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10. INtimal hyPerplasia evAluated by oCT in de novo COROnary lesions treated by drug-eluting balloon and bare-metal stent (IN-PACT CORO): study protocol for a randomized controlled trial

Author

Burzotta Francesco, Brancati Marta, Trani Carlo, Porto Italo, Tommasino Antonella, De Maria Gianluigi, Niccoli Giampaolo, Leone Antonio, Coluccia Valentina, Schiavoni Giovanni, and Crea Filippo

Subjects
Bare-metal stent, Drug-eluting balloon, Percutaneous coronary interventions, Medicine (General), R5-920
Abstract

Abstract Background Neointimal hyperplasia plays a pivotal role in the pathogenesis of in-stent restenosis in patients undergoing percutaneous coronary interventions. Drug-eluting balloons are a promising tool to prevent restenosis after coronary angioplasty. Moreover, an increased knowledge of the pathophysiology of restenosis my help improve therapeutic strategies. Methods/Design We present the design of an open-label, randomized three-arm clinical trial aimed to assess whether a strategy of bare-metal stent implantation with additional use of drug-eluting balloons, either before (pre-dilation) or after stenting (post-dilation), reduces the primary endpoint of in-stent neointimal hyperplasia area as compared with a strategy of bare-metal stent implantation alone. This primary endpoint will be assessed by optical coherence tomography at follow-up. Secondary endpoints will be the percentage of uncovered struts, and the percentage of struts with incomplete apposition. An ancillary study investigating the relation between systemic levels of endothelial progenitors cells and neointimal hyperplasia, and the interaction between endothelial progenitors cell levels and drug-eluting balloons has been planned. Thirty consecutive patients undergoing percutaneous coronary intervention will be randomized with a 1:1:1 design to bare-metal stent implantation alone (n = 10); bare-metal stent implantation after pre-dilation with a drug-eluting balloon (n = 10); or bare-metal stent implantation followed by post-dilation with a drug-eluting balloon (n = 10). Six-month follow-up coronary angiography with optical coherence tomography imaging of the stented segment will be performed in all patients. Blood samples for the assessment of endothelial progenitors cell levels will be collected on admission and at 6 months. Discussion Experimental and early clinical data showed that inhibition of neointimal hyperplasia may be obtained by local administration of antiproliferative drugs loaded on the surface of angioplasty balloons. The INtimal hyPerplasia evAluated by oCT in de novo COROnary lesions treated by drug-eluting balloon and bare-metal stent (IN-PACT CORO) trial was conceived to test the superiority of a strategy of bare-metal stent implantation with additional drug-eluting balloon use (either before or after stenting) versus a strategy of bare-metal stent implantation alone for the reduction of neointimal hyperplasia. We also planned an ancillary study to assess the role of endothelial progenitors cells in the pathophysiology of neointimal hyperplasia. Trial registration Clinicaltrials.gov NCT01057563.

Published
2012
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11. Comparison of Right and Left Upper Limb Arterial Variants in Patients Undergoing Bilateral Transradial Procedures

Author

Burzotta, Francesco, Brancati, Marta Francesca, Porto, Italo, Saffioti, Silvia, Aurigemma, Cristina, Niccoli, Giampaolo, Leone, Antonio Maria, Coluccia, Valentina, Crea, Filippo, Trani, Carlo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Porto, Italo (ORCID:0000-0002-9854-5046), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Crea, Filippo (ORCID:0000-0001-9404-8846), Trani, Carlo (ORCID:0000-0001-9777-013X), Burzotta, Francesco, Brancati, Marta Francesca, Porto, Italo, Saffioti, Silvia, Aurigemma, Cristina, Niccoli, Giampaolo, Leone, Antonio Maria, Coluccia, Valentina, Crea, Filippo, Trani, Carlo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Porto, Italo (ORCID:0000-0002-9854-5046), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Crea, Filippo (ORCID:0000-0001-9404-8846), and Trani, Carlo (ORCID:0000-0001-9777-013X)

Abstract

Transradial approach (TRA), when compared with transfemoral, improves the safety of percutaneous coronary procedures. Arterial axis variants are known to hinder the performance of transradial approach percutaneous coronary procedures. Data on the occurrence of arterial axis variants in the right and left arm arterial axes of individual patients are lacking.

