\”Anti-healing\” versus \”pro-healing\”

Seth DA.

Max Heart and Vascular Institute, New Delhi, India.

Percutaneous coronary intervention utilizing a new endothelial progenitor cells antibody-coated stent: A prospective single-center registry in high-risk patients.

OBJECTIVE:: To prospectively evaluate the outcome with circulating endothelial progenitor cell (EPC) capture stent implantation in a cohort of consecutive patients with high-risk angiographic and/or clinical features. BACKGROUND:: Genous R-stenttrade mark is a stainless steel coronary stent covered with antibodies specific to EPC\’s surface antigens, designed to promote the formation of a confluent functional endothelial layer over the device; conceivably, this may prevent both stent thrombosis and restenosis. METHODS:: From November 2005 to March 2007, 80 patients received 93 EPC capture stents at Campus Bio-Medico, University of Rome. Patients had two or more of the following high-risk features: diabetes mellitus (33%), unstable coronary syndromes (73%), left ventricular dysfunction (8%), multivessel intervention (9%), B2/C lesions (56%). RESULTS:: Acute success was achieved in 79/80 patients (98%), without Q-wave myocardial infarction (MI), in-hospital death or emergency bypass surgery; no patient had acute or subacute stent thrombosis. Follow-up was available in 78 patients (mean 14 +/- 4 months): noncardiac death occurred in one patient, acute MI in one patient; no patient required bypass surgery; 10 patients (13%) underwent percutaneous target lesion revascularization (TLR); three patients (4%) had reintervention on a nontarget vessel. Kaplan-Meyer life-table analysis showed event-free survival of 86% and TLR-free survival of 90% at one and a half year follow-up. CONCLUSIONS:: The cell capture stent is safe and effective, with satisfactory immediate results and mid-term outcome, without evidence of stent thrombosis. Whether those devices represent a viable alternative to currently available drug-eluting or bare metal stents will need to be evaluated in larger randomized studies. (c) 2008 Wiley-Liss, Inc.

Miglionico M, Patti G, D\’Ambrosio A, Di Sciascio G.

Department of Cardiovascular Sciences, Campus Bio‐Medico University, Rome, Italy.

Treatment of drug-eluting stent restenosis: A sandwich may not be the best combo.

Belardi J.

Blanco Encalada, 1543 Buenos Aires, Argentina 1428.

Hemodynamics of myocardial bridging.

Costello FM, Stouffer GA.

Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.

Treatment of a ruptured saphenous vein graft pseudoaneurysm using a vascular plug.

Saphenous vein graft pseudoaneurysm is an uncommon complication of coronary bypass grafting. Hemoptysis associated with diffuse bleeding into the lung tissue may be the initial manifestation of this condition. We report a case of a saphenous vein graft pseudoaneurysm that presented with hemoptysis and was successfully treated with a proximal vascular plug. (c) 2008 Wiley-Liss, Inc.

Tonelli AR, Desai AK, Anderson RD.

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Florida, Gainesville, Florida.

I have seen the future, and it works-Lincoln Steffens (1866-1936).

Block PC.

Emory University Hospital 1364 Clifton Rd. F606 Atlanta, Georgia.

Percutaneous implantation of the first repositionable aortic valve prosthesis in a patient with severe aortic stenosis.

OBJECTIVES AND BACKGROUND:: Percutaneous aortic valve replacement is a new less-invasive alternative for high-risk surgical candidates with aortic stenosis. However, the clinical experience is still limited, and the currently available \’first-generation devices\’ revealed technical shortcomings, such as lack of repositionability and presence of paravalvular leakages. We report the first-in-man experience with the new self-expanding Lotustrade mark Valve prosthesis composed of a nitinol frame with implemented bovine pericardial leaflets which is designed to address these issues, being repositionable and covered by a flexible membrane to seal paravalvular gaps. We implanted this prosthesis in a 93-year old patient presenting with severe symptomatic aortic stenosis (valve area: 0.6 cm(2)). Surgical valve replacement had been declined due to comorbidities. METHODS AND RESULTS:: We used a retrograde approach for insertion of the 21-French Lotus catheter loaded with the valve prosthesis via surgical cut-down to the external iliac artery. Positioning of the valve was guided by transesophageal echo and supra-aortic angiograms. The prosthesis was successfully inserted and deployed within the calcified native valve. Echocardiography immediately after device deployment showed a significant reduction of the transaortic mean pressure gradient (32 to 9 mmHg; final valve area 1.7 cm(2)) without evidence of residual aortic regurgitation. The postprocedural clinical status improved from NYHA-IV to NYHA-II. These results remained unchanged up to the 3 month follow-up. CONCLUSIONS:: Successful percutaneous aortic valve replacement can be performed using the new self-expanding and repositionable Lotus valve for treatment of high-risk patients with aortic valve stenosis. Further studies are mandatory to assess device safety and efficacy in larger patient populations. (c) 2008 Wiley-Liss, Inc.

Buellesfeld L, Gerckens U, Grube E.

Department of Cardiology, HELIOS Heart Center Siegburg, Siegburg, Germany.

An indeterminate occlusion duration predicts procedural failure in the recanalization of coronary chronic total occlusions.

