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Cimmino G, Gallinoro E, di Serafino L, De Rosa G, Sugraliyev A, Golino P, Cirillo P. Uric acid plasma levels are associated with C-reactive protein concentrations and the extent of coronary artery lesions in patients with acute coronary syndromes. Intern Emerg Med 2023; 18:1751-1757. [PMID: 37466806 DOI: 10.1007/s11739-023-03360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
Many studies have pointed out that inflammation plays a pivotal role in pathophysiology of acute coronary syndromes (ACS) because several inflammatory molecules impair the endothelial functions in the coronary circulation and promote atherothrombotic events. Recently, many clinical/experimental evidences indicate that elevated plasma levels of uric acid (UA) might be considered a risk factor for developing ACS. It has been reported that elevated UA doses impair physiologic functions of endothelial cells, shifting them toward a pro atherothrombotic phenotype. In the present manuscript, we investigated the relationship between UA plasma levels, inflammatory burden, and extension of coronary atherosclerotic disease in patients with ACS. Patients with a clinical presentation of ACS (ST-elevated and non-ST-elevated myocardial infarction) admitted to the Vanvitelli Catheterization Laboratory at Monaldi Hospital in 2019, before the COVID-19 pandemia, were retrospectively analyzed. Biochemical profile, type of ACS presentation, as well as extension of coronary atherosclerosis were assessed. A total of 132 ACS patients were included in the analysis, and grouped into 3 tertiles according to the UA values (UA < 4.72 mg/dl, UA between 4.72 and 6.15 mg/dl, and UA > 6.15 mg/dl). Patients with UA plasma levels ≥ 6.15 mg/dL showed higher levels of C-reactive protein (mean of 5.1 mg/dL) as compared to patients with lower UA plasma levels. Moreover, the former group of patients showed higher levels of cardiac troponin and CPK, and presented more often with multivessel disease and complex coronary stenosis (type C of Ellis classification). Even though monocentric and with limited sample size, the present study shows that plasma levels of UA and hs-CRP are elevated in ACS patients and are associated with a more severe coronary disease, suggesting a potential role of UA in the pathophysiology of acute coronary events.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Gallinoro
- Cardiology Department, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | - Luigi di Serafino
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Gennaro De Rosa
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Akhmetzhan Sugraliyev
- Department of Internal Disease, Kazakh National Medical University, Almaty, Kazakhstan
| | - Paolo Golino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
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Benfor B, Sinha K, Karmonik C, Lumsden AB, Roy TL. Human Cadaveric Model for Vessel Preparation Device Testing in Calcified Tibial Arteries. J Cardiovasc Transl Res 2023; 16:502-509. [PMID: 36103037 PMCID: PMC10151304 DOI: 10.1007/s12265-022-10319-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022]
Abstract
To describe an ex vivo model for vessel preparation device testing in tibial arteries. We performed orbital atherectomy (OA), intravascular lithotripsy (IVL), and plain balloon angioplasty (POBA) on human amputated limbs with evidence of concentric tibial artery calcification. The arterial segments were then harvested for ex vivo processing which included imaging with microCT, decalcification, and histology. The model was tested out in 15 limbs and was successful in 14 but had to be aborted in 1/15 case due to inability to achieve wire access. A total of 22 lesions were treated with OA on 3/22 lesions, IVL on 8/22, and POBA without vessel preparation on the remaining 11/22. Luminal gain was assessed with intravascular ultrasound and histology was able to demonstrate plaque disruption, dissections, and cracks within the calcified lesions. A human cadaveric model using amputated limbs is a feasible, high-fidelity option for evaluating the performance of vessel preparation devices in calcified tibial arteries.
