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Introduction: Percutaneous epicardial access (EA) was first described more than two decades ago. Since its initial introduction, indications for its utilization in the field of electrophysiology have expanded dramatically. Discussion: Epicardial mapping and ablation in patients with ventricular tachycardia is routinely performed in tertiary electrophysiology centers around the world. Although limited by lack of randomized controlled trials, epicardial ablation for atrial fibrillation has been suggested as a conjunctive strategy in patients who have failed an initial endocardial catheter ablation attempt, and it is necessary for placement of some left atrial appendage occlusion devices as well. An accurate understanding of the cardiac anatomy is crucial to avoid complications such as inadvertent right ventricular puncture, injury to the coronary arteries, abdominal viscera, phrenic nerves, and esophagus during both EA and catheter ablation. Conclusion: The aim of this review is to provide a comprehensive overview of the cardiac anatomy, technical aspects to optimize the safety of epicardial puncture, recognize and avoid potential complications. [ABSTRACT FROM AUTHOR]

Radiofrequency catheter ablation (RFCA) procedure is performed for many tachyarrhythmias. We performed successful RFCA in a 5‐year‐old child for supraventricular tachyarrhythmia and Wolff‐Parkinson‐White syndrome. Acute circumflex artery (CxA) occlusion occurred due to RFCA. After percutaneous balloon angioplasty was performed into the CxA, the patient was treated with systemic steroid to resolve myocardial edema. To the best of our knowledge, systemic steroid was used first time for acute coronary artery injury related myocardial ischemia. [ABSTRACT FROM AUTHOR]

Background: Ablation of right ventricular outflow tract (RVOT) ventricular arrhythmia (VA) within the left pulmonary sinus of Valsalva (LPSV) may increase the risk of left main coronary artery (LMCA) injury. Purpose: To delineate the anatomical characteristics between LMCA and LPSV and their association with atrial potential (AP) mapping in LPSV. Methods: A total of 104 consecutive patients with RVOT‐VA undergoing cardiac‐gated computed tomography coronary angiography (CTCA) after ablation were retrospectively analyzed. Results: The LMCA‐LPSV anatomic relationship was classified into three types based on the CTCA measurements. Types 1 and 2 had a shorter LMCA‐LPSV distance than that of type 3 (P < .001). The left atrial appendage (LAA)‐LMCA distance and LAA‐LPSV distance were associated with the incidence of AP in LPSV (odds ratio [OR] = 3.43, 95% confidence interval [CI]: 1.86‐6.34, P < .001; OR = 1.196, 95% CI: 1.09‐1.31, P < .001, respectively). Furthermore, the LMCA‐LPSV distance showed a linear correlation with the LAA‐LPSV distance (r2 = 0.93, P < .001). According to receiver operating characteristic (ROC) analysis, a LMCA‐LPSV distance <5.4 mm could predict the possibility of AP during LPSV mapping (sensitivity 83%, specificity 81%, and area under the ROC curve 0.86). Conclusions: The presence of AP in the LPSV may be useful to predict a short distance from the LPSV to the LMCA and to identify patients at higher risk of LMCA injury. This information may contribute to efficient and safe ablation in this area but should be confirmed in future studies. [ABSTRACT FROM AUTHOR]

