Ticagrelor and rosuvastatin when given in combination have an additive effect on local myocardial adenosine levels in the setting of ischemia reperfusion. This translates into an additive cardioprotective effect mediated by adenosine-induced effects including downregulation of pro- but upregulation of anti-inflammatory mediators.

A remote robotic catheter navigation system was able to assist stenting of an anastomotic pulmonary artery stenosis following failure of conventional interventional techniques.

Numerous interventions have been shown to limit myocardial infarct size in animal models; however, most of these interventions have failed to have a significant effect in clinical trials. One potential explanation for the lack of efficacy in the clinical setting is that in bench models, a single intervention is studied without the background of other interventions or modalities. This is in contrast to the clinical setting in which new medications are added to the "standard of care" treatment that by now includes a growing number of medications. Drug-drug interaction may lead to alteration, dampening, augmenting or masking the effects of the intended intervention. We use the well described model of statin-induced myocardial protection to demonstrate potential interactions with agents which are commonly concomitantly used in patients with stable coronary artery disease and/or acute coronary syndromes. These interactions could potentially explain the reduced efficacy of statins in the clinical trials compared to the animal models. In particular, caffeine and aspirin could attenuate the infarct size limiting effects of statins; morphine could delay the onset of protection or mask the protective effect in patients with ST elevation myocardial infarction, whereas other anti-platelet agents (dipyridamole, cilostazol and ticagrelor) may augment (or mask) the effect due to their favorable effects on adenosine cell reuptake and intracellular cAMP levels. We recommend that after characterizing the effects of new modalities in single intervention bench research, studies should be repeated in the background of standard-of-care medications to assure that the magnitude of the effect is not altered before proceeding with clinical trials.

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as requested by the rheumatology service at our institution. All procedures were performed under local anesthesia and sedation, with no major complications. We evaluated the patient demographics, biopsy results, and characteristics of the biopsy specimen.Results: In this period, we performed 33 temporal artery biopsies in 27 patients (23 women, 85%; 4 men, 5%) who were a mean age of 73.1 years. Results of 29 biopsy specimens were negative (88%), 3 were positive (9%), and 1 was inconclusive (3%). Visual disturbance with headache was present in all patients in our series, with a mean sed rate of 61. There were 5 bilateral temporal artery biopsies (30.3%), 12 left-sided biopsies (36.3%), and 11 right-sided biopsies (33.3%); biopsies were performed in the symptomatic side. The mean length of the biopsied artery was 2.6 cm. The performance of a temporal artery biopsy offers a negative predictive value of 96% (CI, 0.80-0.99).Conclusions: The vascular surgeon should be aware that the performance of temporal artery biopsy has limited impact on the diagnosis of giant-cell arteritis, and is only one of the five criteria for diagnosis. The performance of a biopsy should be limited to patients who have a contraindication to treatment with steroids.

2017-08-25T16:29:30

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