Spontaneous coronary artery dissection: review, case report and analysis of COVID-19-related cases

Spontaneous coronary artery dissection (SCAD) accounts for 1-4% of all acute coronary syndromes (ACS). Since the first description in 1931, our understanding of the disease has evolved; however, its pathophysiology and management are still a matter of debate. SCAD typically occurs in a middle-aged woman with no or few traditional cardiovascular risk factors. Two hypotheses have been proposed to explain the pathophysiology depending on the primary event: an intimal tear in the "inside-out" hypothesis and a spontaneous hemorrhage from the vasa vasorum in the "outside-in" hypothesis. Etiology appears to be multifactorial: different predisposing and precipitating factors have been identified. Coronary angiography is the gold standard for the diagnosis of SCAD. Current recommendations on the treatment of SCAD patients are based on expert opinions: a conservative strategy is preferred in hemodynamically stable SCAD patients, while urgent revascularization should be considered in hemodynamically unstable patients. Eleven cases of SCAD in COVID-19 patients have already been described: although the exact pathophysiological mechanism remains unclear, COVID-19-related SCAD is considered a combination of significant systemic inflammatory response and localized vascular inflammation. We present a literature review of SCAD, and we report an unpublished case of SCAD in a COVID-19 patient.

P338 PERCEPTION OF THE BENEFITS AND LIMITATIONS OF TELEVISIT IN A GROUP OF PATIENTS WITH CHRONIC HEART FAILURE

 

Telemedicine (T) has now become an indispensable operational tool for the management of patients with chronic conditions, in particular for patients with chronic heart failure (HF).

The current COVID 19 pandemic has accelerated the development and application oh this method in daily clinical practice. Up to now, the evaluation of he advantage and disadvantage of televisit by cardiological patients have been very limited. In order to assess the satisfaction and criticalities of this method, we administered a satisfaction questionnaire to 74 patients (49 males and 25 females with an average of 75) followed in our clinic. Of the 74 questionnaire administered, 70 were received. When asked whether the inclusion of T had improved the quality of service 43 patients (61%) answered a lot, 24 patients (34%) sufficiently and 3 patients (4%) not at all. When asked if the organization of the T had been adequate, 50 patients (71%) responded adequately, 19 patients (27%) sufficiently adequate and 1 patient (1%) not at all adequate. When asked about the modalities of connection to the T for 54 patients (77%) they were found to be sìmple, for 13 patients (18%) a little complicated and for 3 patients (4%) difficult, very complicated. When asked what would be proposed to improve the service 7 patients (10%) answered the possible extension of hours also in the afternoon, 3 patients (4%) the provision by the ASL of electromedical devices, 14 patients (20%) the ability to directly request an appointment in T and 38 patients (54%) all options. In detail, 1 patient (1%) requested both the extension of the afternoon schedule and the provision of electromedicals, 4 patients (6%) requested both the extension of the afternoon schedule and the direct request for an appointment, 2 patients (2%) required both electromedical equipment and direct request for an appointment, 1 patient (1%) did not indicate any option. Finally, as regards the degree of satisfaction, 45 patients (64%) were considered totally satisfied, 22 patients (31%) partially satisfied and 3 patients (4%) dissatisfied.

Conclusions

The televisit in the setting of patients with chronic HF, despite the limitations of a limited series, was generally well accepted, easy to access and with some useful operational proposal for public administration.

Late cerebral embolization after emboli-protected carotid artery stenting

Carotid artery stenting (CAS) is nowadays considered as alternative therapeutic option to carotid endarterectomy for patients suffering from carotid artery disease. Recent studies and meta-analyses have demonstrated equal performance of carotid stenting to endarterectomy as regard as the overall adverse events (death/stroke rates), especially when periprocedural myocardial infarction and nerve pulses are also included. However, carotid stenting was inferior to endarterectomy when compared in terms of acute and late embolic events. In the present review, we collect all studies available in the published literature regarding the late embolic events. We mainly attempted to gather data regarding the silent embolic events occurring after the acute post-procedural period. We analyzed the results and reported the incidence of the problem. Finally, we aimed to identify possible causes and propose effective solutions to reduce the incidence of late embolic events.

PRIAMUS--proximal flow blockage cerebral protectIon during carotid stenting: results from a multicenter Italian registry

AIM

The aim of this Italian prospective registry was to evaluate the applicability and efficacy of the Mo.Ma Device (Invatec, Roncadelle, Italy) for the prevention of cerebral embolization during carotid artery stenting (CAS) in a real world population.

METHODS

In 4 Italian centers, 416 patients (300 men; mean age 71.6+/-9 years) between October 2001 and March 2005 were enrolled in a prospective registry. Two-hundred and sixty-four symptomatic (63.46%) with >50% diameter stenosis and 152 (36.54%) asymptomatic patients with >70% diameter stenosis were included. The Mo.Ma Proximal Flow Blockage Embolic Protection System was used to perform protected CAS, achieving cerebral protection by endovascular clamping of the common carotid artery (CCA) and of the external carotid artery (ECA).

RESULTS

Technical success, defined as the ability to establish protection with the Mo.Ma device and to deploy the stent, was achieved in 412 cases (99.03%). The mean duration of flow blockage was 4.91+/-1.1 min. Transient intolerances to flow blockage were observed in 24 patients (5.76%), but in all cases the procedure was successfully completed. No peri-procedural strokes and deaths were observed. Complications during hospitalization included 16 minor strokes (3.84%), 3 transient ischemic attacks (0.72%), 2 deaths (0.48%) and 1 major stroke (0.24%). This resulted in a cumulative rate at discharge of 4.56% all strokes and deaths, and of 0.72% major strokes and deaths. All the patients underwent thirty-day follow-up. At thirty-day follow-up, there were no deaths and no minor and major strokes, confirming the overall cumulative 4.56% incidence of all strokes and deaths rate, and of 0.72% rate of major strokes and deaths at follow up. In 245 cases (58.89%) there was macroscopic evidence of debris after filtration of the aspirated blood.

CONCLUSIONS

This Italian multicenter registry confirms and further supports the efficacy and applicability of the endovascular clamping concept with proximal flow blockage in a broad patient series. Results match favorably with current available studies on carotid stenting with cerebral protection.

Non-steroidal treatment of pollen-induced conjunctivitis: comparison of different pharmacological protocols

Pharmacological treatment of allergic conjunctivitis may be based on the therapeutic use of topical steroids; however, because of the side effects, steroids are not clinically suitable in either prolonged treatment, or pollinosis. Because non-steroidal topical drugs are suitable in prolonged treatment, this single-blind study evaluated the following topical drugs: cromoglycate plus chlorphenamine, cromoglycate plus tetryzolin and imidazolin plus nafazolin, compared with placebo. The results confirm significant clinical efficacy of these drugs on signs and symptoms compared with placebo. Thus, "non-steroidal" topical drugs should be the preferred choice in prolonged forms of pollen-induced (e.g. Parietaria and/or grasses) conjunctivitis.

Levocabastine versus cromolyn sodium in the treatment of pollen-induced conjunctivitis

Thirty patients with allergic conjunctivitis, caused by Parietaria or grass pollens, participated in a double-blind parallel study comparing levocabastine to cromolyn sodium, both given as eye drops. Symptom and sign scores were recorded during a 4-week period. The patients received only these drugs during the time of observation. The evaluation of the clinical signs and symptoms by the clinicians and by the patients revealed a significant improvement of conjunctivitis in all patients. The intergroup comparison was equal in the two groups treated respectively with levocabastine and cromolyn. Therefore, levocabastine and cromolyn are effective in the treatment of pollen-induced allergic conjunctivitis.