Effectiveness of a novel biodegradable polymer, sirolimus-eluting stent platform in percutaneous coronary intervention.

BACKGROUND: The purpose of this registry is to report the immediate and long-term safety and efficacy of the Biotronik Orsiro stent in an unselected population during everyday practice. METHODS: Between May 2012 and June 2013, 246 consecutive coronary angioplasty procedures were performed using at least one Orsiro drug-eluting stent, in 225 patients and 303 lesions. RESULTS: Diabetes was present in 34.7% of patients. Procedures were non-elective percutaneous coronary intervention (PCI) in 17.1% of cases and acute coronary syndromes were 55.1%. Radial vascular access was used in 78% of cases, multivessel PCI was performed in 19.5% of the procedures. In 81.6% of cases lesions were B2/C type, 20.7% of procedures had bifurcation lesions. Procedural success was 99.6%. No acute thrombosis occurred. Clinical follow-up median period was 24.3 (±8.28) months and FU was available in 93.7% of patients. Death for any cause occurred in 11 patients (5.2%), 6 of them were non cardiac-related. Cardiac-related death rate was 2.4%. Two patients had in-stent restenosis. The overall target lesion failure rate was 3.3%. CONCLUSIONS: This observational data regards our experience with Biotronik Orsiro stent in an unselected population. This initial data, although limited by a mainly clinical follow-up and restricted number of patients, confirms the good clinical performance of this sirolimus-eluting stent with a biodegradable polymer in everyday practice, including complex lesions, according to current larger studies in the literature.

Operator exposure to x-ray in left and right radial access during percutaneous coronary procedures: OPERA randomised study.

OBJECTIVE: Left radial access (LRA) and right radial access (RRA) have been shown to be safe and effective for coronary arteries catheterisation. However, the differences between the two approaches in terms of radiation exposure are still unclear. The aim of the present investigation is to evaluate in a randomised study, the dose of radiation absorbed by operators using either LRA or RRA. DESIGN: Randomised, prospective, double arm, single centre study. SETTING: University Hospital. PATIENTS: Male or female subjects with stable, unstable angina and silent ischaemia. INTERVENTIONS: The present study is a comparison of LRA and RRA for coronary artery catheterisation in terms of operators' radiation exposure. MAIN OUTCOME MEASURES: The primary outcome measure was the radiation dose absorbed by operators; secondary outcome measures were fluoroscopy time, dose-area product and contrast delivered. RESULTS: A total of 413 patients were enrolled; 209 were randomly selected to undergo diagnostic procedures with RRA and 204 with LRA. The operator's radiation exposure was significantly lower in the left radial group (LRA 33±37 µSv vs RRA 44±32 µSv, p=0.04). No significant differences were observed in  fluoroscopy time (LRA 349±231s vs RRA 370±246 s p=0.09) and dose-area product (LRA 7011.42±3617.30 µGym(2) vs RRA 7382.38±5226.61 µGym(2), p=0.80), even though in both there was a trend towards a lower level in the LRA. No differences were observed in contrast medium delivered (LRA 89.92±32.55 ml vs RRA 88.88±35.35 ml, p=0.45). CONCLUSIONS: The LRA was associated in the present report with a lower radiation dose absorbed by the operator during coronary angiography.

Idiopathic, serial coronary vessels dissection in a young woman with psychological stress: a case report and review of the literature.

Spontaneous coronary artery dissection (SCAD) is a very rare disease, associated with high mortality rate, whose etiology and pathogenesis are poorly understood. Its sporadic nature and the varied angiographic extent make firm recommendations regarding revascularization impossible. The case described is that of a young, otherwise healthy woman, without a known underlying condition which may lead to SCAD, but with a history of intense psychological stress. We managed the patient with a conservative approach based on watchful waiting, medical therapy, and plain old balloon angioplasty (POBA) with low inflation atmospheres.

Left radial versus right radial approach for coronary artery catheterization: a prospective comparison.

BACKGROUND: Despite several advantages of the transradial over the transfemoral approach, the use of transradial access for coronary interventions in daily practice is still low. Major limitations are the technical and anatomical issues related with right radial artery access. The left radial approach may have an advantage from the point of view of the vascular anatomy. The aim of this study was to evaluate the safety and feasibility of routinely using the left radial compared to the right radial approach. METHODS: This is a prospective single center study comparing left radial to right radial access for coronary artery catheterization. The overall in-hospital major adverse cardiac and cerebral events (MACCE), procedural success rate, bleeding, vascular and procedural complications, fluoroscopy time, number of catheters, and amount of contrast agent used were assessed. RESULTS: A total of 1,032 coronary angiograms were performed: 420 were performed using the right radial artery and 612 the left radial artery. No differences were observed in MACCE and success rate between the two groups. No cases of major or minor bleeding and vascular complications requiring surgical intervention were reported. Fluoroscopy time and the number of catheters used were significantly less in the left radial group (P = 0.001 and P = 0.007, respectively), while the volume of contrast was similar (P = 0.264). CONCLUSIONS: The left radial approach in our series was demonstrated to be safe and feasible in daily practice, and in this study was associated with a reduction in fluoroscopy time and number of catheters used.

Thyroid cancer in Luxembourg: a national population-based data report (1983-1999).

BACKGROUND: Twenty years after the nuclear accident in Chernobyl (Eastern Europe), there is still a controversial debate concerning a possible effect of the radioactive iodines, especially I-131, on the increase of thyroid carcinomas (TCs) in Western Europe. Time trends in incidence rates of TC in Luxembourg in comparison with other European countries and its descriptive epidemiology were investigated. METHODS: The population-based data of the national Morphologic Tumour Registry collecting new thyroid cancers diagnosed between 1983 and 1999 at a nation-wide level in the central division of pathology were reviewed and focused on incidence rates of TC. Data from 1990 to 1999 were used to evaluate the distribution by gender, age, histological type, tumour size and the outcome. RESULTS: Out of 310 new thyroid carcinomas diagnosed between 1990 and 1999, 304 differentiated carcinomas (A: 80% papillary; B: 14.5% follicular; C: 3.5% medullary) and 6 anaplastic/undifferentiated TCs (D: 2%) were evaluated. The M/F-ratio was 1:3.2, the mean age 48.3 years (range: 13-92). The overall age-standardized (world population) incidence rates over the two 5-year periods 1990-1994 and 1995-1999 increased from 7.4 per 100,000 to 10.1 per 100,000 in females, from 2.3 per 100,000 to 3.6 per 100,000 in males. Only 3 patients were children or adolescents (1%), the majority of the patients (50%) were between 45 and 69 years of age. The percentage of microcarcinomas (<1 cm) was A: 46.4%, (115/248); B: 13.3%, (6/45); C: 27.3%, (3/11). The unexpected increase of TCs in 1997 was mainly due to the rise in the number of microcarcinomas. The observed 5-year survival rates for both genders were A: 96.0+/-2%; B: 88.9%; C: 90.9%; D: 0%. Prognosis was good in younger patients, worse in males and elderly, and extremely poor for undifferentiated TCs. CONCLUSION: The increasing incidence rates of TC, especially of the papillary type, seem mainly due to a rise in diagnosed microcarcinomas due to some extent to a change in histologic criteria and to more efficient diagnostic tools. This rise appears to be independent of the number of surgical treatments, the immigration rate, and the Chernobyl fallout as the incidence of TC in children remained stable.