Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A Contemporary Perspective

Alcohol septal ablation is a minimally invasive procedure for the treatment of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite optimal medical therapy. The procedure causes a controlled myocardial infarction of the basal portion of the interventricular septum by the injection of absolute alcohol with the aim of reducing LVOT obstruction and improving the patient's hemodynamics and symptoms. Numerous observations have demonstrated the efficacy and safety of the procedure, making it a valid alternative to surgical myectomy. In particular, the success of alcohol septal ablation depends on appropriate patient selection and the experience of the institution where the procedure is performed. In this review, we summarize the current evidence on alcohol septal ablation and highlight the importance of a multidisciplinary approach involving a team of clinical and interventional cardiologists and cardiac surgeons with high expertise in the management of HOCM patients-the Cardiomyopathy Team

A Prospective, observational, Italian multi-center registry of self-aPposing® cOronary Stents in patients presenting with ST-segment Elevation Myocardial InfarcTION: The iPOSITION registry

Background: Primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) can be challenging for high thrombus burden and catecholamine-induced vasoconstriction. The Xposition-S stent was designed to prevent stent undersizing and minimize strut malapposition. We evaluated 1-year clinical outcomes of a nitinol, self-apposing®, sirolimus-eluting stent, pre-mounted on a novel balloon delivery system, in de novo lesions of patients presenting with STEMI undergoing pPCI. Methods: The iPOSITION is a prospective, multicenter, post-market, observational study. The primary endpoint, target lesion failure (TLF), was defined as the composite of cardiac death (CD), recurrent target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR). Results: The study enrolled 247 STEMI patients from 7 Italian centers. Both device and procedural success occurred in 99.2% of patients, without any death, TV-MI, TLR, or stent thrombosis (ST) during the hospital stay and at 30-day follow-up. At 1 year, TLF occurred in 2.6%, CD occurred in 1.7%, TV-MI occurred in 0.4%, and TLR in 0.4% of patients. The 1-year ST rate was 0.4%. Conclusions: The use of an X-position S self-apposing® stent is feasible in STEMI pPCI, with excellent post-procedural results and 1-year outcomes

New non invasive conservation methods for cultural heritage

Dottorato di Ricerca in Medicina Traslazionale. Ciclo XXIXUniversità della Calabri

Remediation of polluted waters by means of surface modified natural cellulose fibers

Dottorato di Ricerca in Medicina Traslazionale. Ciclo XXXIUniversità della Calabri

Impact of vascular access on acute kidney injury after percutaneous coronary intervention.

OBJECTIVES We performed a systematic review of the literature and a meta-analysis to examine the role of access site in affecting the incidence of acute kidney injury (AKI) after percutaneous coronary intervention (PCI). BACKGROUND The vascular access site may play a central role among procedure-related risk factors for AKI after PCI. Transradial access is associated with reduced vascular complications and major bleeding which, in turn, is an emerging risk factor for post-procedural AKI. METHODS Results of six observational studies, three out of six providing propensity matching adjustment, of patients undergoing PCI from the radial and the femoral access were pooled, including overall 26,185 patients. The endpoint was the incidence of study-defined AKI. A meta-regression analysis was performed to further assess the role of study-level covariates. Random-effects models were privileged. RESULTS There was a significant difference in the incidence of AKI after PCI, favoring radial access (odds ratio [OR] 0.51, 95% CI 0.39-0.67, p<0.0001), and the effect size was larger in studies including only patients presenting with ST-elevation myocardial infarction (STEMI) (OR 0.42, 95% CI 0.24-0.72, p=0.001). The meta-regression showed a significant relationship between the benefit of radial access and the proportion of STEMI patients (p=0.031) in each of the included studies. CONCLUSIONS Transradial intervention is associated with a reduction in the incidence of AKI after PCI, as compared to the femoral access, and this benefit is more evident in STEMI patients. These findings warrant further confirmation in randomized controlled trials

Radial vs femoral access for the prevention of acute kidney injury (AKI) after coronary angiography or intervention: A systematic review and meta-analysis.

OBJECTIVES We sought to investigate the impact of radial vs femoral access on the incidence of acute kidney injury (AKI) after coronary angiography or intervention. BACKGROUND There is a growing recognition of the importance of access site selection as an adjudicative measure to mitigate the risk of renal impairment for patients with coronary artery disease undergoing angiography with or without percutaneous coronary intervention. METHODS We conducted a systematic review of the literature and meta-analyzed available evidence comparing the rates of AKI with radial vs femoral access in patients undergoing coronary angiography or intervention. Studies reporting the incidence of AKI as a primary or secondary outcome were pooled in fixed- and random-effects meta-analyses and meta-regression techniques were used to account for across-study heterogeneity. RESULTS Across data pooled from nine studies (n = 32 181), radial access was significantly associated with a reduction in the incidence of AKI (OR 0.57, 95% CI 0.50 to 0.66, P < 0.0001 with fixed-effects model, OR 0.55, 95% CI 0.45 to 0.67, P < 0.0001 with random-effects model) as compared to femoral. In the meta-regression model, the effect size of radial access effect was related to the number of centers in which studies were conducted. CONCLUSIONS Compared with the femoral approach, radial access was associated with a lower incidence of AKI after coronary angiography or intervention, although this benefit was less pronounced in multicenter than in single-center studies