Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type

Aim To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Methods and results Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). Conclusion A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957

Indications de l’angioplastie des artères rénales : à revisiter ?

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[CT and MR imaging follow-up of medically treated acute aortic syndrome].

International audienceThe follow-up of medically treated acute aortic syndromes relies on CT and MR imaging. Comparison with prior examinations is essential. For aortic dissections, progressive enlargement of the false lumen, visceral hypoperfusion, and extension should be excluded. Mural hematomas and ulcers also undergo close follow-up to detect progression and recanalization. It is important to be familiar with the risk factors of disease progression for medically treated acute aortic syndromes and their management. It is also important to be familiar with the imaging features of disease progression. Acute aortic syndromes managed medically should undergo routine follow-up with CT or MR because these lesions may evolve silently over time and present with complications

The apex of the aortic arch backshifts with aging

BACKGROUND: Only a few studies, involving small numbers of patients, have globally assessed the curvature of the thoracic aorta but without any details concerning the location of the supra-aortic trunks. OBJECTIVES: Using CT to describe normal aortic-arch morphology and its changes with age and sex. METHODS: 344 CT scans were studied. We measured the distances from the apex to the ascending and descending aorta, the curvilinear length of the entire arch, that of the segment, including bifurcations of supra-aortic vessels, and the angle, height, and shift of the arch. RESULTS: In men, the arch was significantly longer (146.2 vs 122.8 mm; p < 0.001), higher (49.3 vs 40.1 mm, p < 0.001), and wider transversely (83.6 vs 73.3 mm; p < 0.001) than in women. The average men's arch also had a more acute angle at the apex (79.7 degrees vs 83.7 degrees p < 0.001). Neither morphology nor age influenced the winding angle around the mediastinum. Aging was accompanied by deflection and extension of the aortic arch, which grew more anteroposteriorly (6.1 mm/10 years in men) than vertically (2.5 mm/10 years in men), while the apex moved towards the rear of the arch. The ascending aorta was the only curvilinear length unaffected by age, whereas the supra-aortic trunks parted from each other. CONCLUSION: We believe that all these original observations could lead to a better assessment of normal aging of the aorta and guide technical choices during surgical or hybrid procedure

[Type III endoleaks at follow-up of covered descending thoracic aortic stent-grafts: report of 3 patients].

International audienceTo describe the imaging work-up and management of type III endoleaks detected after covered stent-graft treatment of descending thoracic aortic aneurysms

Intérêt des gants radio-atténuateurs en radiologie interventionnelle: une évaluation expérimentale

Objective: to determine the potential of leaded radiation attenuation gloves to decrease the X-ray exposure of operators' hands, in interventional radiology and in surgical units. Material and method: we used: radiation attenuation gloves bought by our hospital, TLD thermoluminescent dosimeters, an anthropomorphic phantom of calibration in bone densitometry, an anthropomorphic hand. The measurements were realized on 2 installations: one with sensor plans, and the other one with a brightness amplifier. We compared doses received by dosimeters without and in a glove, in the direct field (10 series of measurements, 2 with the brightness amplifier) and in the diffuse field (3 series on sensor plans), in fluoroscopy and graphy. Results: in the diffuse field, dosimeters in the glove measured a decrease in dose, varying from 1 to 3. In the direct field, 7 measurements out of 10 showed an increase in dose in the glove (13 to 42%). 3/10 measurements showed an almost stable dose. Conclusion: our measurements show the efficiency ofleaded radiation attenuation gloves in the diffuse field. In the direct field, the radiation attenuation gloves increase the hand dose, because of the automatic tuning of the parameters. © EDP Sciences, 2011.Objectif : déterminer l’intérêt des gants radio-atténuateurs plombés pour diminuer l’exposition des mains des opérateurs, en radiologie interventionnelle et au bloc opératoire. Matériel et méthode : on a utilisé des gants radio-atténuateurs plombés du marché, des dosimètres TLD thermoluminescents, un fantôme anthropomorphe de calibration en ostéodensitométrie, une main anthropomorphe. Les mesures étaient réalisées sur 2 installations : l’une avec capteurs plans, l’autre avec amplificateur de brillance. On a comparé les doses reçues par dosimètres sans et dans un gant, dans le champ direct (10 séries de mesures dont 2 avec amplificateur de brillance) et dans le diffusé (3 séries sur capteurs plans), en scopie et graphie. Résultats : dans le diffusé, les dosimètres dans le gant mesuraient une diminution de dose, variant de 1 à 3. Dans le champ direct, 7 mesures sur 10 montraient une augmentation de dose dans le gant (13 à 42 %). 3/10 mesures montraient une quasi stabilité de dose avec le gant (–3,3 % à +2 %). Conclusion : nos mesures objectivent une efficacité des gants radio-atténuateurs plombés dans le diffusé. Dans le rayonnement direct, le port des gants radio-atténuateurs plombés entraîne une augmentation de la dose – main, du fait des réglages automatiques des paramètres

[Role of endovascular treatment of symptomatic splanchnic artery stenoses in HIV patients: report of three cases].

International audiencePatients with HIV or AIDS frequently present with GI symptoms, sometimes due to early and diffuse atherosclerosis. We report 3 cases of HIV patients with abdominal pain due to severe splanchnic arterial stenosis. Only one patient presented typical clinical findings of mesenteric ischemic. Endovascular treatment was performed in all three cases. Good clinical outcome was immediate in 2 cases. In the third case, subsequent bowel resection was required due to irreversible ischemic injury in spite of local thrombolysis and endovascular revascularization in a patient presenting with acute severe mesenteric ischemia. In all three cases, vascular patency was demonstrated at follow-up. Mesenteric ischemia is a severe complication requiring early diagnosis in HIV patients, especially those with vascular risk factors, especially since endovascular treatment is a valid therapeutic option

Thoracic sarcopenia as a predictive factor of SARS-COV2 evolution

Purpose: Evaluation of CT sarcopenia as a predictor of intensive care hospitalization during SARS-COV2 infection.Materials and methods: Single-center retrospective study of patients admitted to hospital with SARS-COV2 infection. The estimation of muscle mass (skeletal muscle index (SMI)) for sarcopenia, measure-ment of muscle density for muscle quality and body adiposity, were based on CT views on the T4 and L3 levels measured at admission. Demographic data, percentage of pulmonary parenchymal involvement as well as the orientation of patients during hospitalization and the risk of hospitalization in intensive care were collected.Results: A total of 162 patients hospitalized for SARS-COV2 infection were included (92 men and 70 women, with an average age of 64.6 years and an average BMI of 27.4). The muscle area measured at the level of L3 was significantly associated with the patient's unfavorable evolution (124.4cm2 [97; 147] vs 141.5 cm2 [108; 173]) (p 1/4 0.007), as was a lowered SMI (p < 0.001) and the muscle area measured in T4 (OR 1/4 0.98 [0.97; 0.99]), (p 1/4 0.026). Finally, an abdominal visceral fat area measured at the level of L3 was also associated with a risk of hospitalization in intensive care (249.4cm2 [173; 313] vs 147.5cm2 [93.1; 228] (p < 0.001).Conclusion: This study demonstrates that thoracic and abdominal sarcopenia are independently asso-ciated with an increased risk of hospitalization in an intensive care unit, suggesting the need to assess sarcopenia on admission during SARS-COV2 infection

Embolisation préventive et en urgence des angiomyolipomes : notre expérience

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