Four-Year Outcomes of Left Main Percutaneous Coronary Intervention with a Bioresorbable Scaffold in the Circumflex Ostium

Publisher Copyright: © 2022 Andrejs Erglis et al.Objectives. The study aimed to investigate the long-term outcomes of a double stent scaffold strategy in patients with left main (LM) bifurcation lesions involving the ostium of the left circumflex artery (LCX), utilizing a drug-eluting stent (DES) in the LM extending into the left anterior descending artery (LAD) and a bioresorbable vascular scaffold (BVS) in the LCX ostium. Background. The high occurrence of in-stent restenosis of the LCX ostium is the major limitation of percutaneous coronary intervention (PCI) for LM lesions with a two-stent strategy. Methods. This was a single-center, prospective, single-arm study of 46 consecutively enrolled patients with a stable coronary artery disease and significant unprotected LM distal bifurcation disease. Patients underwent imaging-guided PCI using DES in the LM-LAD and BVS in the LCX using a T-stent or mini-crush technique. The primary outcome at four years was the composite of death, myocardial infarction, stroke, and target lesion revascularization (TLR). Results. At four years, the primary outcome was identified in 9 patients (19.6%). All events were TLRs except one myocardial infarction due to BVS thrombosis. Seven of the eight TLRs were a result of side branch BVS restenosis. Univariate predictors of the 4-year outcome were higher LDL cholesterol and BVS size ≤2.5 mm. On multivariate analysis, LCX lesion preparation with a cutting balloon and post-procedure use of intravascular ultrasound for optimization were found to be independent protective factors of MACE. Conclusions. In selected patients with LM distal bifurcation disease, an imaging-guided double stent scaffold strategy with DES in the LM and BVS in the LCX ostium was technically successful in all patients and was reasonably safe and effective for four years.Peer reviewe

Transcatheter vs. surgical closure of atrial septal defects in adults

Funding Information: This study was supported in part by Latvian National Research Programme “Biomedicine for Public Health” (BIOMEDICINE) and by grant from corporation „Sistçmu Inovâcijas". Publisher Copyright: © 2018 De Gruyter Open Ltd. All rights reserved.Percutaneous transcatheter device closure of secundum atrial septal defects (ASD) has now largely replaced surgical closure in most centres. The aim of this study was to compare results of transcatheter and surgical ASD closure in adults in Latvia during the years 2002-2014 and to analyse long-term outcomes of transcatheter closure. We analysed data from 334 patients with secundum ASD who underwent ASD closure in Pauls Stradiņč Clinical University Hospital. Patients were included into device or surgical closure groups. In the device group, three follow-ups were made 1, 6, and 12 months after the procedure. No follow-up data were available for surgical arm patients beyond their hospitalisation period. The mean age of patients was 45.3 ± 19.9 years for the device group and 40.0 ± 16.9 years for the surgical group (p = 0.023). The mean secundum ASD size in the device and surgical groups was 14.2 ± 5.6 mm and 28.7 ± 10.0 mm, respectively (p < 0.001). No differences were observed regarding procedure success rates: 99.2% in the device group and 100% in the surgical group (p = 0.451). Periprocedural complications generally were more common in the surgical closure group. The study results show a successful introduction of the percutaneous ASD closure method in Latvia with good early and late outcomes and without significant differences in procedure success rate compared to surgical closure.publishersversionPeer reviewe

Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch:the Nordic-Baltic Bifurcation Study IV

Background - It is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation. Methods - The study was a randomised, superiority trial. Enrolment required a SB≥2.75 mm, ≥50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates. Results - A total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, respectively. The primary endpoint of major adverse cardiac events (MACE) at 6 months was 5.5% vs 2.2% (risk differences 3.2%, 95% CI −0.2 to 6.8, p=0.07) and at 2 years 12.9% vs 8.4% (HR 0.63, 95% CI 0.35 to 1.13, p=0.12) after simple versus complex treatment. In the subgroup treated by newer generation drug-eluting stents, MACE was 12.0% vs 5.6% (HR 0.45, 95% CI 0.17 to 1.17, p=0.10) after simple versus complex treatment. Conclusion - In the treatment of bifurcation lesions involving a large SB with ostial stenosis, routine two-stent techniques did not improve outcome significantly compared with treatment by the simpler main vessel stenting technique after 2 years

Carotid artery stenting outcomes in high-risk patients receiving best medical therapy : Results from a single high-volume interventional cardiology practice

Publisher Copyright: © 2016Background Carotid artery stenting (CAS) is now being widely used in the treatment of carotid artery stenosis. Recent clinical studies have demonstrated low adverse event rates after CAS. This study evaluates the 30-day and 1-year results in patients treated with CAS and receiving intensive medical therapy in a high-volume percutaneous coronary intervention center. Methods A total of 184 patients underwent CAS between January 2011 and December 2013. In addition to antiplatelet therapy, patients received intensive antihypertensive treatment, high intensity statin and heart rate normalization therapy. Patients were stratified according to age and symptomatic status. Results Most of the patients (86.4%) had at least one high surgical risk criteria. The procedural success rate was 98.4%. The 30-day and 1-year incidence of stroke were 4.1% and 4.5%, respectively. At 30 days the combined rate of stroke/cardiovascular (CV) death/myocardial infarction (MI) was 5.8% and 10.9% in 1 year. The 30-day incidence of stroke/CV death in asymptomatic and symptomatic patients was 5.4% and 4.2%, respectively. Age ≥80 years increased the risk of stroke/CV death/MI at 1 year (OR 4.41; 95% CI 1.06–18.36; P = 0.04). Conclusions The study demonstrated acceptable clinical outcome results in patients with high medical comorbidities treated with CAS and intensive medical therapy. Adverse event rate in symptomatic patients did not exceed the guideline recommended range while in asymptomatic patients it was increased.publishersversionPeer reviewe