Published
2015

12. Results of emergency postoperative re-angiography after cardiac surgery procedures

Author

Gaudino, Mario Fulvio Luigi, Nesta, Marialisa, Burzotta, Francesco, Trani, Carlo, Coluccia, Valentina, Crea, Filippo, Massetti, Massimo, Gaudino, Mario Fulvio Luigi (ORCID:0000-0001-7529-438X), Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Crea, Filippo (ORCID:0000-0001-9404-8846), Massetti, Massimo (ORCID:0000-0002-7100-8478), Gaudino, Mario Fulvio Luigi, Nesta, Marialisa, Burzotta, Francesco, Trani, Carlo, Coluccia, Valentina, Crea, Filippo, Massetti, Massimo, Gaudino, Mario Fulvio Luigi (ORCID:0000-0001-7529-438X), Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Crea, Filippo (ORCID:0000-0001-9404-8846), and Massetti, Massimo (ORCID:0000-0002-7100-8478)

Abstract

BACKGROUND: The purpose of this study was to evaluate the diagnostic and therapeutic role of emergency coronary angiography (ECA) in the setting of acute ischemic or hemodynamic instability after cardiac surgery. METHODS: Between January 2005 and September 2014 we prospectively collected data from a consecutive cohort of 5,275 patients who underwent cardiac surgery. Patients who underwent ECA due to new ST-segment changes on electrocardiogram (ECG), ventricular arrhythmias, cardiac arrest or hemodynamic collapse, new changes in regional wall motion, or any other relevant suspect of myocardial ischemia during postoperative intensive care unit stay were included. RESULTS: Forty patients (0.7% of the overall population) were enrolled. Nineteen patients (47.5%) received isolated coronary surgery, 21 (52.5%) underwent valve or aortic or combined operations. The most common indications to ECA were new ECG or echo signs of acute ischemia (62.5%). The mean time from primary operation to ECA was 51 hours (27 minutes to 9 days). Graft failure was found in 17 cases (42.5%), native coronary artery occlusion in 7 (20%), and coronary spasm in 5 (12.5%). No pathologic alterations were found in 7 cases (17.5%). Three patients (7.5%) underwent reoperation (group 1), 15 (37.5%) underwent percutaneous interventions (PCI) (group 2), and 22 (55%) were managed conservatively (group 3). In-hospital mortality was 100% in group 1, 6% in group 2, and 0% in group 3; 93% of the patients who underwent PCI had complete resolution of the ischemic or hemodynamic problems. No complications related to angiography occurred. Kaplan-Meier survival curves differed significantly according to the post-angiography management. At multivariate analysis combined surgery and the strategy of treatment were independent predictors of long-term mortality. CONCLUSIONS: Emergency coronary angiography is safe and allows diagnosis and resolution of the instability in the great majority of cases. An ECA should be the f

Published
2015

13. Usefulness of EuroSCORE systems for risk stratification

Author

Saffioti, Silvia, Burzotta, Francesco, Coluccia, Valentina, Trani, Carlo, Bruno, Piergiorgio, Massetti, Massimo, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Bruno, Piergiorgio (ORCID:0000-0002-1075-5808), Massetti, Massimo (ORCID:0000-0002-7100-8478), Crea, Filippo (ORCID:0000-0001-9404-8846), Saffioti, Silvia, Burzotta, Francesco, Coluccia, Valentina, Trani, Carlo, Bruno, Piergiorgio, Massetti, Massimo, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Bruno, Piergiorgio (ORCID:0000-0002-1075-5808), Massetti, Massimo (ORCID:0000-0002-7100-8478), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

Risk stratification of patients undergoing open-heart surgery or percutaneous interventions may help physicians select the best individual management of patients with advanced heart disease.European System for Cardiac Operative Risk Evaluation (EuroSCORE) is an easy-to-calculate, clinical scoring system which has been developed for coronary surgery and applied in various cardiological settings. Recently, the EuroSCORE II model has been launched with the aim of improving the stratification performance over the first model.In the present study, we review the available scientific data on the use of EuroSCORE systems in patients undergoing surgical or percutaneous procedures.

