DIAMondback Atherectomy With OCT Visualization for Calcified PAD Lesions (DIAMOCT-PAD Study)

OBJECTIVE

In this study, we aimed to describe the immediate and long-term vascular effects of OAS in patients with peripheral arterial disease (PAD) and moderate to severely calcified lesions.

BACKGROUND

Debulking the calcified atherosclerotic plaque with the orbital atherectomy system (OAS) can potentially enhance vessel compliance and increase the chance of reaching a desirable angioplasty result.

METHODS

A total of 7 patients were evaluated both at baseline and at 6-month follow-up. Following a diagnostic peripheral angiogram, patients with significant SFA disease had a baseline intravascular optical coherence tomography (IV-OCT) and the lesion was treated with OAS. Repeat IV-OCT was performed after atherectomy and after drug-coated balloon, if used. Patients were also evaluated with angiography and IV-OCT imaging at their 6-month follow-up.

RESULTS

The majority of tissue removed was fibrous tissue. During follow-up, luminal volume increased for 4 of the 7 patients from baseline to 6-month follow-up and decreased in 3 patients. On average there was a 6% increase of luminal volume (P<.01 compared with baseline). A recent virtual histology algorithm was used for automatic classification of IV-OCT images unaided by any reader. The algorithm used convolutional neural networks to identify regions as either calcium, fibrous, or lipid plaque, and it agreed with an expert reader 82% of the time.

CONCLUSION

To the best of our knowledge, the current report is the first to describe vascular effects of OAS in medial calcified lesions immediately after and at follow-up using IV-OCT in patients with severe PAD.

Co-use of tobacco and cannabis: Complicated partnerships

Introduction

Treating addiction is more challenging when there are co-addictions. Tobacco smoking is commonly associated with substance abuse, alcohol use disorders, excessive caffeine intake and pathological gambling among other addictions. Smoking reduction and cessation programmes´ objectives benefit from interventions targeting co-addictions.

Objectives

Difficulties arising from smoking reduction and cessation in the context of co-use of cannabis prompt literature review and reflection of a smoking cessation programme team.

Methods

Pubmed and Google Scholar literature search using terms smoking cessation / tobacco cessation and cannabis.

Results

Co-use of tobacco and cannabis is: 1) very common, 2) associated with greater prevalence of morbidity and social problems, 3) associated with greater dependence of the other substances, 4) negatively influences quit outcomes of either, 5) increases the risk of relapse. Co-users are more likely to perceive the harmful effects of tobacco, have greater motivation and are more likely to quit tobacco than cannabis, which may be perceived as low risk. Treatment of either tobacco smoking or cannabis use may lead to compensatory increase in use of the other substance. There is a significant lack of literature on co-use treatment strategies.

Conclusions

Co-use of tobacco and cannabis makes cessation and relapse prevention of either addiction more difficult and should be taken into account in smoking reduction and cessation programmes and in cannabis treatment interventions. Treatment targetting both tobacco and cannabis use, either simultaneously or sequentially, is likely more successful than interventions targeting only either one. Much remais to be studied on how to treat co-use of tobacco and cannabis.

The impact of protective face masks and coverings on patient-health provider communication

Introduction

Amid the COVID-19 pandemic the trend points to universal use of protective face masks. The impact posed on verbal and non-verbal communication by masks is yet another challenge to be addressed in clinical care.

Objectives

To reflect on the consequences of face mask and covering use on communication in the clinical setting, including mental health settings.

Methods

Pubmed and Google Scholar literature search using terms face mask / face covering and communication / emotion.

Results

There is a lack of literature on the impact of protective face masks and coverings on communication in clinical settings. Face masks and coverings may have a significant impact on patient-healthcare professional relationship due to disruption of verbal (poorer quality of speech transmission) and non-verbal communication (emotional expression and recognition) with consequences on: 1) clarity of communication with potential for misunderstanding clinical information, advice and prescriptions posing safety issues, 2) emotion perception, expression and reciprocity, 4) perception of healthcare professionals’ empathy and therefore, 3) patient satisfaction, 4) quality of care, and 5) clinical outcomes. Difficulties in communication between the patients´family or other carers and healthcare providers and between healthcare professionals are likewise challenged. People with hearing impairment, children and people with mental illness may be especially vulnerable to these difficulties in communication.

Conclusions

Protective face masks and coverings are undoubtedly important in preventing spread of COVID-19, nonetheless mental healthcare professionals should take into account their significant impact on verbal and non-verbal communication in clinical care. Alternative strategies to enhance communication and rapport may be warranted.

Assessment of Vascular Patency and Inflammation with Intravascular Optical Coherence Tomography in Patients with Superficial Femoral Artery Disease Treated with Zilver PTX Stents

PURPOSE

Zilver PTX nitinol self-expanding drug-eluting stent with paclitaxel coating is effective for treatment of superficial femoral artery (SFA) disease. However, as with any stent, it induces a measure of vascular inflammatory response. The current clinical trial (NCT02734836) aimed to assess vascular patency, remodeling, and inflammatory markers with intravascular optical coherence tomography (OCT) in patients with SFA disease treated with Zilver PTX stents.

