[Percutaneous coronary intervention for chronic total occlusion: clinical perspectives in 2015]. / Traitement percutané de l'occlusion coronaire totale chronique: perspectives cliniques en 2015.

Chronic total occlusions (CTOs) are considered as the last frontier of percutaneous coronary intervention (PCI). Despite an incidence of 15-30%, CTOs are largely undertreated (< 10%) by percutaneous techniques, as the majority of patients are managed conservatively or surgically. Although data from randomized trials are lacking, current evidence suggests that successful CTO-PCI improves symptoms, quality of life and long-term survival. CTO-PCI represents the most technically challenging procedure in contemporary interventional cardiology. Recent interventional developments and increasing experience of dedicated operators have significantly improved procedural success rates up to 90%. This review aims to provide a contemporary overview on the current body of evidence regarding CTO-PCI, with an emphasis on the clinical benefits and patient selection criteria.

Oxidative stress and viral Infections: rationale, experiences, and perspectives on N-acetylcysteine.

This article explores current evidence on the role of oxidative stress in viral infections, and on the use of antioxidant drugs as adjunctive treatment. MEDLINE/PubMed was searched for appropriate keywords, and preclinical and clinical studies with reviews were retrieved and examined by authors. Old and current evidence shows that GSH content reduction is the main mechanism of redox imbalance in viral-infected cells. Clinical studies found that GSH levels are depleted in patients with viral infections such as HIV and SARS-CoV. Viral infections activate inflammation through different pathways, and several of these mechanisms are related to oxidative stress. NAC is a precursor of GSH, and many of its intracellular effects are mediated by GSH replenishment, but it also activates some anti-inflammatory mechanisms. NAC has an excellent safety profile and better oral and topical bioavailability than GSH. These characteristics make NAC a suitable option as a repurposed drug. Adjunctive antioxidant treatment may improve the outcomes of antiviral therapies. Current evidence supports the rationale for this practice and some clinical experience showed encouraging results.