Pathologies of the carotid arteries, and in particular atherosclerosis, are now an important medical problem. Stroke is the third leading cause of severe disability in the Western World leading to millions of deaths every year. Extracranial carotid atherosclerotic disease is the major risk factor for stroke. In years, with the advent of multidetector-row CT (MDCT) scanners and the use of specific angiographic protocols (MDCTA), CT imaging of the carotid arteries has become increasingly effective. In addition, the volume data obtained can be further rendered to generate high-quality two-dimensional and three-dimensional images. The purpose of this study was to review the atherosclerotic carotid arteries, their complications and how MDCTA depicts them, underlining the benefits and pitfalls of this diagnostic technique.

Noninvasive CFR assessment by CE-TTE is an accurate method of monitoring significant restenosis in the LAD when following up patients submitted to elective PTCA.

Percutaneous vertebroplasty (PVP) is a therapeutic, interventional radiological procedure involving bone cement injection into a vertebral body. Although PVP is considered a minimally invasive procedure, cement leakage into the perivertebral venous system can occur with its migration towards the right heart and the pulmonary circulation. We report a case of accidental finding of asymptomatic cardiac and pulmonary embolism caused by cement leakage after PVP.

Objective: To assess immediate and mid-term clinical and angiographic outcomes of the dexamethasone drug-eluting stent (D-DES) in patients with acute coronary syndrome (ACS). Patients and methods: A prospective, nationwide, controlled, registry. Inflammation plays a key role in ACS, and the anti-inflammatory effects of local elution of dexamethasone in unstable plaques may represent a valid therapeutic approach. All patients had ACS on admission (n = 332). 81.5% of the patients had unstable angina and 18.5% had non-ST elevation myocardial infarction (MI). 47% had ST-T segment changes, 59% had troponin elevation, 77% had elevated C-reactive protein levels and 48% had intermediate-high Thrombolysis in Myocardial Infarction risk score. Patients were treated according to an early invasive approach with 420 D-DES in 387 coronary lesions. Primary end point was the cumulative incidence of death, MI and ischaemia-driven target vessel revascularisation (TVR) at 6 months. Results: At 30 days, 2 (0.6%) patients died, and sub-acute stent thrombosis occurred in 2 patients. At 6 months, 328 (98.8%) patients were controlled, 3 (0.9%) patients had died, 7 (2.1%) had MI and 28 (8.5%) underwent ischaemia-driven TVR. Therefore, the primary end point occurred in 11.5% of patients. At multivariate analysis, multi-vessel coronary artery disease (odds ratio (OR) = 2.16, 95% CI = 1.47 to 3.17, p = 0.0001) and vessel diameter (2.75 mm (OR = 1.64, 95% CI = 1.08 to 2.49, p = 0.02) were independent predictors of 6-month clinical events. Global angiographic restenosis rate was 33.3%. Conclusion: This is the first large, multicentre analysis of the clinical and angiographic outcomes obtained with D-DES implanted in ACS. D-DES offers a low rate of clinical events at 6 months, but has no antirestenosis effect.A n ''early-invasive approach'' for the treatment of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is superior to a conservative strategy in patients with either ST-segment depression, troponin elevation or other high-risk indicators. However, recurrence of ischaemia at mid-term in this setting was as high as 22-32.3% in the landmark FRagmin during InStability in Coronary artery disease (FRISC) study and Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 (TACTICS-TIMI) study. Recently, the high efficacy of drug-eluting stents (DES) in reducing restenosis has been confirmed in a subgroup of patients with NSTE-ACS enrolled in randomised studies not designed, however, to assess the performance of these stents in this specific clinical setting. Inflammation plays a predominant role in the cellular mechanisms of unstable plaque. The evolution either towards plaque passivation, healing and stabilisation or towards plaque rupture and the occurrence of major adverse cardiac events (MACE) is influenced by inflammatory mechanisms. Local elution of anti-inflammatory agents is the rationale for the use of D-DES in these patients. This...

No abstract