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A study was conducted to evaluate the incidence, predictors, and clinical outcome of stent thrombosis after implantation of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice. The result showed that the cumulative incidence of stent thrombosis 9 months after successful drug-eluting stent implantation in consecutive 'real world' patients was substantially higher than the rate reported in clinical trials.

Byline: G. Breteau (1), F. Mounier-Vehier (4), O. Godefroy (1), J.-Y. Gauvrit (2), M.-A. Mackowiak-Cordoliani (1), M. Girot (1), D. Bertheloot (5), H. Henon (1), C. Lucas (1), X. Leclerc (2), F. Fourrier (3), J. P. Pruvo (2), D. Leys (1) Keywords: Key words cerebral venous thrombosis; ischemic stroke; hemorrhagic stroke; stroke outcome; isolated intra-cranial hypertension Abstract: An early diagnosis and heparin therapy have contributed to a decreased mortality in cerebral venous thrombosis (CVT). However, predictors of outcome are difficult to identify, because most studies suffered heterogeneity in diagnostic findings and treatments, retrospective design, and recruitment bias. The aim of this study was to evaluate the clinical outcome in 55 consecutive patients with CVT admitted over a 4-year period. The study population consisted of 42 women and 13 men, with a median age of 39 years (range 16--68). The diagnosis was performed with MRI in 53 patients, and angiography in 2. The outcome was assessed with the modified Rankin scale (mRs). After a median follow-up of 36 months (range: 12--60), 45 patients were independent (mRS 0--2), and 10 were dependent or dead (mRS 3--6). Of 48 survivors, 7 had seizures, 6 motor deficits, 5 visual field defects, 29 headache (migraine in 14, tension headache in 13, other in 2). The logistic regression analysis found focal deficits and cancer at time of diagnosis, as independent predictors of dependence or death at year 3, and isolated intra-cranial hypertension as an independent predictor of survival and independence. Mortality rates are low in the absence of cancer and focal deficits, and more than 80 % of survivors are independent after 3 years. However, 3/4 of survivors have residual symptoms. Therefore, despite a low mortality rate, CVT remains a serious disorder. Author Affiliation: (1) Department of Neurology, Stroke Department, University of Lille, Roger Salengro Hospital, 59037 Lille, France. dleys@chru-lille.fr, FR (2) Dept. of Neuroradiology, Lille University Hospital, Lille, France, FR (3) Dept. of Intensive Care, Lille University Hospital, Lille, France, FR (4) Dept. of Neurology, Lens Hospital, Lens, France, FR (5) Dept. of Radiology, Lens Hospital, Lens, France, FR Article note: Received: 27 July 2001, Received in revised form: 17 April 2002, Accepted: 23 July 2002 Funding: grant 1993 from the Fondation pour la Recherche Medicale. Grant EA 2691 from the Ministere de l'Education Nationale, de la Recherche et de la Technologie. Correspondence to D. Leys

Byline: Jose A. Silva, Stephen R. Ramee, Christopher J. White, Tyrone J. Collins, J.Stephen Jenkins, Eduardo Nunez, Shuyang Zhang, Suresh P. Jain Abstract: Background The outcome of patients with diabetes after myocardial infarction (MI) has traditionally been worse than in their nondiabetic counterparts before and during the thrombolytic therapy era. Whether the fate of patients with diabetes might improve with mechanical intervention, particularly with primary stenting, has not previously been studied. Methods We compared the angiographic and clinical outcome of 76 nondiabetic patients (aged 61 [+ or -] 14 years; 66% male) and 28 patients with diabetes (aged 65 [+ or -] 12 years; 64% male) consecutively treated with primary stenting for acute MI. Coronary Thrombolysis In Myocardial Infarction grade 3 flow was restored in 96% of diabetic and 97% of nondiabetic patients. Results Angiographic results after stent deployment were similar in the 2 groups. At 1-month follow-up, all patients in both groups were alive. Patients with diabetes had a much higher incidence of stent thrombosis (18% vs 1%; P = .003), which accounted for the majority of the major cardiac events at 1 month (21% vs 4%; P = .009). At a mean follow-up of 315 [+ or -] 13 days, 99% of nondiabetic and 89% of patients with diabetes were alive (P = .04). Overall freedom from a major cardiac event (death, MI, target vessel revascularization) at 315 [+ or -] 13 day follow-up was 88% for nondiabetics and 54% for patients with diabetes (P = .0003). By multivariate analysis, diabetes mellitus was the most important predictor for development of 1-month (RR 9.89; 95% confidence interval, 1.6-30) and late major cardiovascular events (RR 8.39; 95% confidence interval, 2.93-24). Conclusions Primary stenting in acute MI is highly effective in restoring immediate TIMI 3 coronary flow in nondiabetic patients and patients with diabetes. This procedure may improve benefit in terms of mortality rate to both groups, particularly in patients with diabetes, compared with previous reports with thrombolytic therapy. Nevertheless, stent thrombosis and major cardiovascular events at 1 month and late follow-up are more frequent in patients with diabetes. (Am Heart J 1999;138:446-55.) Article History: Received 7 July 1998; Accepted 30 November 1998 Article Note: (footnote) [star] From the Department of Cardiology, Ochsner Medical Institutions., [star][star] Reprint requests: Stephen R. Ramee, MD, Cardiac Catheterization Laboratory, Department of Cardiology, Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA 70121.E-mail: sramee@aol.com , a 0002-8703/99/$8.00 + 0 4/1/96330

