OBJECTIVETo compare the effect of short-term metformin and fenofibrate treatment, administered alone or in sequence, on glucose and lipid metabolism, cardiovascular risk factors, and monocyte cytokine release in type 2 diabetic patients with mixed dyslipidemia.RESEARCH DESIGN AND METHODSWe studied 128 type 2 diabetic patients with mixed dyslipidemia complying throughout the study with lifestyle intervention who were randomized twice, initially to either metformin or placebo, and then to micronized fenofibrate or placebo.RESULTSFenofibrate alleviated diabetic dyslipidemia–induced changes in plasma high-sensitivity C-reactive protein, fibrinogen, and plasminogen activator inhibitor (PAI)-1 and in monocyte cytokine release, whereas metformin or lifestyle intervention improved mainly glucose and lipid metabolism. The strongest pleiotropic effect was observed when fenofibrate was added to metformin.CONCLUSIONSFenofibrate, particularly administered together with metformin, is superior to metformin and lifestyle intervention in exhibiting beneficial effects on systemic inflammation, hemostasis, and monocyte secretory function in type 2 diabetic patients with mixed dyslipidemia.

Background: Novel sirolimus eluting stents (SES) have shown non-inferior clinical outcomes when compared to everolimus eluting stents (EES), EES and BMS (0.18 ± 0.1 vs. 0.39 ± 0.1 vs. 0.34 ± 0.2 mm, respectively; p = 0.04). There was no difference in the proportion of malapposed or uncovered struts, although protruding covered struts were more common in p = 0.03). (0.24 ± 0.1 vs. 0.4 ± 0.1 vs. 0.77 ± 0.4; p < 0.01) whilst EES and BP-SES had higher fibrin scores than BMS (1.2 ± 0.4 vs. 1.3 ± 0.3 vs. 0.17 ± 0.2; p < 0.01 (Cardiol J 2016; 23, 6: 657-666) In pathology, the lowest neointimal thickness was confirmed in BP-SES (p < 0.05). The inflammation score was significantly lower in BP-SES and EES when compared to BMS

The MynxGrip was safe and effective in sealing access sites after antegrade femoral artery puncture with same-day discharge.

Background: The prevalence of diabetes has increased significantly in well-developed countries during the last decade and it continues to grow. Diabetes increases the risk of restenosis in patients treated percutaneously for peripheral artery disease. The present study sought to compare outcomes of atherectomy treatment in diabetic (DM) vs. non-diabetic (nDM) patients suffering from peripheral artery disease. Method: Between 2008 and 2012, 204 revascularization atherectomy procedures were performed on arteries of the lower extremities. The endpoints included target lesion revascularization (TLR), amputation and death. The type of atherectomy (excisional-soft plaque, orbital-calcified plaque, with active aspirationwith a thrombus) was left to operator discretion. Results: This study contains 132 DM (66% male, age 68 ± 11.2 years) and 72 nDM (63% male, age 75 ± 11.3 years) subjects. DM were younger but had a higher prevalence of coronary artery disease (DM: 91% vs. nDM: 62%, p < 0.0001) and end-stage renal disease (DM: 22% vs. nDM: 2.5%, p < 0.0001). There were no differences in critical limb ischemia between the groups (DM: 21% vs. nDM: 12%, p = 0.13). Mean time of follow-up was 384 and 411 days in DM and nDM, respectively (p = 0.43). There were no significant differences in TLR (DM: 15.2% vs. nDM: 22.2%, p = 0.249), amputations (DM: 3.0% vs. nDM: 1.5%, p = NS) or death rates (DM: 2.2% vs. nDM: 2.7%, p = NS). Kaplan-Mayer analysis showed no significant differences between the groups in the time to TLR, amputation or death. Conclusions: Plaque modification with adjusted atherectomy appears to have similar outcomes in diabetic as well as in non-diabetic patients. Nonetheless, a randomized study would be warranted to confirm the findings of the current study.

In this observational analysis, BP-PES were comparable to DP-PES, with regard to incidence of repeated revascularizations, stent thromboses and MACCE despite earlier DAPT discontinuation.

ObjectivesThe aim of the study is to evaluate the functionality, durability, and temporal biocompatibility of a novel, balloon-expandable polymeric transcatheter heart valve (ATHV) system (InFlow, CardValve Consortium, Poland). Along with expanding TAVI indications, the demand for new transcatheter valves is increasing.MethodsA surgical ascending aortic banding model was created in 20 sheep. Two weeks later, 16 sheep were implanted with ATHV systems (15–16F). Three animals were euthanized after a 30-day follow-up, four animals after a 90-day follow-up, and six animals after a 180-day follow-up. A follow-up transthoracic echocardiography (TTE) was performed.ResultsThere was one procedure-related (6,25%) and two model-related deaths (12,5%; banding site calcification with subsequent infection originating externally from banding). TTE revealed the flow gradients (max/average) of 30,75/17,91; 32,57/19,21; and 21,34/10,63 mmHg at 30, 90, and 180 days, respectively. There were two cases of low-degree regurgitation after 180 days with no perivalvular leak observed. Histopathological analysis showed no valve degeneration at terminal follow-up with optimal healing. Small thrombi were present at the aortic wall adjacent to the base of the leaflets, and between the aortic wall and the stent in most of the valves; however, leaflets remained free from thrombi in all cases. Scanty calcifications of leaflets were reported in three animals evaluated 180 days after implantation.ConclusionThis preclinical study in the aortic banding model showed good hemodynamic performance, durability, and biocompatibility of the novel ATHV. Furthermore, regulatory studies with longer follow-ups are warranted.

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reassuring early outcome. In contrast, in the femoropopliteal artery mechanical stress is high, thus implanted stents are exposed to the risk of stent fracture and malformation, increasing the rate of restenosis. 8, 9 In the below-the-knee (BTK) region, use of metal, balloon-expandable drugeluting stents is more common than the self-expandable nitinol ones, because those stents are even more susceptible to fracture. Moreover, due to the characteristics of BTK lesions, in most cases multiple stents are needed. 10 Therefore, atherectomy (AT), which removes the atherosclerotic plaque from the arterial wall, appears to be promising. This expectancy is linked to the fact that these devices cut out the plaque from the artery wall, thus significantly increasing lumen diameter and removing potential sources of inflammation, thus facilitating satisfactory outcome. 11Thus far, the long-term outcomes after endovascular A ccording to recent clinical practice and evidence, endovascular revascularization of the lower limb arteries has superseded surgical procedures. 1,2 Regardless of advancement in endovascular technology, restenosis and the need for repeat revascularization are still challenging. Moreover, the mortality in peripheral artery disease (PAD), especially in critical limb ischemia (CLI), is high, fluctuating at around 20% at 6-month follow-up, and exceeding 50% within 5 years from diagnosis. 3,4 These numbers increase in patients with coexisting symptomatic coronary artery disease (CAD). Additionally, CLI is associated with poor quality of life 5 and high treatment costs. Background: The impact of endovascular revascularization of the lower extremity arteries with atherectomy (AT) compared with percutaneous transluminal angioplasty (PTA) is still unclear. Therefore, the aim of the study was to compare long-term outcomes after percutaneous PTA and AT in patients requiring endovascular revascularization.