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Background: The objective of this retrospective study was to evaluate the tolerance of rapid right ventricular pacing (RRVP) compared with that of the traditional methods of hypotension used during thoracic endovascular aortic repair (TEVAR)., Methods: From January 2002 to December 2012, we retrospectively included all the patients treated with TEVAR by comparing the 2 groups: patients operated with RRVP (RRVP+) and those operated without RRVP (RRVP-). The characteristics of the population and the procedures were recorded. The rates of complications were compared up to 1 year., Results: Sixty-one patients were operated. Treated pathologies were multiple with 19 aneurysms, 14 false aneurysms, 12 isthmic ruptures, 11 dissections, 3 coarctations, and 2 endoleaks. Twenty-four patients were RRVP+ and 37 patients were RRVP-. Mortality rates at 1 month in groups RRVP+ and RRVP- were of 0% and 2.7%, respectively (P = 1), and reintervention rates were 0% and 13.5%, respectively (P = 0.15). Three peroperative rhythm disorders (12.5%) were observed in the RRVP+ group including 2 ventricular fibrillations and 1 atrial fibrillation, both reduced without complications. One pacemaker was implanted for atrioventricular block in the RRVP- group. In the RRVP+ group, 83.3% of the patients presented a rise in troponin Ic (TnI) >0.04 ng/mL in 72 hours compared with 40.5% of the patients in the RRVP- group (P = 0.0013), with a spontaneously favorable evolution. No coronary syndrome was observed at 1 year with a mortality rate of 10.8% in the RRVP- group vs. 0% in the RRVP+ (P = 0.15)., Conclusions: In spite of a frequent moderate rise of TnI at the time of RRVP, this technique does not present more complications at 1 year than the use of a chemical hypotension. It thus seems an interesting alternative for selected patients, in trained teams., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Radiation-induced stenosis of the carotid artery is considered a challenging entity for direct revascularization. We performed a carotid artery stenting for a radiation-induced stenosis using a transapical approach on an asymptomatic 63-year-old male patient. Transapical approach, which is often used for cardiac surgery, was not yet described for the endovascular treatment of carotid stenosis. The transapical approach could be an attractive alternative path for patients presenting significant supra-aortic trunks lesions and unfit for direct approach or peripheral access. This case reports the feasibility and the safety of carotid artery stenting using the transapical approach in well-trained teams., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: The objective of this exploratory study was to determine the rate of the complications of early surgery for symptomatic carotid stenosis, in 2 centers of Western France., Methods: Between January 2011 and January 2013, we prospectively enrolled all the patients admitted for transient ischemic accident (TIA) or minor stroke (Rankin ≤ 3) associated with an ipsilateral carotid stenosis >50% (North American Symptomatic Carotid Endarterectomy Trial) and operated before the 14th day following the neurologic event at the University hospitals of Angers and Tours. The demographic data (gender, age, and medical history) and the characteristics of the procedures were recorded. The rates of stroke, TIA, and postoperative deaths defined the cumulative morbidity and mortality rate (CMMR) of the study., Results: Ninety-one patients were included in the study. They presented 27 TIAs and 64 strokes. The average elapsed time between the neurologic event and surgery was 9.8 days. During this time, 10 patients, that is, 11% of the operated cohort, presented a new ischemic neurologic event while waiting for surgery. Surgical operations consisted of 56 eversions (61.5%), 32 endarterectomies with patch (35.1%), 2 bypasses, and 1 direct closure. The CMMR reached 3.3%. Two patients presented with a stroke and 1 patient died of a cardiologic cause during the postoperative period., Conclusions: This study confirms the interest of an early surgery for symptomatic carotid stenoses with a Rankin score of ≤3. The risk of recurrence of a cerebral ischemic accident during the preoperative period remains high., (Copyright © 2014 Elsevier Inc. All rights reserved.)