TCT-845 Femoral Approach with Systematic Use of FemoSeal™ Closure Device Compared to Radial Approach in Primary Angioplasty: a Propensity-matched Comparison

n/

Large, sustained cardiac lipid peroxidation and reduced antioxidant capacity in the coronary circulation after brief episodes of myocardial ischemia

AbstractOBJECTIVESWe sought to investigate whether a brief episode of myocardial ischemia produces a detectable cardiac oxidative stress in patients undergoing elective coronary angioplasty (PTCA).BACKGROUNDAlthough cardiac oxidative stress has been clearly demonstrated in experimental models of ischemia-reperfusion, its presence in patients after transient myocardial ischemia is still unclear.METHODSIn order to evaluate oxidative stress in ischemic cardiac regions, plasma conjugated dienes (CD), lipid hydroperoxides (ROOHs) and total antioxidant capacity (TRAP), independent indexes of oxidative stress, were measured in the aorta and great cardiac vein (GCV) before (t0), 1, (t1), 5 (t5) and 15 min (t15) after first balloon inflation in 15 patients undergoing PTCA on left anterior descending coronary artery (Group 1); six patients with right coronary artery stenosis (Group 2), which is not drained by the GCV, were studied as controls.RESULTSIn Group 1 at baseline, CD and ROOHs levels were higher in GCV than in aorta (p < 0.01 for both), and TRAP levels were lower (p < 0.01). Aortic levels of CD, ROOHs and TRAP did not change at any time after t0; venous levels of CD and ROOHs levels markedly increased at t1, at t5and remained elevated at t15(p < 0.01 for all comparisons vs. t0); venous levels of TRAP decreased at t1and t5(p < 0.01 vs. t0) and returned to normal at t15. In Group 2, CD, ROOHs and TRAP levels were similar in the aorta and GCV and did not change throughout the study.CONCLUSIONSShort episodes of myocardial ischemia during PTCA induce a sustained oxidative stress, which is detectable in the venous effluent of reperfused myocardium

The loess deposits of Buca Dei Corvi section (Central Italy): Revisited

Loess deposits have been described in the past for the upper section of Buca Dei Corvi succession (Central Italy). In this paper the depositswere re-analysed to clarify the depositional environment and to attempt a paleoclimate reconstruction. Two radiocarbon dates on pedogenic carbonate constrain the ages to the Late Glacial, and are consistent with previous OSL dating of the top of the succession. The non-marine mollusc assemblage shows typical character of cold and dry climatic conditions, testified by strong oligotypical composition. Mineralogy and geochemistry of the sediments indicate the abundant presence of exotic quartz mineral which can be explained only by wind transport. Probably,wind transportwas also responsible of deposition of carbonatewhich then dissolved and re-precipitated producing pedogenic concretions. Stable isotopes (13C/12C and 18O/16O ratios) of the concretions are consistent with a climate drier than present conditions, with an environment characterized by sparse vegetation

Transcatheter aortic valve implantation with the novel-generation Navitor device. Procedural and early outcomes

Transcatheter aortic valve implantation (TAVI) has proved beneficial in patients with severe aortic stenosis, especially when second-generation devices are used. We aimed at reporting our experience with Navitor, a third-generation device characterized by intrannular, large cell, and cuffed design, as well as high deliverability and minimization of paravalvular leak. Between June and December 2021, a total of 39 patients underwent TAVI with Navitor, representing 20% of all TAVI cases. Mean age was 80.0 +/- 6.7 years, and 14 (36.8%) women were included. Severe aortic stenosis was the most common indication to TAVI (37 [97.4%] cases), whereas 2 (5.3%) individuals were at low surgical risk. Device and procedural success was obtained in all patients, with a total hospital stay of 6.6 +/- 4.5 days. One (2.9%) patient required permanent pacemaker implantation, but no other hospital events occurred. At 1-month follow-up, a cardiac death was adjudicated in an 87-year-old man who had been at high surgical risk. Echocardiographic follow-up showed no case of moderate or severe aortic regurgitation, with mild regurgitation in 18 (47%), and none or trace regurgitation in 20 (53%). The Navitor device, thanks to its unique features, is a very promising technology suitable to further expand indications and risk-benefit profile of TAVI

Determinants of radiation dose during right transradial access. insights from the RAD-MATRIX study