Published
2015

17. Three-year follow-up of patients with bifurcation lesions treated with sirolimus- or everolimus-eluting stents: SEAside and CORpal cooperative study

Author

Pan, M, Burzotta, Francesco, Trani, Carlo, Medina, A, Suárez De Lezo, J, Niccoli, Giampaolo, Romero, M, Porto, Italo, Mazuelos, F, Leone, Antonio Maria, Martín, P, Coluccia, Valentina, Ojeda, S, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Porto, Italo (ORCID:0000-0002-9854-5046), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Crea, Filippo (ORCID:0000-0001-9404-8846), Pan, M, Burzotta, Francesco, Trani, Carlo, Medina, A, Suárez De Lezo, J, Niccoli, Giampaolo, Romero, M, Porto, Italo, Mazuelos, F, Leone, Antonio Maria, Martín, P, Coluccia, Valentina, Ojeda, S, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Porto, Italo (ORCID:0000-0002-9854-5046), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

To compare the 3-year incidence of major events in patients with bifurcation lesions treated with provisional sirolimus-eluting stents vs everolimus-eluting stents.

Published
2014

18. Usefulness of EuroSCORE systems for risk stratification

Author

Saffioti, Silvia, Burzotta, Francesco, Coluccia, Valentina, Trani, Carlo, Bruno, Piergiorgio, Massetti, Massimo, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Bruno, Piergiorgio (ORCID:0000-0002-1075-5808), Massetti, Massimo (ORCID:0000-0002-7100-8478), Crea, Filippo (ORCID:0000-0001-9404-8846), Saffioti, Silvia, Burzotta, Francesco, Coluccia, Valentina, Trani, Carlo, Bruno, Piergiorgio, Massetti, Massimo, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Bruno, Piergiorgio (ORCID:0000-0002-1075-5808), Massetti, Massimo (ORCID:0000-0002-7100-8478), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

Risk stratification of patients undergoing open-heart surgery or percutaneous interventions may help physicians select the best individual management of patients with advanced heart disease.European System for Cardiac Operative Risk Evaluation (EuroSCORE) is an easy-to-calculate, clinical scoring system which has been developed for coronary surgery and applied in various cardiological settings. Recently, the EuroSCORE II model has been launched with the aim of improving the stratification performance over the first model.In the present study, we review the available scientific data on the use of EuroSCORE systems in patients undergoing surgical or percutaneous procedures.

Published
2014

19. Fractional flow reserve or optical coherence tomography guidance to revascularize intermediate coronary stenosis using angioplasty (FORZA) trial: study protocol for a randomized controlled trial

Author

Burzotta, Francesco, Leone, Antonio Maria, De Maria, Giovanni Luigi, Niccoli, Giampaolo, Coluccia, Valentina, Pirozzolo, Giancarlo, Saffioti, Silvia, Aurigemma, Cristina, Trani, Carlo, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), De Maria, Giovanni Luigi (ORCID:0000-0003-3572-1855), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Trani, Carlo (ORCID:0000-0001-9777-013X), Crea, Filippo (ORCID:0000-0001-9404-8846), Burzotta, Francesco, Leone, Antonio Maria, De Maria, Giovanni Luigi, Niccoli, Giampaolo, Coluccia, Valentina, Pirozzolo, Giancarlo, Saffioti, Silvia, Aurigemma, Cristina, Trani, Carlo, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), De Maria, Giovanni Luigi (ORCID:0000-0003-3572-1855), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Trani, Carlo (ORCID:0000-0001-9777-013X), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

The management of patients with angiographically intermediate coronary lesions is a major clinical issue. Fractional flow reserve provides validated functional insights while optical coherence tomography provides high resolution anatomic imaging. Both techniques may be applied to guide management in case of angiographically intermediate coronary lesions. Moreover, these techniques may be used to optimize the result of percutaneous coronary intervention. We aim to compare the clinical and economic impact of fractional flow reserve versus optical coherence tomography guidance in patients with angiographically intermediate coronary lesions.

