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Pacchioni A, Pesarini G, Sanz-Sanchez J, Sgueglia GA, Bellamoli M, Ferro J, Mugnolo A, Morandin R, Penzo C, Turri R, Guiducci V, Benfari G, Giovannini D, Saccà S, Ribichini FL, Versaci F, Biondi-Zoccai G, Reimers B. Radial artery occlusion after transradial procedures: impact on 1-year adverse events. Minerva Cardiol Angiol 2023; 71:414-420. [PMID: 36468762 DOI: 10.23736/s2724-5683.22.06112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Radial artery occlusion after transradial procedures is a frequent iatrogenic thrombotic process. The impact on prognosis has not been investigated. This study sought to investigate whether radial artery occlusion is related to increased risk of major adverse cardiac and cerebrovascular events, defined as death, myocardial infarction, stroke and coronary revascularization. METHODS Eight hundred thirty-seven consecutive patients who underwent a transradial coronary procedure had patency of radial artery checked at 24 hours. Radial artery occlusion occurred in 41 over 837 patients (4.8%); 764 (91.2%) were available for planned follow-up at 1 year and were included in the analysis. Event-free survival rate between patients with and without radial artery occlusion was calculated using Kaplan-Meier estimates, and Cox proportional-hazards models were used to identify independent risk factors. RESULTS At a median 370-day follow-up (IQR: 366-375 days), adverse events occurred in 37 patients (4.8%), 2 in patients with radial artery occlusion and 35 in patients without. One-year survival rate was 94.9% vs. 95% (unadjusted HR=1.026, 95% CI: 0.24 to 4.6, P=0.9). After multivariable modeling, age and coronary artery disease extension was associated with increased risk of adverse events. CONCLUSIONS Age and coronary artery disease extension were independent predictors of adverse events at follow-up. RAO had no prognostic impact.
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Affiliation(s)
- Andrea Pacchioni
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy -
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jorge Sanz-Sanchez
- Division of Cardiology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Division of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Centro de Investigation Biomedica en Red (CIBERCV), Madrid, Spain
| | | | - Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jayme Ferro
- Arcispedale Santa Maria, Reggio Emilia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Riccardo Morandin
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Penzo
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Riccardo Turri
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | | | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Giovannini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Salvatore Saccà
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Versaci
- UOC of Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Bernhard Reimers
- Division of Cardiology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
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Cacia M, Cozzi O, Gohar A, Mangieri A, Sorropago G, Pacchioni A, Saccà S, Favero L, Regazzoli D, Reimers B. Different Degrees of Degeneration of Transcatheter Valves Implanted in the Aortic Position or Embolized Distally: A Case Report. Cardiovasc Revasc Med 2023; 53S:S144-S148. [PMID: 36402699 DOI: 10.1016/j.carrev.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Michele Cacia
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ottavia Cozzi
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Aisha Gohar
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antonio Mangieri
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | - Luca Favero
- Cardiology, ULSS2 Treviso Hospital, Treviso, Italy
| | - Damiano Regazzoli
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
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Calamelli S, Noto S, Baldoni A, Casarin A, Calzavara A, Bolgan I, Coccato S, Saccà S, Laurino L, Azzarello G, Ausoni S. Cardiac wasting in head and neck cancer and in cardiac autopsies from different cancer types: A study in a chemo-naïve setting. J Cachexia Sarcopenia Muscle 2023. [PMID: 36999538 DOI: 10.1002/jcsm.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Cardiac wasting is a detrimental consequence of cancer that has been traditionally ignored and often misinterpreted as an iatrogenic effect. METHODS We conducted a retrospective study on 42 chemo-naive patients affected by locally advanced head and neck cancer (HNC). Based on unintentional weight loss, patients were divided into cachectic and non-cachectic. Left ventricular mass (LVM), LV wall thickness (LVWT), interventricular septal (IVS) thickness, left ventricular internal diameter diastolic (LVIDd), left ventricular internal diameter systolic (LVIDs), internal ventricular septum diastolic (IVSd), left ventricular posterior wall thickness diastolic (LVPWd) and LV ejection fraction (LVEF) were analysed by echocardiography. In parallel, we retrospectively analysed 28 cardiac autoptic specimens of patients who either died of cancer before chemotherapy or with a diagnosis of cancer at autopsy. Presence or absence of myocardial fibrosis at microscopic observation was used for sample stratification. Conventional histology was performed. RESULTS Cachectic and non-cachectic patients had a significantly different value of LVWT and IVS thickness and LVPWd. LVWT was 9.08 ± 1.57 versus 10.35 ± 1.41 mm (P = 0.011) in cachectic and non-cachectic patients, IVS was 10.00 mm (8.50-11.00) versus 11.00 mm (10.00-12.00) (P = 0.035), and LVPWd was 9.0 (8.5-10.0) and 10.00 mm (9.5-11.0) (P = 0.019) in cachectic and non-cachectic patients. LVM adjusted for body surface area or height squared did not differ between the two populations. Similarly, LVEF did not show any significant decline. At multivariate logistic regression analysis for some independent predictors of weight loss, only LVWT maintained significant difference between cachectic and non-cachectic patients (P = 0.035, OR = 0.240; P = 0.019). The secondary analysis on autoptic specimens showed no significant change in heart weight, whereas LVWT declined from 9.50 (7.25-11.00) to 7.50 mm (6.00-9.00) in cardiac specimens with myocardial fibrosis (P = 0.043). These data were confirmed in multivariate logistic regression analysis (P = 0.041, OR = 0.502). Histopathological analysis confirmed severe atrophy of cardiomyocytes, fibrosis and oedema as compared with controls. CONCLUSIONS Subtle changes in heart structure and function occur early in HNC patients. These can be detected with routine echocardiography and may help to select appropriate cancer treatment regimens for these patients. Histopathological analysis provided conclusive evidence that atrophy of cardiomyocytes, oedema and fibrosis occur during cancer progression and may precede the onset of overt cardiac pathology. To our knowledge, this is the first clinical study that establishes a direct relationship between tumour progression and cardiac remodelling in HNCs and the first pathological study conducted on human cardiac autopsies from selected chemo-naïve cancer patients.
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Affiliation(s)
- Sara Calamelli
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Samantha Noto
- Department of Pathology, Local Health Unit 3 Serenissima, Mestre, Venice, Italy
| | - Alessandra Baldoni
- Department of Oncology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Alessandra Casarin
- Department of Oncology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Alessandro Calzavara
- Department of Information Systems, Local Health Unit 3 Serenissima, Dolo, Venice, Italy
| | - Irene Bolgan
- Department of Information Systems, Local Health Unit 3 Serenissima, Dolo, Venice, Italy
| | - Silvia Coccato
- Department of Oncology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Salvatore Saccà
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Licia Laurino
- Department of Pathology, Local Health Unit 3 Serenissima, Mestre, Venice, Italy
| | - Giuseppe Azzarello
- Department of Oncology, Local Health Unit 3 Serenissima, Mirano, Venice, Italy
| | - Simonetta Ausoni
- Department of Biomedical Science, University of Padova, Padova, Italy
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Tarantini G, Fovino LN, Varbella F, Trabattoni D, Caramanno G, Trani C, De Cesare N, Esposito G, Montorfano M, Musto C, Picchi A, Sheiban I, Gasparetto V, Ribichini FL, Cardaioli F, Saccà S, Cerrato E, Napodano M, Martinato M, Azzolina D, Andò G, Mugnolo A, Caruso M, Rossini R, Passamonti E, Teles RC, Rigattieri S, Gregori D, Tamburino C, Burzotta F. A large, prospective, multicentre study of left main PCI using a latest-generation zotarolimus-eluting stent: the ROLEX study. EUROINTERVENTION 2023; 18:e1108-e1119. [PMID: 36043326 PMCID: PMC9909455 DOI: 10.4244/eij-d-22-00454] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/11/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Data on left main (LM) percutaneous coronary interventions (PCI) have mostly been obtained in studies using drug-eluting stent (DES) platforms without dedicated large-vessel devices and with limited expansion capability. AIMS Our study aimed to investigate the safety and efficacy of LM PCI with the latest-generation Resolute Onyx DES. METHODS ROLEX (Revascularization Of LEft main with resolute onyX) is a prospective, multicentre study (ClinicalTrials.gov: NCT03316833) enrolling patients with unprotected LM coronary artery disease and a SYNTAX score <33 undergoing PCI with the Resolute Onyx zotarolimus-eluting coronary stent, that includes dedicated extra-large vessel platforms. The primary endpoint (EP) was target lesion failure (TLF): a composite of cardiac death, target vessel myocardial infarction (TVMI) and ischaemia-driven target lesion revascularisation (ID-TLR), at 1 year. All events were adjudicated by an independent clinical event committee. An independent core lab analysed all procedural angiograms. RESULTS A total of 450 patients (mean age 71.8 years, SYNTAX score 24.5±7.2, acute coronary syndrome in 53%) were enrolled in 26 centres. Of these, 77% of subjects underwent PCI with a single-stent and 23% with a 2-stent technique (8% double kissing [DK] crush, 6% culotte, 9% T/T and small protrusion [TAP] stenting). Intravascular imaging guidance was used in 45% (42% intravascular ultrasound [IVUS], 3% optical coherence tomography [OCT]). At 1 year, the primary EP incidence was 5.1% (cardiac death 2.7%, TVMI 2.7%, ID-TLR 2.0%). The definite/probable stent thrombosis rate was 1.1%. In a prespecified adjusted subanalysis, the primary EP incidence was significantly lower in patients undergoing IVUS/OCT-guided versus angio-guided PCI (2.0 vs 7.6%; hazard ratio [HR] 0.28, 95% confidence interval [CI]: 0.13-0.58; p<0.001). CONCLUSIONS In this large, multicentre, prospective registry, LM PCI with the Resolute Onyx DES showed good safety and efficacy at 1 year, particularly when guided by intracoronary imaging.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | | | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli ICCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmine Musto
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Picchi
- Cardiovascular Department, Azienda USL Toscana SudEst, Misericordia Hospital, Grosseto, Italy
| | - Imad Sheiban
- Division of Cardiology, Peschiera del Garda Hospital, Verona, Italy
| | | | - Flavio L Ribichini
- Division of Cardiovascular Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Andò
- Division of Cardiology, University of Messina, Messina, Italy
| | | | - Marco Caruso
- Division of Cardiology, University of Palermo, Palermo, Italy
| | - Roberta Rossini
- Division of Cardiology, ASST Papa Giovanni XXIII Hospital, Cuneo, Italy
| | - Enrico Passamonti
- Division of Cardiology, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Rui Campante Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | | | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Corrado Tamburino
- Cardiology, CAST-Policlinico Hospital, Cardio-Thorax-Vascular and Transplant Department, University of Catania, Catania, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli ICCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Catalfamo LM, Scozzaro C, Cicchiello S, Scozzaro MP, Romeo C, De Rinaldis D, Saccà S, Nava C, Calvo A, De Ponte FS. Maxillofacial Injuries in Padel Game. J Maxillofac Oral Surg 2022; 21:1393-1396. [PMID: 36896067 PMCID: PMC9989071 DOI: 10.1007/s12663-022-01725-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/14/2022] [Indexed: 10/16/2022] Open
Abstract
Background Maxillofacial injuries are very frequent in the sports environment. Padel is a new sport of Mexican origin, very popular in Mexico, Spain, and Italy, but with a rapid spread in Europe and other continents. Aims The aim of this article is to report our experience of 16 patients with maxillofacial injuries that occurred during padel matches in 2021. All these injuries occurred due to the racket bouncing against the glass of the padel court. The bounce of the racquet is given either because the player was trying to hit the ball near the glass or by throwing the racket against the glass for an act of nervousness. Methods We carried out a literature review about sports traumas, and we calculated the possible force with which the racket, once bounced off the glass, hits the players' faces. Results and Conclusions The racket, bouncing off the glass wall, arrives with a specific force in the face of the player who threw the racket, being able to cause skin wounds, injuries, and fractures mainly at the level of the dentoalveolar junction.
