Treatment of coronary bifurcation lesions with bioresorbable vascular scaffolds.

AIM: Aim of the study was to report on the feasibility and early safety and efficacy of Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) for coronary artery bifurcations (CABs) treatment at a single high-volume center. METHODS: All patients treated with Absorb implantation at our institution from March 2013 to March 2014 were enrolled in the prospective, single-center, ongoing, all-comers registry, which has the main purpose of evaluating the safety and efficacy of Absorb implantation in unselected patients treated in daily practice. In-hospital and at follow-up clinical outcomes of 46 patients undergoing treatment with Absorb in 46 CAB lesions were reported in the present study. RESULTS: Treated CAB lesions involved the left main in 13.0% of cases, the left anterior descending artery in 65.0%, the left circumflex in 19.6%, and the right coronary artery in 2.2%. Bifurcations were classified as true (47.8%) and non-true (52.2%) according to the Medina classification. The provisional and the two-BVS techniques were used in 78.3% and 21.7%, respectively. Two-BVS techniques included: mini-crush 13.0%; reverse culotte 2.2%; T-stenting 2.2%; and V-stenting 4.3%. No in-hospital adverse events occurred. At 6 months no adverse events occurred. Only one case of target lesion revascularization was observed at day 227. No stent thrombosis occurred during follow-up. CONCLUSION: Our preliminary experience suggested that CABs treatment with Absorb is feasible and associated with promising immediate and short-term clinical outcomes. However, larger studies with long-term follow-up are needed to adequately address the safety and efficacy of BVS use in CABs.

[Clinical characteristics and therapeutic perspectives of boutonneuse fever. Assessment of a caseload of 39 patients]. / Aspetti clinici e prospettive terapeutiche della febbre bottonosa. Valutazione di una casistica di 39 pazienti.

Rickettsia conorii is the etiologic agent of Boutonneuse fever, a rickettsiosis of the spotted fever group that is endemic in Southern Italy. Chloramphenicol or tetracyclines are still the treatment of choice for this disease, and recently quinolones have also been utilized with success. In 1994-95, 39 otherwise healthy patients were admitted to our unit for Boutonneuse fever. They were treated, in random order, with quinolones (10 subjects received ciprofloxacin, 500 mg/12 h per os; 8 subjects received intravenous pefloxacin, 200 mg/12 h), or tetracyclines (21 subjects received intravenous rolitetracycline, 275 mg/12 h). Outcome was favorable in all cases and no significant complications were observed. However, in a significant number of cases, increased blood concentrations of glutamic-oxalacetic (68.4%) and glutamic-pyruvic (60.5%) transaminases were found. Above normal blood creatinine values were observed in 29.7% of the cases, and urinanalysis disclosed blood in 35.9% and proteins in 56.4% of the cases. Both tetracyclines and quinolones were well tolerated and effective, with apyrexia achieved after 2.7 +/- 0.1 days (mean +/- SEM). All patients were discharged after an average of 7.1 +/- 0.4 days. Liver and kidney function derangements seem to occur to some extent in the acute phase of Boutonneuse fever. This finding might partially explain the increased mortality rate reported for subjects with simultaneous systemic or organ diseases or when the administration of an effective antibiotic is delayed. Together with chloramphenicol and tetracyclines, quinolones might be considered as first line antibiotics.