coronary stents in patients undergoing non-cardiac surgery: a subgroup analysis of the LEADERS FREE trial.

AIMS: To compare the outcomes of patients undergoing non-cardiac surgery (NCS) after PCI with either a drug-coated stent (DCS) or a bare-metal stent (BMS), followed by 1-month dual antiplatelet therapy and to explore the impact of the timing of NCS. METHODS: This is a subgroup analysis of the LEADERS FREE trial. The primary safety end point was a composite of cardiac death, myocardial infarction, or stent thrombosis, and the primary efficacy end point was clinically driven target lesion revascularization (TLR). RESULTS: Out of 2432 patients included in the LEADERS FREE trial, 278 (11.4%) underwent NCS within 1 year after PCI. Among NCS patients, the 1-year safety end point was numerically lower with DCS; however, this difference was not significant as compared to BMS (4.7% vs. 10.1%, HR: 0.459 [0.178-1.183], p = 0.099), clinically driven TLR was significantly lower after DCS (2.4% vs. 8.3%, HR: 0.281 [0.079-0.996], p = 0.036), and BARC 3-5 bleeding was similar with DCS vs. BMS (10.2% vs. 7.5%, p = 0.438). In patients treated with BMS, NCS within 3 months after PCI was associated with higher incidence of the safety end point than NCSs performed later: 14.9% vs. 4.4%, HR: 3.586 [1.012-12.709], p = 0.034. The timing of surgery had no impact on patients treated with DCS (4.7% vs. 4.7%, p = 0.947). CONCLUSIONS: Among patients undergoing NCS after PCI, DCS-treated patients had a lower probability of clinically driven TLR compared with BMS. However, there was no significant difference in the occurrence of the primary composite safety end point or bleeding complications. Early NCS after BMS-PCI was associated with impaired safety, while the timing of NCS had no such influence after DCS implantation.

Ambulatory TAVR: Early Feasibility Experience During the COVID-19 Pandemic.

The COVID-19 pandemic has modified practice for patients with symptomatic aortic stenosis and could result in higher mortality rates due to treatment delays. In this clinical case series, 3 patients underwent ambulatory transcatheter aortic valve replacement (TAVR) thanks to patient and entourage willingness, careful patient selection (including a history of permanent pacemaker placement), and a minimalist procedural approach. No complications occurred during the 30-day follow-up. Performing ambulatory TAVR could reduce the clinical consequences of wait times, minimize exposure to coronavirus contamination, and reduce the use of hospital resources that might be needed for COVID-19 patients. Thanks to a scrupulous minimalist TAVR protocol, ambulatory outpatient management of aortic stenosis was possible in the context of the COVID-19 pandemic.

La pandémie de COVID-19 a modifié la prise en charge des patients présentant une sténose aortique symptomatique, et les retards dans les traitements pourraient entraîner une hausse des taux de mortalité. Dans le cadre de cette série de cas cliniques, trois patients ont subi un remplacement valvulaire aortique par cathéter (RVAC) ambulatoire, rendu possible grâce à la volonté des patients et de leur entourage, aux choix consciencieux des candidats (par exemple, les receveurs d'un stimulateur cardiaque implantable) et à une approche comportant des interventions minimales. On n'a observé aucune complication durant les 30 jours du suivi. Le RVAC ambulatoire pourrait atténuer les répercussions cliniques associées au temps d'attente, réduire le risque d'exposition au coronavirus et diminuer l'utilisation des ressources hospitalières, qui pourraient être consacrées aux patients atteints de la COVID-19. Un protocole méticuleux et minimaliste de RVAC a permis la prise en charge ambulatoire de la sténose aortique durant la pandémie de COVID-19.

Evaluation of emotional disorders before and during treatment with interferon beta in patients with multiple sclerosis.

BACKGROUND: Domains encompassing emotional disorders in relapsing-remitting MS (RRMS) patients are still unclear. METHODS: We performed a 24-month, multicenter, single-arm, prospective study. RRMS patients started IFN-ß treatment at baseline. The primary endpoint was lack of emotional control, measured using the "Echelle d'HumeurDépressive" (EHD) scale three times at baseline and at 10 post-treatment visits. Secondary endpoints were emotional blunting, irritability, fatigue, depression and anxiety. A linear mixed covariance model assessed change from baseline on an intention-to-treat basis, under the assumption of no mood disorder effect (one-sided 97.5% level), in which autoregressive type of autocorrelation was tested. RESULTS: Out of 79 recruited patients, 70 were analyzed: 80% female; mean (SD) age, 37.0 (11.5) years. Mean (SD) lack of emotional control score at baseline and Month 24 was 12.7 (4.4) and 12.6 (5.5), respectively, versus 10.1 (3.2) in a healthy control population matched for age and sex. Stepwise analysis identified younger age, male sex and antidepressant use as significant predictors of higher lack of emotional control values. CONCLUSIONS: Based on 24 months of prospective follow-up, the results of this study highlights a broad spectrum of emotional disorders in the MS population at the time of disease modifying drugs initiation but no major IFN-ß-related emotional disorders (mood dyscontrol, anxiety, depression) were observed. However, sporadic occurrences of severe mood disorders and suicidality cannot be excluded.

