The covered stent could solve emergent condition for patients with coronary artery perforation with high TLR and stent thrombosis rate at long-term follow-up. The patients with cardiac tamponade had worse clinical outcomes in 30-day and 1-year follow-up.

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Background: This study tested the hypothesis that hyperbaric oxygen (HBO) therapy enhanced the circulating levels of endothelial progenitor cells (EPCs), soluble angiogenesis factors, and blood flow in ischemic areas in patients with peripheral arterial occlusive disease (PAOD). Methods: In total, 57 consecutive patients with PAOD undergoing the HBO therapy (3 atmospheres (atm) for 2 h each time) were prospectively enrolled into the present study. Venous blood sampling was performed to assess the circulating levels of EPCs and soluble angiogenesis factors prior to and during five sessions of HBO therapy. Additionally, skin perfusion pressure (SPP), an indicator of blood flow in ischemic areas, was measured by moorVMS-PRES. Results: The results demonstrated that the circulating levels of EPCs (cluster of differentiation (CD)34+/CD133+/CD45dim, CD31+/CD133+/CD45dim, CD34+) and soluble angiogenesis factors—vascular endothelial growth factor/stromal cell-derived factor 1/hepatocyte growth factor/fibroblast growth factor (VEGF/SDF-1α/HGF/FGF) were significantly increased post-HBO therapy as compared to pre-HBO therapy (all p < 0.01). Additionally, Matrigel assay showed that the angiogenesis was significantly increased in post-HBO therapy as compared to prior to therapy (p < 0.001). Furthermore, SPP was significantly increased in the ischemic area (i.e., plantar foot and mean SPP of the ischemic foot) in post-HBO therapy as compared to pre-HBO therapy (all p < 0.01). Importantly, the HBO therapy did appear to result in complications, and all the patients were uneventfully discharged without amputation. Conclusions: HBO therapy augmented circulating levels of EPCs and angiogenesis factors, and improved the blood flow in the ischemic area.

Atrial fibrillation (AF) is one of the risk factors for dementia. Female sex is an inconsistent risk factor for dementia after adjusting for age in the general population, and there lacks research on its impact in developing dementia in patients with AF. This paper aims to investigate whether female sex is a risk factor for dementia in AF patients. Data of patients with newly diagnosed AF between 2001–2013 were retrieved from Taiwan’s National Health Insurance Research Database. Exclusion criteria were: patients with incomplete demographic data, age < 20 years, rheumatic heart disease, hyperthyroidism, past valvular heart surgery, and a history of dementia. Propensity score matching (PSM) between sexes was performed, including comorbidities, medications and index date stratified by age. The primary outcome was a new diagnosis of dementia at follow-up. A total of 117,517 men and 156,705 women were eligible for analysis. After 1:1 PSM, both 100,065 men and women (aged 72.5 ± 12.5 years) were included for analysis. Dementia risk varied with age in women compared with men. The difference was negligible for ≤55 years (sub distribution HR (SHR) = 0.89, 95% CI 0.73–1.07), but increased between 56–65 years (SHR = 1.13, 95% CI 1.02–1.25), 66–75 years (SHR = 1.14, 95% CI 1.09–1.20), 75–85 years (SHR = 1.11, 95% CI 1.07–1.15) and >85 years (SHR 1.10, 95% CI 1.04–1.16) for females. This study establishes that female sex increases the risk of developing dementia compared to male sex in AF patients aged >56 years. However, the impact of female sex on dementia in AF patients differs between dementia types.