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Affiliation(s)
- L. M. Catalfamo
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
| | - C. Scozzaro
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
| | - S. Cicchiello
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
| | - M. P. Scozzaro
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
| | - C. Romeo
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
| | - D. De Rinaldis
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
| | - S. Saccà
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
| | - C. Nava
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
| | - A. Calvo
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
| | - F. S. De Ponte
- Division of Maxillofacial Surgery, BIOMORF Department, University of Messina, Messina, Italy
- AOU Policlinico “G. Martino”, Via Consolare Valeria 1, 98125 Messina, ME Italy
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6
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Zuin M, Mugnai G, Zamboni A, Zakja E, Valle R, Turiano G, Themistoclakis S, Scarpa D, Saccà S, Roncon L, Rizzetto F, Purita P, Polo A, Pantano I, Mugnolo A, Molon G, Meneghin S, Mancuso D, Lia M, Grassi G, Cutolo A, Chirillo F, Bozzini P, Bonapace S, Anselmi M, Rigatelli G, Bilato C. Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region. Viruses 2022; 14:v14091925. [PMID: 36146731 DOI: 10.3390/v1409192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 05/27/2023] Open
Abstract
Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.
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Affiliation(s)
- Marco Zuin
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Alberto Zamboni
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Edlira Zakja
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | - Roberto Valle
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Giovanni Turiano
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | | | - Daniele Scarpa
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, 45100 Rovigo, Rovigo, Italy
| | - Francesca Rizzetto
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Paola Purita
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Angela Polo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Ivan Pantano
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Giulio Molon
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Samuele Meneghin
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Daniela Mancuso
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Micaela Lia
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Giuseppe Grassi
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Ada Cutolo
- Division of Cardiology, All'Angelo Hospital, 30174 Mestre, Venezia, Italy
| | - Fabio Chirillo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Paolo Bozzini
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Maurizio Anselmi
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Gianluca Rigatelli
- Division of Cardiology, Madre Teresa Hospital, 35043 Padova, Schiavonia, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
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7
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Zuin M, Mugnai G, Zamboni A, Zakja E, Valle R, Turiano G, Themistoclakis S, Scarpa D, Saccà S, Roncon L, Rizzetto F, Purita P, Polo A, Pantano I, Mugnolo A, Molon G, Meneghin S, Mancuso D, Lia M, Grassi G, Cutolo A, Chirillo F, Bozzini P, Bonapace S, Anselmi M, Rigatelli G, Bilato C. Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region. Viruses 2022; 14:v14091925. [PMID: 36146731 PMCID: PMC9502380 DOI: 10.3390/v14091925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.
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Affiliation(s)
- Marco Zuin
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
- Correspondence: (M.Z.); (C.B.); Tel.: +39-0444-479106 (C.B.); Fax: +39-0444-931163 (C.B.)
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Alberto Zamboni
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Edlira Zakja
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | - Roberto Valle
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Giovanni Turiano
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | | | - Daniele Scarpa
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, 45100 Rovigo, Rovigo, Italy
| | - Francesca Rizzetto
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Paola Purita
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Angela Polo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Ivan Pantano
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Giulio Molon
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Samuele Meneghin
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Daniela Mancuso
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Micaela Lia
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Giuseppe Grassi
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Ada Cutolo
- Division of Cardiology, All’Angelo Hospital, 30174 Mestre, Venezia, Italy
| | - Fabio Chirillo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Paolo Bozzini
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Maurizio Anselmi
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Gianluca Rigatelli
- Division of Cardiology, Madre Teresa Hospital, 35043 Padova, Schiavonia, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
- Correspondence: (M.Z.); (C.B.); Tel.: +39-0444-479106 (C.B.); Fax: +39-0444-931163 (C.B.)
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Vio R, China P, Marras E, Cutolo A, Valle R, Grassi G, Saccà S, Chinellato A, Themistoclakis S. C51 SAFETY AND EFFICACY OF DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION ON CONCOMITANT TREATMENT WITH DRONEDARONE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The use of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) is associated with bleedings. Interactions with dronedarone may increase this risk, but data on concomitant treatment of DOACs with dronedarone are limited.
Aim
The primary endpoint was to compare the survival free from the composite endpoint of clinically relevant bleeding, thromboembolic event and death, between AF patients on treatment with dronedarone and different DOACs. The secondary endpoints were to compare the survival free from i) clinically relevant bleeding and ii) clinically relevant major bleeding.
Methods
A retrospective study was conducted at the Local Health Unit “Ulss3 Serenissima” of Venice, Italy, from January 1st 2016 to December 31st 2020. The eligible population included AF patients with concomitant prescriptions of DOACs and dronedarone. Patients were divided in 4 groups (rivaroxaban, apixaban, edoxaban, dabigatran).
Results
165 patients were included: 46/165 (28%) on rivaroxaban, 66/165 (40%) on apixaban, 45/165 (27%) on edoxaban, and 8/165 (5%) on dabigatran (Fig.1). Over a median follow–up of 339 days, 14/165 (8%) met the primary composite endpoint: 8/165 (5%) had clinically relevant bleedings, of which 1/165 (0.6%) was a clinically relevant major bleeding, 2/165 (1%) had TIAs, and 5/165 (3%) died. We found no difference in survival free from the primary composite endpoint and from clinically relevant bleeding between groups (log–rank test p = 0.19 and p = 0.69, respectively) (Fig. 2A–B). However, survival free from clinically relevant major bleeding was significantly lower in dabigatran users (p = 0.003) (Fig. 2C). At a secondary analysis, DOACs contraindicated by 2015 EHRA guide (dabigatran, edoxaban 60 mg), and not by 2018/2021 EHRA guides (rivaroxaban, dabigatran, edoxaban 60 mg), were associated with lower survival from either clinically relevant bleeding or clinically relevant major bleeding (log–rank test p = 0.03 and p < 0.001, respectively) (Fig. 3).
Conclusions
In our study, there was no difference in survival free from the primary composite endpoint and from clinically relevant bleeding between groups of coadministration. However, survival free from clinically relevant major bleeding was significantly lower in dabigatran users. DOACs contraindicated by 2015 EHRA guide (and not by the latest 2018/2021 EHRA guides) are associated with lower survival from either clinically relevant bleeding or clinically relevant major bleeding.