OBJECTIVES:: To identify the impact of occlusion duration (OD) and, in particular, an indeterminate occlusion duration (IOD) on immediate angiographic success and long-term clinical outcomes in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS:: From May 2003 to October 2006, all patients having PCI for a CTO were consecutively registered. In addition to an assessment of procedural outcomes, patients were followed long-term for occurrence of major adverse cardiac events (MACE). RESULTS:: 202 consecutive patients were included. Of these, 123 (60.9%) had a known OD while in the remaining 79 (39.1%), OD was indeterminate. Overall technical success was 82.7% and was lower in the IOD group (70.9% vs. 90.2%, P = 0.0004). An IOD was a predictor of procedural failure (adjusted OR 4.51, 95% CI 1.7-11.5, P = 0.002). An IOD (HR 2.59, 95%CI 1.08-6.23, P = 0.032) and procedural success (HR 0.26, 95%CI 0.11-0.60, P = 0.002) were the only independent predictors of long-term MACE. Patients with a failed PCI and an IOD had a 5-fold increased risk of MACE compared to those with known OD (37.0% vs. 7.1%, log rank P = 0.0036). CONCLUSIONS:: In addition to the traditional predictors of procedural success and clinical outcome, this study, for the first time uncovered the importance of OD and, in particular, of an IOD. Still, in patients who are successfully recanalized, a long or IOD bears the same low rate of MACE as the general CTO population while in patients with failed PCI, an IOD carries a considerable risk of adverse prognosis. (c) 2008 Wiley-Liss, Inc.

Barlis P, Kaplan S, Dimopoulos K, Tanigawa J, Schultz C, Di Mario C.

Department of Cardiology and National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom.

Carotid artery dissection: Endovascular treatment. Report of 12 patients.

OBJECTIVE:: The purpose of this article is to report our experience with endovascular treatment of internal carotid artery (ICA) dissection with the use of stents. BACKGROUND:: Carotid Dissection is an important cause of ischemic stroke in young and middle-aged patients. There are some patients in whom invasive management is recommended. METHODS:: Twelve patients (eight females, four males), mean age of 50 years (range 35-80 years) with ICA dissection, were treated with the endovascular approach during a 24-month period. Patients included in this study underwent magnetic resonance (MR) and digital subtraction angiography (DSA) for diagnosis. Over this time period, 162 patients with ICA dissections were seen at our institution. Indications for endovascular treatment were: recurrent ischemic events despite adequate anticoagulant treatment in seven cases, contraindication to anticoagulation in four cases, and one case with significant mismatch between diffusion and perfusion weighted MR. Eleven dissections were spontaneous and one was traumatic. The follow-up was performed clinically with Doppler ultrasound (US) and MR at 6, 12, and 24 months. RESULTS:: Stent deployment was successful in all cases. Acute symptoms were resolved in 66.7% of patients. No patients deteriorated their neurological status. There were no new clinical events, stent stenosis or occlusion on 24 months follow-up. CONCLUSION:: Our results showed an excellent clinical outcome of the treated patients. This suggests promising results with the use of endovascular treatment in selected patients. (c) 2008 Wiley-Liss, Inc.

Fava M, Meneses L, Loyola S, Tevah J, Bertoni H, Huete I, Mellado P.

Interventional Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile.

Antimicrobial susceptibility of Haemophilus influenzae strains and antibiotics usage patterns in pediatric outpatients: results from a children\’s hospital in China (2000-2004).

OBJECTIVE: To investigate the nasopharyngeal carriage and antimicrobial susceptibility of H. influenzae among children younger than 5 years old and to assess antibiotics usage patterns in the outpatient department of Beijing Children\’s Hospital from 2000 to 2004. MATERIALS AND METHODS: From 2000 to 2004, At least 100 strains of H. influenzae were isolated from the pediatric patients who were younger than 5 years and who presented with symptoms of acute upper respiratory tract infections during February to May in each of the study years. Antimicrobial susceptibilities were determined; and antibiotics usage was expressed as defined daily dose (DDD)/100 patient days. RESULTS: The overall nasopharyngeal carriage rate of H. influenzae is 26.3% (562/2,137) in children younger than 5 years old with acute upper respiratory tract infection. The percentage of ampicillin-resistant isolates ranges from 4.0% (4/100) to 14.3% (17/119) from 2000 to 2004. All the ampicillin-resistant isolates are beta-lactamase producers. More than 80% of the isolates are susceptible to amoxicillin, cefaclor, and chloramphenicol; whereas, almost all (99-100%) of the isolates are sensitive to amoxicillin/clavulanic acid, ceftriaxone, and cefuroxime. For antibiotics utilization, macrolides are the predominantly used antibiotics, followed by cephalosporins and penicillins among pediatric patients in the outpatient department during the study period. CONCLUSION: All amoxicillin-resistant isolates of H. influenzae are producing beta-Lactamase; and the rates of amoxicillin-resistant isolates are increasing over time. Amoxicillin/clavulanic acid and cephalosporins are highly sensitive to H. influenzae isolated from Chinese pediatric patients. Macrolides are the most used antibiotics in the outpatient department during the study period. Pediatr Pulmonol. (c) 2008 Wiley-Liss, Inc.

Wang A, Yu S, Yao K, Zhang W, Yuan L, Wang Y, Wei J, Shen X, Yang Y.

Beijing Children\’s Hospital, Capital Medical University, Beijing 100045, China.