COMPARISON OF TWO DIFFERENT TECHNIQUES FOR ISOLATED LEFT SUBCLAVIAN ARTERY REVASCULARIZATION DURING THORACIC ENDOVASCULAR AORTIC REPAIR

Introduction - Endovascular repair of distal aortic arch/descending thoracic aortic diseases (TEVAR) may require the intentional coverage of the left subclavian artery (LSA) to increase the proximal landing zone and secure the sealing of the aortic lesion. Coverage without revascularization of the LSA may lead to cerebrovascular events, spinal cord deficits or upper arm ischemia. Up to date, no guidelines exist reporting which type of intervention should be preferred to revascularized the LSA. The aim of our paper is to analyze the results the isolated LSA revascularization during TEVAR, comparing the carotid-subclavian by-pass (CSbp) and the \u201cdouble barrel\u201d technique (DB). Methods - This is a multicenter, observational descriptive study. Inclusion criteria was TEVAR with isolated LSA revascularization. This experience includes patients observed from January 2012 to December 2016; for the final analysis, the end of study was December 31st 2016. All patients underwent follow-up program with computed-tomography angiography evaluation at 1, 6 and 12 months, on yearly basis thereafter. Primary end-points were early and long-term survival, LSA graft patency, freedom from TEVAR-related and aortic-related mortality (ARM), and freedom from reintervention. Categorical variables were presented using frequencies and percentages, continuous variables were presented with mean \uf0b1 standard deviation (SD). Cumulative survival, freedom from ARM and freedom from reintervention rates were estimated using the Kaplan-Meier method with 95% confidence interval (CI). A P value < .05 was considered significant. Results - During the study period we performed 308 TEVARs: in 73 (24%) cases the LSA was intentionally covered. Revascularization was performed with CSbp in 42 (57.5%), and DB in 31 (43.5%). The two groups were comparable for demographic data, comorbidities, risk factors and type of aortic disease treated. Overall, primary technical success was 100%. The DB was more frequently used when LSA had an acute angle (47 \ub1 17 vs. 63.5 \ub1 20, P = .020) at its origin, and when the distance between the LSA and the ipsilateral vertebral artery was longer (48 \ub1 11 vs. 36 \ub1 12, P = .007). The two groups did not differ significantly in terms of major complications (CSbp 7 vs. DB 11; P = .112), and in-hospital mortality (CSbp 1 vs. DB 1; P = 1.0). At a mean follow-up of 24 \ub1 20 mesi (range, 3-72), no LSA graft thrombosis was observed; the two groups did not differ significantly in terms of ARM (CSbp, 97 \ub1 3 vs. DB, 96 \ub1 4, log-rank = .868), need of aortic reintervention (CS 2 vs. DB 2; P = .836), or endoleak development (CSbp 2 vs. DB 1; P = .695). Conclusion - In our experience, LSA revascularization was safe and effective with both the techniques; at mid-term, both techniques offered durable results with no graft thrombosis

Radial versus femoral access in patients with acute coronary syndromes withor without ST-segment elevation

Aims To assess whether radial compared with femoral access is associated with consistent outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods and results In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) programme patients were randomized to radialor femoral access, stratified by STEMI (2001 radial, 2009 femoral) and NSTE-ACS (2196 radial, 2198 femoral). The 30-day co-primaryoutcomes were major adverse cardiovascular events (MACE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACEor major bleeding In the overall study population, radial access reduced the NACE but not MACE endpoint at the prespecified 0.025 alpha. MACE occurred in 121 (6.1%) STEMI patients with radial access vs. 126 (6.3%) patients with femoral access [rate ratio (RR) = 0.96, 95% CI = 0.75-1.24; P = 0.76] and in 248 (11.3%) NSTE-ACS patients with radial access vs. 303 (13.9%) with femoral access (RR = 0.80, 95% CI = 0.67-0.96; P = 0.016) (Pint = 0.25). NACE occurred in 142 (7.2%) STEMI patients with radial access and in 165 (8.3%) patients with femoral access (RR = 0.86, 95% CI = 0.68-1.08; P = 0.18) and in 268 (12.2%) NSTE-ACS patients with radial access compared with 321 (14.7%) with femoral access (RR = 0.82, 95% CI = 0.69-0.97; P = 0.023) (Pint = 0.76). All-cause mortality and access site-actionable bleeding favoured radial access irrespective of ACS type (Pint = 0.11 and Pint = 0.36, respectively). Conclusion Radial as compared with femoral access provided consistent benefit across the whole spectrum of patients with ACS, without evidence that type of presenting syndrome affected the results of the random access allocation

Safety and efficacy of polymer-free biolimus-eluting stents in all-comer patients. the RUDI-FREE study

Polymer-free biolimus-eluting stents (PF-BES) have been shown superior to bare metal stents in high bleeding risk (HBR) patients treated with 1-month dual antiplatelet therapy (DAPT). However, limited evidence is available on PF-BES in non-HBR patients. We aim to evaluate the safety and efficacy of PF-BES in all-comer patients undergoing percutaneous coronary interventions (PCI)