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Affiliation(s)
- R Vio
- OSPEDALE DELL‘ANGELO; UNITÀ OPERATIVA COMPLESSA DI CARDIOLOGIA, MESTRE; OSPEDALE MADONNA DELLA NAVICELLA; UNITÀ DI CARDIOLOGIA, CHIOGGIA; OSPEDALE CIVILE; UNITÀ DI CARDIOLOGIA, VENEZIA; OSPEDALE DI MIRANO; UNITÀ DI CARDIOLOGIA, MIRANO; OSPEDALE DELL‘ANGELO; FARMACIA OSPEDALIERA, MESTRE
| | - P China
- OSPEDALE DELL‘ANGELO; UNITÀ OPERATIVA COMPLESSA DI CARDIOLOGIA, MESTRE; OSPEDALE MADONNA DELLA NAVICELLA; UNITÀ DI CARDIOLOGIA, CHIOGGIA; OSPEDALE CIVILE; UNITÀ DI CARDIOLOGIA, VENEZIA; OSPEDALE DI MIRANO; UNITÀ DI CARDIOLOGIA, MIRANO; OSPEDALE DELL‘ANGELO; FARMACIA OSPEDALIERA, MESTRE
| | - E Marras
- OSPEDALE DELL‘ANGELO; UNITÀ OPERATIVA COMPLESSA DI CARDIOLOGIA, MESTRE; OSPEDALE MADONNA DELLA NAVICELLA; UNITÀ DI CARDIOLOGIA, CHIOGGIA; OSPEDALE CIVILE; UNITÀ DI CARDIOLOGIA, VENEZIA; OSPEDALE DI MIRANO; UNITÀ DI CARDIOLOGIA, MIRANO; OSPEDALE DELL‘ANGELO; FARMACIA OSPEDALIERA, MESTRE
| | - A Cutolo
- OSPEDALE DELL‘ANGELO; UNITÀ OPERATIVA COMPLESSA DI CARDIOLOGIA, MESTRE; OSPEDALE MADONNA DELLA NAVICELLA; UNITÀ DI CARDIOLOGIA, CHIOGGIA; OSPEDALE CIVILE; UNITÀ DI CARDIOLOGIA, VENEZIA; OSPEDALE DI MIRANO; UNITÀ DI CARDIOLOGIA, MIRANO; OSPEDALE DELL‘ANGELO; FARMACIA OSPEDALIERA, MESTRE
| | - R Valle
- OSPEDALE DELL‘ANGELO; UNITÀ OPERATIVA COMPLESSA DI CARDIOLOGIA, MESTRE; OSPEDALE MADONNA DELLA NAVICELLA; UNITÀ DI CARDIOLOGIA, CHIOGGIA; OSPEDALE CIVILE; UNITÀ DI CARDIOLOGIA, VENEZIA; OSPEDALE DI MIRANO; UNITÀ DI CARDIOLOGIA, MIRANO; OSPEDALE DELL‘ANGELO; FARMACIA OSPEDALIERA, MESTRE
| | - G Grassi
- OSPEDALE DELL‘ANGELO; UNITÀ OPERATIVA COMPLESSA DI CARDIOLOGIA, MESTRE; OSPEDALE MADONNA DELLA NAVICELLA; UNITÀ DI CARDIOLOGIA, CHIOGGIA; OSPEDALE CIVILE; UNITÀ DI CARDIOLOGIA, VENEZIA; OSPEDALE DI MIRANO; UNITÀ DI CARDIOLOGIA, MIRANO; OSPEDALE DELL‘ANGELO; FARMACIA OSPEDALIERA, MESTRE
| | - S Saccà
- OSPEDALE DELL‘ANGELO; UNITÀ OPERATIVA COMPLESSA DI CARDIOLOGIA, MESTRE; OSPEDALE MADONNA DELLA NAVICELLA; UNITÀ DI CARDIOLOGIA, CHIOGGIA; OSPEDALE CIVILE; UNITÀ DI CARDIOLOGIA, VENEZIA; OSPEDALE DI MIRANO; UNITÀ DI CARDIOLOGIA, MIRANO; OSPEDALE DELL‘ANGELO; FARMACIA OSPEDALIERA, MESTRE
| | - A Chinellato
- OSPEDALE DELL‘ANGELO; UNITÀ OPERATIVA COMPLESSA DI CARDIOLOGIA, MESTRE; OSPEDALE MADONNA DELLA NAVICELLA; UNITÀ DI CARDIOLOGIA, CHIOGGIA; OSPEDALE CIVILE; UNITÀ DI CARDIOLOGIA, VENEZIA; OSPEDALE DI MIRANO; UNITÀ DI CARDIOLOGIA, MIRANO; OSPEDALE DELL‘ANGELO; FARMACIA OSPEDALIERA, MESTRE
| | - S Themistoclakis
- OSPEDALE DELL‘ANGELO; UNITÀ OPERATIVA COMPLESSA DI CARDIOLOGIA, MESTRE; OSPEDALE MADONNA DELLA NAVICELLA; UNITÀ DI CARDIOLOGIA, CHIOGGIA; OSPEDALE CIVILE; UNITÀ DI CARDIOLOGIA, VENEZIA; OSPEDALE DI MIRANO; UNITÀ DI CARDIOLOGIA, MIRANO; OSPEDALE DELL‘ANGELO; FARMACIA OSPEDALIERA, MESTRE
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9
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Moscarella E, Campo G, Leoncini M, Geraci S, Nicolini E, Cortese B, Loi B, Guiducci V, Saccà S, Varricchio A, Vicinelli P, Candia GD, Silvestro A, Calabrò P, Brugaletta S, Latib A, Tespili M, Ielasi A. 299 3-Year results of STEMI patients treated with a pre-specified BVS implantation strategy: BVS SYTEMI strategy-it long term. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Data on Absorb bioresorbable vascular scaffold (BVS) use in patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Furthermore, Absorb studies including STEMI patients lacked a prespecified implantation technique to optimize BVS deployment. To assess the 3-year clinical outcomes STEMI patients undergoing primary percutaneous coronary intervention (pPCI) with a pre-specified BVS implantation strategy.
Methods and results
BVS STEMI STRATEGY-IT (NCT02601781) included 505 STEMI patients undergoing pPCI with BVS following a dedicated implantation protocol. Device-oriented composite endpoint [(DOCE) cardiac death, ischemia-driven target lesion revascularization (ID-TLR) and target vessel myocardial infarction (TV-MI)] and scaffold thrombosis (ScT) at 3-year were evaluated. A subgroup analysis was performed on patients in whom dual antiplatelet therapy (DAPT) was continued 36 months after pPCI (‘longer-term DAPT’), and outcomes of this cohort compared to the remaining population (‘shorter-term DAPT’: <36 months) are also reported. Three-year DOCE and ScT rates were low (2.4% and 1.0%, respectively). In 319 (63.2%) patients DAPT was continued 36 months after pPCI. DOCE rate was significantly lower in the longer- compared to shorter-DAPT group (HR: 0.29; 95% CI: 0.1–0.9; P = 0.03), driven by a lower rate of TV-MI (0% vs. 2.2%, P = 0.018). Significantly lower rate of ScT was observed in longer-DAPT group (0% vs. 2.7%, P = 0.007).
Conclusions
In STEMI patients undergoing pPCI, a strategy of optimized BVS implantation technique is associated with favourable DOCE and ScT rates at 3 year. DAPT extension up to 36 months further improves long-term clinical outcomes.
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10
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Moscarella E, Campo G, Leoncini M, Geraci S, Nicolini E, Cortese B, Loi B, Guiducci V, Saccà S, Varricchio A, Vicinelli P, De Candia G, Silvestro A, Calabrò P, Brugaletta S, Latib A, Tespili M, Ielasi A. Three-year results of ST-segment elevation myocardial infarction patients treated with a prespecified bioresorbable vascular scaffold implantation strategy. J Cardiovasc Med (Hagerstown) 2021; 23:278-280. [DOI: 10.2459/jcm.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Pacchioni A, Mugnolo A, Sanz Sanchez J, Sgueglia GA, Pesarini G, Bellamoli M, Saccà S, Ribichini F, Reimers B, Gasparini GL. Radial artery occlusion after conventional and distal radial access: Impact of preserved flow and time-to-hemostasis in a propensity-score matching analysis of 1163 patients. Catheter Cardiovasc Interv 2021; 99:827-835. [PMID: 34783423 DOI: 10.1002/ccd.30005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/01/2021] [Accepted: 10/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare incidence of forearm radial artery occlusion (RAO) and hemostasis characteristics between distal and conventional transradial approach (DRA and TRA, respectively). BACKGROUND DRA has the potential advantage of reducing RAO. DRA effectively reduces time-to-hemostasis, however its role on preserving flow in the radial artery (PF) during hemostasis and consequent impact on RAO remains speculative. METHODS Eight hundred thirty-seven patients with TRA were previously enrolled in a prospective registry investigating the relationship of residual anticoagulation and RAO. Three hundred twenty-six additional patients with DRA were added to the cohort and matched to the original cohort by propensity score. The composite end-point of RAO at forearm and distal site of puncture (dRAO) was evaluated as secondary end-point. RESULTS RAO occurred in 4.8% (41 of 837) of patients undergoing TRA and in 0% (0 of 326) of those undergoing DRA (p < 0.0001). DRA was associated with higher percentage of PF (97.2% vs. 78.5% in TRA group, p < 0.0001) and reduced time-to-hemostasis (147 ± 99 min vs. 285 ± 138 min, p < 0.0001). After matching, hemostasis characteristics were still significant different (PF 95.7% vs. 90.1%, p = 0.023, and 190 ± 92 vs. 323 ± 162 min, p < 0.0001) with reduction in the incidence of RAO (0 of 213, 0% vs. 7 of 213, 3.3%, p = 0.0015). dRAO occurred in one case (0.3% and 0.5% after matching, p < 0.0001 and p = 0.032 compared to TRA). CONCLUSIONS DRA was associated with lower rates of RAO compared to TRA. This effect is potentially explained by reduced time-to-hemostasis and maintained flow at the wrist during hemostasis.
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Affiliation(s)
| | - Antonio Mugnolo
- Division of Cardiology, Ospedale Mater Salutis, Legnago, Italy
| | - Jorge Sanz Sanchez
- Division of Cardiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.,Division of Cardiology, Hospital Universitario y Politecnico La Fe, Valencia, Spain.,Centro de Investigacion Biomedica en Red (CIBERCV), Madrid, Spain
| | | | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | - Michele Bellamoli
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | - Bernhard Reimers
- Division of Cardiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
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12
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Sirignano P, Stabile E, Mansour W, Capoccia L, Faccenna F, Intrieri F, Ferri M, Saccà S, Sponza M, Mortola P, Ronchey S, Praquin B, Grillo P, Chiappa R, Losa S, Setacci F, Pirrelli S, Taurino M, Ruffino MA, Udini M, Palombo D, Ippoliti A, Montelione N, Setacci C, de Donato G, Ruggeri M, Speziale F. 1-Year Results From a Prospective Experience on CAS Using the CGuard Stent System: The IRONGUARD 2 Study. JACC Cardiovasc Interv 2021; 14:1917-1923. [PMID: 34391704 DOI: 10.1016/j.jcin.2021.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the 1-year safety and efficacy of a dual-layered stent (DLS) for carotid artery stenting (CAS) in a multicenter registry. BACKGROUND DLS have been proved to be safe and efficient during short-term follow-up. Recent data have raised the concern that the benefit of CAS performed with using a DLS may be hampered by a higher restenosis rate at 1 year. METHODS From January 2017 to June 2019, a physician-initiated, prospective, multispecialty registry enrolled 733 consecutive patients undergoing CAS using the CGuard embolic prevention system at 20 centers. The primary endpoint was the occurrence of death and stroke at 1 year. Secondary endpoints were 1-year rates of transient ischemic attack, acute myocardial infarction, internal carotid artery (ICA) restenosis, in-stent thrombosis, and external carotid artery occlusion. RESULTS At 1 year, follow-up was available in 726 patients (99.04%). Beyond 30 days postprocedure, 1 minor stroke (0.13%), four transient ischemic attacks (0.55%), 2 fatal acute myocardial infarctions (0.27%), and 6 noncardiac deaths (1.10%) occurred. On duplex ultrasound examination, ICA restenosis was found in 6 patients (0.82%): 2 total occlusions and 4 in-stent restenoses. No predictors of target ICA restenosis and/or occlusion could be detected, and dual-antiplatelet therapy duration (90 days vs 30 days) was not found to be related to major adverse cardiovascular event or restenosis occurrence. CONCLUSIONS This real-world registry suggests that DLS use in clinical practice is safe and associated with minimal occurrence of adverse neurologic events up to 12-month follow-up.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy.
