The molecular logic of endocannabinoid signalling

The endocannabinoids are a family of lipid messengers that engage the cell surface receptors that are targeted by Δ9-tetrahydrocannabinol, the active principle in marijuana (Cannabis). They are made on demand through cleavage of membrane precursors and are involved in various short-range signalling processes. In the brain, they combine with CB1 cannabinoid receptors on axon terminals to regulate ion channel activity and neurotransmitter release. Their ability to modulate synaptic efficacy has a wide range of functional consequences and provides unique therapeutic possibilities. © 2003, Nature Publishing Group. All rights reserved

A complex case of right coronary artery chronic total occlusion treated by a successful multi-step Japanese approach

Percutaneous revascularization of coronary chronic total occlusion remains a challenge for the interventional cardiologist. Operator experience and specific tips and tricks for more difficult cases are needed to obtain procedural success in the majority of situations. We describe a case of successful reopening of a chronically occluded right coronary artery using a retrograde wire as a landmark of the true lumen and a novel penetration device (Tornus, Ashai) to facilitate balloon and stent deployment

Coronary bifurcation lesions: To stent one branch or both? A meta-analysis of patients treated with drug eluting stents

Background: In the treatment of coronary bifurcation lesions (CBL), with drug eluting stents (DES), we sought to compare angiographic and clinical outcomes of a simple strategy of stenting main vessel only with balloon dilatation of the side branch with a complex strategy of stenting both branches. Methods: We performed a meta-analysis of six studies, randomized (three) or prospective observational (three), including 963 patients, that directly compared the simple strategy to the complex strategy, in the treatment of CBL with DES. Results: Final minimal lumen diameter (MLD) of the side branch was significantly smaller in the simple strategy group [WMD -0.50 mm, 95% CI (-0.76, -0.24), p<0.00001]. The risk of main vessel restenosis [RR 0.66, 95% CI (0.38-1.17), p = 0.16], side branch restenosis [RR 0.62, 95% CI (0.24-1.56), p = 0.31], follow up death [RR 0.60, 95% CI (0.19-1.86), p = 0.38], follow up myocardial infarction [RR 0.71, 95% CI (0.46-1.10), p = 0.13], or target vessel revascularization [RR 0.90, 95% CI (0.56-1.46), p = 0.67] was similar between the two strategies. The simple strategy showed a trend to a lower risk of early myocardial infarction [RR 0.65, 95% CI (0.41-1.05), p = 0.08]. Conclusion: In the treatment of unselected CBL with DES, the complex strategy does not penalize angiographic and clinical outcomes compared to the simple strategy. Further randomized studies are needed to assess the benefit of simple or complex strategy in the treatment of specific subsets of bifurcated lesions. (C) 2008 Elsevier Ireland Ltd. All rights reserved