Introduction: Cryoenergy is accepted as an alternative to radiofrequency ablation (RFA) in childen for ablation of supraventricular tachycardia substrates. Single cryoenergy application has been shown to be inferior to RFA. Double cryoenergy application has therefore been introduced into clinical practice, but experience concerning efficacy is limited. Coronary artery stenosis has been reported as serious complication after RFA for arrhythmia substrates but not after single cryoablation. The purpose of the study was to assess lesion volume (efficacy) and risk of coronary artery damage (safety), late, that is, 6 months, after double cryoenergy application in a piglet model. Methods: Two sequential cycles of cryoenergy were delivered at −75°C for 4 minutes at the atrioventricular groove in five piglets. Animals were restudied after 6 months by coronary angiography and intracoronary ultrasound (ICUS). Ablation lesions were examined histologically and lesion volume was determined by three‐dimensional morphometric analysis. Results: Cryolesion volume was 174.04 ± 67.18 mm3 for atrial and 238.69 ± 112.1 mm3 for ventricular lesions (P > .05). Ventricular lesions, 4.06 ± 1.05 mm, were significantly deeper than atrial lesions, 3.58 ± 0.78 mm, (P < .05). In two of the 29 lesions, cryoenergy induced minor coronary artery injury with mild medial and adventitial thickening as well as minimal intimal proliferation, which had neither been detected by coronary angiography nor by ICUS. Conclusion: Late after double cryoenergy application at growing myocardium, subclinical minor affection of the coronary artery wall could be detected with minimal intimal proliferation. As lifetime sequelae of this finding remains unknown, further studies are warranted to address safety of repeated cycles of cryoenergy application for tachycardia substrates in children. [ABSTRACT FROM AUTHOR]

Introduction: Left main coronary artery (LMCA) injury is a rare but potentially fatal complication of catheter ablation. Due to LMCA large perfusion area, its occlusion is usually a dramatic event. Methods and Results: Reports of LMCA injury complicating catheter ablations from 1987 to 2018 were searched in electronic databases. Twenty‐two cases of serious LMCA damage have been identified. Additionally, four reports of direct mechanical trauma involving major LMCA branches induced by inadvertent catheter insertion have been studied. Typically 86% LMCA injury presented as an acute/subacute complication of retrograde ablation in left ventricle/left ventricular outflow tract or aortic cusps. In at least 86% of patients with an in‐hospital presentation, the LMCA trauma manifested dramatically as a life‐threatening arrhythmia, cardiogenic shock, or severe hypotension requiring vasopressors. In‐hospital mortality rate was 32%. Direct stenting has been found to be the most successful strategy. Conclusion: LMCA injury, even if initially asymptomatic with normal angiographic appearance, may cause delayed flow deterioration, requiring prolonged monitoring and extended follow‐up. Special caution should be given to the prevention whereas survival depends on prompt detection and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Catheter ablation (CA) has emerged as the preferred modality of treatment for many cardiac arrhythmias. Anatomical sites of ablation are often located in close proximity to coronary arteries. However, the incidence of CA‐related coronary injury has not been well studied. We sought to systematically evaluate all cases of CA‐related coronary injuries. Methods and Results: A PubMed search was conducted from inception until May 1, 2017 using the keywords "coronary artery" and "ablation." We identified 2817 published articles of which 43 articles met our inclusion criteria representing 61 cases of coronary artery injury attributed to CA procedures from 1992 to 2017. Posteroseptal accessory pathway ablation was associated with the highest incidence of coronary injury (35.6% of cases), followed by cavotricuspid isthmus‐dependent flutter (19.3%). The right coronary artery was the site of injury in over two‐thirds of all reported cases. Coronary injury was detected intraprocedurally in about half of the cases (43.1%), whereas it was a delayed presentation in the other half. Coronary intervention was performed in a third of all cases (32.7%). There were a total of three deaths attributed to coronary artery injury. Conclusions: Most (91.8%) coronary injuries are a result of anatomic proximity to the site of ablation. Awareness of the relation between coronary artery course and anatomical site of ablation could prevent myocardial damage and improve procedural safety. [ABSTRACT FROM AUTHOR]