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Federico Faccenna
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Intrieri
- Unit of Vascular and Endovascular Surgery, Annunziata Hospital, Cosenza, Italy
| | - Michelangelo Ferri
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano Public Hospital, Mirano, Italy
| | - Massimo Sponza
- Division of Vascular and Interventional Radiology, Udine University Hospital, Udine, Italy
| | - Paolo Mortola
- Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa, Italy
| | - Sonia Ronchey
- Unit of Vascular Surgery, Surgical Specialty Department, S. Filippo Neri Hospital, Rome, Italy
| | - Barbara Praquin
- Unit of Vascular Surgery, Surgical Specialty Department, S. Filippo Neri Hospital, Rome, Italy
| | - Placido Grillo
- Division of Cardiology, Sant. Anna Hospital, Catanzaro, Italy
| | - Roberto Chiappa
- Department of Vascular and Endovascular Surgery, Sandro Pertini Hospital, Rome, Italy
| | - Sergio Losa
- Cardiovascular Department, MultiMedica IRCCS Scientific Institute, Milan, Italy
| | - Francesco Setacci
- Cardiovascular Department, MultiMedica IRCCS Scientific Institute, Milan, Italy
| | - Stefano Pirrelli
- Division of Vascular Surgery, Carlo Poma Hospital, Mantova, Italy
| | - Maurizio Taurino
- Unit of Vascular Surgery, Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Maria Antonella Ruffino
- Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Udini
- Vascular Surgery, Moriggia Pelascini Hospital, Gravedona, Como, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Arnaldo Ippoliti
- Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nunzio Montelione
- Vascular Surgery, University of Campus Biomedico of Rome, Rome, Italy
| | - Carlo Setacci
- Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery, University of Siena, Siena, Italy
| | - Gianmarco de Donato
- Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery, University of Siena, Siena, Italy
| | - Massimo Ruggeri
- Vascular Surgery, San Camillo de Lellis Hopital, Rieti, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy
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Abstract
Since it came into being as a discipline, cardio-oncology has focused on the prevention and treatment of cardiotoxicity induced by antitumor chemotherapy and radiotherapy. Over time, it has been proved that even more detrimental is the direct effect generated by cancer cells that release pro-cachectic factors in the bloodstream. Secreted molecules target different organs at a distance, including the heart. Inflammatory and neuronal modulators released by the tumor bulk, either as free molecules or through exosomes, contribute to the pathogenesis of cardiac disease. Progressive cancer causes cachexia and severe cardiac muscle wasting accompanied by cardiomyocyte atrophy, tissue fibrosis, and several functional impairments up to heart failure. The molecular mechanisms responsible for such a cardiac muscle wasting have been partially elucidated in animal models, but minimally investigated in humans, although severe cardiac dysfunction exacerbates global cachexia and hampers efficient anti-cancer treatments. This review provides an overview of cancer-induced structural cardiac and functional damage, drawing on both clinical and scientific research. We start by looking at the pathophysiological mechanisms and evolving epidemiology and go on to discuss prevention, diagnosis, and a multimodal policy of intervention aimed at providing overall prognosis and global care for patients. Despite much interest in the cardiotoxicity of cancer therapies, the direct tumor effect on the heart remains poorly explored. There is still a lack of diagnostic criteria for the identification of the early stages of cardiac disease in cancer patients, while the possibilities that there are for effective prevention are largely underestimated. Research on innovative therapies has claimed considerable advances in preclinical studies, but none of the molecular targets suitable for clinical application has been approved for therapy. These issues are critically discussed here.
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Affiliation(s)
- Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, Padova, Italy.
| | - Sara Calamelli
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano Hospital, Mirano, Venice, Italy
| | - Salvatore Saccà
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano Hospital, Mirano, Venice, Italy
| | - Giuseppe Azzarello
- Department of Medical Oncology, Local Health Unit 3 Serenissima, Mirano Hospital, Mirano, Venice, Italy.
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14
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Sirignano P, Stabile E, Mansour W, Capoccia L, Faccenna F, Intrieri F, Ferri M, Saccà S, Sponza M, Mortola P, Ronchey S, Grillo P, Chiappa R, Losa S, Setacci F, Pirrelli S, Taurino M, Ruffino MA, Udini M, Palombo D, Ippoliti A, Montelione N, Setacci C, de Donato G, Ruggeri M, Speziale F. 1-Month Results From a Prospective Experience on CAS Using CGuard Stent System. JACC Cardiovasc Interv 2020; 13:2170-2177. [DOI: 10.1016/j.jcin.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/26/2022]
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Rivezzi F, Vio R, Bilato C, Pagliani L, Pasquetto G, Saccà S, Verlato R, Migliore F, Iliceto S, Bossone V, Bertaglia E. Screening of unknown atrial fibrillation through handheld device in the elderly. J Geriatr Cardiol 2020; 17:495-501. [PMID: 32952524 PMCID: PMC7475215 DOI: 10.11909/j.issn.1671-5411.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of unknown atrial fibrillation (AF) in the elderly population of the Veneto Region, Italy. METHODS 1820 patients aged ≥ 65 years with no history of AF and not anticoagulated were enrolled in primary-care settings. They underwent an opportunistic electrocardiogram screening with a handheld device (MyDiagnostick) designed to specifically detect AF. The electrocardiogram recordings were reviewed by the researchers, who confirmed the presence of AF. RESULTS The device detected an arrhythmia in 143 patients, which was confirmed as AF in 101/143 (70.6%), with an overall prevalence of AF of 5.5% (101/1820). Prevalence of unknown AF resulted in 3.6% in patients aged 65-74 years, and 7.5% in patients age 75 or older, and increased according to CHA2DS2-VASc score: 3.5% in patients with a score of 1 or 2, 5.6% in patients with a score of 3, 7.0% in patients with a score of 4, and 7.2% in patients with a score ≥ 5. The detection rate was significantly higher in patients with mild symptoms compared to asymptomatic counterparts (24.1% vs. 4.0%, P < 0.0001). At multivariate analysis, congestive heart failure and age ≥ 75 years-old were independent predictors for screen-detected AF. CONCLUSIONS An opportunistic screening with handheld device revealed an unexpectedly high prevalence of unknown AF in elderly patients with mild symptoms. Prevalence increased with age and CHA2DS2-VASc score.
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Affiliation(s)
- Francesco Rivezzi
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Riccardo Vio
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | | | - Giampaolo Pasquetto
- Division of Cardiology, "Riuniti Hospitals Padova Sud", Monselice, Padova, Italy
| | - Salvatore Saccà
- Department of Cardiology, General Hospital, Mirano, Venezia, Italy
| | - Roberto Verlato
- Division of Cardiology, Pietro Cosma Hospital, Camposampiero, Padova, Italy
| | - Federico Migliore
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Emanuele Bertaglia
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Emanuele Bertaglia, MD, PhD, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy. E-mail:
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Pacchioni A, Bellamoli M, Mugnolo A, Ferro J, Pesarini G, Turri R, Ribichini F, Saccà S, Versaci F, Reimers B. Predictors of patent and occlusive hemostasis after transradial coronary procedures. Catheter Cardiovasc Interv 2020; 97:1369-1376. [PMID: 32761864 DOI: 10.1002/ccd.29066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/09/2020] [Accepted: 05/24/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess the independent predictors of patent and occlusive hemostasis (PH and OH, respectively) during radial hemostasis after coronary procedures. BACKGROUND Radial artery occlusion (RAO) is a thrombotic complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Sheath-vessel diameter ratio, postprocedure compression time, occlusive hemostasis, inadequate, and excessive anticoagulation are all predictors of RAO. METHODS As a part of a previously published study investigating the relationship between residual anticoagulation and risk of RAO, 837 patients undergoing transradial diagnostic coronary angiography or percutaneous coronary interventions were enrolled. Cumulative heparin dose used during the procedure and ACT measured before sheath removal were recorded. PH with reverse Barbeau test was attempted in all patients (NCT02762344). RESULTS PH was less frequently obtained for increasing cumulative heparin dose and ACT values (p < .0001 and p = .0034, respectively). At logistic regression analysis both cumulative heparin dose and ACT values were independent predictors of OH (OR 1.017, 95% IC 1.011-1.023 p < .0001 and OR 1.004, 95% IC 1.001-1.006, p = .0004) while adjusted probability for RAO showed exponential relationship with both parameters. CONCLUSIONS The level of anticoagulation is strongly related to the incidence of RAO, and should be taken into account when choosing hemostasis protocol.