Byline: Y. Inoue (), M. Kato (), T. Ohsuka (), A. Morikawa () Abstract: We describe a 6-year-old girl with Epstein-Barr virus-related hemophagocytic lymphohistiocytosis who developed inferior vena cava (IVC) thrombosis during chemotherapy. Treatment with an anticoagulant, thrombolytic agent and short-term placement of an IVC filter was followed by complete resolution. Pulmonary perfusion scintigraphy performed subsequently revealed no evidence of pulmonary embolism. We conclude that temporary placement of an IVC filter can be an important part of the treatment of IVC thrombosis in children. Author Affiliation: () Department of Pediatrics, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan, JP

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2009.10.002 Byline: Edoardo Camenzind (a), William Wijns (b), Laura Mauri (c), Eric Boersma (d), Keyur Parikh (e), Volkhard Kurowski (f), Runlin Gao (g), Christoph Bode (h), John P. Greenwood (i), Anthony Gershlick (j), William O'Neill (k), Patrick W. Serruys (l), Brenda Jorissen (m), P. Gabriel Steg (n) Abstract: Drug-eluting stents (DES) reduce restenosis rates compared to bare-metal stents. Most trials using DES enrolled selected patient and lesion subtypes, and primary endpoint focused on angiographic metrics or relatively short-term outcomes. When DES are used in broader types of lesions and patients, important differences may emerge in long-term outcomes between stent types, particularly the incidence of late stent thrombosis. PROTECT is a randomized, open-label trial comparing the long-term safety of the zotarolimus-eluting stent and the sirolimus-eluting stent. The trial has enrolled 8,800 patients representative of those seen in routine clinical practice, undergoing elective, unplanned, or emergency procedures in native coronary arteries in 196 centers in 36 countries. Indications for the procedure and selection of target vessel and lesion characteristics were at the operator's discretion. Procedures could be staged, but no more than 4 target lesions could be treated per patient. Duration of dual antiplatelet therapy was prespecified to achieve similar lengths of treatment in both study arms. The shortest predefined duration was 3 months, as per the manufacturer's instructions. The primary outcome measure is the composite rate of definite and probable stent thrombosis at 3 years, centrally adjudicated using Academic Research Consortium definitions. The main secondary end points are 3-year all-cause mortality, cardiac death, large nonfatal myocardial infarction, and all myocardial infarctions. This large, international, randomized, controlled trial will provide important information on comparative rates of stent thrombosis between 2 different DES systems and safety as assessed by patient-relevant long-term clinical outcomes. Author Affiliation: (a) Cardiology Department, University Hospital, Geneva, Switzerland (b) Cardiovascular Center, OLV Hospital, Aalst, Belgium (c) Brigham and Women's Hospital, Boston, MA (d) Clinical Epidemiology Unit, Erasmus MC, Rotterdam, The Netherlands (e) The Heart Care Clinic, Ahmedabad, India (f) Universitatsklinikum Lubeck, Lubeck, Germany (g) Beijing Fuwai Hospital, Beijing, China (h) Universitatsklinikum Freiburg, Freiburg, Germany (i) Leeds General Infirmary, Leeds, UK (j) Glenfield Hospital, Leicester, UK (k) University of Miami Hospital Miller School of Medicine, University of Miami, Miami, FL (l) Erasmus MC, Thoraxcentrum, Rotterdam, The Netherlands (m) Medtronic Bakken Research Center, Maastricht, The Netherlands (n) INSERM U-698, Universite Paris 7, Assistance Publique - HA[acute accent]pitaux de Paris, Paris, France (o) Steering committee members and investigators are listed in . Article History: Received 9 March 2009; Accepted 2 October 2009 Article Note: (footnote) Clinical trial registration: ClinicalTrials.gov.no RCT no. NC T00476957.

Byline: S. J. M. Weatherby (1), N. C. Edwards (2), R. West (3), M. T. E. Heafield (2) Author Affiliation: (1) Neurology Department, City Hospital, Dudley Road, Birmingham, B18 7QH, UK (2) University Dept. of Neurosciences, Queen Elizabeth Hospital Edgbaston, Birmingham, UK (3) Dept. of Neuroradiology, Queen Elizabeth Hospital Edgbaston, Birmingham, UK Article History: Registration Date: 01/01/2003 Received Date: 23/12/2002 Accepted Date: 13/05/2003