METHODS

Serial OCT examinations were performed in 13 patients at baseline and 12-month follow-up. Variables evaluated included neointimal area, luminal narrowing, thrombus area, stent expansion as well as measures of inflammation including, peri-strut low-intensity area (PLIA), macrophage arc, neovascularization, stent strut apposition and coverage.

RESULTS

Percentage of malapposed struts decreased from 10.3 ± 7.9% post-intervention to 1.1 ± 2.2% at 12-month follow-up, but one patient showed late-acquired stent malapposition (LASM). The percent of uncovered struts at follow-up was 3.0 ± 4.5%. Average expansion of stent cross-sectional area from baseline to follow-up was 35 ± 19%. The average neointimal area was 7.8 ± 3.8 mm². Maximal luminal narrowing was 61.1 ± 25.0%, and average luminal narrowing was 35.4 ± 18.2%. Average peri-strut low-intensity area (PLIA) per strut was 0.017 ± 0.018 mm². Average number of neovessels per mm of stent was 0.138 ± 0.181. Average macrophage angle per frame at follow-up was 7 ± 11°. Average thrombus area at follow-up was 0.0093 ± 0.0184 mm².

CONCLUSION

At 12-month follow-up, OCT analysis of Zilver PTX stent shows outward remodeling and minimal neointimal growth, but evidence of inflammation including PLIA, neovessels, thrombus and macrophages.

SUMMARY

Thirteen patients with PAD had paclitaxel-coated stents implanted in their SFAs and were then imaged with OCT at baseline and 12-month follow-up. OCT proxy metrics of inflammation were quantified.

Endovascular Therapy for Acute Ischemic Stroke: A Comprehensive Review of Current Status

Stroke remains among the leading causes of disability and death worldwide. Fibrinolytic therapy is associated with poor patency and functional outcomes. Recently, multiple randomized trials have been published that have consolidated the role of endovascular therapy for ischemic stroke due to large vessel occlusion in the anterior cerebral circulation. This manuscript reviews the current understanding of the endovascular management of acute stroke including technical aspects and current evidence base.

PVL closure after TAVR: Yes, we can do it

Paravalvular leak (PVL) remains a significant problem after transcatheter aortic valve replacement. PVL is associated with long-term morbidity and mortality. Percutaneous management of post-TAVR PVL seems to be feasible and should be adopted by the structural heart interventionalist.

Healthy lifestyles programme in an acute psychiatric inpatient unit

Introduction

Mental health issues and illnesses are associated with poor self-care and unhealthy lifestyles that contribute to morbidity, mortality and overall decrease in quality of life when compared to the general population. Healthy lifestyle promotion is infrequently considered a priority in mental healthcare services, especially in acute psychiatric inpatient units.

Objectives

To present a healthy lifestyles promotion programme implemented in an acute psychiatric inpatient unit.

Aims

To reflect on how to design an adequate programme for patients with complex needs.

Methods

In a general psychiatric inpatient unit, a team of two psychologists and one psychiatrist, ventured to introduce weekly activities that included drawing, colouring, painting, crafts and games, that provided a context for patients and the team to sit down together or to gradually “drift” together and make possible conversations focusing on tobacco smoking, caffeine consumption, weight control, physical activity and health promoting activities.

Results

Instead of individual or group psychoeducation talk interventions, play and art strategies, in closer proximity with the patients, made it far easier to engage difficult patients and made psychoeducation possible and fun.

Conclusions

Patients with severe mental illness are frequently reluctant to engage in activities targeting healthy lifestyles, especially in acute psychiatric inpatient units, when insight and motivation for change may be low due to illness and consequences of illness. Play and art therapy interventions led by a team of mental healthcare professionals who participate directly with the patients, may be an innovative, more effective and enjoyable strategy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Smoking reduction/cessation and psychiatric patients: What about weight control?

Introduction

Smoking cessation has long been associated with weight gain and is one of the many reasons that smokers invoke for not giving up smoking. Many psychiatric medications are also associated with increased weight gain and metabolic syndrome. Unhealthy lifestyles reflect symptoms of illness with poor coping strategies and financial and social difficulties.

There are many reasons why smoking cessation may be viewed as much more difficult for psychiatric patients and weight gain is one of them.

Objective

To study how patients’ weight evolves during smoking reduction and cessation in a smoking reduction/cessation program in a psychiatric hospital.

Aims

To demystify weight gain as a significant problem in smoking reduction and cessation in this patient population.

Methods

Every patient entering the smoking reduction/cessation program is evaluated initially with regard to weight and BMI.

Patients’ weights are evaluated during the duration of the program for each patient as is smoking status.

Results

We are still collecting data at this time.

Conclusions

There are three groups of patient according to weight changes during the program: those who gain weight, those who maintain the same weight (± 1 kg) and those who lose weight.

Most patients who gain weight end up recuperating their initial weight or are able to lose weight later.

Some patients had weight control issues and their fear of gaining weight led them to overcompensate leading to weight loss.

We have included interventions on healthy lifestyles that have aided patients in controlling their weight.

Disclosure of interest

The authors have not supplied their declaration of competing interest.