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Affiliation(s)
- Bright Benfor
- Department of Vascular Surgery, Houston Methodist Debakey Heart & Vascular Center, 6565 Fannin St, Suite B5-022, Houston, TX, 77030, USA.
| | - Kavya Sinha
- Department of Vascular Surgery, Houston Methodist Debakey Heart & Vascular Center, 6565 Fannin St, Suite B5-022, Houston, TX, 77030, USA
| | - Christof Karmonik
- Translational Imaging Center, Houston Methodist Academic Institute, Houston, TX, USA
| | - Alan B Lumsden
- Department of Vascular Surgery, Houston Methodist Debakey Heart & Vascular Center, 6565 Fannin St, Suite B5-022, Houston, TX, 77030, USA
| | - Trisha L Roy
- Department of Vascular Surgery, Houston Methodist Debakey Heart & Vascular Center, 6565 Fannin St, Suite B5-022, Houston, TX, 77030, USA
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Rota Ablation - When There is No Other Option. A Complex Case of 86 Years Old Male with Multiple Comorbids Presenting With Stemi. J Community Hosp Intern Med Perspect 2023; 13:73-76. [PMID: 36817305 PMCID: PMC9924629 DOI: 10.55729/2000-9666.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 01/11/2023] Open
Abstract
The aim of this report is to explore the direct and long-term outcome in a high risk patient who was treated with rotational atherectomy (RA) to assist the placement of drug eluting stents in heavily calcified lesions. The patient presented with acute STEMI and had severely calcified Left main stem (LMS) disease, requiring plaque modification before coronary angioplasty and stent implantation. As the patient was elderly, with multiple comorbids including a number of coronary interventions, a decision of conservative management was made. Patient then re-presented with typical chest pain and pulmonary edema. A Heart Team meeting was called and high risk decision of RA to LMS was taken. His percutaneous transluminal coronary angioplasty (PTCA) to LM and LAD was planned. LMS to LAD was rotablated with 1.75 burr and PTCA with 3.5 NC at 20 Atm. During the procedure, patient developed flash pulmonary edema. In post-operative care, his renal functions deteriorated and nephrology was taken on board. After multiple sessions of hemodialysis, patient was clinically improved and stabilized. The report highlights the expertise required in RA of a complex LMS disease and judicious post-procedure care which resulted in significant reduction of morbidity, mortality and frequent hospitalizations of the patient.
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Reappraisal Value of a Modified Rotational Atherectomy Technique in Contemporary Coronary Angioplasty Era. J Interv Cardiol 2020; 2020:9190702. [PMID: 32082099 PMCID: PMC7007738 DOI: 10.1155/2020/9190702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/11/2019] [Accepted: 12/27/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives To introduce a modified rotational atherectomy (RA) procedure and investigate the early and midterm outcomes of the RA-facilitating diversified percutaneous coronary intervention (PCI) in a large group of aged patients with higher cardiovascular risk. Background Previous studies about the outcomes of RA were limited with small sample size and low-risk population. Methods Between January 2013 and November 2015, 1169 consecutive patients treated with modified RA-facilitated PCI were retrospectively enrolled, including de novo calcified lesions and in-stent restenosis. Patients were regularly followed up for at least 1 year. Major adverse cardiac events (MACE) were analyzed for all participants by different strategies. Cox regression analysis was performed to identify risk factors for the events. Results The median age of patients was 75 years, with 11.7% of patients on maintenance hemodialysis. Most lesions (99.9%) were complex (American Heart Association type B2/C), and 68.3% were treated with RA + drug-eluting-stent (DES). Successful angiography was achieved in 97.8% cases, with 1.7% (20/1169) experiencing coronary perforation (including guidewire perforation). The incidence of MACE was 20.5% and 26.8% at 1-year and 2-year follow-up and were mainly driven by target lesion revascularization (TLR) (10.3% and 12.5%, respectively). The strategy of RA + DES had the lowest 2-year MACE, compared with the RA + drug-coated balloon and RA + plain old balloon angioplasty (14.5%, 30.5%, and 26.0%, respectively). Conclusions The modified RA technique is a safe and effective tool in the contemporary PCI era, even in high-risk patients. The TLR rate was relatively high but acceptable in such complex lesions.
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Sorini Dini C, Nardi G, Ristalli F, Mattesini A, Hamiti B, Di Mario C. Contemporary Approach to Heavily Calcified Coronary Lesions. Interv Cardiol 2019; 14:154-163. [PMID: 31867062 PMCID: PMC6918474 DOI: 10.15420/icr.2019.19.r1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022] Open
Abstract
Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.