Objectives: To compare outcomes in patients receiving polytetrafluoroethylene (PTFE) and polyurethane (PL) covered stents (CS) after coronary artery perforation (CAP).Background: The prognosis of CAP has improved with the advent of CSs. Information is scarce about the outcomes of new-generation CSs.Methods: Sixty-one patients were treated with CSs in a 5-years period (age = 77 ± 8.75% males). Procedural and clinical data were retrospectively collected. The primary endpoint was procedural success. Secondary endpoints included death and major adverse cardiac events (MACE) defined as a composite of death, myocardial infarction, target vessel, and lesion revascularization and need for surgical repair).Results: Twenty-two (36%) received PL-CSs and 39 (65%) PTFE-CSs. There were no differences in procedural success (86% vs 69%, P = 0.216). Time to deliver was shorter with PL-CS despite larger length of stents (8[11] vs 15[16] min, P = 0.001; 20[5] vs 16[3] mm, P < 0.001). This group had lower rate of pericardial effusion and cardiac arrest (41% vs 72%, P = 0.028; 5% vs 26%, P = 0.045). At 1-year follow-up, MACE rates were similar (58% vs 56%, P = 1.000) with atrend toward TVR in the PL-CS arm (21% vs 5%, P = 0.083). No differences were found in mortality (26% vs 41%, P = 0.385). Each group had 1 stent thrombosis and in-stent restenosis trended higher in the PL-CS group (12% vs 3%, P = 0.223).Conclusions: Time to deliver was shorter with the PL-CS and resulted in lower rate of pericardial effusion and cardiac arrest. However, there were no significant differences in procedural success and 1-year follow-up MACE in patients treated with PL-CS or PTFE-CS. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the impact of stent inflation pressure and type of guidewire on "jailed" coronary guidewire damage occurring during bifurcation angioplasty.Background: Despite new techniques and treatment options during percutaneous coronary intervention (PCI) we still observe peri- and postoperative complications for to various known and unknown reasons.Methods: Patients undergoing PCI within the coronary bifurcation were randomly assigned to one of four groups: Pilot 50 or BMW guidewire and pressure ≤12 or >12 atm. After PCI each "jailed" guidewire was evaluated under an optical microscope. The Wide Beast Scale (WBS) was developed for the internal purposes of the study and was used for qualitative assessment. Also, the inflation pressure, the patients' characteristics and the technical parameters of the procedure were recorded.Results: The clinical characteristics were similar in all the groups. There was no statistical significance of the degree of damage, rated on the WBS, for either guidewire group with respect to inflation pressure (P = 0.49). The prevalence of guidewire damage was higher in the BMW versus the Pilot 50 group (98.4% vs 67.4% respectively, P = 0.00001) as was the severity of the damage (grades 3 and 4) in BMW versus Pilot 50 (55.6% vs 13.0% respectively, P = 0.00001).Conclusions: The inflation pressure during stent implantation had no impact on "jailed" guidewire damage. The difference in the prevalence of serious damage and total damage number was statistically significant for the BMW guidewire compared to the Pilot50. The BMW guidewire was an independent predictor of the degree of damage to the guidewire. [ABSTRACT FROM AUTHOR]

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. This case describes a complex PCI of the left main coronary artery and of a CTO of the right coronary artery using a minimal extracorporeal circulation system (MECC) in a patient with an aortic valve bioprothesis in extraanatomic position. It illustrates that complex recanalization strategies can be solved combining it with mechanical circulatory support technologies. [ABSTRACT FROM AUTHOR]