Published
2014

20. Value of EuroSCORE II in Predicting Total and Cardiac Mortality in Patients Undergoing Percutaneous Coronary Interventions

Author

Saffioti, Silvia, Coluccia, Valentina, Burzotta, Francesco, Trani, Carlo, Niccoli, Giampaolo, Leone, Antonio Maria, Aurigemma, Cristina, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Crea, Filippo (ORCID:0000-0001-9404-8846), Saffioti, Silvia, Coluccia, Valentina, Burzotta, Francesco, Trani, Carlo, Niccoli, Giampaolo, Leone, Antonio Maria, Aurigemma, Cristina, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

n/a

Published
2014

21. Seguimiento de 3 años de pacientes con lesiones de bifurcación tratados con stents liberadores de sirolimus o everolimus: estudio de colaboración de SEAside y CORpal

Author

Pan, Manuel, primary, Burzotta, Francesco, additional, Trani, Carlo, additional, Medina, Alfonso, additional, Suárez de Lezo, Jose, additional, Niccoli, Giampaolo, additional, Romero, Miguel, additional, Porto, Italo, additional, Mazuelos, Francisco, additional, Leone, Antonio Maria, additional, Martín, Pedro, additional, Coluccia, Valentina, additional, Suárez de Lezo, Javier, additional, Ojeda, Soledad, additional, and Crea, Filippo, additional

Published
2014
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22. Fractional flow reserve or optical coherence tomography guidance to revascularize intermediate coronary stenosis using angioplasty (FORZA) trial: study protocol for a randomized controlled trial

Author

Burzotta, Francesco, primary, Leone, Antonio Maria, additional, De Maria, Giovanni Luigi, additional, Niccoli, Giampaolo, additional, Coluccia, Valentina, additional, Pirozzolo, Giancarlo, additional, Saffioti, Silvia, additional, Aurigemma, Cristina, additional, Trani, Carlo, additional, and Crea, Filippo, additional

Published
2014
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25. EuroSCORE predicts long-term mortality of unselected patients undergoing percutaneous coronary interventions

Author

Coluccia, Valentina, Burzotta, Francesco, Romagnoli, Enrico, Trani, Carlo, Giammarinaro, Maura, Talarico, Giovanni Paolo, Jannelli, Giuseppe Vincenzo, Niccoli, Giampaolo, Porto, Italo, Leone, Antonio Maria, Tommasino, Antonella, Schiavoni, Giovanni, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Porto, Italo (ORCID:0000-0002-9854-5046), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Crea, Filippo (ORCID:0000-0001-9404-8846), Coluccia, Valentina, Burzotta, Francesco, Romagnoli, Enrico, Trani, Carlo, Giammarinaro, Maura, Talarico, Giovanni Paolo, Jannelli, Giuseppe Vincenzo, Niccoli, Giampaolo, Porto, Italo, Leone, Antonio Maria, Tommasino, Antonella, Schiavoni, Giovanni, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Porto, Italo (ORCID:0000-0002-9854-5046), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

BACKGROUND: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a simple risk model able to predict early and late mortality after cardiac surgery. Recent data suggest that this score may also predict early clinical outcome after percutaneous coronary intervention (PCI). Data regarding EuroSCORE usefulness to predict late outcome after PCI in unselected patients are lacking. METHODS: EuroSCORE was prospectively assessed in consecutive patients undergoing PCI during 18 months. The primary end-point was cardiac mortality during the follow-up after PCI. Total mortality was the secondary end-point. Kaplan-Meyer analyses were performed dividing the study population in three subgroups according to the additive EuroSCORE algorithm (low risk group: EuroSCORE 0-2; medium risk group: EuroSCORE 3-5; high-risk group: EuroSCORE ≥ 6). Receiver operating characteristics (ROC) curve and landmark analysis on cardiac mortality after 30 days were performed. RESULTS: The study population comprised 1170 patients undergoing PCI. Mean follow-up duration was 633 days (range: 365-1000 days). Cardiac mortality was 2%; 2.4%; 13.2% in patients with low, medium and high EuroSCORE respectively. Kaplan-Meyer survival curves for cardiac death differed significantly between EuroSCORE groups (p<0.0001). The area under the ROC curve for the prediction of cardiac death was 0.77. Similar results were obtained for total mortality. At landmark analysis starting 30 days after PCI, EuroSCORE groups were significantly associated with different survival in the long term (P=0.014). CONCLUSION: EuroSCORE risk model can be efficiently utilized to predict late mortality in consecutive, unselected, patients undergoing PCI.

