Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON / Plaque modification in calcified chronic total occlusions: the PLACCTON study

Introducción y objetivos: La calcificación grave está presente en más del 50% de las oclusiones coronarias crónicas totales (OCT) tratadas mediante intervención percutánea. Nuestro objetivo fue describir el uso contemporáneo de los dispositivos de modificación de placa (DMP) en este contexto. Métodos: Los pacientes se incluyeron en el Registro Ibérico de OCT de forma prospectiva y consecutiva (32 centros de España y Portugal), de 2015 a 2020. Se compararon en función del uso o no de DMP. Resultados: Se incluyó a 2.235 pacientes, en 1.900 de los cuales se logró cruzar con éxito la lesión con guía. Se utilizó al menos un DMP en un 7% (134 pacientes) y más de uno en 24 pacientes (1%). Los DMP seleccionados fueron: aterectomía rotacional (35,1%), litotricia (5,2%), láser (11,2%), balones de corte (27,6%), balones OPN (2,9%) o combinaciones de más de uno (18%). Se utilizaron DMP en pacientes más ancianos, con mayor riesgo cardiovascular y puntuaciones Syntax y J-CTO más elevados. Esta mayor complejidad se asoció con procedimientos más prolongados, pero similar longitud total de stent (52 frente a 57mm; p=0,105). Cuando la guía cruzó con éxito la oclusión, la tasa de éxito final del procedimiento fue del 87,2%, pero se incrementó al 96,3% cuando se utilizaron DMP (p=0,001). Por el contrario, los DMP no se asociaron con mayor tasa de complicaciones en el procedimiento (3,7 frente a 3,2%; p=0,615). Pese al peor perfil de riesgo basal, a los 2 años de seguimiento no hubo diferencias en la tasa de supervivencia (94,3% DPM frente a no-DMP: 94,3% no-DPM, respectivamente, p=0,967). Conclusiones: Cuando la guía cruzó con éxito una OCT, la tasa de uso de los DMP fue del 7% y se asoció a una tasa de éxito final del procedimiento significativamente mayor. Los resultados a medio plazo fueron comparables cuando se precisaron DMP pese a su mayor riesgo basal, lo que sugiere que un mayor uso adecuado de estas técnicas en este contexto (AU)

Introduction and objectives: Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. Methods: Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. Results: Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). Conclusions: Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits (AU)

Purification and characterization of a specific Fasciola antigen.

Specific Fasciola antigen was prepared from homogenates of Fasciola hepatica adult worms. The homogenate was ultracentrifuged and the supernatant containing crude Fasciola antigen was then passed over a cyanogen bromide activated sepharose 4B column coupled with antiserum against Schistosoma mansoni adult worm surface antigen. The specific, Schistosoma-free Fasciola antigen was tested for its specificity by immunodiffusion. Characterization of the specific Fasciola antigen was done by gradient poly-acrylamide gel electrophoresis and immunoblotting technique. The electrophoresis migration pattern of specific Fasciola antigen, stained with Coomassie blue, showed 7 bands in the 12-54 kDa regions. Using the immunoblotting technique, a batch of positive fascioliasis sera recognized two specific bands at the 33 and 54 kDa regions.

Detection of Schistosoma mansoni antigen in the liver and antibodies in serum of patients with hepatic schistosomiasis.

Liver biopsies were taken from 28 patients with chronic hepatitic schistosomiasis for histopathological study and S. mansoni antigen detection by indirect immunofluorescence test. Circulating antibodies were estimated by indirect haemagglutination test. Thirteen cases (46.4%) revealed diffuse S. mansoni antigen in the liver blood sinusoids and in the formed granulomata. Circulating antibodies were detected in 21 cases, 11 of them showed antigen in the liver. Five cases only revealed definite granulomatous reactions around bilharzial ova, while the remaining 23 cases showed periportal fibrosis. So, for proper diagnosis of chronic hepatic schistosomiasis, it is recommended to examine the liver for S. mansoni antigen together with circulating antibodies detection.

Serum concentration of N-terminal procollagen peptide of collagen type III in schistosomal liver fibrosis.

The major cause of mortality in human schistosomiasis is the chronic granulomatous reaction of the liver tissue to Schistosoma mansoni eggs. Liver biopsy still provides the best evaluation of the degree of liver damage. However, liver biopsy does not provide an image of the dynamic process of fibrogenesis. Variations of concentrations of procollagen type III peptide in sera have been proposed to be significant markers of liver fibrosis. Thus, liver function tests in relation to histopathological diagnosis and procollagen type III peptide concentrations were studied in patients with schistosomiasis and revealed a high correlation between the serum procollagen type III peptide and the degree of fibrosis in liver tissue.