Background: We present our clinical experience with coronary artery bypass grafting (CABG) in children.Methods: Ten children who underwent CABG between July 1995 and August 2017 were retrospectively analyzed. Data including congenital cardiac malformations, previous surgical procedures, age and sex, type of coronary complications, ischemic events preceding surgery, and ventricular function before and after CABG were recorded.Results: The study population consisted of five males and five females with a median age of 2.5 years (range, 88 days to 15 years). Eight internal mammary arteries (IMAs) and two saphenous veins were used for grafting. Indications for bypass grafting were coronary artery (CA) complications related to the post-arterial switch operation in six, CA complications during the Ross procedure in two, and an iatrogenic CA injury during complete repair of tetralogy of Fallot with abnormal CA, crossing the right ventricular outflow tract in two patients. Six of the grafts were performed as rescue procedures. Three patients died during hospitalization. The mean follow-up time was 6.8 years (range, 3 months to 18 years). Anastomoses were evaluated by coronary angiography in four patients, and were all patent. Echocardiography revealed normal myocardial function in all patients.Conclusion: Our study suggests that the IMA should be the graft of choice in children due to its growth potential and long-term patency. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the role of miR-138 in human coronary artery endothelial cell ( HCAEC) injury and inflammatory response and the involvement of the PI3K/Akt/ eNOS signalling pathway. Oxidized low-density lipoprotein ( OX- LDL)-induced HCAEC injury models were established and assigned to blank, miR-138 mimic, miR-138 inhibitor, LY294002 (an inhibitor of the PI3K/Akt/ eNOS pathway), miR-138 inhibitor + LY294002 and negative control ( NC) groups. qRT- PCR and Western blotting were performed to detect the miR-138, PI3K, Akt and eNOS levels and the protein expressions of PI3K, Akt, eNOS, p-Akt, p- eNOS, Bcl-2, Bax and caspase-3. ELISAs were employed to measure the expressions of TNF-α, IL-4, IL-6, IL-8, IL-10 and nitric oxide ( NO) and the activities of lactate dehydrogenase ( LDH) and eNOS. MTT and flow cytometry were performed to assess the proliferation and apoptosis of HCAECs. Compared to the blank group, PI3K, Akt and eNOS were down-regulated in the miR-138 mimic and LY294002 groups but were up-regulated in the miR-138 inhibitor group. The miR-138 mimic and LY294002 groups showed decreased concentrations of TNF-α, IL-6, IL-8 and NO and reduced activities of LDH and eNOS, while opposite trends were observed in the miR-138 inhibitor group. The concentrations of IL-4 and IL-10 increased in the miR-138 mimic and LY294002 groups but decreased in the miR-138 inhibitor group. The miR-138 mimic and LY294002 groups had significantly decreased cell proliferation and increased cell apoptosis compared to the blank group. These findings indicate that up-regulation of miR-138 alleviates HCAEC injury and inflammatory response by inhibiting the PI3K/Akt/ eNOS signalling pathway. [ABSTRACT FROM AUTHOR]

A 56-year-old man presented for lead extraction of a left ventricular (LV) lead that had been deactivated due to hiccups and of a right ventricular (RV) lead with a high threshold. Pus was noted upon entering the pocket. The right atrial and RV leads were extracted, but traction on the LV lead caused ischemia and was not performed. An echocardiogram demonstrated the lead in the left atrium and a robotic-assisted thoracotomy was used to remove the lead that had unroofed the coronary sinus, gone into the left atrium, and perforated through the free wall into the pericardium. [ABSTRACT FROM AUTHOR]

The article presents several case studies related to applications of runthrough hypercoat guidewire during percutaneous coronary interventions (PCIs) such as the 60-year-old man with refractory coronary artery, the 63-year-old man with severe chest pain for two hours, and the 73-year-old man with myocardial infarction due to stent thrombosis. It mentioned the use of the guidewire in crossing the coronary lesions which are complex.

Objectives: To investigate the long-term clinical outcomes of biolimus-eluting stents with biodegradable polymers in real-world clinical practice.Background: Long-term clinical outcomes of biolimus-eluting stents have not been clearly established.Methods: A total of 824 all-comer patients (971 lesions) treated with unrestricted implantation of a biolimus-eluting stent with a biodegradable polymer were prospectively enrolled. Patients were divided into complex (413 patients) versus noncomplex (411 patients) groups according to the complexity of coronary lesions. Long-term clinical outcomes for stent efficacy (target lesion revascularization) and safety (composite of cardiac death, target lesion-related myocardial infarction, and definite or probable stent thrombosis) were compared between the two groups during 5 years of follow-up.Results: The complex group showed higher rates of decreased left ventricular ejection fraction, impaired renal function, previous history of myocardial infarction, and diabetes mellitus compared to the noncomplex group. In the overall population, the 5-year cumulative rate of target lesion revascularization was 4.8% (8.3% in the complex group vs 1.6% in the noncomplex group, P < 0.001). For stent safety, the 5-year cumulative rate for a composite of cardiac death, target lesion-related myocardial infarction, and stent thrombosis was 2.5% overall (3.9% in the complex group vs 1.1% in the noncomplex group, P = 0.010). Overall 5-year cumulative rate of stent thrombosis was 0.4% (0.5% in the complex vs 0.2% in the noncomplex group, P = 0.561) with no very late stent thrombosis (VLST).Conclusions: Biodegradable polymer-based biolimus-eluting stents showed favorable efficacy and safety in all-comer patients during 5 years of follow-up. [ABSTRACT FROM AUTHOR]

