Use of shockwave intravascular lithotripsy for the treatment of calcified renal artery stenosis in a symptomatic subject.

Aim: The use of shockwave lithotripsy for the treatment of heavily calcified atherosclerotic plaques before stenting showed great results in terms of feasibility and safety with favorable initial success. Evidence suggests that it is a useful tool to treat calcified lesions in peripheral and coronary arteries. Here, we describe the case of a patient with calcified renal artery stenosis successfully treated with the shockwave lithotripsy system. Case Report: We present a 76-year-old man with a known significant atherosclerotic renal artery stenosis and refractory hypertension. The patient received an angioplasty of the right renal artery in the first session and he was admitted for a second session to intervene in the left renal artery. The lesion was successfully treated with the lithotripsy system. Final angiography demonstrated an excellent position of the stent and good wall apposition. Conclusion: Our clinical case demonstrates that lithotripsy is safe and effective also for the treatment of the renal artery.

[Interventional electrophysiology in cardiac MRI : what is the current status?]. / Interventionelle Elektrophysiologie in der kardialen MRT : Wie ist der aktuelle Stand?

The ablation of simple and complex cardiac arrhythmias has become a first-line therapy in interventional cardiology and is mainly guided by conventional fluoroscopy. Cardiac magnetic resonance imaging (cMRI) allows exact three-dimensional (3D) visualization of complex anatomical structures and serves in the planning and implementation of ablation procedures. Post-procedural lesion visualization using cMRI can assess the success of ablation therapy and may distinguish potential complications. Performing ablation directly in the MRI scanner, with the option of anatomical substrate imagining, exact catheter navigation and real-time lesion visualization, holds the promise of improving success rates and safety in the interventional therapy of simple and complex arrhythmias.

Effector-independent representations of simple and complex imagined finger movements: a combined fMRI and TMS study.

Kinesthetic motor imagery and actual execution of movements share a common neural circuitry. Functional magnetic resonance imaging was used in 12 right-handed volunteers to study brain activity during motor imagery and execution of simple and complex unimanual finger movements of the dominant and the nondominant hand. In the simple task, a flexible object was rhythmically compressed between thumb, index and middle finger. The complex task was a sequential finger-to-thumb opposition movement. Premotor, posterior parietal and cerebellar regions were significantly more active during motor imagery of complex movements than during mental rehearsal of the simple task. In 10 of the subjects, we also used transcranial magnetic brain stimulation to examine corticospinal excitability during the same motor imagery tasks. Motor-evoked potentials increased significantly over values obtained in a reference condition (visual imagery) during imagery of the complex, but not of the simple movement. Imagery of finger movements of either hand activated left dorsal and ventral premotor areas and the supplementary motor cortex regardless of task complexity. The effector-independent activation of left premotor areas was particularly evident in the simple motor imagery task and suggests a left hemispherical dominance for kinesthetic movement representations in right-handed subjects.