760-4 Initial Multicenter Experience with Therapeutic Ultrasonic Coronary Angioplasty in Patients

Therapeutic ultrasonic (195 kHz) catheters with 1.2 or 1.7 mm ball tips for coronary angioplasty have recently been developed. During the first phase of a multi-center European trial (CRUSADE) this system was evaluated in 100 patients (86% male, mean age 57 years) with symptomatic coronary artery disease or acute myocardial infarction. Lesions were located in the LAD (n = 61), CX (n = 17), and RCA (n = 22); 62% were type B or C; 11 lesions were restenotic, 19 occlusive, 9 longer than 20 mm, 37 calcified, 18 thrombotic, and 15 collateralised.ResultsThe ultrasound catheter crossed 82/100 lesions, adjunctive balloon angioplastywas needed in 98 lesions. There was no death and myocardial infarction, or CABG in the first 24 hours. There was no perforation, but 2 acute vessel closures; intimal cleft or dissection was seen in 17 lesions of which 1 required stenting. Procedural success was obtained in 93%. At 24 hours 11/100 vessels were reoccluded. At 6 months angiographic follow-up in 51 patients restenosis (>50% stenosis) occured in 33%.ConclusionsTherapeutic ultrasound angioplasty is a feasible and safe new treatment modality. Adjunctive balloon angioplasty is regularly necessary. Preliminary experience suggests usefulness in lesions with visible thrombus, and undilatable or uncrossable lesions

Percutaneous transluminal coronary rotary ablation with rotablator (European experience)

This study reports the results from 3 European centers using rotary ablation with Rotablator, a device that is inserted into the coronary artery and removes atheroma by grinding it into millions of tiny fragments. Rotary ablation was performed in 129 patients. Primary success (reduction in percent luminal narrowing greater than 20%, residual stenosis less than 50%, without complications) was achieved by rotary angioplasty alone in 73 patients (57%). An additional 38 patients (29%) had successful adjunctive balloon angioplasty. Thus primary success was achieved in 111 patients (86%) at the end of the procedure. Acute occlusion occurred in 10 patients (7.7%). Recanalization was achieved by balloon angioplasty in 7: urgent bypass grafting was undertaken in 2. Q-wave and non-Q-wave myocardial infarction occurred in 3 and 7 patients, respectively. No deaths occurred. Follow-up angiography was performed in 74 patients (60%). Restenosis, defined as the recurrence of significant luminal narrowing (greater than 50%) occurred in 17 of 37 patients (46%) who underwent rotary ablation alone, and 11 of 37 patients (30%) who had adjunctive balloon angioplasty. The overall angiographic restenosis rate was 37.8%. In conclusion, rotary ablation is technically feasible, and relatively safe i

A systematic variation of the stellar initial mass function in early-type galaxies

Much of our knowledge of galaxies comes from analysing the radiation emitted by their stars. It depends on the stellar initial mass function (IMF) describing the distribution of stellar masses when the population formed. Consequently knowledge of the IMF is critical to virtually every aspect of galaxy evolution. More than half a century after the first IMF determination, no consensus has emerged on whether it is universal in different galaxies. Previous studies indicated that the IMF and the dark matter fraction in galaxy centres cannot be both universal, but they could not break the degeneracy between the two effects. Only recently indications were found that massive elliptical galaxies may not have the same IMF as our Milky Way. Here we report unambiguous evidence for a strong systematic variation of the IMF in early-type galaxies as a function of their stellar mass-to-light ratio, producing differences up to a factor of three in mass. This was inferred from detailed dynamical models of the two-dimensional stellar kinematics for the large Atlas3D representative sample of nearby early-type galaxies spanning two orders of magnitude in stellar mass. Our finding indicates that the IMF depends intimately on a galaxy's formation history.Comment: 4 pages, 2 figures, LaTeX. Accepted for publication as a Nature Letter. More information about our Atlas3D project is available at http://purl.org/atlas3

Usefulness of quantitative and qualitative angiographic lesion morphology, and clinical characteristics in predicting major adverse cardiac events during and after native coronary balloon angioplasty

Major, adverse cardiac events (death, myocardial infarction, bypass surgery and reintervention) occur in 4 to 7% of all patients undergoing coronary balloon angioplasty. Prospectively collected clinical data, and angiographic quantitative and qualitative lesion morphologic assessment and procedural factors were examined to determine whether the occurrence of these events could be predicted. Of 1,442 patients undergoing balloon angioplasty for native primary coronary disease in 2 European multicenter trials, 69 had major, adverse cardiac procedural or in-hospital complications after ≥1 balloon inflation and were randomly matched with patients who completed an uncomplicated in-hospital course after successful angioplasty. No quantitative angiographic variable was associated with major adverse cardiac events in univariate and multivariate analyses. Univariate analysis showed that major adverse cardiac events were associated with the following preprocedural variables: (1) unstable angina (odds ratio [OR] 3.11; p 45 ° (OR 2.34; p 45 ° (OR 2.87; p 45 ° (OR 2.54; p < 0.006) were independent predictors of major adverse cardiac events

Scaling relations in early-type galaxies from integral-field stellar kinematics

We study the origin of the scaling relations of early-type galaxies (ETGs) by constructing detailed models of the stellar dynamics for the K-band selected, volume-limited ATLAS3D sample of 263 nearby ETGs, spanning a large range of masses and stellar velocity dispersions (60 < sigma < 350 km/s).Comment: 1 page, no figures, LaTeX. Invited talk to Joint Discussion 01 "Dark Matter in Early-Type Galaxies". To appear in Highlights of Astronomy, Vol. 15, Proc. of the XXVIIth IAU General Assembly, Rio de Janeiro, Brazil, August 2009, eds. L. V. E. Koopmans & T. Treu, Cambridge University Pres

The Atlas3D project -- XIII. Mass and morphology of HI in early-type galaxies as a function of environment

We present the Atlas3D HI survey of 166 nearby early-type galaxies (ETGs) down to M(HI)~10^7 M_sun. We detect HI in ~40% of all ETGs outside the Virgo cluster and in ~10% of all ETGs inside it. This demonstrates that it is common for non-cluster ETGs to host HI. The HI morphology varies from regular discs/rings (the majority of the detections) to unsettled gas distributions. The former are either small discs (M(HI)<10^8 M_sun) confined within the stellar body and sharing the same kinematics of the stars, or large discs/rings (M(HI) up to 5x10^9 M_sun) extending to tens of kpc from the host galaxy and frequently kinematically decoupled from the stars. Neutral hydrogen provides material for star formation in ETGs. Galaxies with central HI exhibit signatures of star formation in ~70% of the cases, ~5 times more frequently than galaxies without central HI. The central ISM is dominated by molecular gas. In ETGs with a small gas disc the conversion of HI into H_2 is as efficient as in spirals. The ETG HI mass function has M*~2x10^9 M_sun and slope=-0.7. ETGs host much less HI than spirals as a family. However, a significant fraction of them is as HI-rich as spirals. The main difference between ETGs and spirals is that the former lack the high-column-density HI typical of the bright stellar disc of the latter. We find an envelope of decreasing M(HI) with increasing environment density. The gas-richest ETGs live in the poorest environments (where star-formation is more common), galaxies in the centre of Virgo have the lowest HI content, and the cluster outskirts are a transition region. We find an HI morphology-density relation. At low environment density HI is mostly distributed on large discs/rings. More disturbed HI morphologies dominate environment densities typical of rich groups, confirming the importance of processes occurring on a galaxy-group scale for the evolution of ETGs.Comment: Accepted for publication on MNRA

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