[Imaging appearance of acute disseminated encephalomyelitis: a study of 22 cases]. / Imagerie de l'encéphalomyélite aiguë disséminée: étude de 22 cas.

Acute disseminated encephalomyelitis (ADEM) is a rare cause of encephalitis in adults, characterized by inflammatory lesions in the white substance of the central nervous system (CNS). Initial clinical presentation may mimic severe CNS infection with fever, encephalopathy, seizures, or multiple sclerosis. The purpose of our study was to report the epidemiological, clinical, radiological, therapeutic and evolutionary features of ADEM and to determine the role of MRI sequences in the diagnosis, monitoring and prognosis of this disease. We conducted a retrospective study of the clinical and radiological records of 22 patients with ADEM followed up in the Department of Neurology over a period of 11 years (January 2006- January 2017). These patients underwent medical imaging at the Mohammed V Military Teaching Hospital, de Rabat. The average age of patients was 35 years (12-57 years). A recent infection was found in 31% of patients, while 4% of patients had recently undergone vaccination. Symptoms were dominated by focal neurologic deficit (72%). CT scan was normal in 78%. MRI showed hyperintense subtentorial and supratentorial white substance on FLAIR sequences in 70% of patients, without diffusion restriction in all cases, with enhancement of the lesions in 27% of cases and involvement of the cervical spinal cord in 68% of cases. Clinical and radiological outcome was favorable in all cases.

Transcoronary Rapid Pacing Solving a Complex Retrograde Chronic Total Occlusion Procedure.

We report a case of revascularization of the right coronary artery via the epicardial collateral, for which we used transcoronary rapid pacing to obtain cardiac standstill while puncturing the distal chronic total occlusion (CTO) cap. To our knowledge, this is the first case in which this technique has been used in CTO. (Level of Difficulty: Advanced.).

Left Ventricular Rapid Pacing Via the Valve Delivery Guidewire in Transcatheter Aortic Valve Replacement.

OBJECTIVES: This study investigated whether left ventricular (LV) stimulation via a guidewire-reduced procedure duration while maintaining efficacy and safety compared with standard right ventricular (RV) stimulation. BACKGROUND: Rapid ventricular pacing is necessary to ensure cardiac standstill during transcatheter aortic valve replacement (TAVR). METHODS: This is a prospective, multicenter, single-blinded, superiority, randomized controlled trial. Patients undergoing transfemoral TAVR with a SAPIEN valve (Edwards Lifesciences, Irvine, California) were allocated to LV or RV stimulation. The primary endpoint was procedure duration. Secondary endpoints included efficacy, safety, and cost at 30 days. RESULTS: Between May 2017 and May 2018, 307 patients were randomized, but 4 were excluded because they did not receive the intended treatment: 303 patients were analyzed in the LV (n = 151) or RV (n = 152) stimulation groups. Mean procedure duration was significantly shorter in the LV stimulation group (48.4 ± 16.9 min vs. 55.6 ± 26.9 min; p = 0.0013), with a difference of -0.12 (95% confidence interval: -0.20 to -0.05) in the log-transformed procedure duration (p = 0.0012). Effective stimulation was similar in the LV and RV stimulation groups: 124 (84.9%) versus 128 (87.1%) (p = 0.60). Safety of stimulation was also similar in the LV and RV stimulation groups: procedural success occurred in 151 (100%) versus 151 (99.3%) patients (p = 0.99); 30-day MACE-TAVR (major adverse cardiovascular event-transcatheter aortic valve replacement) occurred in 21 (13.9%) versus 26 (17.1%) patients (p = 0.44); fluoroscopy time (min) was lower in the LV stimulation group (13.48 ± 5.98 vs. 14.60 ± 5.59; p = 0.02), as was cost (€18,807 ± 1,318 vs. €19,437 ± 2,318; p = 0.001). CONCLUSIONS: Compared with RV stimulation, LV stimulation during TAVR was associated with significantly reduced procedure duration, fluoroscopy time, and cost, with similar efficacy and safety. (Direct Left Ventricular Rapid Pacing Via the Valve Delivery Guide-wire in TAVR [EASY TAVI]; NCT02781896).