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Affiliation(s)
| | - Michele Bellamoli
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | | | - Jayme Ferro
- Division of Cardiology, IRCCS Arcispedale Santa Maria, Reggio Emilia, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | | | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy
| | - Bernhard Reimers
- Division of Cardiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
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Migliore F, Zorzi A, Gregori D, Del Monte A, Falzone PV, Verlato R, Siciliano M, Themistoclakis S, China P, Marchese D, Pasquetto G, Ignatiuk B, Cernetti C, Giacomin E, Calzolari V, Bilato C, Dalla Valle C, Frigo GM, Marinaccio L, Saccà S, Lupo A, Roncon L, Marcantoni L, Tosi A, Turiano G, Folino F, Perazzolo Marra M, Cacciavillani L, Iliceto S. Urgent Pacemaker Implantation Rates in the Veneto Region of Italy After the COVID-19 Outbreak. Circ Arrhythm Electrophysiol 2020; 13:e008722. [PMID: 32434373 PMCID: PMC7299094 DOI: 10.1161/circep.120.008722] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Alvise Del Monte
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Pasquale Valerio Falzone
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Roberto Verlato
- Cardiology Division, Hospital of Cittadella, Italy (R.V., M.S., G.M.F.).,Cardiology Division, Hospital of Camposampiero, Padova, Italy (R.V.)
| | | | | | - Paolo China
- Department of Cardiology, Dell' Angelo Hospital, Mestre, Italy (S.T., P.C.)
| | - Domenico Marchese
- Cardiology Division, Hospital of Piove di Sacco, Padova, Italy (D.M., L. Marinaccio)
| | - Giampaolo Pasquetto
- Division of Cardiology, Riuniti Hospital Padova Sud, Monselice, Italy (PD) (G.P., B.I.)
| | - Barbara Ignatiuk
- Division of Cardiology, Riuniti Hospital Padova Sud, Monselice, Italy (PD) (G.P., B.I.)
| | - Carlo Cernetti
- Department of Cardiology, Hospital of Treviso, Italy (C.C., E.G., V.C.)
| | - Enrico Giacomin
- Department of Cardiology, Hospital of Treviso, Italy (C.C., E.G., V.C.)
| | | | - Claudio Bilato
- Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Arzignano, Vicenza, Italy (C.B., C.D.V.)
| | - Chiara Dalla Valle
- Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Arzignano, Vicenza, Italy (C.B., C.D.V.)
| | | | - Leonardo Marinaccio
- Cardiology Division, Hospital of Piove di Sacco, Padova, Italy (D.M., L. Marinaccio)
| | - Salvatore Saccà
- Cardiology Department, Public Hospital of Mirano, Venezia, Italy (S.S., A.L.)
| | - Antonio Lupo
- Cardiology Department, Public Hospital of Mirano, Venezia, Italy (S.S., A.L.)
| | - Loris Roncon
- Cardiology Department, Arrhythmia & Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy (L.R., L. Marcantoni)
| | - Lina Marcantoni
- Cardiology Department, Arrhythmia & Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy (L.R., L. Marcantoni)
| | - Alberto Tosi
- Department of Cardiology, Civil Hospital, Belluno, Italy (A.T., G.T.)
| | - Giovanni Turiano
- Department of Cardiology, Civil Hospital, Belluno, Italy (A.T., G.T.)
| | - Franco Folino
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Luisa Cacciavillani
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
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Berti S, Pastormerlo LE, Santoro G, Brscic E, Montorfano M, Vignali L, Danna P, Tondo C, Rezzaghi M, D'Amico G, Stabile A, Saccà S, Patti G, Rapacciuolo A, Poli A, Golino P, Magnavacchi P, Meucci F, Pezzulich B, Stolcova M, Tarantini G. Intracardiac Versus Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion: The LAAO Italian Multicenter Registry. JACC Cardiovasc Interv 2019; 11:1086-1092. [PMID: 29880104 DOI: 10.1016/j.jcin.2018.05.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to evaluate the feasibility, safety, and efficacy of intracardiac echocardiography (ICE)-guided versus transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) by the use of Amplatzer Cardiac Plug or Amulet devices included in a large Italian registry. BACKGROUND TEE is widely used for LAAO procedure guidance. ICE may be a potential alternative imaging modality in LAAO. METHODS Data from 604 LAAO procedures performed in 16 Italian centers were reviewed. ICE-guided LAAO was performed in 187 patients, whereas TEE was used in 417 patients. Procedural success was defined as LAAO without occurrence of pericardial tamponade, stroke, systemic embolism with end organ damage, major bleeding, and device embolization. Stroke, transient ischemic attack, major bleeding, overall and cardiovascular death were analyzed. RESULTS CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65 to 74 years, sex category) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol) scores were similar between the ICE and TEE groups. TEE implied lower procedural (delta 12 min) and fluoroscopy time (delta 5 min) when compared with ICE. Procedural success was similarly high (≥94%) between the TEE and ICE groups with a complication rate of 6.5% for TEE versus 4.2% for ICE (odds ratio: 1.468; 95% confidence interval: 0.681 to 3.166; p = 0.327). At median follow-up of 451 days (interquartile range: 162 to 899 days), the rate of cerebral ischemic events was similar between TEE-guided and ICE-guided procedures. CONCLUSIONS ICE-guided LAAO by means of Amplatzer devices may represent a second alternative imaging modality after an appropriate learning curve and bearing in mind that pre-procedural computed tomography imaging is mandatory. When comparing ICE with TEE, TEE remains the gold standard.
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Affiliation(s)
- Sergio Berti
- UOC Cardiologia Diagnostica ed Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Ospedale del Cuore, Massa, Italy.
| | - Luigi Emilio Pastormerlo
- UOC Cardiologia Diagnostica ed Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Ospedale del Cuore, Massa, Italy
| | - Gennaro Santoro
- UO Cardiologia Generale, Azienda Ospedaliero-Universitaria di Careggi, Firenze, Italy
| | - Elvis Brscic
- UO Cardiologia, Maria Pia Hospital, Turin, Italy
| | - Matteo Montorfano
- UO Cardiologia Interventistica ed Emodinamica, Ospedale San Raffaele, Milan, Italy
| | - Luigi Vignali
- UO Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paolo Danna
- UO Cardiologia, Ospedale Luigi Sacco, Milan, Italy
| | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Università di Milan, Milan, Italy
| | - Marco Rezzaghi
- UOC Cardiologia Diagnostica ed Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Ospedale del Cuore, Massa, Italy
| | - Gianpiero D'Amico
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | - Giuseppe Patti
- UOS di Servizi Cardiologici, Campus Bio-medico, Rome, Italy
| | - Antonio Rapacciuolo
- Department of advanced biomedical sciences, Federico II University, Naples, Italy
| | - Arnaldo Poli
- USD Cardiologia Interventistica-ASST Ovest Milanese-Ospedale Legnano-Magenta, Legnano, Italy
| | - Paolo Golino
- UOC Cardiologia Clinica, Azienda Ospedaliera "Sant'Anna e San Sebastiano" di Caserta, Caserta, Italy
| | - Paolo Magnavacchi
- UO Cardiologia, Policlinico di Modena-Ospedale di Baggiovara, Modena, Italy
| | - Francesco Meucci
- UO Cardiologia Generale, Azienda Ospedaliero-Universitaria di Careggi, Firenze, Italy
| | | | - Miroslava Stolcova
- UOC Cardiologia Diagnostica ed Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Ospedale del Cuore, Massa, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Sirignano P, Mansour W, Capoccia L, Intrieri F, Ferri M, Saccà S, Sponza M, Mortola P, Stabile E, Speziale F. CAR 8. Preliminary Results From a Prospective Real-World Multicenter Clinical Practice of Carotid Artery Stenting Using the CGuard Embolic Prevention System: The IRONGUARD 2 Study. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pacchioni A, Ferro J, Pesarini G, Mantovani R, Mugnolo A, Bellamoli M, Penzo C, Marchese G, Benedetto D, Turri R, Fede A, Benfari G, Saccà S, Ribichini F, Versaci F, Reimers B. The Activated Clotting Time Paradox. Circ Cardiovasc Interv 2019; 12:e008045. [DOI: 10.1161/circinterventions.119.008045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Radial artery occlusion (RAO) is a thrombotic complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Sheath-vessel diameter ratio, postprocedure compression time, occlusive hemostasis, and insufficient anticoagulation are all predictors of RAO. However, excessive anticoagulation can lead to longer time to achieve complete hemostasis and less patent hemostasis rate. This study was designed to assess the relationship among residual anticoagulation at the end of a percutaneous coronary procedure and the risk of RAO.
Methods:
Eight hundred thirty-seven patients undergoing transradial catheterization were enrolled. Activated clotting time (ACT) was measured before sheath removal. Patients were divided into 3 groups according to ACT values (ACT <150 s, ACT between 150 and 249 s, ACT >250 s), patent hemostasis with reverse Barbeau test was attempted in all patients, and compression device removed as soon as possible. Within 24 hours, patency of radial artery was checked by Doppler using reverse Barbeau technique.
Results:
Incidence of RAO was higher for the extreme ACT values. Patent hemostasis were less frequently obtained and time to hemostasis significantly longer for increasing ACT values (
P
=0.004 for trend and <0.0001 for trend, respectively). At logistic regression analysis, ACT values <150 s were an independent predictor of RAO (odds ratio, 3.53; 95% IC, 1.677–7.43;
P
=0.001) while adjusted probability for RAO confirmed U-shaped relationship with ACT values.
Conclusions:
The level of anticoagulation is strongly related to incidence of RAO and should be measured objectively by ACT.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02762344.
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Affiliation(s)
- Andrea Pacchioni
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Jayme Ferro
- Department of Cardiology, Arcispedale Santa Maria, Reggio Emilia, Italy (J.F.)
| | - Gabriele Pesarini
- Department of Cardiology, Università di Verona, Italy (G.P., M.B., G.B., F.R.)
| | - Riccardo Mantovani
- Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy (R.M., B.R.)
| | - Antonio Mugnolo
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Michele Bellamoli
- Department of Cardiology, Università di Verona, Italy (G.P., M.B., G.B., F.R.)
| | - Carlo Penzo
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Giuseppe Marchese
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Daniela Benedetto
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Riccardo Turri
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Alfredo Fede
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Giovanni Benfari
- Department of Cardiology, Università di Verona, Italy (G.P., M.B., G.B., F.R.)
| | - Salvatore Saccà
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Flavio Ribichini
- Department of Cardiology, Università di Verona, Italy (G.P., M.B., G.B., F.R.)
| | - Francesco Versaci
- Department of Cardiology, Università di Tor Vergata, Roma, Italy (F.V.)
| | - Bernhard Reimers
- Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy (R.M., B.R.)
