Background and Purpose-To compare potential risk factors, clinical symptoms, diagnostic delay, and 3-month outcome between spontaneous internal carotid artery dissection (sICAD) and spontaneous vertebral artery dissection (sVAD). Methods-We compared patients with sICAD (n=668) and sVAD (n=302) treated in 3 university hospitals. Results-Patients

Background— Although newer immunosuppressive agents, such as mTOR (mammalian target of rapamycin) inhibitors, have lowered the occurrence of malignancies after transplantation, cancer is still a leading cause of death late after heart transplantation. Statins may have an impact on clinical outcomes beyond their lipid-lowering effects. The aim of the present study was to delineate whether statin therapy has an impact on cancer risk and total mortality after heart transplantation. Methods and Results— A total of 255 patients who underwent heart transplantation at the University Hospital Zurich between 1985 and 2007 and survived the first year were included in the present study. The primary outcome measure was the occurrence of any malignancy; the secondary end point was overall survival. During follow-up, a malignancy was diagnosed in 108 patients (42%). The cumulative incidence of tumors 8 years after transplantation was reduced in patients receiving a statin (34% versus 13%; 95% confidence interval, 0.25–0.43 versus 0.07–0.18; P <0.003). Statin use was associated with improved cancer-free and overall survival (both P <0.0001). A Cox regression model that analyzed the time to tumor formation with or without statin therapy, adjusted for age, male sex, type of cardiomyopathy, and immunosuppressive therapy (including switch to mTOR inhibitors or tacrolimus), demonstrated a superior survival in the statin group. Statins reduced the hazard of occurrence of any malignancy by 67% (hazard ratio, 0.33; 95% confidence interval, 0.21–0.51; P <0.0001). Conclusions— Although it is not possible to adjust for all potential confounders because of the very long follow-up period, this registry suggests that statin use is associated with improved cancer-free and overall survival after cardiac transplantation. These data will need to be confirmed in a prospective trial.

in target lesion revascularization and target vessel occlusion in patients with diabetes and critical limb ischemia (CLI).Summary: It is well known percutaneous treatment of calcific tibial artery disease is now possible. Efficacy of PTA using conventional balloons for treatment of tibial artery lesions has, however, been limited by 12-month restenosis rates reported as high as 70% (Schmidt A et al, Catheter Cardiovasc Interv 2010;76:1047-54). For treatment of below-the-knee arteries, however, there is increasing evidence that local delivery of paclitaxel using drug-eluting balloons may result in a decrease in tibial artery restenosis after angioplasty. Reductions in 3-month binary restenosis rates have been observed with drug-eluting balloons for below-the-knee angioplasty compared with PTA alone (Schmidt A et al, J Am Coll Cardiol 2011; 58:1105-9). In this article, the authors report a prospective randomized trial comparing the performance of a specific drug-eluting balloon (IN.PACT Amphirion; Medtronic, Santa Rosa, Calif) with conventional PTA in treatment of de novo, long atherosclerotic lesions of tibial arteries in patients with diabetes. The primary end point was 1-year binary restenosis. This was a randomized, but open-label, single-center study. Inclusion criteria were presence of diabetes mellitus, CLI, as defined as Rutherford class $4, significant stenosis or occlusion >40 mm of at least one below-theknee vessel with distal runoff, and life expectancy >1 year. Angiography or ultrasound follow-up was used to determine binary in-segment restenosis at 1 year. Secondary end points included clinically driven target lesion revascularization, major amputation, and target vessel occlusion. This was not an intention-to-treat study. Patients were enrolled in the study only after successful passage of the wire through the lesion. The authors enrolled 132 patients with 158 infrapopliteal atherosclerotic lesions. Mean length of the treated segments was 129 6 83 mm in the drug-eluting balloon group compared with 131 6 79 mm in the PTA group (P ¼ .7). As assessed by angiography, in >90% of patients, binary restenosis occurred in 20 of 74 lesions (27%) in the drug-eluting balloon group and in 55 of 74 lesions (74%) in the PTA-alone group (P < .001). Target lesion revascularization occurred in 18% in the drug-eluting balloon group vs 43% in the PTA-alone group (P ¼ .002). Target vessel occlusion occurred in 17% of the drugeluting balloon group vs 55% of the PTA-alone group (P < .001). There was only one major amputation, which occurred in the PTA-alone group (P ¼ .9).Comment: This was a nonblinded device trial performed by a single high-volume center, and no external angiography or duplex ultrasound core laboratories adjudicated end points. Only one major amputation was necessary in this group of 132 patients with diabetes and CLI, suggesting that the "critical" portion of the limb ischemia may not have been as critical as that of patients in other centers. Nevertheless, there is enough here to encourage industry to ...

BackgroundTransfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland.MethodsIn this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed.Results560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients.ConclusionThis study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

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