In patients with chronic renal insufficiency and global obstructive atherosclerotic renovascular disease, renal artery stenting improves or stabilizes renal function and preserves kidney size.

Subclavian or brachiocephalic artery obstruction can be effectively treated by primary stenting or surgery. Comparison of stenting and the surgical experience demonstrates equal effectiveness but fewer complications and suggests that stenting should be considered as first line therapy for subclavian or brachiocephalic obstruction.

Percutaneous aortic balloon valvuloplasty (PABV) was developed to provide a less invasive alternative to aortic valve replacement. Despite initially favorable results, PABV has not produced reliable and durable outcomes. The Inoue balloon used for PABV via an antegrade transseptal approach may offer an improvement over the Mansfield balloons via the identical route. Thirteen consecutive patients with severe symptomatic aortic stenosis were referred for percutaneous aortic balloon valvuloplasty. All patients were considered unacceptably high-risk surgical candidates. Seven consecutive patients underwent antegrade transseptal PABV with Mansfield balloons and in the following six the Inoue balloon was used. The study group was characterized by advanced age (mean, 77) and multiple comorbid conditions (mean, 2.5/patient). Before PABV, the two groups did not differ with respect to age, mean NYHA class, LVEF, transaortic gradient, cardiac output, or aortic valve area. All patients had initial hemodynamic improvement. Complications included one stroke and one vascular injury. After valvuloplasty, cardiac output was not significantly changed. However, there was a significant decrease in aortic gradient and an increase in aortic valve area in both groups; the increase in aortic valve area was significantly greater in those treated with the Inoue balloon (P = 0. 039). Total follow-up mortality was high but appeared to be delayed in the Inoue group. The use of the Inoue balloon with an antegrade transseptal approach warrants further investigation as a preferred technique for PABV.

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Background: Stent thrombosis (ST) is a feared complication of percutaneous coronary intervention due to its adverse consequences.Methods: We analysed records of 4226 consecutive patients from January 2004 to October 2010 who underwent successful stenting. Baseline clinical characteristics, angiographic features and outcomes were compared in patients with and without ST.Results: A total of 64 cases of angiographic ST were recorded including six patients who had more than one episode of ST. Fifty-six percent of ST cases occurred in the first 30 days, 31% in days 30-365 and 13% after 365 days. Patients undergoing primary PCI (PPCI) had the highest risk of ST (3.1% vs 1.1% in all others, p = 0.0001). There was no difference in ST rate between patients treated with DES and BMS (1.4% vs 1.6%, p = ns). Incidence of ST beyond one year was 0.2% for BMS and 0.3% for DES (p = ns). There was a trend towards higher ST rate in patients who had a 2.25 mm diameter stent compared to larger stents (3.8% vs 1.5%, p = 0.06). Age, sex, diabetes and smoking status were not predictive of ST. Early experience with 20 primary PCI patients treated with Prasugrel was associated with no stent thrombosis. Patients with ST had a mortality rate of 10.9% compared with 2.7% in those without ST (p < 0.01).Conclusions: The risk of ST is higher in the first 30 days post procedure. PPCI patients had the highest risk of ST. There was no significant difference in ST rate between DES and BMS. ST was associated with significantly higher mortality during follow-up.

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