The efficacy of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has improved dramatically due to the development of new devices. Severe calcification of coronary lesions may be encountered even when the guidewire crosses the CTO, preventing the balloon from penetrating the lesion. A new "Tornus" penetration catheter has been developed for CTO recanalization. The purpose of this study was to evaluate the feasibility and safety of the Tornus catheter compared with traditional rotational atherectomy for CTO lesions. From August 2002 to July 2009, 77 patients with CTO of the coronary artery were selected to undergo PCI. Forty-one patients were treated with rotational atherectomy before the availability of the Tornus catheter when the smallest balloon failed to pass the CTO lesion. Later, 36 patients were treated with a Tornus catheter. Device and angiographic success rates as well as procedural complications were assessed. Device success was defined when the Tornus or Rota burr passed through the lesion. Major complications included death, Q-myocardial infarction, or emergency bypass surgery. Minor complications included perforation, cardiac tamponade, no reflow phenomenon, or long spiral dissection.The mean procedural time was significantly longer in the Tornus group (144 minutes versus 115 minutes, P = 0.01), while the device success rate was significantly lower (77% versus 95%, P = 0.024). Rotational atherectomy was subsequently performed in 3 of 8 Tornus failure cases. There were no between group differences in major complication rate (6% Tornus versus 5% rotational atherectomy). There was an insignificant trend for lower minor complication rates in the Tornus group (17% versus 20%).Use of the Tornus catheter was associated with significantly longer procedural duration and lower device success rates compared to rotational atherectomy. Major and minor complications were not different between the groups. Our findings suggest that Tornus catheter penetration is not superior to conventional rotational atherectomy for CTO recanalization.

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s opposed to 1-or 2-vessel coronary artery diseases (CAD), patients with unprotected left main artery disease carry poor outcomes if left unrevascularized. 1,2 Percutaneous coronary intervention (PCI) is regarded as a potential alternative management of unprotected left main coronary artery (ULMCA) disease to coronary artery bypass graft surgery (CABG) in selected patients due to comparable short-term clinical results. [3][4][5] Given the high percentage of distal bifurcation lesions and the large vessel diameter in ULMCA disease, most PCI for ULMCA stenoses are performed via the transfemoral approach using either 7 or 8 French (Fr) guiding catheters. [6][7][8][9] With recent advances in PCI instruments and techniques, most coronary lesions can now be safely treated via the transradial approach with a high procedural success rate and relatively few local vascular complications. 10,11 Nevertheless, the literature review reveals few case reports regarding transraCirculation Journal Vol.71, June 2007 dial stenting for ULMCA disease and only one small-scale study comparing the transradial and the transfemoral approach for both protected and unprotected left main PCI. [12][13][14][15] Thus, the feasibility and safety of routine transradial stenting for ULMCA stenoses remains unclear. To elucidate the feasibility and safety of this procedure, we retrospectively reviewed the success rate, in-hospital complications and 1-year outcomes of patients undergoing transradial coronary stenting for ULMCA stenoses in our medical facility. Methods Study Population and ProceduresAll patients undergoing elective coronary stent implantation in Chang Gung Memorial Hospital -Kaohsiung Medical Center, between June 2001 and August 2006, for ULMCA diseases with diameter stenosis ≥50% were selected for retrospective analysis. Patients presenting with ST-segment elevation acute myocardial infarction (MI) were excluded from the present study. Instead of surgery, PCI was chosen when suitable anatomy for stenting via a percutaneous approach was present and CABG was considered high risk owing to the presence of either old age or comorbidity, or in cases involving simple patient preference, which was defined as CABG eligibility. The unilateral radial artery was punctured routinely for the initial coronary angiogram at our institute unless patients had positive Allen's test, weak radial artery pulsation, wrist joint deformity or a local wound unsuitable for this approach. If the puncture of bilateral radial arteries failed, either the Circ J 2007; 71: 855 -861 (Received November 28, 2006; revised manuscript received February 13, 2007; accepted March 7, 2007) Feasibility and Safety of Transradial Stenting for Unprotected Left Main Coronary Artery StenosesCheng-I Cheng, MD* , **; Chiung-Jen Wu, MD**; Chih-Yuan Fang, MD**; Ali A. Youssef, MD**; Chien-Jen Chen, MD**; Shyh-Ming Chen, MD**; Cheng-Hsu Yang, MD**; Shu-Kai Hsueh, MD**; Hon-Kan Yip, MD**; Mien-Cheng Chen, MD**; Morgan Fu, MD**; Yuan-Kai Hsieh, MD** Background Percutaneous corona...