Background The RAD-MATRIX trial reported a large operator radiation exposure variability in right radial percutaneous coronary procedures. The reasons of these differences are not well understood. Our aim was to appraise the determinants of operator radiation exposure during coronary right transradial procedures. Methods Patient arrangement during transradial intervention was investigated across operators involved in the RAD-MATRIX trial. Operator radiation exposure was analyzed according to the position of the patient right arm (close or far from the body) and in relation to the size of the upper leaded glass. Results Among the 14 operators who agreed to participate, there was a greater than 10-fold difference in radiation dose at thorax level (from 21.5 to 267 μSv) that persisted after normalization by dose-area product (from 0.35 to 3.5 μSv/Gy*cm2). Among the operators who positioned the instrumented right arm far from the body (110.4 μSv, interquartile range 71.5-146.5 μSv), thorax dose was greater than that in those who placed the instrumented arm close to the right leg (46.1 μSv, 31.3-56.8 μSv, P =.02). This difference persisted after normalization by dose-area product (P =.028). The use of a smaller full glass shield was also associated with a higher radiation exposure compared with a larger composite shield (147.5 and 60 μSv, respectively, P =.016). Conclusions In the context of the biggest radiation study conducted in patients undergoing transradial catheterization, the instrumented right arm arrangement close to the leg and greater upper leaded shield dimensions were associated with a lower operator radiation exposure. Our findings emphasize the importance of implementing simple preventive measures to mitigate the extra risks of radiation exposure with right radial as compared with femoral access

How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease?

Over 50% of ST-segment elevation myocardial infarction (STEMI) patients suffer multi-vessel coronary artery disease, which is known to be associated with worse prognosis. Treatment strategies used in clinical practice vary from acute multi-vessel percutaneous coronary intervention (PCI), through staged PCI procedures to a conservative approach with primary PCI of only the infarct-related artery (IRA) and subsequent medical therapy unless recurrent ischaemia occurs. Each approach has advantages and disadvantages. This review paper summarizes the international experience and authors’ opinion on this clinically important question. Multi-vessel disease in STEMI is not a single entity and thus the treatment approach should be individualized. However, the following general rules can be proposed till future large randomized trials prove otherwise

DIG-MAN: Integration of digital tools into product development and manufacturing education

General objectives of PRODEM education. Teaching of product development requires various digital tools. Nowadays, the digital tools usually use computers, which have become a standard element of manufacturing and teaching environments. In this context, an integration of computer-based technologies in manufacturing environments plays the crucial and main role, allowing to enrich, accelerate and integrate different production phases such as product development, design, manufacturing and inspection. Moreover, the digital tools play important role in management of production. According to Wdowik and Ratnayake (2019 paper: Open Access Digital Tool’s Application Potential in Technological Process Planning: SMMEs Perspective, https://doi.org/10.1007/978-3-030-29996-5_36), the digital tools can be divided into several main groups such as: machine tools and technological equipment (MTE), devices (D), internet(intranet)-based tools (I), software (S). The groups are presented in Fig. 1.1. Machine tools and technological equipment group contains all existing machines and devices which are commonly used in manufacturing and inspection phase. The group is used in physical shaping of manufactured products, measurement tasks regarding tools and products, etc. The next group of devices (D) is proposed to separate the newest trends of using mobile and computer-based technologies such as smartphones or tablets and indicate the necessity of increased mobility within production sites. The similar need of separation is in the case of internet(intranet)-based tools which indicate the growing interest in network-based solutions. Hence, D and I groups are proposed in order to underline the significance of mobility and networking. These two groups of the digital tools should also be supported in the nearest future by the use of 5G networks. The last group of software (S) concerns computer software produced for the aims of manufacturing environments. There is also a possibility to assign the defined solutions (e.g. computer programs) to more than one group (e.g. program can be assigned to software and internet-based tools). The main role of tools allocated inside separate groups is to support employees, managers and customers of manufacturing firms focused on abovementioned production phases. The digital tools are being developed in order to increase efficiency of production, quality of manufactured products and accelerate innovation process as well as comfort of work. Nowadays, digital also means mobile. Universities (especially technical), which are focused on higher education and research, have been continuously developing their teaching programmes since the beginning of industry 3.0 era. They need to prepare their alumni for changing environments of manufacturing enterprises and new challenges such as Industry 4.0 era, digitalization, networking, remote work, etc. Most of the teaching environments nowadays, especially those in manufacturing engineering area, are equipped with many digital tools and meet various challenges regarding an adaptation, a maintenance and a final usage of the digital tools. The application of these tools in teaching needs a space, staff and supporting infrastructures. Universities adapt their equipment and infrastructures to local or national needs of enterprises and the teaching content is usually focused on currently used technologies. Furthermore, research activities support teaching process by newly developed innovations. Figure 1.2 presents how different digital tools are used in teaching environments. Teaching environments are divided into four groups: lecture rooms, computer laboratories, manufacturing laboratories and industrial environments. The three groups are characteristic in the case of universities’ infrastructure whilst the fourth one is used for the aims of internships of students or researchers. Nowadays lecture rooms are mainly used for lectures and presentations which require the direct communication and interaction between teachers and students. However, such teaching method could also be replaced by the use of remote teaching (e.g. by the use of e-learning platforms or internet communicators). Unfortunately, remote teaching leads to limited interaction between people. Nonverbal communication is hence limited. Computer laboratories (CLs) usually gather students who solve different problems by the use of software. Most of the CLs enable teachers to display instructions by using projectors. Physical gathering in one room enables verbal and nonverbal communication between teachers and students. Manufacturing laboratories are usually used as the demonstrators of real industrial environments. They are also perfect places for performing of experiments and building the proficiency in using of infrastructure. The role of manufacturing labs can be divided as: • places which demonstrate the real industrial environments, • research sites where new ideas can be developed, improved and tested. Industrial environment has a crucial role in teaching. It enables an enriched student experience by providing real industrial challenges and problems

