[Coronary angioplasty in diabetic patients]. / L'angioplastica coronarica nei diabetici.

Increased thrombogenicity, endothelial dysfunction, proliferation of both the cells and the matrix in the vessel walls, dislipidemia and insulin-resistance are the main metabolic alterations in the diabetic scenario, with possible implications in terms of vessel restenosis after coronary angioplasty. The outcome of balloon coronary angioplasty in diabetics is poor. This is due to both increased restenosis and a high incidence of medium/long-term cardiac events; the use of stents in these patients has substantially improved the results, but the recurrence rate has not been abated to the level observed in the general population. Abciximab may be a helpful adjunct to coronary angioplasty in these patients, while coronary artery bypass grafting may still be preferable--as at present--in case of multivessel coronary artery disease. This viewpoint is likely to be substantially modified in the near future, if the promise of "zero restenosis" devices is kept.

[Transcatheter aortic valve implantation in bicuspid aortic valve: never say never]. / Valvola bicuspide e impianto di valvola aortica transcatetere: mai dire mai.

Transcatheter aortic valve implantation (TAVI) is an emerging alternative technique that has shown promise in the treatment of severe aortic stenosis in patient populations at high risk with conventional surgery. The presence of a bicuspid aortic valve (BAV) has been considered an exclusion criterion for TAVI, because of the presumed risk for poor seating or paravalvular regurgitation due to severe distortion of the native valve leaflets. For this reason, BAV disease has generally been an exclusion criterion in major trials of TAVI and there is little clinical experience available. We report a case of transcatheter valve replacement in a poor surgical candidate with BAV stenosis using a new 29 mm Edwards Sapien prosthesis.