Published
2013

26. Management of the access site after transradial percutaneous procedures: literature overview

Author

Coluccia, Valentina, Burzotta, Francesco, Trani, Carlo, Brancati, Marta Francesca, Niccoli, Giampaolo, Leone, Antonio Maria, Schiavoni, Giovanni, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Crea, Filippo (ORCID:0000-0001-9404-8846), Coluccia, Valentina, Burzotta, Francesco, Trani, Carlo, Brancati, Marta Francesca, Niccoli, Giampaolo, Leone, Antonio Maria, Schiavoni, Giovanni, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

The transradial approach (TRA) is emerging as a promising strategy to improve the safety of percutaneous coronary diagnostic or interventional procedures. Nevertheless, a series of specific complications related to the radial access have been described so that their prevention and optimal management is clinically relevant. In this article, the types of access-related vascular complications potentially occurring after TRA and their possible management are described. In particular, the vascular complications have been classified in three groups according to the main pathogenetic mechanism: thrombotic, hemorrhagic and nonthrombotic nonhemorrhagic. Moreover, a practical operative protocol for prompt diagnosis and treatment has been proposed.

Published
2013

27. Management and timing of access-site vascular complications occurring after trans-radial percutaneous coronary procedures

Author

Burzotta, Francesco, Mariani, Luca, Trani, Carlo, Coluccia, Valentina, Brancati, Mf, Porto, Italo, Leone, Antonio Maria, Niccoli, Giampaolo, Tommasino, Antonella, Tinelli, Giovanni, Mazzari, Mario Attilio, Mongiardo, Rocco, Snider, Francesco, Schiavoni, Giovanni, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Porto, Italo (ORCID:0000-0002-9854-5046), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Tinelli, Giovanni (ORCID:0000-0002-2212-3226), Mazzari, Mario Attilio (ORCID:0000-0002-7301-6834), Snider, Francesco (ORCID:0000-0002-8102-7015), Crea, Filippo (ORCID:0000-0001-9404-8846), Burzotta, Francesco, Mariani, Luca, Trani, Carlo, Coluccia, Valentina, Brancati, Mf, Porto, Italo, Leone, Antonio Maria, Niccoli, Giampaolo, Tommasino, Antonella, Tinelli, Giovanni, Mazzari, Mario Attilio, Mongiardo, Rocco, Snider, Francesco, Schiavoni, Giovanni, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Porto, Italo (ORCID:0000-0002-9854-5046), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Tinelli, Giovanni (ORCID:0000-0002-2212-3226), Mazzari, Mario Attilio (ORCID:0000-0002-7301-6834), Snider, Francesco (ORCID:0000-0002-8102-7015), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

Access-site vascular complications (ASVC) in patients undergoing trans-radial coronary procedures are rare but may have relevant clinical consequences. Data regarding the optimal management of radial-access-related ASVC are lacking.

Published
2013

28. Intracoronary use of GP IIb/IIIa inhibitors in percutaneous coronary interventions

Author

De Vita, Maria, Coluccia, Valentina, Burzotta, Francesco, Romagnoli, Enrico, Trani, Carlo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), De Vita, Maria, Coluccia, Valentina, Burzotta, Francesco, Romagnoli, Enrico, Trani, Carlo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), and Trani, Carlo (ORCID:0000-0001-9777-013X)

Abstract

The glycoprotein (GP) IIb/IIIa receptor is critical to the process of platelet aggregation and thrombus formation as it serves as the final common pathway for platelet aggregation. For this reason, the development of GP IIb/IIIa inhibitors that block fibrinogen binding to the receptor has become an attractive strategy for antiplatelet therapy with an expected strong and specific effect. Presently, there are three commercially available GP IIb/IIIa inhibitors: abciximab, eptifibatide and tirofiban. All three drugs are commonly administered intravenously, and large-scale clinical trials have demonstrated a clear clinical benefit and good safety profile in patients at high risk, especially those undergoing percutaneous coronary interventions (PCI). Recently, several studies tested the intracoronary (IC) route for GP IIb/IIIa inhibitors in order to verify its safety and its possible superiority as compared to the intravenous (IV) route. The majority of the studies testing the IC route were conducted using abciximab and in patients with STEMI with better results in terms of myocardial reperfusion and infarct size and also promising results in terms of clinical outcome. On the IC administration of eptifibatide and tirofiban only some, even if promising, data are available. Larger and randomized studies are warranted to confirm the superiority of the IC route of administration of the GP IIb/IIIa inhibitors to the IV one in patients with coronary artery disease undergoing PCI.

