Effect of sevoflurane on serum CK-MB levels after percutaneous coronary stent placement: A prospective randomized clinical trial

OBJECTIVES. Markers of myocardial injury, such as creatine kinase-myocardial band (CK-MB) mass, are elevated in up to 30% of patients undergoing percutaneous coronary intervention (PCI) with stent deployment. This elevation represents myocardial injury that can impact the patient in the long term, including the risk of death. Sevoflurane, an inhaled anesthetic, may have cardioprotective properties that benefit patients undergoing PCI. The primary objective was to compare serum CK-MB mass raise in patients who received sevoflurane to those who received a placebo prior to PCI. METHODS. We enrolled patients with coronary artery disease who were eligible for PCI in a randomized (1:1), double-blind, placebo-controlled trial; patients having experienced acute myocardial infarction within 72 hours and those with saphenous vein graft stenting were excluded. Patients (n = 1254) were randomized to receive sevoflurane (2% inspired fraction) or placebo (oxygen alone) for 30 minutes prior to PCI. Additionally, we compared substantial elevations in CK-MB mass (defined as >5x the upper limit of normal), length of stay in the intensive care unit and in-hospital, and 1-year mortality. RESULTS. Sevoflurane was unable to promote cardioprotection, as determined by CK-MB mass levels (sevoflurane group: 2.52 ± 9.64; control group: 1.84 ± 8.58; P=.32). No effect was noticed on the reduction among patients who (AQ: with?) increase (AQ: increased?) marker levels (prevalence of increase in CK-MB mass greater than the upper limit of normality was 30.8% in the sevoflurane group and 28.9% in the control group; P=.33; 4.6% vs 3.1%, respectively, for increases 5x above the upper limit of normality [P=.21]). CONCLUSIONS. Sevoflurane failed to reduce myocardial injury after PCI. Therefore, its usage should not be routinely recommended.

Effect of sevoflurane on serum CK-MB levels after percutaneous coronary stent placement: A prospective randomized clinical trial.

OBJECTIVES: Markers of myocardial injury, such as creatine kinase-myocardial band (CK-MB) mass, are elevated in up to 30% of patients undergoing percutaneous coronary intervention (PCI) with stent deployment. This elevation represents myocardial injury that can impact the patient in the long term, including the risk of death. Sevoflurane, an inhaled anesthetic, may have cardioprotective properties that benefit patients undergoing PCI. The primary objective was to compare serum CK-MB mass raise in patients who received sevoflurane to those who received a placebo prior to PCI. METHODS: We enrolled patients with coronary artery disease who were eligible for PCI in a randomized (1:1), double-blind, placebo-controlled trial; patients having experienced acute myocardial infarction within 72 hours and those with saphenous vein graft stenting were excluded. Patients (n = 1254) were randomized to receive sevoflurane (2% inspired fraction) or placebo (oxygen alone) for 30 minutes prior to PCI. Additionally, we compared substantial elevations in CK-MB mass (defined as >5x the upper limit of normal), length of stay in the intensive care unit and in-hospital, and 1-year mortality. RESULTS: Sevoflurane was unable to promote cardioprotection, as determined by CK-MB mass levels (sevoflurane group: 2.52 ± 9.64; control group: 1.84 ± 8.58; P=.32). No effect was noticed on the reduction among patients who (AQ: with?) increase (AQ: increased?) marker levels (prevalence of increase in CK-MB mass greater than the upper limit of normality was 30.8% in the sevoflurane group and 28.9% in the control group; P=.33; 4.6% vs 3.1%, respectively, for increases 5x above the upper limit of normality [P=.21]). CONCLUSIONS: Sevoflurane failed to reduce myocardial injury after PCI. Therefore, its usage should not be routinely recommended.

Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease / Eficácia da Seleção de Pacientes para Cateterismo Coronário por Suspeita de Doença Arterial Coronariana

AbstractBackground:Guidelines recommend that in suspected stable coronary artery disease (CAD), a clinical (non-invasive) evaluation should be performed before coronary angiography.Objective:We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.Methods:We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.Results:A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77), age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26), diabetes (OR, 2.01; CI 95%, 1.40 - 2.90), dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07), typical angina (OR, 2.92; CI 95%, 1.77 - 4.83) and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27).Conclusions:In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.