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare but important cause of acute coronary syndrome with a spectrum of disease that can include unstable angina, acute myocardial infarction, or sudden cardiac death. It has also been found in case reports to be caused by shear stress from physical exertion. We present a rare cycling induced SCAD that occurred in our institution in an otherwise healthy male with no cardiac risk factors. Case Presentation. A 36-year-old male presented to the emergency department with complaints of lightheadedness and diaphoresis after a bicycle fall. In the emergency department, he complained of feeling lightheaded and diaphoretic and having mid back pain. Patient had an ECG performed which showed lateral ST segment elevation and troponin I that was positive. A coronary angiography was subsequently performed demonstrating a spontaneous coronary artery dissection of left anterior descending coronary artery. Conclusion. SCAD is a rare cause of myocardial infarction, occurring in healthy individuals, which is rarely reported in the literature. Nearly 70% are diagnosed in postmortem studies after sudden cardiac death. Only 12 cases have been reported from activities involving physical exertion and no studies to our knowledge demonstrate this. [ABSTRACT FROM AUTHOR]

Purpose: The buildup of noncalcified plaques (NCPs) that are vulnerable to rupture in coronary arteries is a risk for myocardial infarction. Interpretation of coronary CT angiography (cCTA) to search for NCP is a challenging task for radiologists due to the low CT number of NCP, the large number of coronary arteries, and multiple phase CT acquisition. The authors conducted a preliminary study to develop machine learning method for automated detection of NCPs in cCTA. Methods: With IRB approval, a data set of 83 ECG-gated contrast enhanced cCTA scans with 120 NCPs was collected retrospectively from patient files. A multiscale coronary artery response and rolling balloon region growing (MSCAR-RBG) method was applied to each cCTA volume to extract the coronary arterial trees. Each extracted vessel was reformatted to a straightened volume composed of cCTA slices perpendicular to the vessel centerline. A topological soft-gradient (TSG) detection method was developed to prescreen for NCP candidates by analyzing the 2D topological features of the radial gradient field surface along the vessel wall. The NCP candidates were then characterized by a luminal analysis that used 3D geometric features to quantify the shape information and gray-level features to evaluate the density of the NCP candidates. With machine learning techniques, useful features were identified and combined into an NCP score to differentiate true NCPs from false positives (FPs). To evaluate the effectiveness of the image analysis methods, the authors performed tenfold cross-validation with the available data set. Receiver operating characteristic (ROC) analysis was used to assess the classification performance of individual features and the NCP score. The overall detection performance was estimated by free response ROC (FROC) analysis. Results: With our TSG prescreening method, a prescreening sensitivity of 92.5% (111/120) was achieved with a total of 1181 FPs (14.2 FPs/scan). On average, six features were selected during the tenfold cross-validation training. The average area under the ROC curve (AUC) value for training was 0.87 ± 0.01 and the AUC value for validation was 0.85 ± 0.01. Using the NCP score, FROC analysis of the validation set showed that the FP rates were reduced to 3.16, 1.90, and 1.39 FPs/scan at sensitivities of 90%, 80%, and 70%, respectively. Conclusions: The topological soft-gradient prescreening method in combination with the luminal analysis for FP reduction was effective for detection of NCPs in cCTA, including NCPs causing positive or negative vessel remodeling. The accuracy of vessel segmentation, tracking, and centerline identification has a strong impact on NCP detection. Studies are underway to further improve these techniques and reduce the FPs of the CADe system. [ABSTRACT FROM AUTHOR]

