Objectives: To evaluate the long-term safety and efficacy of the novel combined sirolimus-eluting endothelial progenitor cell capture Combo stent (OrbusNeich, Fort Lauderdale, FL) at 5 years in the REMEDEE (Randomized study to Evaluate the safety and effectiveness of an abluMinal sirolimus coated bio-Engineered stEnt) trial.Background: Drug-eluting stents have limited restenosis and reintervention but are complicated by late and very late thrombosis and accelerated neoatherosclerosis.Alternative or adjunctive technologies are needed to address these limitations.Methods: A total of 183 patients with de novo lesions in native coronary arteries were randomized 2:1 to Combo (n = 124) or Taxus Liberté (n = 59). Primary endpoint was 9 month angiographic in-stent late lumen loss and the secondary endpoint was the occurrence of major adverse events (MACE) through 5-year follow-up.Results: Compared with Taxus, after 5 years the Combo stent was associated with similar rates of MACE (18.3% vs. 16.9%, p = .89), cardiac death (0.8% vs. 5.1%, p = .07), myocardial infarction (4.1% vs. 3.4%, p = .81), target lesion (9.4% vs. 10.2%, p = .78), and target vessel revascularization (14.4% vs. 11.9%, p = .73). No cases of definite stent thrombosis were reported in the Combo group. The follow-up rate at 5 years was 97.7%. Conclusion: At 5-year follow-up, the Combo stent remained clinically safe and effective with an overall low rate of MACE comparable to Taxus. K E Y W O R D S drug-eluting stents, percutaneous coronary intervention, progenitor endothelial cells, sirolimus

In the REMEDEE trial the Combo stent has shown to be effective by meeting the primary noninferiority angiographic endpoint and safe, with an overall low rate of clinical events in both stent groups, including no stent thrombosis up to 12 months.

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PF-SES are superior over analogue BMS of identical stent architecture in daily clinical routine with lower rates of TLR and MACE in a PS-matched, unselected patient population without differences in accumulated ST rates and bleeding frequencies given the currently favored postprocedural comedication (ClinicalTrials.gov Identifier NCT02629575).

In this largest ever patient-level pooled comparison on the treatment of diabetic patients with BRS out to two years, individuals with diabetes treated with the Absorb BVS had a similar rate of MACE as compared with diabetics treated with the Xience EES. © 2017 Wiley Periodicals, Inc.

A 35-year-old multiparous woman was found unresponsive, tachypnoeic, hypoxic and in shock 4 h postpartum. The ECG revealed S1 Q3 T3, a right bundle branch block pattern and right-axis deviation. The computed tomography of her pulmonary arteries revealed bilateral pulmonary artery thrombosis with dilated right ventricle. She was fibrinolyzed with intravenous Tenecteplase 30 mg bolus. Her saturation and tachypnoea improved and her ECG reverted to sinus rhythm subsequently. We discuss our use of off-label Tenecteplase in postpartum pulmonary embolism and review the literature.

SummaryWe report a 69 year old female who presented with chest pain to the Emergency Department of the National Heart Institute Malaysia. Her history revealed that she had had 2 separate episodes of chest pain beginning in 2002, resulting in total occlusion of her mid left anterior descending artery (LAD) requiring percutaneous coronary intervention and stenting on both occasions. Cine angiogram on her current admission revealed recurrent target lesion in-stent restenosis with total occlusion of the distal LAD. Intravascular ultrasound revealed multilayered suboptimally deployed stents in the LAD. Successive drug-eluting balloon deployments resulted in sustained patency of the LAD after 1 year. (Int Heart J 2011; 52: 61-63) Key words: In-stent restenosis, Angioplasty, Drug-eluting balloon S tents are a crucial and indispensible tool for coronary interventionists. Their efficacy, however, has been limited by the development of in-stent restenosis (ISR) secondary to neointimal proliferation. 1) Drug-eluting stents (DES) have, in the past decade, markedly reduced the incidence of binary restenosis and repeat coronary revascularization.2) However, there is limited data on optimal management of DES restenosis. Some studies have shown similar benefits between repeat DES stenting and conventional balloon angioplasty, whereas others have shown clear benefit for repeat DES stenting.2-4) Percutaneous coronary balloon angioplasty has been largely superseded by repeat DES stenting or the 'sandwich stenting' technique, which is steadily gaining prominence.5) We report a case of recalcitrant target lesion ISR which was successfully treated with drug-eluting balloon deployment. A repeat coronary angiogram 1 year later revealed sustained target lesion patency and the patient remains symptom free. Case ReportA 69-year-old female with a history of diabetes, hypertension, and hyperlipidemia since 1990 and on regular medication, has had recurrent episodes of stable angina since 1997. She was put on aspirin but was never investigated for coronary artery disease due to patient refusal to consent for further evaluation or intervention.In 2002, she had a severe episode of chest pain which necessitated admission to a peripheral hospital from where she was eventually referred to the National Heart Institute in Kuala Lumpur. Her coronary angiogram then revealed a total occlusion of the left anterior descending artery (LAD) which was remedied with two overlapping Cypher DES extending from the mid to distal LAD (2.5 × 33 mm and 2.75 × 33 mm, Cypher TM sirolimus-eluting stent; Cordis Corp., Miami, FL) (Figures 1A-F). She was discharged with dual antiplatelet therapy.In 2003, she had recurrent symptoms and a repeat angiogram showed ISR with total occlusion of the mid LAD. Percutaneous coronary intervention (PCI) was attempted with a cutting balloon (3.0 × 15 mm, 3.5 × 15 mm and 4.0 × 10 mm; InterVentional Technologies Inc., San Diego, CA). This was followed by two bare-metal stents (BMS), Multi-Link Penta The PCI was complicated by perfor...

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