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Objective: This study aimed to investigate the predictive value of circumferential iliofemoral calcifications and current manufacturer recommendations, which are not evidence-based, in transfemoral (TF) transcatheter aortic valve implantation (TAVI) Methods: A patient cohort with a broad range of iliofemoral anatomies undergoing TF TAVI (n=132) were retrospectively divided as “suitable” (n=76, 58%) and “unsuitable” (n=56, 42%) candidates according to current recommendations. Iliofemoral angiography and reconstructed mul- tislice CT (MSCT) images were used for access screening in the majority of patients. Results: Vessel properties were significantly worse in the “unsuitable group.” The sheath-to-iliofemoral artery ratio (SIFAR) and calcium score were 1.35±0.2 and 1.7±0.8 in the unsuitable group, compared to 1.0±0.12 (p

CONTEXT The role of percutaneous closure of patent foramen oval (PFO) in patients with cryptogenic stroke has been very controversial for years due to a lack of clear evidence. OBJECTIVE Systematic review and meta analysis of the effect of percutaneous PFO closure for secondary prevention of cryptogenic strokes as compared to best medical therapy (BMT). DATA SOURCES Trials were identified through a literature search until 28 May 2013. STUDY SELECTION Controlled clinical trials (randomised and non randomised) comparing percutaneous PFO closure with BMT. DATA EXTRACTION AND SYNTHESIS Main end point of interest was stroke. A random effects model was used to calculate the pooled relative risks (RR) with 95 CIs. RESULTS A total of 14 studies (three randomised controlled trials (RCT) and 11 non randomised observational studies (non RCT)) and a total of 4335 patients were included for this analysis. There was no significant treatment effect of PFO closure regarding stroke among the RCT (RR 0.66 95 CI 0.37 to 1.19 p=0.171). However among non RCT stroke was reduced (RR 0.37 95 CI 0.20 to 0.67 p

CONTEXT The optimal treatment option for in stent restenosis is currently unclear. OBJECTIVE Systematic review and meta analysis of the effect of drug eluting balloons (DEB) to treat in stent restenosis. DATA SOURCES Trials were identified through a literature search from 2005 through 7 November 2012. STUDY SELECTION Randomised clinical trials comparing DEB with a control treatment (plain balloon angioplasty or drug eluting stents). DATA EXTRACTION AND SYNTHESIS Main endpoints of interest were major adverse cardiac events (MACE) target lesion revascularisation (TLR) binary in segment restenosis stent thrombosis (ST) myocardial infarction (MI) and mortality. A random effects model was used to calculate the pooled relative risks (RR) with 95 CIs. RESULTS Five studies and a total of 801 patients were included in this analysis. Follow up duration ranged from 12 to 60months. Most endpoints were significantly reduced for DEB compared with the control groups. For MACE the relative risk RR was 0.46 (0.31 to 0.70) p

In about 30% of patients undergoing coronary revascularisation by planned percutaneous coronary intervention (PCI), the procedure itself results in periprocedural myocardial necrosis.1 This form of PCI-related myocardial injury, which is often clinically silent, can be detected as an increase in serum cardiac enzymes above the 99th centile upper reference limit.2 Periprocedural myocardial necrosis following PCI, as measured by raised levels of serum troponin, has been shown to be associated with higher major adverse cardiac events (MACE), with a twofold and threefold increased risk of overall death and subsequent myocardial infarction, respectively.3 MACE are further amplified in the 15% of patients who experience periprocedural myocardial infarction (PMI) during the PCI procedure (termed type 4a myocardial infarction and defined as an elevation of cardiac biomarkers more than three times the 99th centile upper reference limit).2 The cause of PMI during PCI is multifactorial and includes distal coronary artery embolisation, side-branch occlusion, coronary dissection, occlusion of collaterals and epicardial or microvascular spasm (see figure 1).1 PMI following PCI can be visualised using cardiac MRI as discrete areas of late gadolinium enhancement, the extent of which correlates with the increase in serum cardiac enzymes.4 A wide variety of factors confer greater susceptibility to PMI during PCI. …

The Authors’ reply We thank Chen et al 1 for their feedback on our paper2 and we fully agree with most of their comments. Instent restenosis continues to be a problem even though the risk has been massively reduced by drug coating of stents.3 A significant proportion of patients had contraindications for drug-eluting stents (DES). Regarding the short-term and long-term follow-up data available for the PACCOCATH trial, we generally …

We thank Dr Ammirati and his colleagues for their very valuable comments on our paper.1 We agree with their interpretation, the low incidence of non-fatal strokes in the medical arm (