Multivessel Disease in a Patient Presenting With ST-Elevation Myocardial Infarction

Patients with multivessel coronary artery disease are common among patients presenting with ST elevation myocardial infarction (STEMI). The way to treat the rest of the lesions after treating the culprit lesion is not well defined yet. In this article we present a patient with inferior STEMI, who had also an ostial left anterior descending (LAD) coronary artery stenosis

Restenosis is not associated with stent length in a pig model of coronary stent implantation

Background: The aim of this study was to determine if stent length is by itself a risk factor for intimal proliferation and restenosis. Long lesions represent an independent risk factor for restenosis after coronary stent implantation. A longer stented segment might result in a higher probability of restenosis. Methods: Twenty-two 7-month-old male farm pigs underwent implantation of two steel stents, one short (8 mm length) and one long (16 mm length), in the right coronary artery. The pigs were sacrificed 28 days after stent implantation and histomorphometric analysis of the coronary arteries was performed for neointimal area proliferation and area stenosis evaluation. Results: Seventeen short stents and 19 long stents were finally implanted. There were no differences in neointimal proliferation (1.84 ± 0.64 mm2 vs. 1.81 ± 0.94 mm2, p = 0.84), area stenosis (40 ± 9% vs. 41 ± 19%, p = 0.86) and lumen area (2.96 ± 1.30 mm2 vs. 2.51 ± ± 1.18 mm2, p = 0.21) between the short stent group and the long stent group, respectively. Conclusions: These data suggest that stent length by itself does not influence restenosis extent in the porcine model

Systemic hypertension augments, whereas insulin-dependent diabetes down-regulates, endothelin A receptor expression in the mammary artery in coronary artery disease patients

Background: Endothelin (ET) A receptor antagonism causes decreased vasodilation in hypertensive coronary arteries and decreased effects on coronary artery compliance in diabetic patients. Methods: We investigate the mRNA expression of ET-1, ETA and ETB receptors, using real time RT-PCR, in biopsies from the internal mammary artery obtained from 49 patients, 18 diabetics and 34 hypertensives, all undergoing coronary artery bypass grafting. Results: Hypertensive patients had higher ET-1 mRNA expression (16438 [8417, 23917]), than normotensive patients (2974 [2283, 18055], p=0.008). Diabetic patients had significantly lower ETA receptor levels than non-diabetic patients (455 [167, 1496] vs. 1660 [700, 3190], respectively, p = 0.003). Conclusions: Multivariate analysis demonstrated that the presence of systemic hypertension was the only independent predictor of log ETA receptor expression and log ET-1 expression, while insulin-dependent diabetes was negatively correlated with ETA receptor expression. ETB receptor expression was not correlated with any predictor. Systemic hypertension is associated with increased ET-1 and ETA receptor mRNA expression, whereas insulin-dependent diabetes down-regulates ETA receptor mRNA expression in the internal mammary artery in patients with coronary artery disease undergoing bypass grafting

TCT-117 Impact of Proximal Cap Ambiguity on the Outcomes of Chronic Total Occlusion Intervention: Insights From the PROGRESS-CTO Registry

Background: The impact of proximal cap ambiguity on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 11,169 CTO PCIs performed in 10,932 patients at 42 US and non-US centers between 2012 and 2022. Results: Proximal cap ambiguity was present in 35% of CTO lesions. Patients whose lesions had proximal cap ambiguity were more likely to have had prior PCI (65% vs 59%; P \u3c 0.01) and prior coronary artery bypass graft surgery (37% vs 24%; P \u3c 0.01). Lesions with proximal cap ambiguity were more complex with higher J-CTO score (3.1 ± 1.0 vs 2.0 ± 1.2; P \u3c 0.01) and lower technical (79% vs 90%; P \u3c 0.01) and procedural success (77% vs 89%; P \u3c 0.01) rates compared with non-ambiguous CTO lesions. The incidence of major adverse cardiovascular events (MACE) was higher in cases with proximal cap ambiguity (2.5% vs 1.7%; P \u3c 0.01). The retrograde approach was more commonly used among cases with ambiguous proximal cap (51% vs 21%; P \u3c 0.01) and was more likely to be the final successful crossing strategy (29% vs 13%; P \u3c 0.01). PCIs of CTOs with ambiguous proximal cap required longer procedure time (140 [95-195] vs 105 [70-150] min; P \u3c 0.01) and more contrast volume (225 [160-305] vs 200 [150-280] mL; P \u3c 0.01). Conclusion: Proximal cap ambiguity in CTO lesions is associated with higher utilization of the retrograde approach, lower technical and procedural success rates, and higher incidence of in-hospital MACE. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p \u3c 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p \u3c 0.001) and diabetes mellitus (50% vs. 42%, p \u3c 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p \u3c 0.001), moderate/severe calcification (68% vs. 40%, p \u3c 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p \u3c 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p \u3c 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p \u3c 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p \u3c 0.001) and procedural (88% vs. 96%, p \u3c 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p \u3c 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions

