[Sirolimus eluting sent in the prevention of restenosis in small coronary arteries]

Angioplasty of coronary arteries with a small diameter [commonly defined as diameter inferior than 2.75 mm] is associated with a high rate of restenosis and revascularization. Since the use of Drug Eluting Stents [DES] and considering their good results on simple lesions compared to other techniques [balloon dilation and bare metal stents], many studies have also demonstrated the superiority of DES in reducing restenosis and revascularization of complex lesions in particular lesions on coronary arteries with small diameter. Assessement of this revascularization procedure. Our study is a prospective one carried on between june 2002 and august 2006, involving a cohort of 299 patients. Patients are divided into 2 groups: group I: 175 patients with 220 lesions on coronary arteries with small diameter treated by 233 sirolimus DES [Cypher] and group II: 124 patients treated by 136 angioplasty of coronary arteries with diameter superior than 2.75 mm using 179 DES. During hospitalisation, there was no significant difference in MACE between the 2 groups. Nevertheless: 2 patients among the first group had no angioplasty because of unsuccessful progression of the balloon through the lesion and the absence of atherectomy in our center. All patients having acute thrombosis during hospitalization and presenting with ST elevated acute coronary syndrom had successful urgent revascularization with TIMI 3 flow. The mid-term follow-up [12 months] concerned 157/174 patients in group land 113/123 patients in group II. We observed a higher mortality and non fatal myocardial infarction in group I without statistically significant difference. despite the complexity of the lesions on coronary arteries with small diameter and despite the association with several risk factors in particular diabetes, the use of DES reduces the MACE specially secondary revascularisations thus improving early and midterm prognosis

[Infective endocarditis on probe of pacemaker]

Infective endocarditis is an uncommon but potentially lethal complication of permanent cardiac pacing. Infection is mainly caused by local contamination during the implantation procedure. The most frequently detected causative microorganisms were staphylococci. The clinical presentation is often atypical causing prolonged diagnostic delay. Bacteriological data and visualisation of neostructures consistent with vegetations on transoesophageal echocardiography, strongly suggest pacemaker lead infection. Management is based on a combined approach using both prolonged antibiotic treatment and early complete device explantation. Percutaneous techniques are currently the method of choice for lead extraction but it is not without possible complications. Antibiotic prophylaxis in order to reduce infection risk related to pacemaker implantation is widely recommended