Pre-Therapy With Statins in Percutaneous Coronary Interventions

Statins present a number of beneficial effects on endothelial function and atherosclerotic plaque, modulating oxidative stress and inflammation. The benefits of long-term statin treatment in the entire spectrum of atherosclerotic vascular disease can largely be explained by its cholesterol-lowering effects and the associated reduction of the progression of atherosclerosis. The short-term benefits of statins use are most likely due to their non-lipid, pleiotropic effects. Myocardial injury during percutaneous coronary intervention (PCI) occurs in 10-40% of cases and is often characterized by a slight increase in the markers of myocardial necrosis, sometimes without symptoms, electrocardiographic changes or impairment of cardiac function. Periprocedural myocardial infarction is associated with a worse outcome on long term follow-up. Several randomized trials have suggested a beneficial effect of pre-treatment with statins in the outcome of the procedure. Myocardial protection by statin pre-therapy in PCI has been studied in several trials published over the last decade. The mechanisms underlying the beneficial pleiotropic effects of statins may be an anti-inflammatory action reducing myocardial injury necrosis due to microembolization, an improvement in endothelial function on microcirculation, and direct myocardial protection. This article reviews the major randomized trials which have studied the use of statins as pre-treatment in PCI and explores future perspectives. Key words: statins, percutaneous coronary intervention, acute coronary syndrome

Endovascular Treatment of Aneurysm With Side Branches - A Simple Method. Myth or Reality?

PURPOSE: The aim of this study is to present performance data on the use of the multilayer stent which is a 3-dimensional (3D) braided mesh made of interconnected layers, particularly in patients with side branches within the aneurysm. METHODS:  A study protocol was designed to examine the safety and efficacy of the multilayer stent in patients with aneurysms in different target vessels. Between December 2006 and November 2009, 19 patients were enrolled in the study. Four patients had a renal aneurysm (1 male / 3 females) (mean diameter: 18 mm), while the other 15 patients (all males) had iliac artery (n=12, mean diameter: 25 mm),  popliteal artery (n=1, diameter: 55 mm), thoracic aorta (n=1, diameter: 57mm) and abdominal aorta (n=1, diameter: 97.3 mm) aneurysms. RESULTS: The multilayer stent was successfully deployed in all patients (100% technical success); Mean follow-up for the peripheral aneurysms was 28 months (range 12 to 36) and for the aortic aneurysms was 3 months. The occlusion rate of the aneurysm at the peripheral arteries was 100% and all the side branches remained patent. For the thoracic and the abdominal aneurysms, the 3 months computed tomography angiography (CTA) showed patent artery side branches and reduced blood flow inside the sac. CONCLUSION: The multilayer stent seems to be efficient with regard to the side branches which remain patent and the aneurysm is excluded. The question remains about the time needed to achieve the exclusion of the aneurysm in large arteries such as the thoracic and abdominal aorta; we believe this is related to the number and size of the branches within the aneurysm as well as the size of the target vessel itself. A larger multi center study is needed to confirm the suitability of the multilayer stent for the large thoracic, abdominal and thoracoabdominal aneurysms