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Objectives: To obtain further, and more focused, information on the efficacy and safety of the antithrombotic regimens, including triple therapy (TT) of warfarin, aspirin, and clopidogrel; dual therapy (DT) of warfarin and single antiplatelet agent (aspirin or clopidogrel); and dual-antiplatelet therapy (DAPT) of aspirin and clopidogrel, prescribed to patients on oral anticoagulation (OAC) undergoing percutaneous coronary intervention with stent (PCI-S)., Background: The true efficacy and safety of TT, DT, and DAPT in OAC patients undergoing PCI-S is largely undefined., Methods: We analyzed the database of the prospective, multicenter WARfarin and coronary STENTing (WAR-STENT) registry (ClinicalTrials.gov identifier NCT00722319), only including the post-discharge period., Results: Of the 401 patients discharged alive from index hospitalization, 339 (85%), 20 (5%), and 42 (10%) were prescribed TT, DT, and DAPT, respectively. Throughout a mean follow-up of 368.3 ± 22.8 days, major adverse cardiovascular events (MACE) (including cardiovascular death, myocardial infarction, repeat revascularization, stent thrombosis, and thromboembolism), total bleeding, major bleeding, and combination of MACE plus total bleeding were comparable across the three treatment groups. The absolute rate of major bleeding with TT was 4%. The antithrombotic treatment actually ongoing at major bleeding was TT in 44%, DT in 50%, and DAPT in 6% of cases., Conclusion: In the real-world population of OAC patients undergoing PCI-S in the WAR-STENT registry, the three antithrombotic regimens of TT, DT, and DAPT showed comparable efficacy and safety. Due to several limitations, our data cannot be considered conclusive in confuting the current recommendations to prescribe TT. Further properly designed and sized studies are warranted.

Context: Percutaneous coronary revascularization of small vessels is associated with a high restenosis rate. Sirolimus-eluting stents reduce restenosis in simple and previously untreated lesions of large coronary arteries, but their outcomes in small vessels have not been adequately investigated., Objective: To determine whether sirolimus-eluting stents are associated with a reduced 8-month rate of angiographic restenosis in comparison with an uncoated stent., Design, Setting, and Patients: This was a randomized, multicenter, single-blind, prospective trial performed with 257 patients undergoing percutaneous coronary revascularization for ischemic heart disease, and who had a previously untreated atherosclerotic lesion located in a small segment with a diameter of 2.75 mm or less, in 20 Italian centers between August 2002 and December 2003., Intervention: Patients were randomly assigned to receive a sirolimus-eluting stent (129 patients) or an uncoated stent having an identical architecture and radiographic appearance (128 patients)., Main Outcome Measures: The primary end point was the 8-month binary in-segment restenosis rate; secondary end points included procedural success and the 8-month rate of major adverse cardiac and cerebrovascular events., Results: The mean (SD) reference diameter of the treated segment was 2.2 (0.28) mm; the lesion length, 11.84 (6.15) mm. After 8 months, the binary in-segment restenosis rate was 53.1% (60/113) in the patients receiving an uncoated stent and 9.8% (12/123) in those receiving a sirolimus-eluting stent (relative risk [RR], 0.18; 95% confidence interval [CI], 0.10-0.32; P<.001). Fewer patients randomized to sirolimus-eluting stents experienced major adverse cardiac events (12/129 [9.3%] vs 40/128 [31.3%]; RR, 0.30; 95% CI, 0.15-0.55; P<.001) mainly because of a reduction in target lesion revascularization (9/129 [7%] vs 27/128 [21.1%]; RR, 0.33; 95% CI, 0.14-0.70; P = .002) and myocardial infarction (2/129 [1.6%] vs 10/129 [7.8%]; RR, 0.20; 95% CI, 0.01-0.93; P = .04)., Conclusion: The use of sirolimus-eluting stents to treat atherosclerotic lesions in small coronary arteries reduces restenosis and may also reduce major adverse cardiac events.

We describe the case of a 60-year-old man with unstable angina and a critical stenosis of an unprotected left main stem. The patient was also affected with oligophrenia and Paget's disease that contraindicated surgical revascularization. We performed a percutaneous transluminal coronary angioplasty in the cardiac surgery operating room, preparing a femoro-femoral cardiopulmonary bypass by means of a portable X-ray system. The final results were good and they were confirmed by an angiographic control performed three months later as well as during the six-month follow-up. Angioplasty of the unprotected left main stem is feasible and adequate technologic support can reduce the risks for the patient.

Introduction: The ability to perform coronary angiography at the bedside has multiple applications., Methods: In this study, we compare the images obtained in 100 patients undergoing elective coronary angiography for coronary heart disease, with a portable X-ray imaging system (OEC 9600 Cardiac Version) to those obtained with a traditional fixed system (Siemens Coroskop C)., Results: A complete concordance between the systems for lesion location, stenosis quantification, morphologic characterization, TI-MI flow and collaterals was found., Conclusions: These findings demonstrate that a portable imaging system can produce high-quality images. The feasibility of performing a complete diagnostic procedure and the routine use of the system require more specific evaluation.

Stenosis is a common cause of the functional loss of vascular shunts used in chronic hemodialysis and percutaneous transluminal angioplasty represents the elective method to correct these anomalies. A total of 42 percutaneous transluminal angioplasties were performed, with a prospective study and follow-up lasting an average of 18 months, in 32 patients with insufficient blood flow of arteriovenous fistula. In over 90% of cases the procedure restored adequate hemodynamic conditions that remained unchanged during follow-up. The authors therefore conclude that percutaneous transluminal angioplasty is an efficacious, easily performed and low-cost method that does not present major complications.

We describe the case of a patient with unstable angina and left main coronary artery occlusion, yet with good collateral circulation from the right coronary artery, and with normal left ventricular function. We identified an anomalous vessel from the ascending aorta ensuring a good supply to the left coronary artery.

To verify the advantages and the systematic use of 5 French catheters in femoral percutaneous coronaroventriculography, 500 consecutive unselected patients with confirmed or suspected coronary artery disease underwent this procedure. In one case only (0.2%) we had recourse to 7 French catheters on account of the inability to enter the left coronary ostium. There were no major local complications. General complications were represented by vagal reactions in 20 cases (4%) and by transient minor motor aphasia in one case (0.2%). The cardiac complications were represented by: -1 (0.2%) atrio-ventricular isorhythmic dissociation; -1 (0.2%) complete right bundle branch block; -3 (0.6%) atrial fibrillation; (all had a rapid and spontaneous regression) -1 (0.2%) ventricular fibrillation treated successfully with D.C. shock; -1 (0.2%) non fatal acute myocardial infarction (at the end of the procedure); -2 (0.4%) attacks of cardiac asthma treated successfully with medical therapy. 5 French catheters have proved to be extremely efficacious, with some technical experience, in percutaneous coronaroventriculography via femoral approach. The possible advantages could consist of a reduction in local complications, a patient's precocious mobilization and a minor traumatism on the arterial wall. The major complications are comparable with those observed using 7-8 French catheters. In the future it might be possible, in selected patients, to use 5 French catheters to perform ambulatory cardiac catheterization with reduction of both costs and hospitalization period.