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Tarantini G, D'Amico G, Latib A, Montorfano M, Mazzone P, Fassini G, Maltagliati A, Ronco F, Saccà S, Cruz-Gonzalez I, Ibrahim R, Freixa X. Percutaneous left atrial appendage occlusion in patients with atrial fibrillation and left appendage thrombus: feasibility, safety and clinical efficacy. EUROINTERVENTION 2019; 13:1595-1602. [PMID: 29086706 DOI: 10.4244/eij-d-17-00777] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate the feasibility, safety and efficacy of percutaneous closure for prevention of thromboembolic events in patients with atrial fibrillation (AF) and left atrial appendage (LAA) thrombus. METHODS AND RESULTS The study included consecutive patients with AF and LAA thrombus who underwent transcatheter occlusion in eight high-volume centres. Clinical and transoesophageal echocardiography (TEE) follow-up was carried out as per each centre's protocol. Twenty-eight patients were included. The location of the LAA thrombus was distal in 100% of cases. Technical and procedural success was achieved in all patients. A cerebral protection device was used in six cases. There were no periprocedural adverse events. Follow-up was complete in all patients (total 32 patient-years). No death or thromboembolic events were reported. There was one major bleeding during follow-up. Among the 23 patients undergoing TEE, device thrombosis was present in one patient. No significant peri-device leaks were observed. CONCLUSIONS In this multicentre study, percutaneous closure in selected patients with distal LAA thrombus appears to be feasible and safe, and is associated with high procedural success and a favourable outcome for the prevention of AF-related thromboembolism. Special implant techniques avoiding mechanical mobilisation of the thrombotic mass and the liberal use of cerebral embolic protection devices are recommended.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Tarantini G, Esposito G, Musumeci G, Fraccaro C, Franzone A, Castiglioni B, La Manna A, Limbruno U, Marchese A, Mauro C, Rigattieri S, Tarantino F, Gandolfo C, Santoro G, Violini R, Airoldi F, Albiero R, Balbi M, Baralis G, Bartorelli AL, Bedogni F, Benassi A, Berni A, Bonzani G, Bortone AS, Braito G, Briguori C, Brscic E, Calabrò P, Calchera I, Cappelli Bigazzi M, Caprioglio F, Castriota F, Cernetti C, Cicala C, Cioffi P, Colombo A, Colombo V, Contegiacomo G, Cremonesi A, D'Amico M, De Benedictis M, De Leo A, Di Biasi M, Di Girolamo D, Di Lorenzo E, Di Mario C, Dominici M, Ettori F, Ferrario M, Fioranelli M, Fischetti D, Gabrielli G, Giordano A, Giudice P, Greco C, Indolfi C, Leonzi O, Lettieri C, Loi B, Maddestra N, Marchionni N, Marrozzini C, Medda M, Missiroli B, My L, Oreglia JA, Palmieri C, Pantaleo P, Paparoni SR, Parodi G, Petronio AS, Piatti L, Piccaluga E, Pierli C, Perkan A, Pitì A, Poli A, Ramondo AB, Reale MA, Reimers B, Ribichini FL, Rosso R, Saccà S, Sacra C, Santarelli A, Sardella G, Satullo G, Scalise F, Siviglia M, Spedicato L, Stabile A, Tamburino C, Tesorio TNM, Tolaro S, Tomai F, Trani C, Valenti R, Valsecchi O, Valva G, Varbella F, Vigna C, Vignali L, Berti S. [Updated SICI-GISE position paper on institutional and operator requirements for transcatheter aortic valve implantation]. G Ital Cardiol (Rome) 2018; 19:519-529. [PMID: 30087514 DOI: 10.1714/2951.29672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program.
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Affiliation(s)
| | | | | | - Chiara Fraccaro
- A.O. Policlinico Universitario di Padova, Centro Gallucci, Padova
| | | | | | - Alessio La Manna
- Cardiologia Centro Alte Specialità e Trapianti, Ospedale Gaspare Rodolico, Catania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ciro Indolfi
- Policlinico Universitario Mater Domini, Catanzaro
| | | | | | | | | | | | - Cinzia Marrozzini
- A.O. Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | | | | | - Luigi My
- Casa di Cura Villa Verde, Taranto
| | | | | | | | | | | | | | | | | | | | - Andrea Perkan
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara, Trieste
| | | | | | | | | | | | | | | | | | - Cosimo Sacra
- Università Cattolica del Sacro Cuore, Campobasso
| | | | | | | | | | | | | | | | - Corrado Tamburino
- Cardiologia Centro Alte Specialità e Trapianti, Ospedale Gaspare Rodolico, Catania
| | | | | | | | - Carlo Trani
- Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | | | | | | | | | - Carlo Vigna
- Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo (FG)
| | | | - Sergio Berti
- Ospedale del Cuore, Fondazione CNR Toscana G. Monasterio, Pisa
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Mazzone P, D’Angelo G, Regazzoli D, Molon G, Senatore G, Saccà S, Canali G, Amellone C, Turri R, Bella PD. Percutaneous Left Atrial Appendage Closure with WATCHMAN™ device: peri-procedural and mid-term outcomes from the TRAPS Registry. J Interv Card Electrophysiol 2018. [DOI: 10.1007/s10840-018-0351-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fede A, Pacchioni A, Penzo C, Turri R, Marchese G, Benedetto D, Saccà S. [Endovascular treatment of symptomatic carotid artery dissection]. G Ital Cardiol (Rome) 2018; 19:62-66. [PMID: 29451511 DOI: 10.1714/2852.28780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Internal carotid artery dissection is one of the possible causes of stroke in young adults. The effectiveness of medical therapy alone is often limited and endovascular strategy should be considered, particularly in the presence of persisting neurological symptoms. Currently, there is no general consensus on the most appropriate therapeutic strategy to follow in symptomatic carotid artery dissection. We here report a case of symptomatic carotid artery dissection treated with an endovascular approach, and we review the recent literature regarding this therapeutic strategy. Materials and methods for performing endovascular treatment are also described, along with the possible steps to follow. Data in the literature and our clinical experience suggest that stenting is promising in patients with internal carotid artery dissection and should be considered as a valid therapeutic strategy in case of failure of medical therapy in highly experienced centers.
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Affiliation(s)
- Alfredo Fede
- Divisione di Cardiologia, Ospedale Civile di Mirano (VE)
| | | | - Carlo Penzo
- Divisione di Cardiologia, Ospedale Civile di Mirano (VE)
| | - Riccardo Turri
- Divisione di Cardiologia, Ospedale Civile di Mirano (VE)
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Berti S, Santoro G, Brscic E, Montorfano M, Vignali L, Danna P, Tondo C, D'Amico G, Stabile A, Saccà S, Patti G, Rapacciuolo A, Poli A, Golino P, Magnavacchi P, De Caterina A, Meucci F, Pezzulich B, Rezzaghi M, Stolcova M, Tarantini G. Left atrial appendage closure using AMPLATZER™ devices: A large, multicenter, Italian registry. Int J Cardiol 2017; 248:103-107. [DOI: 10.1016/j.ijcard.2017.07.052] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/07/2017] [Accepted: 07/13/2017] [Indexed: 12/13/2022]
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Saccà S, Ferro J, Umemoto T, Turri R, Penzo C, Pacchioni A. A New Strategy for Transcatheter Left Atrial Appendage Closure With Cerebral Embolic Protection in Patient With Left Auricular Thrombosis and Total Contraindication to Long-Term Anticoagulation. J Invasive Cardiol 2017; 29:E37-E38. [PMID: 28255107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, occurring in 1%-2% of the general population. An important aspect is the treatment of AF in terms of stroke prevention. In patients with absolute contraindication to long-term anticoagulation due to high bleeding risk, a valuable alternative exists in left atrial appendage (LAA) closure. Unfortunately, thrombus in the LAA is a contraindication to the procedure because of high risk of embolization. We describe a clinical case with permanent AF, absolute contraindication to long-term anticoagulation therapy, and persistent thrombus formation in the LAA that was treated with transcatheter LAA closure and supraaortic trunk protection system in order to avoid risk of periprocedural stroke.
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Affiliation(s)
| | - Jayme Ferro
- Cardiology Department, Mirano General Hospital, via Mariutto 13, Mirano, Venice, Italy.
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Mazzone P, Angelo GD, Regazzoli D, Molon G, Senatore G, Saccà S, Canali G, Amellone C, Turri R, Bella PD. 16-27: Percutaneous Left Atrial Appendage Closure with WATCHMAN device: results from the TRAPS Registry. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Schwindt A, Reimers B, Scheinert D, Selmon M, Pigott JP, George JC, Robertson G, Janzer S, McDaniel HB, Shrikhande GV, Torsello G, Schaefers J, Saccà S, Versaci F. Crossing chronic total occlusions with the Ocelot system: the initial European experience. EUROINTERVENTION 2016; 9:854-62. [PMID: 23838387 DOI: 10.4244/eijv9i7a139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to determine the safety, efficacy and feasibility of a new chronic total occlusion (CTO) device using optical coherence tomography (OCT) technology, the Ocelot catheter (Avinger, Inc., Redwood City, CA, USA), for crossing of SFA CTOs following guidewire failure. METHODS AND RESULTS Prospective, multicentre, market preference testing. Thirty-three patients with confirmed CTO (99-100% stenosis by visual estimate) of their superficial femoral artery (SFA) were treated between September 28, 2011, and December 9, 2011, at three European centres. Ocelot crossed 94% (31/33) of CTOs, allowing guidewire placement in the distal true lumen. All (100%) lesions were treated without any major adverse safety events. Procedural time and contrast dose were significantly reduced (p<0.0001) when compared with a similar, non-OCT-guided CTO crossing device (Wildcat catheter; Avinger, Inc.). Overall physician feedback on the catheter performance was positive with an 87% average rating of excellent or good across seven categories. Performance ratings of Ocelot's OCT imaging guidance were consistently positive with an 86% average rating of excellent or good across five OCT categories. CONCLUSIONS The Ocelot catheter combines advanced CTO crossing technology with real-time OCT guidance. When compared with a similar non-OCT-guided catheter, crossing efficacy and safety profile improved. Total procedure time and contrast volumes were significantly reduced. The Ocelot is a safe, efficient and effective tool for crossing CTOs.