ResumoFundamento:Diretrizes recomendam que na suspeita de doença arterial coronariana (DAC) estável, uma avaliação clínica (não-invasiva) deve ser realizada antes da realização da coronariografia.Objetivo:Avaliar a eficácia da seleção de pacientes à coronariografia invasiva na suspeita de DAC estável.Métodos:Prospectivamente, selecionamos pacientes sem diagnóstico prévio de DAC referenciados a um centro terciário de grande volume. Características demográficas, fatores de risco, sintomatologia e resultados de exames não-invasivos foram correlacionados com a presença de DAC obstrutiva. Estimamos a probabilidade de DAC com base nos dados clínicos disponíveis e no valor incremental diagnóstico dos exames não-invasivos.Resultados:Um total de 830 pacientes foi incluído, mediana de idade de 61 anos, 49,3% homens, 81% hipertensos e 35,5% de diabéticos. Exames não-invasivos foram realizados em 64,8% dos pacientes. Na coronariografia, 23,8% dos pacientes tinham DAC obstrutiva. Os preditores independentes para DAC obstrutiva foram: sexo masculino (odds ratio [OR], 3,95; intervalo de confiança [IC] de 95%, 2,70 – 5,77), idade (OR por incremento de 5 anos, 1,15; IC 95%, 1,06 – 1,26), diabetes (OR, 2,01; IC 95%, 1,40 – 2,90), dislipidemia (OR, 2,02; IC 95%, 1,32 – 3,07), angina típica (OR, 2,92; IC 95%, 1,77 – 4,83) e teste não-invasivo prévio (OR 1,54; IC 95% 1,05 – 2,27).Conclusão:Nesse estudo, menos de um quarto dos pacientes referenciados a um centro terciário para a realização de coronariografia por suspeita de DAC estável teve o diagnóstico confirmado. Uma melhor avaliação clínica e maior acesso a exames não-invasivos são necessários para aumentar a eficácia da seleção de pacientes para coronariografia invasiva.

Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease.

BACKGROUND: Guidelines recommend that in suspected stable coronary artery disease (CAD), a clinical (non-invasive) evaluation should be performed before coronary angiography. OBJECTIVE: We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD. METHODS: We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests. RESULTS: A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77), age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26), diabetes (OR, 2.01; CI 95%, 1.40 - 2.90), dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07), typical angina (OR, 2.92; CI 95%, 1.77 - 4.83) and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27). CONCLUSIONS: In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.

A randomized trial of creatine-kinase leak after rosuvastatin in elective percutaneous coronary intervention (CLEAR-PCI)

OBJECTIVES: To determine the impact of percutaneous coronary intervention (PCI) performed at the same time of the peak concentration of rosuvastatin to reduce periprocedural myocardial infarction (PMI). BACKGROUND: Prior studies suggest that a high dose of statin before PCI reduce periprocedural myocardial infarction. However, there is no information regarding the elective PCI performed at the time of the peak of statin concentration to reduce PMI. METHODS: From 2001 to 2013, at a single center in Brazil we enrolled 544 patients who underwent elective PCI and after exclusions for baseline biases in clinical and angiographic characteristics, yielding 528 patients, we prospectively randomly assigned them to either a high loading dose of Rosuvastatin before PCI (n = 264) or standard treatment (n = 264). After exclusions for biases in procedural characteristics a total of 487 patients underwent to end points analysis. The primary outcome was the incidence of MB fraction of creatine kinase (CK-MB) greater than three times the upper limit of normal.RESULTS:The primary end point occurred in 7.6% in the rosuvastatin and 4.8% in the control group (P = 0.200). There was a higher incidence in elevation of CK-MB than normal baseline in the rosuvastatin (67.1% vs 59.2%, P = 0.701). There was no difference in major adverse event (0% in the rosuvastatin group vs 0.8% in control).

Risco da ingesta exagerada de sódio na utilização de espessante para disfagia / Risk of excessive sodium intake in the use of a thickener for dysphagia

A disfagia orofaríngea é um distúrbio de deglutição decorrente de causas neurológicas e/ou estruturais que pode ocasionar alteração da interação social, prazer alimentar do indivíduo, desnutrição, desidratação, quadros infecciosos pulmonares e outros de alta morbidade...

