121 research outputs found
TCT-386 Global risk score for choosing the best revascularization strategy in patients with unprotected left main stenosis
Modernista, 1920.Primer pla d'edifici unifamiliar.De planta baixa,
planta semisoterrani i un cos de garatge
adossat.Les obertures situen a les llindes
uns motllurats i sinuosos motius escultĂČrics.
Un element de cerĂ mica divideix els baixos
del coronament
Coronary EndotheliumâDependent Vasomotor Function After DrugâEluting Stent and Bioresorbable Scaffold Implantation
Infarto de miocardio; DisfunciĂłn endotelial; TomografĂa de coherencia ĂłpticaMyocardial infarction; Endothelial dysfunction; Optical coherence tomographyInfart de miocardi; DisfunciĂł endotelial; Tomografia de coherĂšncia ĂČpticaBackground
Early generation drugâeluting stents (DESs) showed a high grade of coronary endothelial dysfunction that was attributed to lack of stent reendothelialization. Endotheliumâdependent vasomotor response of current DESs and bioresorbable scaffolds (BRSs) remains unknown. This study sought to assess the deviceârelated endothelial function of current devices and to correlate neointima healing with endothelial function.
Methods and Results
A total of 206 patients from 4 randomized trials treated with the durableâpolymer everolimusâeluting Xience (n=44), bioresorbableâpolymer sirolimusâeluting Orsiro (n=35), polymerâfree biolimusâeluting Biofreedom (n=24), bioactive endothelialâprogenitor cellâcapturing sirolimusâeluting Combo DES (n=25), polymerâbased everolimusâeluting Absorb (n=44), and Mgâbased sirolimusâeluting Magmaris BRS (n=34) underwent endotheliumâdependent vasomotor tests and optical coherence tomography imaging, as per protocol, at followâup. Crude vasomotor responses of distal segments to lowâdose acetylcholine (10â6 mol/L) were different between groups: bioresorbablepolymer DEShad the worst (â8.4%±12.6%) and durableâpolymer DES had the most physiologic (â0.4%±11.8%; P=0.014). Highâdose acetylcholine (10â4 mol/L) showed similar responses between groups (ranging from â10.8%±11.6% to â18.1%±15.4%; P=0.229). Device healing was different between devices. Uncovered struts ranged from 6.3%±7.1% (bioresorbableâpolymer DES) to 2.5%±4.5% (bioactive DES; P=0.056). In multivariate models, endotheliumâdependent vasomotor response was associated with age, bioresorbableâpolymer DES, and angiographic lumen loss, but not with strut coverage nor plaque type. Endothelial dysfunction (defined as â„4% vasoconstriction) was observed in 46.6% of patients with lowâdose and 68.9% with highâdose acetylcholine, without differences between groups.
Conclusions
At followâup, endothelial dysfunction was frequently observed in distal segments treated with current stents without remarkable differences between devices. Although neointima healing was different between devices, poor healing was not associated with endothelial dysfunction.The source funding of the 4 randomized trials included in this study is the following. The BVSâFLOW trial (Coronary vasomotor function and myocardial flow with bioresorbable vascular scaffolds or everolimusâeluting metallic stents: a randomised trial) was funded by a grant of âLa Maratoâ Foundation. The Spanish Heart Foundation funded the REâTROFI2 (LongâTerm Coronary Functional Assessment of the InfarctâRelated Artery Treated With EverolimusâEluting Bioresorbable Scaffolds or EverolimusâEluting Metallic Stents: Insights of the TROFI II Trial) and MAGSTEMI (MagnesiumâBased Resorbable Scaffold Versus Permanent Metallic SirolimusâEluting Stent in Patients With STâSegment Elevation Myocardial Infarction) trials. The FUNCOMBO (Coronary endothelial and microvascular function distal to polymerâfree and endothelial cellâcapturing drugâeluting stents) trial was funded by OrbusNeich and was promoted by the Spanish Heart Foundation
Antiplatelet efficacy of ticagrelor versus clopidogrel in Mediterranean patients with diabetes mellitus and chronic coronary syndromes: A crossover pharmacodynamic investigation