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Fede A, Reimers B, Saccà S. Stent-assisted coil embolization for the treatment of aneurysm involving a coronary bifurcation. Catheter Cardiovasc Interv 2016; 87:1269-1272. [DOI: 10.1002/ccd.26363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/22/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Alfredo Fede
- Division of Cardiology; Public Hospital; Mirano (VE) Italy
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30
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Pacchioni A, Umemoto T, Penzo C, Saccà S, Ferro J, Fede A, Turri R, Reimers B. Successful Endovascular Treatment of Unbenign Spontaneous Dissection of the Left Internal Carotid Artery Combining Advanced Carotid and Coronary Techniques. JACC Cardiovasc Interv 2015; 8:e233-5. [PMID: 26718524 DOI: 10.1016/j.jcin.2015.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/19/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Carlo Penzo
- Division of Cardiology, Ospedale Civile, Mirano, Italy
| | | | - Jayme Ferro
- Division of Cardiology, Ospedale Civile, Mirano, Italy
| | - Alfredo Fede
- Division of Cardiology, Ospedale Civile, Mirano, Italy
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Abstract
Coronary artery aneurysms are defined as coronary dilations as greater than 1.5 times the largest diameter of the adjacent coronary segment. They are a relatively rare finding on coronary angiography, with prevalence ranging from 0.3% to 5% depending on case series. The identification of a coronary artery aneurysm is often a dilemma for both the clinician and the interventionist in terms of diagnosis, treatment and follow-up. This review summarizes the etiologic, pathogenetic, clinical and therapeutic aspects of coronary artery aneurysms in the light of the latest research on this topic.
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Affiliation(s)
| | - Luca Favero
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto (TV)
| | | | | | - Carlo Cernetti
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto (TV)
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Gallo A, Cisico S, Reimers B, Saccà S. Late surgical retrieval of a nitinol occluder system embolized in the aortic arch. Eur J Cardiothorac Surg 2015; 48:e63. [PMID: 26088587 DOI: 10.1093/ejcts/ezv220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/13/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alina Gallo
- Department of Cardiac Surgery, Mirano Hospital, Mirano, Italy
| | - Stefano Cisico
- Department of Cardiac Surgery, Mirano Hospital, Mirano, Italy
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Molon G, Canali G, Casu G, Mazzone P, Barbato G, Ramondo A, Saccà S, Scaglione M, Senatore G, Solimene F, Grassi G, Nardi S, Luise R. [Letter to the editor]. G Ital Cardiol (Rome) 2015; 16:188-90. [PMID: 25837463 DOI: 10.1714/1820.19832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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34
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Chieffo A, Buchanan GL, Parodi G, Versaci F, Bianchi RM, Valenti R, Saccà S, Mongiardo A, Span S, Migliorini A, Spaccarotella C, Reimers B, Antoniucci D, Indolfi C, Ferrari A, Maehara A, Mintz GS, Colombo A. Drug-eluting stent implantation in patients with acute coronary syndrome - the Activity of Platelets after Inhibition and Cardiovascular Events: Optical Coherence Tomography (APICE OCT) study. EUROINTERVENTION 2014; 10:916-23. [DOI: 10.4244/eijy14m06_10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Pacchioni A, Mugnolo A, Parizi ST, Versaci F, Saccà S, Turri R, Reimers B. TCT-551 Randomized Comparison of Flow Reversal vs Distal Filter for Cerebral Protection During Carotid Artery Stenting in Patients With Stable Carotid Disease. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Pacchioni A, Mugnolo A, Penzo C, Nikas D, Saccà S, Agostoni P, Garami Z, Versaci F, Reimers B. Cerebral microembolism during transradial coronary angiography: Comparison between single and double catheter strategy. Int J Cardiol 2014; 170:438-9. [DOI: 10.1016/j.ijcard.2013.11.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/18/2013] [Accepted: 11/23/2013] [Indexed: 11/16/2022]
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37
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Pacchioni A, Versaci F, Mugnolo A, Penzo C, Nikas D, Saccà S, Favero L, Agostoni PF, Garami Z, Prati F, Reimers B. Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach. Int J Cardiol 2013; 167:3021-6. [DOI: 10.1016/j.ijcard.2012.09.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/19/2012] [Accepted: 09/12/2012] [Indexed: 11/25/2022]
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38
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Versaci F, Saccà S, Mugnolo A, Pacchioni A, Reimers B. Simultaneous patent foramen ovale and left atrial appendage closure. J Cardiovasc Med (Hagerstown) 2013; 13:663-4. [PMID: 22011553 DOI: 10.2459/jcm.0b013e32834cad8d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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39
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Saccà S, Pacchioni A, Nikas D. Coil embolization for distal left main aneurysm: a new approach to coronary artery aneurysm treatment. Catheter Cardiovasc Interv 2011; 79:1000-3. [PMID: 21735516 DOI: 10.1002/ccd.23195] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 04/01/2011] [Indexed: 12/16/2022]
Abstract
Coronary artery aneurysm is an uncommon disease, whose natural history and therapeutic approach are still controversial: medical therapy, surgical revascularization with or without aneurysm ligation or excision, and endovascular exclusion with membrane covered stents are all accepted and viable options, according to anatomic characteristics. Intracranial aneurysms are adequately treated by means of coil embolization, an option that, to our knowledge, has never been tested in coronary interventions. We report the first case of a coronary aneurysm involving the distal left main and the proximal left anterior descending artery treated with "stent-assisted" coil embolization.
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Affiliation(s)
- Salvatore Saccà
- Cardiology Department, Ospedale Civile di Mirano, Mirano, Venice, Italy
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40
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Reimers B, Nikas D, Stabile E, Favero L, Saccà S, Cremonesi A, Rubino P. Preliminary experience with optical coherence tomography imaging to evaluate carotid artery stents: safety, feasibility and techniques. EUROINTERVENTION 2011; 7:98-105. [PMID: 21550909 DOI: 10.4244/eijv7i1a17] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Optical coherence tomography (OCT) is an increasingly used intravascular imaging modality to assess coronary stent implantation and vessel healing. A recently developed catheter (C7 Dragonfly; LightLab Imaging Inc.,Westford, MA, USA) allows visualisation of peripheral arteries up to 10 mm of diameter with high speed pullback. Safety, feasibility and the technique of OCT following carotid artery stenting (CAS) were evaluated in the present study. METHODS AND RESULTS OCT was performed in seven consecutive patients following successful CAS using proximal cerebral protection devices, occluding the common and external carotid artery and gentle manual injection of a total of 8-14 ml of 50% diluted contrast media with normal saline in order to displace the blood from the artery. Once the blood was displaced, pullback was started through the stented segment continuing the gentle contrast injection. After completion of the pullback all injected contrast was aspirated and discarded. In the first three patients, OCT was also performed without internal carotid artery flow blockage. Due to the high blood flow in the ICA it was not possible to replace all residual blood and obtain adequate OCT images. No procedural, in-hospital, or 30-day follow-up complications occurred. One patient experienced transient intolerance to vessel occlusion without any neurological sequels. OCT images were of good quality providing important information regarding stent geometry, presence and lack of strut apposition, plaque fracture, and plaque prolapse. CONCLUSIONS Intravascular OCT under occlusive proximal protection appears feasible and safe to assess stent implantation in carotid arteries.
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Affiliation(s)
- Bernhard Reimers
- Cardiovascular Department, Mirano, Public Hospital, Mirano, Italy.
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41
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Favero L, Penzo C, Nikas D, Pacchioni A, Pasquetto G, Saccà S, Reimers B. Cardiac and extracardiac complications during CTO interventions: prevention and management. Interv Cardiol 2010. [DOI: 10.2217/ica.10.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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42
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Pacchioni A, Nikas D, Penzo C, Saccà S, Favero L, Pasquetto G, Reimers B. Management and Prevention of Vascular Complications Related to Transcatheter Aortic Valve Implantation and Aortic Aneurysm Repair Procedures – A Technical Note. Interv Cardiol 2010. [DOI: 10.15420/icr.2010.5.1.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR) are increasingly being used as therapeutic options for patients with severe aortic stenosis who are ineligible for surgery and who have aortic aneurysm with suitable anatomical features. These procedures can be associated with severe complications, especially related to vascular access and the use of a large introducer sheath (from 18 to 24 French [Fr]). In this article we describe possible vascular complications emerging during TAVI and EVAR and their appropriate management, beginning with patient selection, the correct way to perform vessel puncture and the use of a vascular closure device, up to the recently proposed cross-over technique, which is thought to minimise the risk of dangerous consequences of vascular damage.
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Favero L, Saccà S, Cernetti C, Pasquetto G, Nikas D, Reimers B. Superselective embolization of renal hemorrhage occurring after percutaneous coronary intervention. Cardiovasc Revasc Med 2009; 10:62-5. [PMID: 19159859 DOI: 10.1016/j.carrev.2007.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 11/29/2007] [Indexed: 10/21/2022]
Abstract
A 69-year-old female was hospitalized for acute coronary syndrome and received full antiplatelet and anticoagulant therapy. The patient underwent angioplasty and stent implantation on right coronary and left circumflex arteries with good angiographic result. After the procedure, the patient developed hemorrhagic shock due to massive left renal hemorrhage. An emergent digital subtraction angiography showed bleeding from a left segmental renal artery. The hemorrhage was successfully managed with transcatheter superselective embolization. The patient was discharged after 22 days in good general condition with normal renal function. One-year follow-up was uneventful.
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Affiliation(s)
- Luca Favero
- Department of Cardiology, Mirano Hospital, Mirano, Italy.
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Reimers B, Tübler T, de Donato G, Della Barbera M, Cernetti C, Schlüter M, Mistrorigo F, Saccà S, Favero L, Setacci F, Setacci C, Thiene G, Schofer J, Angelini A. Endovascular Treatment of In-Stent Restenosis After Carotid Artery Stenting: Immediate and Midterm Results. J Endovasc Ther 2006; 13:429-35. [PMID: 16928155 DOI: 10.1583/06-1811.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the immediate and midterm outcome and analyze the debris captured after repeat endovascular intervention for the treatment of in-stent restenosis after carotid artery stenting (CAS). METHODS Thirty-one consecutive patients (27 men; mean age 63.7+/-13.0 years, range 53- 81) underwent repeat endovascular intervention (balloon angioplasty and provisional stenting) for the treatment of 32 in-stent restenoses following CAS. RESULTS Procedural success was achieved in all patients. An additional stent was implanted in 10 (31%) cases. No procedural complication was observed. Filter analysis was performed in 17 (53%) procedures; on 12 (71%), macroscopically visible material was captured. The histomorphometric analysis performed on 6 (19%) filters showed fibrin nets entrapping erythrocytes, leucocytes, platelets, and in 2 cases, fibrous hypercellular tissue fragments. At 30 days and during follow-up (mean 17+/-5 months), no deaths, transient ischemic attacks, or strokes were observed. In 1 (3.1%) patient, asymptomatic recurrence of ISR was found on Doppler ultrasonography and successfully treated with balloon angioplasty. CONCLUSION Repeat endovascular intervention using balloon angioplasty with provisional stenting and routine cerebral protection appears to be a feasible, safe, and clinically effective strategy for the treatment of in-stent restenosis after CAS.