Perforation of coronary arteries is a relatively rare yet life-threatening complication of percutaneus coronary interventions and is encountered in approximately 0.5% of these procedures. According to the type of coronary perforation, various methods of correction are employed, ranging from conservative approach to emergency cardiac surgery. Coronary stent-grafts are composed of two metal stents and a polytetrafluoroethylene layer between them. Advent of such stents enabled efficient endovascular repair of coronary artery perforation. We present a case of coronary artery perforation which had occurred during stent implantation for the treatment of a bridged segment in the distal portion of the left anterior descending artery. This perforation was successfully managed by implanting a stent-graft. [ABSTRACT FROM AUTHOR]

Aims To retrospectively evaluate coronary anomalies and coronary wall atheromatous changes by using dual-source computed tomography angiography (DSCTA) for preoperative assessment of patients with thoraco-abdominal and noncoronary cardiovascular disease. Materials and Methods One hundred and eighty-one patients scheduled for elective noncoronary cardiovascular surgery (heart valve disease group, HVD; arrhythmia group, Arrhy; or aortic aneurysm group, AA) underwent a DSCTA examination for preoperative preparation. Anomalous origin of coronary arteries, myocardial bridge (MB), coronary wall atheromatous changes, luminal stenosis, and types of plaques were evaluated and compared among the three groups. Results Anomalous origin of coronary arteries and MB were observed in 5.1% and 21.5% of patients. Anomalous origin of the coronary artery from the opposite sinus was most common (55.6%). MB was most frequently detected in the distal segment of the left anterior descending artery (LAD) (1.2%). Plaques were most common in the proximal segment of the LAD (16.4%) and LAD branches (42.2%). Diseased vessels and segments were more common in AA group, followed by Arrhy patients and finally HVD groups (p < 0.001 for each group). Multivessel involvement and significant stenosis of AA group were significantly more common than the other two groups. Noncalcified plaque and all grades of stenosis were more common in AA patients. Conclusion DSCTA is useful for preoperative assessment of coronary arteries in patients undergoing thoraco-abdominal and noncoronary cardiovascular surgery. DSCTA detected higher prevalence of coronary artery disease in AA patients than in the other two groups of patients. doi: 10.1111/jocs.12244 (J Card Surg 2014;29:59-65) [ABSTRACT FROM AUTHOR]

Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery. [ABSTRACT FROM AUTHOR]

Objectives and Background Rotational atherectomy (RA) is used as a debulking technique prior to stenting in some specialized cardiac centers for calcified coronary lesions amenable to percutaneous coronary intervention (PCI). A specific possible complication, burr entrapment, is unusual but carries serious risks and may sometimes necessitate surgery as a rescue procedure. However, different modalities using a percutaneous approach were proposed as a bail-out. We aim to propose a framework for possible management for trapped RA burr. Methods and Results A literature review of the most relevant cases of entrapped burr during PCI was performed. Twelve cases were reported and different solutions were discussed. Surgery was needed in only 1 patient to retrieve the trapped burr, and in all the other cases, different percutaneous solutions were successful to retract the trapped device. Conclusions These cases illustrate that burr entrapment during RA, albeit rare, may occur and may transform a relatively simple PCI to a procedure failure. Although prevention is better than treatment, the operators should be aware of such serious complication and they should keep in mind that various possible percutaneous solutions may be successful to retrieve the burr and to avoid surgery. [ABSTRACT FROM AUTHOR]

We describe a patient who developed coronary vein (CV) stenosis shortly (<3 months) after an initial left ventricular (LV) lead implantation with significant fibrous tissue. The virtual histological intravascular ultrasound analysis was useful for characterizing the plaque component of the stenotic lesion and formulating the strategy. A summarized review of the CV angioplasty for LV lead implantations disclosed that CV stenosis was often found in patients who had a previous history of cardiac surgery or an LV lead implantation and that a stent implantation was required to deploy the LV lead in the targeted CV in some (9.3%) patients. (PACE 2013; 36:e59-e63) [ABSTRACT FROM AUTHOR]