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Affiliation(s)
- Carlotta Sorini Dini
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
- Cardiology Division, Spedali RiunitiLivorno, Italy
| | - Giulia Nardi
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Francesca Ristalli
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Brunilda Hamiti
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
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Bamford P, Parkinson MD, Gunalingam B, David M, Lau GTM. A New Era for Rotational Atherectomy: An Australian Perspective. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819852070. [PMID: 31217694 PMCID: PMC6557014 DOI: 10.1177/1179546819852070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/29/2019] [Indexed: 11/23/2022]
Abstract
Background: Rotational atherectomy (RA) has been used in percutaneous coronary intervention (PCI) for 30 years. With advances in technology, this observational study looks at how rates of RA have changed over the past decade in Australia in relation to PCI and coronary artery bypass graft (CABG) rates. Methods: Retrospective analysis of RA, PCI, and CABG rates per Australian state from Australian Government Department of Human Services’ data on Medicare items from 2007 to 2017 was carried out. Results: There were 149 RA procedures in 2007, increasing to 452 in 2017. Rotational atherectomy accounted for 0.67% of PCI procedures in 2007, increasing to 1.48% in 2018 (+0.81%, 95% confidence interval [CI] = [0.64%-0.91%]; P < .001). Most of this increase has come from procedures in New South Wales (441% increase). Australian PCI rate increased from 22 301 to 30 480. Rate of CABG decreased from 5418 to 5206. Conclusions: From 2007 to 2017, rates of RA trebled in Australia. This is despite stable rates of PCI and a fall in rates of CABG. There are several clinical explanations for this trend.
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Affiliation(s)
- Paul Bamford
- Gosford Hospital, Gosford, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia
| | | | - Brendan Gunalingam
- Gosford Hospital, Gosford, NSW, Australia.,St Vincent's Hospital, Sydney, NSW, Australia
| | | | - George Tat-Ming Lau
- Gosford Hospital, Gosford, NSW, Australia.,Sydney Adventist Hospital, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
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Gholampour S, Hajirayat K. Minimizing thermal damage to vascular nerves while drilling of calcified plaque. BMC Res Notes 2019; 12:338. [PMID: 31200774 PMCID: PMC6570876 DOI: 10.1186/s13104-019-4381-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/11/2019] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Drilling of calcified plaque (DCP) inside the artery is a method for removing calcified plaques. This study investigated the effect of drill. To validate the maximum temperature calculated by computer simulation, this value was also measured by an experimental on a phantom model. RESULTS Increasing drill bit diameter during drilling would increase the temperature in vascular nerves. In a drill bit with a diameter of 4 mm, the risk of thermal necrosis in vascular nerves of the artery wall decreased by 8.57% by changing the drill from WC to NT. The same value for a drill bit with a diameter of 6 mm was 10.17%. However, the trend of the generated temperature in the vascular nerves did not change significantly with change of the material and diameter of the drill bit. The results showed that for DCP with the least risk of thermal necrosis in vascular nerves and subsequently the lowest risk of restenosis, coagulation and thermal stroke of the patient, the best option is to use a drill bit with a diameter of 4 mm and NT material for drilling.
