Evaluation of Mandibular Incisive Canal using Cone Beam Computed Tomography in Malaysians.

OBJECTIVES: The risk of damaging the mandibular incisive canal (MIC) during surgery in the anterior mandible should not be overlooked. Hence, preoperative radiographic assessment is essential to avoid complications. This study was aimed to estimate the length of the MIC in the interforaminal safe zone, to analyse its course in relation to the lingual and the buccal cortical plates of the mandible using cone beam computed tomography (CBCT) scans and to relate the above findings to age, gender, dental status and Malaysian races. METHODS: Retrospective analysis of 100 CBCT scans (n = 200) was performed on both sides of the mandible. Cross-sectional and panoramic images were reconstructed. The length of the MIC and the horizontal distances between the MIC and the buccal and the lingual cortical plates were measured at the three different points (starting, mid-, end points). Independent samples t-test and one-way ANOVA test were used to analyse the variation in the length and course of the MIC in gender, age, dental status and Malaysian races. RESULTS: The mean length of the MIC was 11.31 ± 2.65 mm, with the Malays having the longest MIC, followed by the Chinese and the Indians (p < 0.05). The MIC deviated towards the lingual cortical plate, with significance seen in the Indian and the male patients (p < 0.05). No significant difference was noticed with respect to patient age and dental status. CONCLUSIONS: Assessment of the MIC should be performed using CBCT on a case-by-case basis as it provides essential information during preoperative planning of surgery in the anterior mandible.

Biolimus-eluting biodegradable polymer-coated stent versus bare metal stent in acute ST-elevation and non-ST elevation myocardial infarction: Justification for biodegradable polymer-coated stent in acute coronary syndrome (JANICE) registry.

AIMS: We evaluated the efficacy and safety of a biolimus- eluting biodegradable polymer-coated stent (BES) in patients with ST-segment elevation and non ST-segment elevation acute myocardial infarction (AMI). METHODS AND RESULTS: This was an observational study involving a single centre patient registry. We compared the rates of cardiac death, myocardial infarction, target vessel revascularization (TVR) and composite end point of cardiac death and myocardial infarction at 24 months in 106 patients who received BES versus 94 patients who received an otherwise similar bare metal stent (BMS) during percutaneous coronary intervention for AMI. There was no significant difference in the rate of cardiac death (0.9% versus 7.4%; P = 0.09), myocardial infarction (4.7% versus 3.2%; P = 0.69), stent thrombosis (0.9% versus 3.2%; P = 0.30) or cardiac death and myocardial infarction (5.7% versus 10.6%; P = 0.30) between the two groups. The rate of TVR was significantly higher in the BMS group (1.9% versus 8.5%; P = 0.04), with patients receiving BMS being four times more likely to require TVR. CONCLUSION: The use of BES in selected patients with AMI appears to be safe and is associated with significantly reduced rate of TVR, when compared with an otherwise similar BMS.

Endothelial progenitor cell capture stent implantation in patients with ST-segment elevation acute myocardial infarction: one year follow-up.

AIMS: The Genous endothelial progenitor cell (EPC) capture stent is a bioengineered R stent coated with immobilised antibodies on its stent struts to allow for the capture of circulating EPCs to promote rapid endothelisation. We assessed the impact of this stent in the primary percutaneous coronary intervention (PCI) of patients with acute ST-elevation myocardial infarction (STEMI) and examined its long term clinical outcomes. METHODS AND RESULTS: All patients with acute STEMI without cardiogenic shock who underwent primary PCI between January 2005 and April 2007 and received the stent were enrolled in the study. The study endpoints were major adverse cardiac events (MACE) defined as death, MI and target vessel revascularisation (TVR) at 30 days, six months and one year. A total of 321 enrolled patients received 357 EPC capture stents during the study period. The cohort comprises 81.0% males with mean age of 54.6+/-11.6 years. The mean stent length used was 20.98+/-5.50 mm and mean stent size was 2.99+/-0.32 mm. Ninety-four percent of patients achieved Thrombolysis in Myocardial Infarction (TIMI) 3 flow post-procedurally. The cumulative MACE rate was 8.1% at 30 days, 10.0% at six months and 12.2% at one year. There was one patient who developed acute stent thrombosis and another two with subacute stent thromboses. No late thrombosis or late cardiac mortality was observed in our cohort. The need for TVR was 4.4% at one year. CONCLUSIONS: The use of EPC capture stents in patients who underwent primary PCI for STEMI is safe and showed good clinical outcomes, with low rates of TVR and no late stent thrombosis.

A novel drug-eluting stent using bioabsorbable polymer technology: two-year follow-up of the CURAMI registry.

BACKGROUND: There are safety concerns on drug-eluting stents (DESs) using durable polymer. The long-term outcome of next generation DESs using bioabsorbable polymer technology remains unknown. METHODS: From March to June, 2005, a novel sirolimus-eluting (170 microg/cm2), bioabsorbable polymer (PLA and PLGA, eroded over 45 days) coated stent was implanted for treatment of acute myocardial infarction (AMI) in 49 patients (male 86%, age 55+10 years, diabetes 31%). All culprits were de novo lesions in the native coronary artery. On discharge, aspirin and clopidogrel for 3 months followed by life-long aspirin were prescribed. Angiographic follow-up was performed at 8 months. Clinical follow-up was performed at 4, 9 and 24 months. RESULTS: Angiographic success rate was 100%. In-hospital adverse events consisted of 1 death (2%). All except one patient (due to aspirin allergy) were compliant to the 3 months dual antiplatelet therapy, and there was no adverse event during this period. One patient developed re-infarction in another coronary territory at 6 months. Twenty-seven patients (56%) underwent 8-month angiographic follow-up (Table 3). At 24 months, 6 patients had 7 major adverse cardiac events (12.2%, 1 death, 2 re-infarctions and 4 target lesion revascularizations). There were no incidences of subacute or late stent thrombosis. CONCLUSIONS: The Cura stent, using bioabsorbable polymer technology, appears to be safe at 2 years follow-up. Although the angiographic follow-up parameters were unfavorable, this report paves the way for further studies on DES using bioabsorbable polymer technology.

Sirolimus-eluting, bioabsorbable polymer-coated constant stent (Cura) in acute ST-elevation myocardial infarction: a clinical and angiographic study (CURAMI Registry).

BACKGROUND: There are safety concerns over the current polymer-based drug-eluting stents (DES) on the possible delayed healing process and adverse reactions to the polymer when drug elution is completed. Cura (Orbus Neich) is a sirolimus-eluting, bioabsorbable, polymer-coated constant stent. METHODS: From March 1 to June 30, 2005, Cura stent implantation was instituted as the default strategy for percutaneous coronary intervention in 49 consecutive ST-Elevation Myocardial Infarction (STEMI) patients (male 86%; average age 55 +/- 10 years; diabetes 31%). RESULTS: The angiographic success rate was 100%. In-hospital adverse events consisted of 1 in-hospital death (2% heart failure). A total of 27 patients (56%) underwent 8-month angiographic follow up. Binary restenosis occurred in 6 patients (22%), and late loss was 0.74 +/- 0.89 mm. At 9-month follow up, a total of 5 patients had 6 major adverse events (1 death, 1 reinfarction, and 4 target lesion revascularizations). There was no incidence of stent thrombosis. CONCLUSION: Cura stent implantation appears to be feasible and safe in the treatment of STEMI. However, the binary restenosis rate and late loss at angiographic follow up were similar to that of bare-metal stents, and therefore compare unfavorably with other proven benchmark DES.