Background The optimal duration of clopidogrel treatment following percutaneous coronary intervention (PCI) and the patient population that would benefit most are still unknown. In a porcine coronary injury model, we tested two different durations of clopidogrel treatment on severely or moderately injured arteries and examined the arterial response to injury. To understand the molecular mechanism, we also investigated the effects on transcription factors nuclear factor-kappaB (NF-κB) and activator protein 1 (AP-1). Materials and methods In 24 cross-bred pigs, one coronary artery was only moderately injured by percutaneous transluminal coronary angioplasty (PTCA) and one coronary artery was severely injured by PTCA and subsequent beta-irradiation (Brachy group). Animals received 325 mg aspirin daily for 3 months and 75 mg clopidogrel daily for either 28 days [short-term (ST) clopidogrel group] or 3 months [long-term (LT) clopidogrel group]. Results After 3 months, the number of proliferating cells per cross-section differed significantly between ST and LT in both injury groups (PTCAST 90·2 ± 10·3 vs. PTCALT 19·2 ± 4·7, P < 0·05; BrachyST 35·8 ± 8·4 vs. BrachyLT 7·5 ± 2·0, P < 0·05). Similar results were seen for inflammatory cells (CD3+ cells): PTCAST 23·5 ± 3·55 vs. PTCALT 4·67 ± 0·92, P < 0·05; BrachyST 83·17 ± 11·17 vs. BrachyLT 20 ± 4·82, P < 0·05). Long-term administration also reduced the activity of NF-κB and AP-1 by 62–64% and 42–58%, respectively. However, the effects of different durations of clopidogrel administration on artery dimensions were not statistically significant. Conclusions Regarding inflammation and transcription factor activity at the PCI site, long-term clopidogrel administration is superior to short-term administration, especially in severely injured arteries. Transferring our results to the human situation, patients with more severely diseased arteries may benefit from a prolonged clopidogrel medication after PCI. [ABSTRACT FROM AUTHOR]

Percutaneous treatment of coronary bifurcation lesions, pose a number of technical challenges to the interventional cardiologist. Each lesion has to be approached with its own, targeted solution in the context of the clinical picture, anatomy, and pathology. To achieve acceptable clinical outcomes a number of established techniques are available. The exact anatomy of the lesion determines the technique used. The most common approach is to stent the main vessel across the ostium of the side branch. The side branch can be additionally treated with a second stent or balloon angioplasty depending on the severity of the ostial lesion and/or evidence of active ischemia. Other techniques involve stenting the main branch up to the carina but sparing the side branches, multiple 'kissing stent' approaches ('Y','T', and 'V') or the 'culottes' technique. Follow-up data demonstrates a high (over 90%) technical success rate. Clinical outcome is variable but with conventional stents restenosis rates higher than 30% have been reported in most studies and there is no added advantage in routine stenting of both main vessel and side branch. Recent introduction of drug-eluting stents has resulted in a lower event rate and reduction of main vessel restenosis in comparison with historical controls. Side branch ostial restenosis remains a problem, which may require the development of novel 'bifurcate' stent designs to allow complete coverage with a single stent. [ABSTRACT FROM AUTHOR]