Correlation between quantitative angiographic and intravascular ultrasound parameters in patients treated with sirolimus analogous-eluting stents / Correlation between quantitative angiographic and intravascular ultrasound parameters in patients treated with sirolimus analogous-eluting stents

Abstract Despite the undeniable contribution of intravascular ultrasound (IVUS) and quantitative coronary

angiography (QCA) to assess drug-eluting stent (DES) effectiveness, the way these image modalities correlate to each other and to target-lesion revascularization

(TLR) after PCI, is yet to be established. Thus we sought to evaluate whether there is an acceptable correlation between QCA and IVUS after DES implantation. We analyzed 204 pts treated with

DES: Zotarolimus- (126), Sirolimus- (57), and Biolimus (31) with baseline and follow-upQCA and IVUS. The correlation between QCA lumen loss (LL) and intimal hyperplasia (IH) volume obstruction by IVUS

was assessed by multiple regression analysis. Two QCA parameters (in-segment diameter stenosis and insegment

LL) and one IVUS variable (in-stent volume of IH) were evaluated as quantitative surrogates of 6 month TLR. The receiver operating characteristic method with c-statistics was used to assess the

ability of each surrogate endpoint to predict TLR. QCA LL correlated positively with IVUS IH volume of obstruction (r = 0.69; CI95% 0.61–0.75: P/0.0001), independent of DES type. The 2 QCA

parameters were superior to the IVUS parameter as surrogates for TLR. Of note, QCA LL (c = 0.99) correlated best with TLR, even better than percent DS. In the DES era there is a good correlation between

QCA measured LL and IVUS IH volume and therefore can be used as a surrogate of DES efficacy.

Preliminary results of the hydroxyapatite nonpolymer-based sirolimus-eluting stent for the treatment of single de novo coronary lesions

Objectives We sought to investigate the performance and efficacy of the third-generation polymerfree Vestasync-eluting stent (VES). Background Recent concerns regarding the long-term safety of drug-eluting stents have been raised. Synthetic polymers have been associated with intensive inflammatory response and late stent thrombosis. Newly developed, the VES combines a stainless steel platform with a nanothinmicroporous hydroxyapatite surface coating impregnated with a polymer-free sirolimus formulation (55 m). Methods In May 2007, 15 patients with single de novo lesion located in native coronary arteries 3.0 to 3.5 mm in diameter and 14 mm in length were consecutively enrolled. Primary end points included in-stent late lumen loss and in-stent percent of obstruction at 4 months. Serial angiography and intravascular ultrasound were obtained at the index procedure and repeated at 4-month follow-up. Results Mean population age was 63.8 years; 33% of patients were diabetic. The left anterior descending artery was the prevalent target vessel (47%). Reference vessel diameter and lesion length were 2.67 0.32 mm and 9.98 1.98 mm, respectively. The VES was successfully implanted in all cases, and there were no procedure and in-hospital complications. Life-long aspirin and 6-month clopidogrel therapy were prescribed for all patients. At 4 months, in-stent late lumen loss was 0.30 0.25 mm and percent of stent obstruction was 2.8 2.2%. After up to 6 months of clinical follow-up, no major adverse cardiac event was registered. Conclusions The third-generation VES demonstrated excellent acute results in the treatment of de novo coronary lesions. Longer follow-up with a more complex subset of patients and lesions is required to confirm these preliminary results. (J Am Coll Cardiol Intv 2008;1:545–51) © 2008 by the American College of Cardiology Foundation

The revascular active percutaneous interventional device for coronary total occlusions study

