Angioplastia de tronco de la coronaria izquierda no protegido: evolución clínica al año y a los 3 años. Predictores de eventos / Unprotected Left Main Percutaneous Coronary Intervention: One and 3-Year Evolution. Event Prediction

RESUMEN Introducción: La angioplastia de Tronco de la Coronaria Izquierda es una opción terapéutica en pacientes con anatomía favorable. Objetivos: Reportar nuestra experiencia en el tratamiento de estos pacientes, así como su evolución clínica y evaluar los predictores de eventos clínicos durante el seguimiento. Material y Métodos: Análisis retrospectivo de pacientes intervenidos entre 2011 y 2017 por obstrucción significativa del Tronco de la Coronaria Izquierda (Clínica Bazterrica y Clínica Santa Isabel). Se registró la incidencia de eventos clínicos al año y alejados (3 años como mínimo). Se realizó un análisis univariado y multivariado (modelo de riesgos proporcionales de Cox) para identificar aquellas variables asociadas a la ocurrencia de eventos (muerte e infarto). Resultados: Se incluyeron consecutivamente 95 pacientes, de los cuales en 39 el procedimiento fue no electivo (41,1%). La mortalidad global fue 9,3 % a los 12 meses y 13,6% alejada. La tasa de infarto de miocardio no fatal fue 7,2% al año y 14,5% alejada. La tasa de accidente cerebrovascular fue 2,1% y la de revascularización fue 10,4% a los 12 meses. El único predictor multivariado de eventos a 12 meses fue la indicación no electiva del procedimiento (p = 0,003). Cuando consideramos los eventos ocurridos luego del primer año, el único predictor multivariado fue la edad >70 años (p <0,0001). Conclusiones: Nuestros resultados de la angioplastia del Tronco de la Coronaria Izquierda corresponden a los reportados por otros autores. La ocurrencia de eventos al año y eventos alejados se relacionó con condiciones identificables como la indicación del procedimiento y la edad de los pacientes.

ABSTRACT Background: Left main percutaneous coronary intervention is a therapeutic option for patients with favorable anatomy. Objectives: The aim of this study was to report our experience in the treatment of these patients, their clinical evolution and the variables associated with clinical events during follow-up. Methods: This was a retrospective analysis of patients that underwent percutaneous coronary artery intervention for left main obstructive disease between 2011 and 2017 at Clínica Bazterrica and Clínica Santa Isabel. The incidence of clinical events was evaluated at one year and at long-term follow-up (at least 3 years after the intervention). An univariate and multivariate analysis (Cox proportional risk model) was performed to identify event-associated variables (death and infarction). Results: Among a total of 95 patients included in the study, 39 (41.1%) underwent a non-elective procedure. The rate of overall mortality was 9.3% at 12 months and 13.6% at long-term follow-up, and that of non-fatal myocardial infarction 7.2% and 14.5%, respectively. On the other hand, the rate of stroke and revascularization was 2.1% and 10.4% at 12 months, respectively. On multivariate analysis, the only independent predictors of adverse clinical events were non-elective intervention at 12 months (p = 0.003) and age >70 years after the first year (p <0.0001). Conclusions: Our results of left main percutaneous coronary intervention correspond with those reported by other authors. The incidence of one-year and long-term clinical events was associated with identifiable conditions, as procedure indication and age of the patients at the time of intervention

Endoleak after Endovascular Abdominal Aortic Aneurysm Repair Treated by Bilateral Transradial Access: Case Report.

The treatment of endovascular leaks after endovascular abdominal aortic repair can be challenging, particularly in patients with a lack of vascular access. We describe the case of a critically ill elderly patient with an endoleak resulting from structural failure of an endograft years after endovascular abdominal aortic repair. The patient was treated with an aorto-uni-iliac endoprosthesis, but a few days later a new endoleak appeared and femoral or axillar access was not feasible. We successfully treated the endoleak using a novel technique via bilateral transradial access involving simultaneous insufflation of two peripheral low-profile balloons to achieve a diameter capable of improving the apposition of the stent graft. In selected cases, bilateral radial access allows procedures to be performed that would otherwise be impossible due to the inherent limitation in sheath size that can be used in the radial artery.

Level spacing statistics for light in two-dimensional disordered photonic crystals.

We study the distribution of eigenfrequency spacings (the so-called level spacing statistics) for light in a two-dimensional (2D) disordered photonic crystal composed of circular dielectric (silicon) rods in air. Disorder introduces localized transverse-magnetic (TM) modes into the band gap of the ideal crystal. The level spacing statistics is found to approach the Poisson distribution for these modes. In contrast, for TM modes outside the band gap and for transverse-electric (TE) modes at all frequencies, the level spacing statistics follows the Wigner-Dyson distribution.

Diagnostic ability of Physical Examination in aortic Valve stenosis / La capacidad diagnóstica del examen físico en la estenosis valvular aórtica

background: Physical examination is essential to detect aortic stenosis but there is scarce information currently available. Objectives: The goal of this study is to evaluate the diagnostic yield of physical examination, the interobserver agreement of clinical signs, and to establish a score to identify severe aortic stenosis. Methods: One-hundred patients were included in the study. Before echocardiographic evaluation, two cardiologists independently evaluated the clinical signs of the physical examination in aortic stenosis. Sensitivity, specificity, and inter-observer agreement were calculated, and the area under the curve was analyzed to develop a score for predicting severe aortic stenosis. results: The decreased intensity of the first heart sound and the crescendo-decrescendo shape of the murmur had sensitivity >90% and specificity <70%. The specificities of an absent second sound, a murmur that peaks later in systole and the presence of a parvus et tardus pulse were >95%, but the sensitivities were <50%. Inter-observer agreement was good for most criteria, except for murmur shape and intensity. The best area under the curve was achieved by the score composed of heart sounds of decreased or absent intensity, duration of the holosystolic murmur, parvus et tardus carotid pulse and a grade 3-4 systolic murmur. Conclusions: Physical examination findings have low sensitivity but good specificity. Inter-observer agreement of clinical signs of severity was moderately good. Correct identification of patients with severe aortic stenosis can be achieved using a simple score.

Simultaneous guidance of slow photons and slow acoustic phonons in silicon phoxonic crystal slabs.

We demonstrate theoretically that photons and acoustic phonons can be simultaneously guided and slowed down in specially designed nanostructures. Phoxonic crystal waveguides presenting simultaneous phononic and photonic band gaps were designed in perforated silicon membranes that can be conveniently obtained using silicon-on-insulator technology. Geometrical parameters for simultaneous photonic and phononic band gaps were first chosen for optical wavelengths around 1550 nm, based on the finite element analysis of a perfect phoxonic crystal of circular holes. A plain core waveguide was then defined, and simultaneous slow light and elastic guided modes were identified for some waveguide width. Joint guidance of light and elastic waves is predicted with group velocities as low as c/25 and 180 m/s, respectively.