Clinical impact of cerebral protection during transcatheter aortic valve implantation.

BACKGROUND: Embolization of debris can complicate transcatheter aortic valve implantation (TAVI) causing stroke. Cerebral embolism protection (CEP) devices can divert or trap debris. PURPOSE: To evaluate the efficacy of CEP during TAVI vs the standard procedure. DATA SOURCES: PubMed, SCOPUS and DOAJ 1/01/2014-04/12/2023. STUDY SELECTION: Randomized and observational studies comparing CEP versus standard TAVI, according to PRISMA. PRIMARY OUTCOME: stroke. SECONDARY OUTCOMES: death, bleeding, vascular access complications, acute kidney injury and infarct area. DATA EXTRACTION: Two investigators independently assessed study quality and extracted data. DATA SYNTHESIS: Twenty-six articles were included (540.247 patients). The primary endpoint was significantly lower (RR = 0.800 95%CI:0.682-0.940; p = 0.007) with CEP. Similarly, death rates were significantly lower with CEP (RR = 0.610 95%CI:0.482-0.771; p < 0.001). No difference was found for bleeding (RR = 1.053 95%CI:0.793-1.398; p = 0.721), vascular complications (RR = 0.937 95%CI:0.820-1.070; p = 0.334) or AKI (RR = 0.982 95%CI:0.754-1.279; p = 0.891). CONCLUSIONS: Use of CEP during TAVI is associated with improved outcomes. Future studies will identify patients who benefit most from CEP.

The relationship between endothelial-dependent flow-mediated dilation and diastolic function in type 2 diabetes.

AIMS: Diastolic dysfunction represents the earliest and most common manifestation of diabetic cardiomyopathy. Nitric oxide (NO), a potent vasodilator and anti-inflammatory mediator released from the subendocardial and coronary endothelium, favors left ventricular distensibility and relaxation. In type 2 diabetes (T2D), the NO bioavailability is reduced due to the oxidative stress and inflammatory state of the endothelium, because of chronic hyperglycemia. The aim of the present research is to evaluate the relationship between endothelial function and diastolic function in subjects with T2D. METHOD: Subjects with T2D and age and sex-matched healthy controls were consecutively recruited. All participants underwent flow-mediated dilation (FMD) to assess endothelial function, and echocardiography to evaluate diastolic function. RESULTS: Thirty-five patients (6 women, 29 men) and 35 healthy controls were included in the final analysis. FMD was significantly lower in T2D than controls (4.4 ± 3.4 vs. 8.5 ± 4.3%, p = 0.001). T2D presented different abnormalities in diastolic function compared to controls: lower E/A (early to late diastolic transmitral flow velocity), lower septal and lateral e' (early diastolic myocardial tissue velocity at septum and lateral wall), and higher E/e' (surrogate of filling pressure). In subjects with T2D, we observed a significant correlation between FMD and E/e' (r = -0.63, p = 0.001), lateral e' (r = 0.44, p = 0.03), and septal e' (r = 0.39, p = 0.05). CONCLUSIONS: Our observational study demonstrated a link between FMD and diastolic dysfunction in subjects with type 2 diabetes.

Mechanical thrombectomy using neurovascular catheter from radial artery during acute myocardial infarction: A case report.

Coronary occlusion due to large thrombus is frequently encountered during ST-elevation myocardial infarction (STEMI). Despite guidelines discourage this practice, often thrombus aspiration is necessary to reduce thrombotic burden and to prevent embolization. We report a case of mechanical thrombectomy with a Neurovascular Catheter from radial artery during inferior STEMI.