IntroductionPatients with diabetes mellitus (DM) have augmented platelet reactivity and diminished responsiveness to clopidogrel. Ticagrelor, a more potent P2Y(12) inhibitor, is clinically superior to clopidogrel in acute coronary syndromes, although its role in chronic coronary syndromes (CCS) is still the subject of debate. The aim of this investigation was to compare the pharmacodynamic effectiveness of ticagrelor and clopidogrel in Mediterranean DM patients with CCS.Materials and methodsIn this prospective, randomized, crossover study, patients (n = 20) were randomized (1:1) to receive, on top of aspirin therapy, either ticagrelor 180 mg loading dose (LD)/90 mg maintenance dose (MD) b.i.d. or clopidogrel 600 mg LD/75 mg MD o.d. for 1 week in a crossover fashion with a 2-4 week washout period between regimens. Platelet function measurements were performed at 4 timepoints in each period (baseline, 2 h and 24 h after LD, and 1 week), including light transmission aggregometry (LTA, primary endpoint), VASP assay, Multiplate and VerifyNow P2Y(12).ResultsThe ticagrelor LD achieved greater platelet inhibitory effect than clopidogrel LD, assessed with LTA (20 mu M ADP as agonist), at 2 h (34.9 & PLUSMN; 3.9% vs. 63.6 & PLUSMN; 3.9%; p < 0.001) and 24 h (39.4 & PLUSMN; 3.5% vs. 52.3 & PLUSMN; 3.8%; p = 0.014). After 1 week of therapy, platelet reactivity was again significantly inferior with ticagrelor compared to clopidogrel (30.7 & PLUSMN; 3.0% vs. 54.3 +/- 3.0%; p < 0.001). The results were consistent with the other platelet function assays employed.ConclusionIn Mediterranean patients with DM and CCS, ticagrelor provides a more potent antiplatelet effect than clopidogrel after the LD and during the maintenance phase of therapy
Researches of Automatic Steering Control Systems Using an Optical Flow Model
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Evaluation with in vivo optical coherence tomography and histology of the vascular effects of the everolimus-eluting bioresorbable vascular scaffold at two years following implantation in a healthy porcine coronary artery model: implications of pilot results for future pre-clinical studies
To quantify with in vivo OCT and histology, the device/vessel interaction after implantation of the bioresorbable vascular scaffold (BVS). We evaluated the area and thickness of the strut voids previously occupied by the polymeric struts, and the neointimal hyperplasia (NIH) area covering the endoluminal surface of the strut voids (NIHEV), as well as the NIH area occupying the space between the strut voids (NIHBV), in healthy porcine coronary arteries at 2, 3 and 4 years after implantation of the device. Twenty-two polymeric BVS were implanted in the coronary arteries of 11 healthy Yucatan minipigs that underwent OCT at 2, 3 and 4 years after implantation, immediately followed by euthanasia. The areas and thicknesses of 60 corresponding strut voids previously occupied by the polymeric struts and the size of 60 corresponding NIHEV and 49 NIHBV were evaluated with both OCT and histology by 2 independent observers, using a single quantitative analysis software for both techniques. At 3 and 4 years after implantation, the strut voids were no longer detectable by OCT or histology due to complete polymer resorption. However, analysis performed at 2 years still provided clear delineation of these structures, by both techniques. The median [ranges] areas of these strut voids were 0.04 [0.03â0.16] and 0.02 [0.01â0.07] mm2 by histology and OCT, respectively. The mean (±SD) thickness by histology and OCT was 220 ± 40 and 120 ± 20 Όm, respectively. The median [ranges] NIHEV by histology and OCT was 0.07 [0.04â0.20] and 0.03 [0.01â0.08] mm2, while the mean (±SD) NIHBV by histology and OCT was 0.13 ± 0.07 and 0.10 ± 0.06 mm2. Our study indicates that in vivo OCT of the BVS provides correlated measurements of the same order of magnitude as histomorphometry, and is reproducible for the evaluation of certain vascular and device-related characteristics. However, histology systematically gives larger values for all the measured structures compared to OCT, at 2 years post implantation
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