Randomized comparison of operator radiation exposure comparing transradial and transfemoral approach for percutaneous coronary procedures: Rationale and design of the minimizing adverse haemorrhagic events by TRansradial access site and systemic implementation of angioX - RAdiation Dose study (RAD-MATRIX)

Background: Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. Methods: The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimet

The impact of intracoronary imaging on PCI outcomes in cases utilising rotational atherectomy: an analysis of 8,417 rotational atherectomy cases from the British Cardiovascular Intervention Society Database

Introduction. There is increasing evidence supporting the use of intracoronary imaging to optimize the outcomes of percutaneous coronary intervention (PCI). However, there are no studies examining the impact of imaging on PCI outcomes in cases utilising rotational atherectomy (RA-PCI). Our study examines the determinants and outcomes of using intracoronary imaging in RA-PCI cases including 12-month mortality. Methods. Using the British Cardiac Intervention Society database, data were analysed on all RA-PCI procedures in the UK between 2007 and 2014. Descriptive statistics and multivariate logistic regressions were used to examine baseline, procedural, and outcome associations with intravascular imaging. Results. Intracoronary imaging was used in 1,279 out of 8,417 RA-PCI cases (15.2%). Baseline covariates associated with significantly more imaging use were number of stents used, smoking history, previous CABG, pressure wire use, proximal LAD disease, laser use, glycoprotein inhibitor use, cutting balloons, number of restenosis attempted, off-site surgery, and unprotected left main stem (uLMS) PCI. Adjusted rates of in-hospital major adverse cardiac/cerebrovascular events (IH-MACCE), its individual components (death, peri-procedural MI, stroke, and major bleed), or 12-month mortality were not significantly altered by the use of imaging in RA-PCI. However, subgroup analysis demonstrated a signal towards reduction in 12-month mortality in uLMS RA-PCI cases utilising intracoronary imaging (OR 0.67, 95% CI 0.44–1.03). Conclusions. Intracoronary imaging use during RA-PCI is associated with higher risk of baseline and procedural characteristics. There were no differences observed in IH-MACCE or 12-month mortality with intracoronary imaging in RA-PCI

Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.

Summary Background It is unclear whether radial compared with femoral access improves outcomes in unselected patients with acute coronary syndromes undergoing invasive management. Methods We did a randomised, multicentre, superiority trial comparing transradial against transfemoral access in patients with acute coronary syndrome with or without ST-segment elevation myocardial infarction who were about to undergo coronary angiography and percutaneous coronary intervention. Patients were randomly allocated (1:1) to radial or femoral access with a web-based system. The randomisation sequence was computer generated, blocked, and stratified by use of ticagrelor or prasugrel, type of acute coronary syndrome (ST-segment elevation myocardial infarction, troponin positive or negative, non-ST-segment elevation acute coronary syndrome), and anticipated use of immediate percutaneous coronary intervention. Outcome assessors were masked to treatment allocation. The 30-day coprimary outcomes were major adverse cardiovascular events, defined as death, myocardial infarction, or stroke, and net adverse clinical events, defined as major adverse cardiovascular events or Bleeding Academic Research Consortium (BARC) major bleeding unrelated to coronary artery bypass graft surgery. The analysis was by intention to treat. The two-sided α was prespecified at 0·025. The trial is registered at ClinicalTrials.gov, number NCT01433627. Findings We randomly assigned 8404 patients with acute coronary syndrome, with or without ST-segment elevation, to radial (4197) or femoral (4207) access for coronary angiography and percutaneous coronary intervention. 369 (8·8%) patients with radial access had major adverse cardiovascular events, compared with 429 (10·3%) patients with femoral access (rate ratio [RR] 0·85, 95% CI 0·74-0·99; p=0·0307), non-significant at α of 0·025. 410 (9·8%) patients with radial access had net adverse clinical events compared with 486 (11·7%) patients with femoral access (0·83, 95% CI 0·73-0·96; p=0·0092). The difference was driven by BARC major bleeding unrelated to coronary artery bypass graft surgery (1·6% vs 2·3%, RR 0·67, 95% CI 0·49-0·92; p=0·013) and all-cause mortality (1·6% vs 2·2%, RR 0·72, 95% CI 0·53-0·99; p=0·045). Interpretation In patients with acute coronary syndrome undergoing invasive management, radial as compared with femoral access reduces net adverse clinical events, through a reduction in major bleeding and all-cause mortality. Funding The Medicines Company and Terumo. © 2015 Elsevier Ltd