The Archaeal Proteome Project advances knowledge about archaeal cell biology through comprehensive proteomics

While many aspects of archaeal cell biology remain relatively unexplored, systems biology approaches like mass spectrometry (MS) based proteomics offer an opportunity for rapid advances. Unfortunately, the enormous amount of MS data generated often remains incompletely analyzed due to a lack of sophisticated bioinformatic tools and field-specific biological expertise for data interpretation. Here we present the initiation of the Archaeal Proteome Project (ArcPP), a community-based effort to comprehensively analyze archaeal proteomes. Starting with the model archaeon Haloferax volcanii, we reanalyze MS datasets from various strains and culture conditions. Optimized peptide spectrum matching, with strict control of false discovery rates, facilitates identifying>72% of the reference proteome, with a median protein sequence coverage of 51%. These analyses, together with expert knowledge in diverse aspects of cell biology, provide meaningful insights into processes such as N-terminal protein maturation, N-glycosylation, and metabolism. Altogether, ArcPP serves as an invaluable blueprint for comprehensive prokaryotic proteomics. While archaeal proteomics advanced rapidly, a comprehensive proteome database for archaea is lacking. Therefore, the authors here launch the Archaeal Proteome Project, a community-effort providing insights into archaeal cell biology via the combined reanalysis of Haloferax volcanii proteomics data

Impact of Insulin-Treated and Noninsulin-Treated Diabetes Mellitus in All-Comer Patients Undergoing Percutaneous Coronary Interventions With Polymer-Free Biolimus-Eluting Stent (from the RUDI-FREE Registry)

Patients with diabetes mellitus (DM) have worse outcomes after percutaneous coronary intervention (PCI). Recent evidences suggest a differential impact of insulin-treated and noninsulin-treated DM on prognosis. We evaluated the clinical outcome of diabetic patients after PCI with polymer-free biolimus-eluting stent from the RUDI-FREE Registry, investigating a possible different prognostic impact of insulin-treated and noninsulin-treated DM. A total of 1,104 consecutive patients who underwent PCI with polymer-free biolimus-eluting stent, enrolled in the RUDI-FREE observational, multicenter, single-arm registry, were stratified by diabetic status; diabetic population was further divided on the basis of insulin treatment. Primary end points of the study were target lesion failure (TLF; composite of cardiac death, target vessel myocardial infarction, target lesion revascularization) and major adverse cardiac and cerebrovascular events (composite of cardiac death, stroke, and myocardial infarction). Multiple ischemic adverse events were also single-handedly considered as secondary end points. At 1 year, TLF was significantly higher in the diabetic cohort, as compared with nondiabetic patients (6.0% vs 3.1%, p 0.022). None of the end points resulted significantly different between nondiabetics and noninsulin-treated diabetic patients. Divergently, compared with nondiabetic, insulin-treated diabetic patients faced significant higher rates of TLF (10.8% vs 3.1%, p 0.003), major adverse cardiac and cerebrovascular events (10.8% vs 3.4%, p 0.004), and of most of the analyzed adverse events. In conclusion, patients with DM had a higher risk of TLF compared with nondiabetics; nonetheless, the worse outcome of the diabetic population seems to be driven by the insulin-treated diabetic subpopulation. This finding suggests a different risk profile of insulin-treated and noninsulin-treated diabetic patients in the modern era of PCI. (C) 2019 Elsevier Inc. All rights reserved

Coronary Lithotripsy as Elective or Bail-Out Strategy After Rotational Atherectomy in the Rota-Shock Registry

Debulking lesions with severe coronary artery calcification (CAC) is highly recommended to obtain good procedural and long-term success. Utilization and performance of coronary intravascular lithotripsy (IVL) after rotational atherectomy (RA) has not been thoroughly studied. This study aimed to evaluate the efficacy and safety of IVL with the Shockwave Coronary Rx Lithotripsy System in lesions with severe CAC as elective or bail-out strategy after RA. This observational, prospective, single-arm, multicenter, international, open-label Rota-Shock registry included patients with symptomatic coronary artery disease and lesions with severe CAC treated by percutaneous coronary intervention, including lesion preparation with RA and IVL, at 23 high-volume centers. Primary efficacy end point was procedural success, defined as final diameter stenosis National Heart, Lung and Blood Institute type B dissection, perforation, abrupt closure, slow or no flow, final thrombolysis in myocardial infarction flow National Heart, Lung and Blood Institute type B occurred in 3 patients (1.9%), whereas slow or no flow occurred in 8 (5.0%), final thrombolysis in myocardial infarction flow <3 in 3 (1.9%), and perforation in 4 patients (2.5%). Free from inhospital major adverse cardiac and cerebrovascular events, including cardiac death, target vessel myocardial infarction, target lesion revascularization, cerebrovascular accident, definite/probable stent thrombosis, and major bleeding, occurred in 158 patients (98.7%). In conclusion, IVL after RA in lesions with severe CAC was effective and safe, with a very low incidence of complications as either elective or bail-out strategy