Despite the well-documented benefit of recanalization of an occluded vessel in some symptomatic patients, attempt is only performed in a minority of them. Percutaneous coronary intervention (PCI) of CTO is associated with high incidence of complications and unsuccessful procedure, mainly due to inability to cross the lesion. We sought to evaluate the efficacy and safety of the novel RVT CTO Guidewire DeviceTM (RVT-GDWTM, ReVascular Therapeutics, Sunnyvale, CA) in this complex scenario. Methods. The RAPID-CTO study is a non-randomized, single center, first-in-man evaluation of a new guidewire system for treatment of CTO. The RVT-GDW is a new device designed to provide enhanced penetration and positioning control for crossing CTO via: (1) an 0.014 ‘‘guidewire with a mechanically active distal end; (2) a handle attached proximally to the guidewire, with an adjustable torquer, and interfaced to (3) a non-disposable, battery-operated, control unit, that provides activation control and audio feedback during the CTO crossing procedure. Per protocol, the RVT-GDW device was only used after at least 5 min (fluoroscopy time) of attempt with commercially available conventional guidewires to cross the target lesion. Results. A total of 16 patients (16 lesions) were treated with the RVT-GDW. Mean age was 56.25 years, 56.2% were men, and 25% diabetics. The average duration of occlusion was 4.7 6 2.1 months. The mean vessel reference diameter was 2.76 6 0.31 mm and the mean lesion length was 16.64 6 7.70 mm (range 4.37–35.0 mm). Thirteen patients (81.2%) had ‘‘tapered stump’’ morphology at the proximal end of the occlusion, and a side branch was involved in 12 (75.0%). All lesions had contralateral circulation; bridging collaterals were seen in three (18.7%). Procedural success was achieved in 10 lesions (62.5%), with an average procedural time of 111.43 6 35.76 min. There were no major adverse cardiac events at both in-hospital and 30-day clinical follow-up. Conclusions. The first-in-man RAPID-CTO study suggests that the novel RVT-GDW device is technically feasible, safe and effective in crossing chronically occluded coronary arteries. Larger studies are warranted.

asociación entre la concentración de plasmática de proteina C reactiva y el volumen de hiperplasia neointimal en pacientes tratados con implante de stent liberador de zotarolimus. Análisis volumétrico con ecografía intracoronariana tridimensional / Relationship between plasma C-reactive protein level and neointimal hyperplasia volume in patients with zotarolimus-eluting stents. Volumetric analysis by three-dimensional intracoronary ultrasound

INTRODUCTION AND OBJECTIVES: C-reactive protein (CRP) is an inflammatory marker that predicts cardiac events in patients with coronary syndromes. However, data on the relationship between the CRP level and in-stent restenosis are contradictory. The objective of this study was to investigate the relationship between the basal CRP level and the neointimal hyperplasia volume measured by intracoronary ultrasound 4 months after implantation of a zotarolimus-eluting stent. METHODS: The study included 40 consecutive patients who underwent zotarolimus-eluting stent implantation. Patients were divided into quartiles according to their preprocedural CRP level. Intracoronary ultrasound was performed after stent implantation and at 4 months, and the neointimal hyperplasia volume was determined using Simpson's rule. Correlation and linear regression analyses were used to evaluate the relationships between variables. Multivariate analysis was used to identify variables that were independently related to neointimal hyperplasia volume. RESULTS: The patients' mean age was 58 (8) years, 55% were male, and 40% had diabetes mellitus. There was no difference in baseline characteristics between the quartiles. The hyperplasia volumes were 4.8 (4.2) microl and 15.8 (10.0) microl in the first and fourth quartiles, respectively (P< .001). There was a significant positive correlation between the CRP level and neointimal hyperplasia volume (r = 0.64, P=.0001). The CRP level, the postimplantation lumen volume, and the final deployment pressure were all independent predictors of neointimal hyperplasia. CONCLUSIONS: In this study, an independent correlation was observed between the CRP level before zotarolimus-eluting stent implantation and the neointimal hyperplasia volume at 4-month follow-up.

Asociación entre la concentración plasmática de proteína C reactiva y el volumen de hiperplasia neointimal en pacientes tratados con implante de stent liberador de zotarolimus. Análisis volumétrico con ecografía intracoronaria tridimensional / Relationship between plasma C-reactive protein level and neointimal hyperplasia volume in patients with zotarolimus-eluting stents. Volumetric analysis by three-dimensional intracoronary ultrasound

