; for the DELIVER Clinical Trial InvestigatorsBackground-Paclitaxel, a microtubule-stabilizing compound with potent antitumor activity, has been shown to inhibit smooth muscle cell proliferation and migration. The DELIVER trial was a prospective, randomized, blinded, multicenter clinical evaluation of the non-polymer-based paclitaxel-coated ACHIEVE stent compared with the stainless steel Multi-Link (ML) PENTA stent. Methods and Results-A total of 1043 patients with focal de novo coronary lesions, Ͻ25 mm in length, in 2.5-to 4.0-mm vessels were randomized (ACHIEVE nϭ524; ML PENTA nϭ519). Angiographic follow-up was performed in a subset of 442 patients (ACHIEVE nϭ228; ML PENTA nϭ214). Prespecified end points were a 40% reduction in target-vessel failure at 9 months (primary clinical end point) and a 50% reduction in binary restenosis at 8 months (major secondary end point). Baseline clinical characteristics were comparable between the groups. Patients in ACHIEVE had more type C lesions and a larger reference diameter. At follow-up, stent late loss was 0.81 versus 0.98 mm (Pϭ0.003), stent binary restenosis was 14.9% versus 20.6% (Pϭ0.076), and target-vessel failure was 11.9% versus 14.5% (Pϭ0.12) for ACHIEVE and ML PENTA, respectively. Conclusions-The ACHIEVE paclitaxel-coated stent decreased neointimal proliferation compared with the bare-metal PENTA stent; however, this reduction was insufficient to meet the prespecified primary end point of target-vessel failure and the secondary end point of binary restenosis.

No abstract

No abstract

ObjectivesWe evaluated the safety and efficacy of orbital atherectomy in real‐world patients with severe coronary artery calcification (CAC).BackgroundThe presence of severe CAC increases the complexity of percutaneous coronary intervention as it may impede stent delivery and optimal stent expansion. Atherectomy may be an indispensable tool for uncrossable or undilatable lesions by modifying severe CAC. Although the ORBIT I and II trials report that orbital atherectomy was safe and effective for the treatment of severe CAC, patients with kidney disease, recent myocardial infarction, long diffuse disease, severe left ventricular dysfunction, and unprotected left main disease were excluded.MethodsThis retrospective study included 458 consecutive patients with severe CAC who underwent orbital atherectomy followed by stenting from October 2013 to December 2015 at 3 centers.ResultsThe primary endpoint of major adverse cardiac and cerebrovascular events at 30 days was 1.7%. Low rates of 30‐day all‐cause mortality (1.3%), myocardial infarction (1.1%), target vessel revascularization (0%), stroke (0.2%), and stent thrombosis (0.9%) were observed. Angiographic complications were low: perforation was 0.7%, dissection 0.9%, and no‐reflow 0.7%. Emergency coronary artery bypass graft surgery was performed in 0.2% of patients.ConclusionIn the largest real‐world study of patients who underwent orbital atherectomy, including high‐risk patients who were not surgical candidates as well as those with very complex coronary anatomy, acute and short‐term adverse clinical event rates were low. A randomized clinical trial is needed to identify the ideal treatment strategy for patients with severe CAC.

No abstract

A prolonged supraselective intracoronary infusion of urokinase can be safely administered and may facilitate angioplasty of chronic total occlusions. Lower doses of urokinase are equally effective and result in fewer bleeding complications than do higher dosage regimens. Vessel patency is frequently maintained, but restenosis remains a problem.

No abstract

Dextrocardia is a rare anomaly affecting 0.01% of newborns. We report on a case of a 60-year-old female with mirror-image dextrocardia who presented with an acute myocardial infarction and underwent primary angioplasty of the left circumflex artery. A review of the literature and technical challenges of the case will be addressed.