Background Corticotropin-releasing hormone (CRH)/adrenocorticotropic hormone (ACTH)/cortisol is the major anti-inflammatory system. After percutaneous translumenal angioplasty, an inflammatory process is triggered. We investigate whether CRH/ACTH/cortisol axis is activated after deep vessel wall injury (DVWI). Materials and methods Plasma and leukocyte CRH and ACTH, serum cortisol and IL-1β, and leukocyte cAMP were measured (ELISA) in 16 pigs after anaesthesia (baseline), 60 min into anaesthesia without causing vascular injury and 90 min after DVWI of the left anterior descending (LAD) coronary artery induced by percutaneous directional atherectomy (Atherocath GTO 7F; DVI, Inc., Temecula, USA). Biochemical variables were also measured at baseline, 60 and 180 min into anaesthesia in six additional pigs without coronary intervention. Results MANOVA showed that CRH/ACTH/Cortisol, cAMP and IL-1β production was not modified during anaesthesia. Post-DVWI plasma CRH (0·077 ± 0·046 ng mL-1), and cellular cAMP (0·14 ± 0·067 pmol 10-6 cells) increased significantly (P = 0·001) with respect to their baseline values (CRH = 0·036 ± 0·013 ng mL-1; cAMP = 0·081 ± 0·034 pmol 10-6). There was also a statistically significant increase (P = 0·02) in post-DVWI IL-1β (from 46·6 ± 12·8 to 64·05 ± 13·5 pg mL-1), and in serum cortisol (P = 0·05) compared to its baseline values (8·98 ± 3·2 µgr dL-1 vs. 6·57 ± 2·3 µgr dL-1, respectively). Conclusion In our experimental model, coronary vessel wall injury-activated CRH/ACTH/cortisol axis caused a significant increase in plasma CRH, cortisol and cellular cAMP levels, which may influence the response of coronary arteries to injury. [ABSTRACT FROM AUTHOR]

Abstract Background: A genetic aberration in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene (677 C to T substitution) has been shown to result in reduced enzyme activity. The hypothesis tested in the present study was that a higher proportion of Kawasaki disease (KD) patients with coronary artery lesions (CAL) would have the T677 allele compared with patients without CAL and healthy subjects. Methods: Genotypes for MTHFR were determined in 75 KD patients (male: female ratio 52:23) and 238 healthy subjects (male: female ratio, 110:128) by the polymerase chain reaction and restriction fragment length polymorphism method. Results: The results indicated that female KD patients had a significantly higher frequency of the TT genotype compared with female control subjects. In the female population, the frequency of the TT genotype in patients with initial coronary aneurysm was significantly lower than in patients without this manifestation. Analysis of the data for the male population showed that the frequency of the TT genotype in KD patients developing coronary stenosis, occlusion or myocardial infarction was higher than that in those without these manifestations, although the difference was statistically insignificant. Conclusions: The TT genotype may protect female KD patients against initial aneurysm formation and predispose male KD patients to severe coronary complications. Further large-scale studies may be required to confirm the contribution of homocysteine in the coronary sequelae of KD. [ABSTRACT FROM AUTHOR]

Hypothermia protects the heart during CV surgery and transplantation. However, severe hypothermia damages the vascular endothelial cells (ECs). We previously showed that catalytic iron, lipid peroxidation and cell injury increases with time at 0°C. In this study, we hypothesized that hypothermic preconditioning (HPC) at 25°C protects human coronary artery ECs from subsequent iron-mediated hypothermic injury by inducing heme oxygenase (HO-1) and ferritin. HPC attenuated the increase in iron at 0°C by 50% and limited cold-induced LDH release to 5% (84% in controls). Pre-treatment with 20 µM DFO decreased iron and protected cells. Incubation of cells with 10 µM hemin (1h/37°C) caused a sequential increase in intracellular heme (maximum at 0h post-hemin), HO-1 (2h), iron (2h) and ferritin (6h). Iron returned to control levels after 4h and ferritin, after 72h. Elevated iron sensitized cells to 0°C (83% LDH release vs 33% in controls) but the increase in ferritin was protective (7% LDH release). HPC increased iron maximally after 2h at 25°C and ferritin levels peaked after 15h. HO-1 and heme were not affected. When the HPC-mediated increases in iron and ferritin were blocked by DFO, the protection at 0°C was attenuated. Our results indicate that relative induction of ferritin and catalytic iron is critical for survival against hypothermic injury and HPC mediated protection involves iron-dependent increases in ferritin. [ABSTRACT FROM AUTHOR]