Introducción y objetivos. La proteína C reactiva (PCR) es un marcador inflamatorio predictor de eventos cardiacos en los síndromes coronarios; sin embargo, existe evidencia contradictoria sobre su relación con la reestenosis intra-stent. El objetivo es evaluar la asociación entre la concentración sérica de PCR basal y el volumen de hiperplasia neointimal por ecografía intracoronaria a los 4 meses tras el implante de stents con zotarolimus. Métodos. Se incluyó a 40 pacientes tratados consecutivamente con stent liberador de zotarolimus. Se determinó el valor de PCR antes del procedimiento y de acuerdo con éste se agrupó a la población en cuartiles. Se realizó ecografía intracoronaria tras el implante y a los 4 meses, evaluando el volumen de hiperplasia neointimal por la fórmula de Simpson. Para relacionar las variables se utilizaron análisis de correlación y regresión lineal. Se realizó un análisis de regresión múltiple de las variables relacionadas de forma independiente con el volumen neointimal. Resultados. La edad media fue 58 ± 8 años, el 55% eran varones y el 40% tenía diabetes, sin diferencias en las características basales entre los grupos. El volumen de hiperplasia fue 4,8 ± 4,2 µl y 15,8 ± 10 µl para el primer y el cuarto cuartil respectivamente (p < 0,001). Existió correlación positiva entre la PCR y el volumen neointimal (r = 0,64; p = 0,0001). La PCR, el volumen luminal postimplante y la presión de liberación fueron predictores independientes de hiperplasia neointimal. Conclusiones. En este estudio observamos que el valor de la PCR antes del implante de stent con zotarolimus se correlacionó de forma independiente con el volumen de hiperplasia neointimal a los 4 meses de seguimiento (AU)

Introduction and objectives. C-reactive protein (CRP) is an inflammatory marker that predicts cardiac events in patients with coronary syndromes. However, data on the relationship between the CRP level and in-stent restenosis are contradictory. The objective of this study was to investigate the relationship between the basal CRP level and the neointimal hyperplasia volume measured by intracoronary ultrasound 4 months after implantation of a zotarolimus-eluting stent. Methods. The study included 40 consecutive patients who underwent zotarolimus-eluting stent implantation. Patients were divided into quartiles according to their preprocedural CRP level. Intracoronary ultrasound was performed after stent implantation and at 4 months, and the neointimal hyperplasia volume was determined using Simpson's rule. Correlation and linear regression analyses were used to evaluate the relationships between variables. Multivariate analysis was used to identify variables that were independently related to neointimal hyperplasia volume. Results. The patients' mean age was 58 (8) years, 55% were male, and 40% had diabetes mellitus. There was no difference in baseline characteristics between the quartiles. The hyperplasia volumes were 4.8 (4.2) µl and 15.8 (10.0) µl in the first and fourth quartiles, respectively (P<.001). There was a significant positive correlation between the CRP level and neointimal hyperplasia volume (r = 0.64, P=.0001). The CRP level, the postimplantation lumen volume, and the final deployment pressure were all independent predictors of neointimal hyperplasia. Conclusions. In this study, an independent correlation was observed between the CRP level before zotarolimus-eluting stent implantation and the neointimal hyperplasia volume at 4-month follow-up (AU)

Late incomplete apposition after drug-eluting stent implantation: incidence and potential for adverse clinical outcomes

Aim Late acquired incomplete stent apposition (ISA) has been documented after drug-eluting stent (DES) implantation; However, its clinical consequences of late ISA after implantation sirolimus - (SES) or paclitaxel-eluting stent (PES) in a non-elected population. Methods and Results From our database, we analysed 195 consecutive patients who underwent DES placetement(175 with SES and 20 with PES) into native artery lesions and had serial intravascular ultrasound studies (IVUS) performed at index procedure and after 6-8 months. They were clinically followed for 29 +- 15 mounths (median of 24.3 months, interquartile range 18.1 - 31.6 months. They were clinically followed for a separation of at least one stent strut from the vessel wall in a segment without a side-branch and where the immediate post-implantation IVUS revealed complete apposition of stent struts...

Percutaneous coronary revascularization using a trilayer metal phosphorycholine-coated zotarolimus-eluting stent

The ZoMaxx Coronary Stent System elutes the antiproliferative agent zotarolimus via a biocompatible phosphorylcholine polymer loaded onto a novel, thin, stainless steel stent platform containing an 0.0007-inch inner layer of tantalum that enhances fluoroscopic radiopacity. The objective of this single-arm prospective clinical trial was to assess the safety and performance of the ZoMaxx stent for the treatment of coronary artery stenosis. Forty consecutive patients with ischemic coronary occlusive disease due to single de novo obstructive lesions of native coronary arteries were treated with 3 x 18 mm ZoMaxx stents at the Dante Pazzanese de Cardiologie in Saõ Paulo, Brazil, between April and July 2005. Independent core laboratories analyzed quantitative coronary angiography and intravascular ultrasound results immediately after stent implantation, and after 4 months. The lesion, procedure, and device-deployment success rates were all 100% (40 of 40). There were no major adverse cardiac events during the study. Follow-up quantitative coronary angiography at 4 months revealed in-stent and in-segment late lumen losses of 0.20 +/- 0.35 and 0.17 +/- 0.35 mm, respectively. Follow-up intravascular ultrasound at 4 months revealed 6.5 +/- 6.2% neointimal volume obstruction. There were no instances of late acquired stent incomplete apposition or stent thrombosis. In conclusion, the ZoMaxx Coronary Stent can be safely implanted for the treatment of de novo coronary artery stenosis. The inhibition of neointima formation as measured by follow-up angiography and IVUS after 4 months suggests therapeutic potential for the reduction of restenosis.