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Affiliation(s)
- Seifollah Gholampour
- Department of Biomedical Engineering, Islamic Azad University-Tehran North Branch, Tehran, Iran
| | - Keyvan Hajirayat
- Department of Biomedical Engineering, Islamic Azad University-Tehran North Branch, Tehran, Iran
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Experimental investigation of the abrasive crown dynamics in orbital atherectomy. Med Eng Phys 2016; 38:639-647. [DOI: 10.1016/j.medengphy.2016.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/26/2016] [Accepted: 04/03/2016] [Indexed: 01/02/2023]
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Abazid RM, Obadah Kattea M, Smettei OA, Beshir Y, Sakr H. Impact of coronary artery calcification on percutaneous coronary intervention and postprocedural complications. J Saudi Heart Assoc 2016; 29:15-22. [PMID: 28127214 PMCID: PMC5247302 DOI: 10.1016/j.jsha.2016.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 03/30/2016] [Accepted: 05/09/2016] [Indexed: 11/16/2022] Open
Abstract
Background Excessive coronary calcification can lead to adverse outcomes after percutaneous coronary intervention (PCI). We therefore evaluated the impact of coronary calcium score (CCS) measured by multidetector computed tomography (MDCT) on immediate complications of PCI and rate of restenosis. Methods We performed a single-center retrospective analysis of 84 patients with coronary stenosis diagnosed by MDCT who underwent PCI. The Agatston method was used to measure total, target-vessel, and segmental (stent deployment site) CCS. Results In 108 PCI procedures, 32 lesions (29.5%) were American College of Cardiology/American Heart Association type A, 60 (55.5%) were type B, and 16 (15%) were type C. ANOVA showed significantly higher segmental CCS in type C than in type A lesions (29 ± 51 vs. 214 ± 162; p = 0.03). Six patients (7.1%) had periprocedural complications and seven (8.3%) had in-stent restenosis and angina. Mean total, target-vessel, and segmental CCS was significantly higher in complicated than in successful PCI (199 ± 325 vs. 816 ± 624, p = 0.001; 92 ± 207 vs. 337 ± 157, p = 0.001; and 79 ± 158 vs. 256 ± 142, p = 0.003, respectively), but there was no significant difference in CCS between successful PCI and PCI complicated by late restenosis. Conclusions CCS measured by MDCT has an important role in predicting early, but not late, complications from PCI.
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Affiliation(s)
- Rami M Abazid
- Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, aSaudi Arabia
| | - M Obadah Kattea
- Department of Cardiology, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, bSaudi Arabia
| | - Osama A Smettei
- Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, aSaudi Arabia
| | - Yasir Beshir
- Department of Cardiology, Invasive Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, cSaudi Arabia
| | - Haitham Sakr
- Department of Cardiology, Invasive Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, cSaudi Arabia
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Chiang MH, Yi HT, Tsao CR, Chang WC, Su CS, Liu TJ, Liang KW, Ting CT, Lee WL. Rotablation in the treatment of high-risk patients with heavily calcified left-main coronary lesions. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:217-25. [PMID: 24133507 PMCID: PMC3796693 DOI: 10.3969/j.issn.1671-5411.2013.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/06/2013] [Accepted: 07/09/2013] [Indexed: 12/12/2022]
Abstract
Objective Heavily calcified left-main coronary diseases (LMCA) remain a formidable challenge for percutaneous interventions (PCI). This study was to investigate the safety and efficacy of using rotational atherectomy (RA) in treating such lesions in actual practice. Methods From February 2004 to March 2012, all consecutive patients who received RA for heavily-calcified LMCA lesions in our cath lab were enrolled. The relevant clinical and angiographic characteristics at the time of index PCI, as well as the clinical follow-up outcomes, were retrieved and analyzed. Results A total of 34 consecutive patients were recruited with a mean age 77.2 ± 10.2 years. There were 82.4% presented with acute coronary syndrome and 11.8% with cardiogenic shock. Chronic renal disease and diabetes were seen in 64.7% and 52.9%, respectively. Triple-vessel coronary disease was found in 76.5% of them. The mean SYNTAX score was 50 ± 15 and EuroSCORE II scale 5.6 ± 4.8. The angiographic success rate was 100% with a procedural success rate of 91.2%. The mean number of burrs per patient was 1.7 ± 0.5. Crossing-over stenting was used in 64.7%. Most stents were drug-eluting (67.6%). Intra-aortic ballon pump was used in 20.6% of the procedures. Three patients died during hospitalization, all due to presenting cardiogenic shock. No major complication occurred. Among 31 hospital survivors, the major adverse cardiac events (MACE) rate was 16.1%, all due to target lesion revascularization or target vessel revascularization. Conclusions In high-surgical-risk elderly patients, plaque modification with RA in PCI of heavily-calcified LMCA could be safely accomplished with a minimal complication rate and low out-of-hospital MACE.
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Affiliation(s)
- Meng-Hsiu Chiang
- Division of Cardiology, Saint Mary's Hospital, 160 Zhongzheng South Road, Luodong, Yilan 26546, Taiwan, China
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