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Favero L, Pasquetto G, Cernetti C, Saccà S, Reimers B. High-tech primary percutaneous coronary intervention. Ital Heart J 2005; 6:465-74. [PMID: 16008151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Coronary recanalization by means of primary percutaneous coronary intervention is actually the treatment of choice in patients with ST-elevation myocardial infarction. However, conventional primary percutaneous coronary intervention still presents several limitations. In recent years sophisticated new devices and techniques have been developed to further improve the results of primary percutaneous coronary intervention: it seems to be appropriate to refer to their utilization using the definition "high-tech primary percutaneous coronary intervention". Although the study data available are controversial and clinical benefits have not clearly been shown, adjunctive devices have been used in many procedures. Patient and lesion selection appears to be crucial and the health economics as well as the safety of high-tech devices should be carefully evaluated.
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Affiliation(s)
- Luca Favero
- Cardiology Department, Civic Hospital, Mirano (VE), Italy
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46
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Napodano M, Pasquetto G, Saccà S, Cernetti C, Scarabeo V, Pascotto P, Reimers B. Intracoronary thrombectomy improves myocardial reperfusion in patients undergoing direct angioplasty for acute myocardial infarction. J Am Coll Cardiol 2003; 42:1395-402. [PMID: 14563581 DOI: 10.1016/s0735-1097(03)01041-6] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We sought to evaluate the effects of mechanical thrombectomy on myocardial reperfusion during direct angioplasty for acute myocardial infarction (AMI). BACKGROUND Embolization of thrombus and plaque debris may occur during direct angioplasty for AMI. This may lead to distal vessel or side branch occlusion and to obstructions in the microvascular system, resulting in impaired myocardial reperfusion. Mechanical thrombectomy is used to reduce distal embolization. METHODS Ninety-two patients with AMI and angiographic evidence of intraluminal thrombus were randomized to either intracoronary thrombectomy followed by stenting or to a conventional strategy of stenting. Thrombectomy was performed using the X-Sizer catheter (EndiCOR Inc., San Clemente, California). Myocardial reperfusion was assessed by myocardial blush and ST resolution. RESULTS Postprocedure Thrombolysis in Myocardial Infarction-3 flow was not different between groups (93.5% vs. 95.7%, p = 0.39). Myocardial blush-3 was observed in 71.7% of patients undergoing thrombectomy and in 36.9% of patients undergoing conventional strategy (p = 0.006). ST-segment resolution >or=50% occurred more often in patients undergoing thrombectomy (82.6% vs. 52.2%, p = 0.001). By multivariate analysis, adjunctive thrombectomy was an independent predictor of blush-3 (odds ratio, 3.27; 95% confidence interval, 1.06 to 10.05; p = 0.039). CONCLUSIONS Intracoronary thrombectomy as adjunct to stenting during direct angioplasty for AMI improves myocardial reperfusion as assessed by myocardial blush and ST resolution.
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47
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Cernetti C, Reimers B, Picciolo A, Saccà S, Pasquetto G, Piccolo P, Favero L, Bonanome A, Dell'Olivo I, Pascotto P. Carotid artery stenting with cerebral protection in 100 consecutive patients: immediate and two-year follow-up results. Ital Heart J 2003; 4:695-700. [PMID: 14664282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Carotid artery stenting is emerging as an alternative to surgical endarterectomy for the treatment of extracranial carotid artery disease. However, few data are available on the long-term clinical efficacy of carotid artery stenting and on the incidence of restenosis. METHODS Stent implantation with the routine use of cerebral protection devices was attempted in a single center experience including 100 consecutive patients (104 lesions) with significant stenosis of the internal carotid artery (mean stenosis 82.8 +/- 9%). The mean age of the patients was 70.8 +/- 14 years, 27 lesions were symptomatic (26.0%) with a lesion related to a previous stroke or transient ischemic attack. RESULTS Procedural success was achieved in 103 lesions (99%) and the cerebral protection was successfully applied in 102 procedures (98%). The 30-day incidence of stroke and death was 4% (4 patients). Complications consisted of one major stroke (1%) with persistent ipsilateral amaurosis, two minor strokes (2%), and one (1%) fatal myocardial infarction occurring 4 days after the stent procedure. During follow-up (minimum 24 months; mean 31 +/- 6 months) no further neurological events occurred, 6 patients died of non-neurological causes (6%) and 2 (2%) presented with a non-fatal myocardial infarction. Echo color Doppler scan control (minimum 24 months) was carried out in all surviving patients showing a restenosis classified as moderate (50-69%) in 2 cases and as critical (> or = 70%) in another 2 cases (1.8%). Both critical restenotic lesions were successfully treated by repeating balloon angioplasty. CONCLUSIONS The present study demonstrates that carotid artery stenting with routine cerebral protection can be performed with an acceptable procedural complication rate. At the 2-year follow-up carotid artery stenting appeared effective in stroke prevention and durable with a low incidence of restenosis.
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Affiliation(s)
- Carlo Cernetti
- Cardiovascular Department, Civic Hospital, Mirano, VE, Italy
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48
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Pasquetto G, Reimers B, Favero L, Saccà S, Cernetti C, Napodano M, Piccolo P, Pascotto P. Distal filter protection during percutaneous coronary intervention in native coronary arteries and saphenous vein grafts in patients with acute coronary syndromes. Ital Heart J 2003; 4:614-9. [PMID: 14635379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Percutaneous coronary interventions on saphenous vein grafts (SVG) and in patients with acute coronary syndromes (ACS) have been associated with the distal embolization of the thrombus and plaque and to the no-reflow phenomenon. We report on the safety and feasibility of a new distal emboli protection filter. METHODS Angioplasty using distal filter protection (Angioguard, Cordis, Warren, NJ, USA) was attempted in 38 patients (mean age 65 +/- 11 years, 79% males) affected by ACS. A percutaneous coronary intervention was performed in 27 native coronary arteries, in 10 SVG and in one arterial graft (mean diameter stenosis 88 +/- 9%). Patients with vessels presenting severe proximal tortuosity, more than mild calcification, a diameter < 3.0 mm and a lesion length > 15 mm were excluded. RESULTS It was possible to position the device in all patients (100%); in 7 patients (18%) the lesion could be crossed with the filter only after balloon predilation. Procedural success with final TIMI flow 3 was obtained in all patients and the mean residual diameter stenosis after stent implantation was 5 +/- 8%. Transient procedural complications without clinical sequelae included the no-reflow phenomenon (2 patients, 5%) and vessel perforation (1 patient, 2.5%). In no case was distal embolization observed. As regards the device-related complications, one occlusive dissection (2.5%) occurred and was successfully treated with stent implantation. In-hospital and 30-day major adverse cardiac events consisted of two non-Q wave myocardial infarctions (5%), both occurring during SVG interventions. CONCLUSIONS The use of the Angioguard filter for preselected lesions in patients with ACS had a high technical success and carried a low rate of device-related complications. The clinical efficacy of the device needs further evaluation.
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Pellizzari N, Reimers B, Saccà S, Pasquetto G, Cernetti C, Napodano M, Calò M, Michielon P, Pascotto P. Percutaneous endovascular stent-graft placement for the treatment of acute rupture of an aneurysm of the thoracic aorta. Ital Heart J 2002; 3:427-30. [PMID: 12189973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A 68-year-old male patient presented with massive hematemesis following the acute rupture of an aneurysm of the descending thoracic aorta into the esophagus. In view of the important cardiac and pulmonary comorbidities, surgical treatment was excluded and successful percutaneous implantation of an endovascular stent-graft in the descending aorta was performed. In selected patients endovascular treatment may constitute an alternative to the surgical repair of ruptured aortic aneurysms.
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Angelini A, Reimers B, Della Barbera M, Saccà S, Pasquetto G, Cernetti C, Valente M, Pascotto P, Thiene G. Cerebral protection during carotid artery stenting: collection and histopathologic analysis of embolized debris. Stroke 2002; 33:456-61. [PMID: 11823652 DOI: 10.1161/hs0202.102337] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Histopathologic analysis was performed to better understand quantity, particle size, and composition of embolized debris collected in protection filters during carotid artery stent implantation. METHODS Elective carotid stent implantation with the use of a distal filter protection was attempted in 38 consecutive lesions (36 patients) of the internal carotid artery presenting >70% diameter stenosis (mean, 82.1+/-11.1%). Mean age of the patients was 70.7+/-7.7 years; 75% were men, and 50% of patients had previous neurological symptoms. RESULTS In 37 lesions (97.4%) it was possible to position the filter device, and in all lesions a stent was successfully implanted. The only complication occurring in the hospital and during the 30-day follow-up was 1 death due to acute myocardial infarction. Neurological sequelae did not occur. Histomorphometric analysis was performed on the filters. Presence of debris was detected in 83.7% of filters. The mean surface area of the polyurethane membrane filter covered with material was 53.2+/-19.8%. Particle size ranged from 1.08 to 5043.5 microm (mean, 289.5+/-512 microm) in the major axis and 0.7 to 1175.3 microm (mean, 119.7+/-186.7 microm) in the minor axis. Collected debris consisted predominantly of thrombotic material, foam cells, and cholesterol clefts. CONCLUSIONS By the use of distal protection filters during carotid artery stenting, it was possible to collect particulate debris potentially leading to distal vessel occlusion in a high percentage of cases. Qualitative analysis of embolized material showed debris dislocated during the percutaneous intervention from atheromatous plaques.
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