Randomized, Double-Blind, Multicenter Study of the Polymer-Based 17-b Estradiol-Eluting Stent for Treatment of Native Coronary Artery Lesions: Six-Month Results of the ETHOS I Trial

Objectives: The ETHOS I trial was the first in-human experience evaluating the safety and efficacy of two different release formulations of the 17-b estradiol-eluting RStent TM versus uncoated control stents for the treatment of patients with single de novo native coronary lesions. Background: Estrogens were reported to inhibit neointimal proliferation and to accelerate endothelial regeneration after coronary angioplasty and thus could be an ideal compound to deliver on a stent for the purpose of reducing in-stent restenosis. Methods: Ninety-five patients were randomized to receive a slowrelease (n = 32) or the moderate release (n = 31) formulations or the bare metal stent (n = 32). The primary end point was the 6-month percent in-stent volume obstruction by intravascular ultrasound (IVUS). Results: Diabetes was present in 29.5% of patients; the mean reference vessel diameter was 2.90 mm; and the mean lesion length was 13.5 mm. Primary endpoint, 6-month percent in-stent volume obstruction by IVUS, did not differ significantly between the 3 groups (31% 6 14%, 33% 6 11%, and 31% 6 14%, P = 0.83). Secondary endpoints also did not differ significantly between the groups including 6-month rates of in-lesion binary angiographic restenosis (13.3%, 14.3%, and 12.5%, P = 0.98), in-stent late loss (0.82 6 0.49 mm, 0.86 6 0.53 mm, and 0.84 6 0.46 mm, P = 0.97), target lesion revascularization (12.5%, 6.9%, and 6.5%, P = 0.64), and major adverse cardiac events (18.8%, 10.3%, and 6.5%, P = 0.31). Conclusions: In this first-in-man randomized trial, the 17-b estradiol-eluting R-StentTM, in either slowor moderate-release formulations, was well-tolerated, but showed no benefit for treatment of coronary lesions when compared to controls.

Seguimento tardio de pacientes diabéticos tratados com stents com eluição de sirolimus: um estudo angiográfico e com ultra-som intracoronário tridimensional / Long-term follow up of diabetic patients treated with Sirolimus-eluting stents: angiographic and tridimensional intracoronary ultrasonographic study

Fundmentos: Os stents com eluição de sirolimus (SES) têm demonstrado sua eficácia tardia em suprimir a hiperplasia neointimal em pacientes que não são de alto risco. A evolução tardia de pacientes diabéticos tratados com SES ainda não foi avaliada. Método e Resultados: A comparação dos resultados da angiografia coronária quantativa e do ulta-som intracoronária foi realizada em 35 pacientes diabéticos tratados com o SES entre o 6º (6,0 +- 1,0 meses) e o 18º mês (18,5 +- 4,9 meses). não foram observadas mudanças significativas no diâmetro mínimo da luz (DML) entre o acompanhamento de curto e longo-prazos (2,69 +- 0,46 vs. 2,61 +- 0,4 mm; p=5), bem como no DML intra-stent (2,38 +-0,54 vs. 2,30 +- 0,62mm; p=0,6)...

Reperfusão endovascular pós-embolia cerebral durante arterografia carotídea / Endovascular reperfusion following crebral embolism during carotid arteriography

Relatamos um caso de um paciente de 72 anos que, durante a realização de uma arteriografia carotídea, apresentou embolia arterial intracerebral sintomática. O paciente foi submetido imediatamente à reperfusão endovscular (mecânica) intracerebral com sucesso (clínico e angiográfico).