Published
2012

29. Management and timing of access-site vascular complications occurring after trans-radial percutaneous coronary procedures

Author

Burzotta, Francesco, Mariani, Luca, Trani, Carlo, Coluccia, Valentina, Brancati, Marta Francesca, Porto, Italo, Leone, Antonio Maria, Niccoli, Giampaolo, Tommasino, Antonella, Tinelli, Giovanni, Mazzari, Mario Attilio, Mongiardo, Rocco, Snider, Francesco, Schiavoni, Giovanni, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Porto, Italo (ORCID:0000-0002-9854-5046), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Tinelli, Giovanni (ORCID:0000-0002-2212-3226), Mazzari, Mario Attilio (ORCID:0000-0002-7301-6834), Snider, Francesco (ORCID:0000-0002-8102-7015), Crea, Filippo (ORCID:0000-0001-9404-8846), Burzotta, Francesco, Mariani, Luca, Trani, Carlo, Coluccia, Valentina, Brancati, Marta Francesca, Porto, Italo, Leone, Antonio Maria, Niccoli, Giampaolo, Tommasino, Antonella, Tinelli, Giovanni, Mazzari, Mario Attilio, Mongiardo, Rocco, Snider, Francesco, Schiavoni, Giovanni, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Porto, Italo (ORCID:0000-0002-9854-5046), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Tinelli, Giovanni (ORCID:0000-0002-2212-3226), Mazzari, Mario Attilio (ORCID:0000-0002-7301-6834), Snider, Francesco (ORCID:0000-0002-8102-7015), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

Background: Access-site vascular complications (ASVC) in patients undergoing trans-radial coronary procedures are rare but may have relevant clinical consequences. Data regarding the optimal management of radial-access-related ASVC are lacking. Methods: During a period of 6 years we prospectively collected ASVC. ASVC were defined as any complication requiring ultrasound examination or upper limb angiography. ASVC were categorized according to the timing of diagnosis: "very early" (in the cath lab), "early" (after cath lab discharge, but during the hospital stay) and "late" (after hospital discharge). The need of surgery (primary end-point) and the development of neurological hand deficit (secondary end-point) were assessed. Results: Fifty-seven radial-artery related ASVC were collected. ASVC diagnosis was obtained by upper limb angiography in 25 patients (44%) and by Doppler in 32 patients (56%). Surgery was required in 6 cases (11%), the remaining patients receiving successful conservative management (which included prolonged local compression). Three patients (who received surgery) exhibited a mild neurological hand deficit in the follow-up. Need for surgery differed significantly according to timing of diagnosis as it occurred in 1 of 26 patients (3.8%) with "very early" diagnosis, in 1 of 21 patients (4.8%) with "early" diagnosis, and in 4 of 10 patients (40%) with "late" diagnosis (p = 0.026). Conclusions: ASVC are diagnosed with different timing after trans-radial procedures. Conservative management including local compression allows successful management in the majority of ASVC. Prompt recognition is pivotal as late diagnosis is associated to the need for surgery.

Published
2012

31. Management and timing of access-site vascular complications occurring after trans-radial percutaneous coronary procedures

Author

Burzotta, Francesco, primary, Mariani, Luca, additional, Trani, Carlo, additional, Coluccia, Valentina, additional, Brancati, Marta Francesca, additional, Porto, Italo, additional, Leone, Antonio Maria, additional, Niccoli, Giampaolo, additional, Tommasino, Antonella, additional, Tinelli, Giovanni, additional, Mazzari, Mario Attilio, additional, Mongiardo, Rocco, additional, Snider, Francesco, additional, Schiavoni, Giovanni, additional, and Crea, Filippo, additional

