Clinical outcome and angiographic results with novel polysulfone polymer coating paclitaxel eluting stent in real-world clinical practice: a clinical centre registry.

BACKGROUND: The Intek-Apollo stent (Switzerland) employs a polysulfone polymer coating which has demonstrated low interaction with blood and high thrombo-resistance. The aim of this study was to assess the clinical and angiographic outcomes after Intek-Apollo stent utilisation in a real-world setting. MATERIAL/METHODS: A total of 130 patients (77.7% males) were enrolled with 174 lesions in native coronary arteries (92.4%), saphenous vein grafts (7.5%) and in-stent restenosis (6.3%). Indications for stenting were stable coronary artery disease (CAD) 52.3%, acute coronary syndrome (ACS) 37.7% and STEMI 10%. Clinical follow-up and coronary angiography (after symptoms occurrence or positive stress test) was performed at 6 and 12 months.The primary end points were target lesion revascularization (TLR) and target vessel revascularization (TVR), while secondary end points were major adverse cardiac events (MACE) during the follow-up period. RESULTS: The mean age of patients included was 61.62±11.13 years. Complex lesions treatment (ostial, bifurcation) reached 13.7%. Mean stenosis diameter was 83.52±10.5%. Reference vessel diameter was 2.85±0.39 mm with a mean lesion length of 14.66±4.5mm. Average stent size was 2.93±0.39mm × 16.6±4.73 mm. At 15±3 months, primary events included TLR (4.6%), TVR (4.6%) and MACE (2.3%). There was 1one myocardial infarction and no cardiac death). No incidence of early or late stent thrombosis was demonstrated. CONCLUSIONS: Intek-Apollo stent implantation is safe and efficient in a real world population. The unique properties of polysulfone polymer coating can effectively protect from late stent thrombosis and lead to reduced rates of TLR, TVR and MACE.

The effect of open-chest cardiac resuscitation on mitral regurgitant flow: an on-line transesophageal echocardiographic study in dogs.

INTRODUCTION: We sought to determine the effect of cardiac massage on a pre-existing regurgitant mitral valve during open-chest cardiopulmonary resuscitation (OCCPR) in an animal experiment. METHODS: Our study included 29 dogs that were used as experimental models. We anesthetized them and inserted a transesophageal echocardiographic (TEE) probe. Then we performed a transverse thoracotomy, attempting to produce acute mitral regurgitation (MR). In models that showed cardiac arrest we initiated OCCPR to restore cardiac function. The regurgitant area of mitral jet and left ventricular (LV) diameters and volumes were calculated before and during OCCPR using TEE. RESULTS: Ventricular fibrillation and/or electromechanical dissociation occurred in 13 animals (45%). In 4 models without preexisting MR, no additional regurgitation was detected during OCCPR, while in another 5 with preexisting MR we noticed a slight increase in the regurgitant flow. The regurgitant flow area changed from 0.62 +/- 1 cm2 before to 1.1 +/- 0.36 cm2 during OCCPR (p<0.008). In the 4 animals that had severe damage to the mitral apparatus after the attempts, the regurgitant flow increased from 4.01 +/- 0.93 cm2 to 7.7 +/- 2.6 cm2 (p<0.002). The LV transverse diameter decreased from 4.39 +/- 0.62 cm to 1.54 +/- 0.5 cm and its volume from 60.5 +/- 7.14 cm3 to 17.02 +/- 4.14 cm3 (both p<0.001), thus showing the effectiveness of OCCPR. CONCLUSIONS: Given the presence of preexisting mitral regurgitation, direct cardiac massage during OCCPR would probably be less effective than expected, because of an increase in the amount of the regurgitant.

Patient dose in cardiac radiology.

INTRODUCTION: In diagnostic and interventional cardiology procedures performed with the use of X-ray diagnostic imaging systems, the long fluoroscopy time and the large number of cine projections, as well as the repetition of the procedure due to the recurrence of the lesion--a common event--result in a high locally delivered skin dose, which may even lead to patient skin necrosis. The purpose of this study was to collect information in order to estimate the patient dose during coronary angiography and coronary angioplasty procedures, using the dose-area product measuring system of the X-ray angiographic machine. METHODS: Dose-area product (DAP), fluoroscopy time, number of sequences and frames per sequence were collected for each of 108 coronary angiography and 101 coronary angioplasty procedures, using the dedicated X-ray machine of the hospital's haemodynamic department, where more than 3000 procedures are performed per year. RESULTS: The median values of DAP were 19.96 and 40.17 Gy.cm(2) for coronary angiography and angioplasty, respectively; fluoroscopy times were 7.7 and 23.4 minutes; and the numbers of frames were 457 and 641, respectively. There was a strong correlation between DAP and fluoroscopy time, the number of frames per sequence, and hence the cine recording time. CONCLUSIONS: The entrance skin dose delivered to the patient in the haemodynamic department was lower than that of other studies, although the mean fluoroscopy time per patient was longer. The practices in use satisfy the diagnostic reference levels as far as DAP values and number of frames per patient are concerned, but not with regard to fluoroscopy time. We did not find the correlation between doctors' experience and DAP values reported in other studies, as we did not take into account the complexity index of the lesion.