Randomized trial of predilation versus direct stenting for treatment of carotid artery stenosis

Background: A controversial aspect of carotid artery stenting (CAS) is the placement of a stent with or without predilation. The study was designed to test the hypothesis that direct stenting (DS) was not inferior to CAS with predilation. Methods: Elective CAS with filter protection was performed in 205 consecutive, unselected patients with carotid artery stenosis (>50% if symptomatic and >= 75% if asymptomatic by Doppler assessment) who were randomly assigned to CAS with predilation (n=100) or direct stenting (DS, n=105). Filter and stent selection were left to the operator's discretion. The study end-point was the angiographic success, defined as <= 30% angiographic residual stenosis after CAS without abnormal angiographic findings in cerebral circulation and without crossover to predilation in the DS group. Results: At baseline, patient clinical characteristics and stenosis anatomic features did not differ between groups. Angiographic success was 99% and 97%, p=0.33, in predilation and DS, respectively. No cross-over to predilation occurred in the DS group. Procedural time was shorter in DS as compared to predilation (24.3+/-7% versus 19.9+/-6%, p=0.001) and visible debris were more frequently captured in predilation as compared to DS (50% versus 36%, p=0.003). No peri-procedural and 30-day death or major stroke occurred in both groups. Minor stroke and TIA rates were similar in either group (2% versus 0% and 8% versus 5.7%, p=ns, respectively). Conclusion: In an unselected, consecutive series of patients submitted to CAS, DS is a feasible technique and is not inferior to CAS with predilation

Biodiversity of Coleoptera (Insecta) in Khvalynsky National Park (Saratov Region, Russia)

(1) Background: Coleoptera is one of the most diverse insect lineages. The beetle species live in many ecosystems around the globe and their roles in ecosystems are very diverse; thus, it is important to know the local and regional fauna varieties, especially for protected areas, such as nature reserves and national parks. (2) Methods: The materials were collected from the territory of the Khvalynsky National Park (European Russia, Saratov region), mainly over the last 30 years (1994–2022). The beetles were collected using different means (manual collection; the use soil traps, fermental crown traps, and Malaise traps; light fishing; sweeping with an entomological net on plants and under water, etc.). (3) Results: The dataset presents data on 914 species and subspecies of Coleoptera from 67 families found in the Khvalynsky National Park. The number of studied specimens was 7445. Four families (Cerylonidae, Byturidae, Phalacridae, and Sphindidae) and 95 species were recorded for the Khvalynsky National Park for the first time. Thirty-two species were recorded for the Saratov region for the first time. (4) Conclusions: The general biodiversity of Coleoptera in the Khvalynsky National Park includes 1203 species from 71 families

Use of multiple overlapping sirolimus-eluting stents for treatment of long coronary artery lesions : results from a single-center registry in 318 consecutive patients

Drug-eluting stents (DES) are superior to bare metal stents in the prevention of restenosis and target lesion revascularization (TLR). This has led to a more aggressive use of DES in everyday interventional cardiology practice. Methods: All consecutive patients who underwent coronary artery stenting with greater than 34 mm of overlapping, sirolimus-eluting stent (SES) were reviewed from a prospectively created database. A prespecified group of patients with greater than 60 mm of SES was also followed. Results: 318 patients were followed up at a minimum of 6 months and a mean of 9 months. The mean target lesion stented length was over 55 mm. Use of IVUS was 19.8%. Forty patients (12.6%) suffered a peri-procedural CK-MB rise. The MACE rate at 9 months was 17% with 12.6% being periprocedural myocardial infarction (MI). Clinically driven TLR was 4.4% and cardiac death was 1.3%. There were 4 cases defined as late stent thrombosis. The independent predictors of periprocedural MI were the presence of a major side branch and longer target lesion stented length, with stable angina being a negative predictor. The independent predictors of in-stent restenosis were unstable angina and target lesion number per patient. There was a trend to increased MACE in the subgroup with longer than 60 mm of SES length. Conclusion: The use of multiple, overlapping SES is safe and effective with an acceptably low follow up MACE rate. A significant periprocedural CK-MB rise appears to be a risk of long segment stenting. Whether this translates to long-term sequelae needs further investigation