Investigation of correlation between inflammatory infiltration of carotid atherosclerotic plapue and circulating inflammation markers

Introduction: Atherothrombotic disease is responsible for 50% of deaths worldwide. The relationship between inflammation and atherosclerosis is a relatively new finding and a topic of great research effort. Aim of this study was to evaluate inflammatory infiltration of the carotid plaque, evaluate circulating inflammation markers and try to identify possible correlations between them. Methods: 109 patients: age 66,2±8,4, 84 (77,1%) male, who underwent carotid endarterectomy for, symptomatic or asymptomatic, significant carotid bifurcation disease. Blood samples were taken preoperatively to evaluate the levels of the following inflammation markers: Interleukin 6 (IL-6), Interleukin 1β (IL-1β), Tumor Necrosis Factor a (TNF a) and high sensitivity C reactive protein (hs-CRP). The endarterectomy specimen, immediately after harvesting, was transferred to the laboratory were it was divided in transverse sections of 4mm. Each section was embedded in paraffin cube. Transverse sections 4μm thick were cut from each cube and were used for haematoxyllin - eosin stain, as well as immunocytochemistry, using specific antibodies against the macrophages (CD 68) and the endothelial cells (CD 34). Results: Patients with symptomatic carotid bifurcation disease had higher circulating IL-6 levels (4,75±3,71pg/ml vs 2,65±1,47pg/ml, p=0,017), as well as higher concentration of macrophages in the plaque (7,20±1,35 vs 5,42±1,50, p70%) στένωσης αυτής. Προεγχειρητικά γινόταν αιμοληψία για τον προσδιορισμό των εξής δεικτών φλεγμονής στο περιφερικό αίμα: Ιντερλευκίνη 1β (IL-1β), Ιντερλευνίνη 6 (IL-6), Παράγων νέκρωσης του όγκου α (TNF α) και ψηλής ευαισθησίας C αντιδρώσα πρωτείνη (hs-CRP). Το αθήρωμα, αμέσως μετά την ενδαρτηρεκτομή μεταφερόταν στο παθολογανατομικό εργαστήριο, όπου κοβόταν σε εγκάρσιες τομές πάχους 4mm, οι οποίες μονιμοποιούνταν σε κύβους παραφίνης. Τομές πάχους 4μm κόβονταν από κάθε κύβο και γινόταν χρώση αιματοξυλίνης - εωσίνης για τον προσδιορισμό των διαφόρων ανατομικών στοιχείων της αθηρωματικής πλάκας. Παράλληλα έγιναν και ειδικές ανοσοιστοχημικές χρώσεις με τη βοήθεια των αντισωμάτων CD 68 και CD 34, τα οποία είναι ειδικά αντισώματα για τη ανίχνευση μακροφάων και ενδοθηλιακών κυττάρων, που σχηματίζουν το τοίχωμα των αγγείων αντίστοιχα. Αποτελέσματα: Οι ασθενείς με συμπτωματική καρωτιδική νόσο έχουν ψηλότερες τιμές Ιντελευκίνης 6 στον ορρό τους σε σχέση με τους ασυμπτωματικούς ασθενείς (4,75±3,71pg/ml vs 2,65±,.47pg/ml, p=0,017), καθώς και μεγαλύτερη συγκέντρωση μακροφάγων στην αθηρωματική τους πλάκα (7,20±1,35 vs 5,42±1,50, p<0,001). Παρ’ όλ’ αυτά, οι τιμές της Ιντερλευκίνης 6, όπως και όλων των άλλων κυτοκινών που μετρήθηκαν, δε συσχετίζονταν με το βαθμό φλεγμονώδους διήθησης της αθηρωματικής πλάκας από τα μακροφάγα. Ένα άλλο αποτέλεσμα ήταν ότι οι ασθενείς οι οποίοι ήταν υπό αγωγή με στατίνες παρουσίαζαν μικρότερη συγκέντρωση νεοαγγείων στην αθηρωματική πλάκα (0,97±0,61 /mm2 vs 1,39±0,98 /mm2, p=0,031), με αποτέλεσμα τη σταθεροποίησή της. Συμπεράσματα: Η φλεγμονή διαδραματίζει σημαντικό ρόλο στην αθηροθρομβωτική διαδικασία, παρόλο που η πολυπαραγοντική της ρύθμιση δε μας επιτρέπει τον άμεσο συσχετισμό των δεικτών περιφερικής φλεγμονής και φλεγμονώδους διήθησης της αθηρωματικής πλάκας. Οι στατίνες φαίνεται να σταθεροποιούν την αθηρωματική πλάκα, όχι μόνο βελτιώνοντας το λιπιδαιμικό προφίλ των ασθενών, αλλά και μέσω μείωσης του αριθμού των νεοαγγείων της αθηρωματικής πλάκας