Published
2013
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32. EuroSCORE predicts long-term mortality of unselected patients undergoing percutaneous coronary interventions

Author

Coluccia, Valentina, primary, Burzotta, Francesco, additional, Romagnoli, Enrico, additional, Trani, Carlo, additional, Giammarinaro, Maura, additional, Talarico, Giovanni Paolo, additional, Jannelli, Giuseppe Vincenzo, additional, Niccoli, Giampaolo, additional, Porto, Italo, additional, Leone, Antonio Maria, additional, Tommasino, Antonella, additional, Schiavoni, Giovanni, additional, and Crea, Filippo, additional

Published
2013
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33. TCT-680 Long Term Outcome of Patients With Bifurcated Lesions Randomized to Sirolimus or Everolimus Eluting Stent: The Sea-Corp BC Study

Author

Burzotta, Francesco, primary, Manuel, Pan, additional, Carlo, Trani, additional, Alfonso, Medina, additional, Josè, Suàrez de Lezo, additional, Giampaolo, Niccoli, additional, Miguel, Romero, additional, Italo, Porto, additional, Francisco, Mazuelos, additional, Maria, Leone Antonio, additional, Pedro, Martin, additional, Coluccia, Valentina, additional, Javier, Suàrez de Lezo, additional, Soledad, Ojeda, additional, and Filippo, Crea, additional

Published
2012
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36. Seguimiento de 3 años de pacientes con lesiones de bifurcación tratados con stentsliberadores de sirolimus o everolimus: estudio de colaboración de SEAside y CORpal

Author

Pan, Manuel, Burzotta, Francesco, Trani, Carlo, Medina, Alfonso, Suárez de Lezo, Jose, Niccoli, Giampaolo, Romero, Miguel, Porto, Italo, Mazuelos, Francisco, Leone, Antonio Maria, Martín, Pedro, Coluccia, Valentina, Suárez de Lezo, Javier, Ojeda, Soledad, and Crea, Filippo

Abstract

Comparar la incidencia en 3 años de eventos mayores en pacientes con lesiones de bifurcación tratados con implante condicional de stentsliberadores de sirolimus frente a stentsliberadores de everolimus.

Published
2014
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37. Thrombus aspiration without additional ballooning or stenting to treat selected patients with ST-elevation myocardial infarction.

Author

Talarico GP, Burzotta F, Trani C, Porto I, Leone AM, Niccoli G, Coluccia V, Schiavoni G, and Crea F

Subjects
Aged, Aged, 80 and over, Coronary Angiography, Coronary Thrombosis therapy, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction diagnostic imaging, Myocardial Reperfusion, Suction, Angioplasty, Balloon, Coronary, Myocardial Infarction therapy, Stents, Thrombectomy methods
Abstract

Background: The use of thrombus aspiration during percutaneous coronary intervention (PCI) is recommended in patients with ST-elevation myocardial infarction (STEMI) undergoing mechanical revascularization. When thrombus aspiration is adopted, the standard technique includes, after mechanical thrombus extraction, angioplasty and/or stent implantation to eliminate residual stenosis. To date, no data are available concerning the use of thrombectomy alone without additional ballooning or stenting., Methods and Results: We report the angiographic and clinical outcome of a series of selected STEMI patients undergoing mechanical reperfusion by thrombus aspiration without additional ballooning or stenting. Four patients out of 316 consecutive STEMI patients were managed by thrombus aspiration alone (1.3%). All patients had angiographic documentation of an occlusive large intracoronary thrombus in the infarct-related artery before intervention and complete restoration of coronary flow in the absence of critical coronary stenosis after thrombus aspiration. Three of these patients had a clinical contraindication to dual antiplatelet therapy, thus suggesting that to avoid stent implantation would be advisable. Angiographic reevaluation was performed before discharge in 3 patients confirming persistent patency of the infarct-related artery (in 1 case the residual stenosis was judged to require intravascular ultrasound evaluation and subsequent elective PCI with stent implantation). The thirty-day clinical course was uneventful in all patients., Conclusions: In selected patients with STEMI undergoing mechanical reperfusion, thrombus aspiration without additional ballooning or stenting may be successfully performed. Further studies are needed to assess the clinical relevance of this novel approach.

Published
2010

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