SummaryAim: Cryptogenic stroke remains the final diagnosis in 40% of ischemic acute cerebrovascular events. Until now there are no clinical evidences that the percutaneous closure of PFO is able to prevent the recurrence of stroke or transient ischemic attack (TIA). The aim of this study was to evaluate the incidence of recurrence in patients successfully. Treated by percutaneous closure of PFO with different occlude devices by using TDC, TTE and clinical evaluation. Material and Method:From June 2004 to February 2010, 72 PTS, (40 females and 32 males; everage age 46 yrs, range 14-66), admitted with diagnosis of recurrent ischemic neurologic events (58 stroke and 14 TIA)underwent percutaneous closure of PFO. Thirty-one (43%) of the 72 patients had a concomitant history of migraine, 16(52%) of whom with aura. Five different occlude devices were used, with a total amount of 74 implants. All pts were studied during the follow-up by clinical evaluation (Rankin modified scale), TCD and TTE.Results: Successful device deployment is achieved in 100% of pts without any periprocedural major complication. Only in two pts atrial arrhythmia have occurred. All pts was discharged within 3 days in good overall conditions. In all pts a double antiplatelet regimen was adopted. The follow-up was complete in 100% of the cases (median 30, range 3-58 months). At five years, there was no recurrent stroke or TIA, and no new cerebral lesions developed by MRI in those patients with residual shunt. Moreover, in 65 (90%)of them the Rankin scale significantly (P<0.0001) reduced to 0 whereas only in 2 pts score 1 was reached. In 19 (61%) of the 31 pts with concomitant migraine, the intensity and the frequency of the attacks significantly (P<0.0001) decreased over time. At the TCD, 5 pts (7%) resulted positive for microembolic signals but, only 1 of them, was successfully treated for an associate defect. The TTE evaluation showed however an optimal sealing of all the devices without signs of erosion, incomplete closure and thrombus formation around the device. Conclusion:Our experience suggests that percutaneous treatment of PFO is safe and beneficial at the medium term follow-up for secondary prevention since able to prevent the clinical recurrence of acute cerebrovascular events irrespective of the device used.Keywords: Stroke, paradoxical embolism, percutaneous transcatheter.Pollice F, Pollice P, Jacob L. Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism.
Objective: Diabetics with coronary artery disease face a high risk of adverse events following coronary revascularization. However, recurrence rates of after the first revascularization have never been appraised. The aim of this study was to evaluate recurrent events in diabetics undergoing percutaneous coronary intervention (PCI) in the current era. Material and Method: Authors collected baseline and outcome data of consecutive type-2 diabetics treated with PCI (January 2005-December 2008). End-points of interest were the long-term rates of major adverse cardiac events (MACE: cardiac death, myocardial infarction [MI], percutaneous target vessel revascularization [TVR-PCI], or coronary artery bypass grafting [CABG]), non-TVR PCI, and stent thrombosis. Results: A total of 429 diabetics were included, 191 (44%) insulin-dependent, with drug-eluting stents implanted in 232 (54%). After a median of 38 months, events were as follows: MACE in 167 (38.9%) subjects, cardiac death in 38 (8.8%), MI in 42(9.8%), TVR PCI in 130 (30.3%), CABG in 11 (6.2%), non-TVR PCI in 52 (12.1%), and definite stent thrombosis (2.1%). Among the 129 patients undergoing TVR PCI as first event, as many as 28 (21.7%) underwent a second TVR PCI, 7 (5.4%) underwent a third TVR PCI, and a further 2 (1.5%) underwent a fourth TVR PCI, whereas CABG was performed in 2 (1.5%)and non-TVR PCI in 4 (3.1%). Conclusion: This work, originally reporting on risk of recurrent repeat revascularization events among diabetics treated with PCI, showed that adverse events occur frequently in these patients, but can be managed in most cases safely and successfully by means of repeat PCI only.
SummaryObjective: Stenosis in the unprotected left main coronary artery (ULMCA) is considered a standard indication for surgical revascularization. Some studies have demonstrated that stenting of the ULMCA is safe and feasible in selected patients. Drug eluting stents (DES) have been shown to be superior to bare metal stents (BMS) in reducing restenosis and major adverse cardiac events (MACE) both in-hospital and at follow-up after treatment of ULMCA disease. Several studies showed that the mid-term prognosis of patients with left main stenting is good, but most of them are limited by small populations and the availability of mid-term results. Thus, we sought to evaluate the very long term impact of DES vs BMS in a large cohort of patients undergoing stent implantation for ULMCA disease in our center. Material and Method:Between June 2002 and June 2008 a total of 354 consecutive patients with ULMCA stenosis were treated with percutaneous coronary intervention with BMS (53 patients) or DES (301 patients) implantation. A multivariable adjustment was provided in order to account for baseline differences between groups. Results:The average clinical follow-up was 551±512 days. Overall, MACE rate was significantly lower in the DES group (16.6% vs 26.4%, P=0.02). The beneficial effect was driven by a reduction of death (6.0% vs 9.4%, P=0.11), MI (2.7% vs 3.8%, P=0.33) and target vessel revascularization after DES implantation (9.0 % vs 15.1%, P=0.11). After correcting for independent predictors of adverse events, the adjusted hazard ratios (HRs) for the risk of mortality and myocardial infarction after DES implantation relative to BMS implantation were 0.99 (95% CIs 0.30-3.21, P=0.98) and 0.59 (95% CIs 0.01-3.45, P=0.56), respectively. The adjusted HR for two-year MACE was 0.50 (95 CIs 0.25-1.02), P=0.056, mainly driven by a statistical significant reduction of TVR ], P=0.018]. Conclusion:Patients presenting with ULMCA disease, who are treated with DES have a significant reduction in the rate of target lesion revascularization with no increased risk of death or myocardial infarction.Keywords: Stroke, bare metal stents, drug eluting stents.
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