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BackgroundTreatment of calcified (in contrast to simple) lesions with PTCA has been associated with a lower success rate and more procedural complications. Rotablation can improve acute results, but the high restenosis rate remains a problem. The purpose of this study was to evaluate the clinical and angiographic outcome of patients with complex and calcified lesions treated with a combination of rotablation and stenting.Methods and resultsSeventy-five consecutive patients with 106 lesions had rotablation prior to coronary stenting. Intravascular ultrasound-guided stenting was used without subsequent anticoagulation in 93% of patients. Procedural success was achieved in 93.4% of lesions. Acute stent thrombosis occurred in two lesions (1.9%), and subacute stent thrombosis in one lesion (0.9%). Angiographic follow-up was performed in 82.5% of lesions at 4.6 +/- 1.9 months with an angiographic restenosis rate of 22.5%. Clinical follow-up was performed in all patients at 6.4 +/- 3 months; target lesion revascularization was needed in 18% of lesions; Q-wave myocardial infarction occurred in 1.3%, coronary bypass surgery in 4.0%, and death in 1.3%.ConclusionsOptimal coronary stenting after rotablation in calcified and complex lesions can be performed with a high success rate, an acceptable rate of procedural complications, and a low rate of stent thrombosis. This approach was associated with a low incidence of angiographic restenosis compared with results usually obtained with other interventional strategies in calcified and complex lesion subsets.

BackgroundThe placement of stents in coronary arteries has been shown to reduce restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the risk of subacute stent thrombosis and complications associated with the anticoagulant regimen. To reduce these complications, the hypothesis that systemic anticoagulation is not necessary when adequate stent expansion is achieved was prospectively evaluated on a consecutive series of patients who received intracoronary stents.Methods and resultsFrom March 1993 to January 1994, 359 patients underwent Palmaz-Schatz coronary stent insertion. After an initial successful angiographic result with < 20% stenosis by visual estimation had been achieved, intravascular ultrasound imaging was performed. Further balloon dilatation of the stent was guided by observation of the intravascular ultrasound images. All patients with adequate stent expansion confirmed by ultrasound were treated only with antiplatelet therapy (either ticlopidine for 1 month with short-term aspirin for 5 days or only aspirin) after the procedure. Clinical success (procedure success without early postprocedural events) at 2 months was achieved in 338 patients (94%). With an inflation pressure of 14.9 +/- 3.0 atm and a balloon-to-vessel ratio of 1.17 +/- 0.19, optimal stent expansion was achieved in 321 of the 334 patients (96%) who underwent intravascular ultrasound evaluation, with these patients receiving only antiplatelet therapy after the procedure. Despite the absence of anticoagulation, there were only two acute stent thromboses (0.6%) and one subacute stent thrombosis (0.3%) at 2-month clinical follow-up. Follow-up angiography at 3 to 6 months documented two additional occlusions (0.6%) at the stent site. At 6-month clinical follow-up, angiographically documented stent occlusion had occurred in 5 patients (1.6%). At 6-month clinical follow-up, there was a 5.7% incidence of myocardial infarction, a 6.4% rate of coronary bypass surgery, and a 1.9% incidence of death. Emergency intervention (emergency angioplasty or bailout stent) for a stent thrombosis event was performed in 3 patients (0.8%). The overall event rate was relatively high because of intraprocedural complications that occurred in 16 patients (4.5%). Intraprocedural complications, however, decreased to 1% when angiographically appropriately sized balloons were used for final stent dilations. There was one ischemic vascular complication that occurred at the time of the procedure and one ischemic vascular complication that occurred at the time of angiographic follow-up. By 6 months, repeat angioplasty for symptomatic restenosis was performed in 47 patients (13.1%).ConclusionsThe Palmaz-Schatz stent can be safely inserted in coronary arteries without subsequent anticoagulation provided that stent expansion is adequate and there are no other flow-limiting lesions present. The use of high-pressure final balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound provide assurance that anticoagulation therapy can be safely omitted. This technique significantly reduces hospital time and vascular complications and has a low stent thrombosis rate.

The purpose of this study was to prospectively test the hypothesis that systemic anticoagulation is not needed following coronary stenting when adequate stent expansion is achieved and documented and other flow limitations eliminated. Intravascular ultrasound (IVUS) was used to confirm adequate stent expansion, which was defined as good plaque compression together with the achievement of an intrastent lumen cross-sectional area (CSA) that was greater than 40% of the average reference vessel CSA. In this prospective study, Palmaz-Schatz coronary stenting was performed on 343 lesions in 263 consecutive patients. Primary stenting was successful in 254 patients (96.6%) and 332 lesions (96.8%). All patients with successful primary stenting underwent IVUS imaging except nine patients (13 lesions) that did not have an IVUS evaluation for technical reasons and three patients (4 lesions) in which IVUS was unsuccessful. The initial IVUS performed after achieving an acceptable angiographic result revealed inadequate stent expansion in 191 patients (79%) and 244 lesions (77%). After further dilatation, final adequate stent expansion was accomplished in 230 patients and 301 lesions. These patients were treated with Ticlopidine 250 mg twice per day for 2 months and did not receive postprocedure anticoagulation. There was one acute stent thrombosis (0.3%) that occurred in a lesion with slow flow and an inadequately expanded stent. There was no subacute stent thrombosis and no bleeding or vascular complications. We conclude that when adequate stent expansion is achieved and confirmed and other flow limiting lesions eliminated, that systemic anticoagulation after the stent procedure is not necessary.

The Bible contains numerous lists of anthroponyms, organized according to genealogical structures. This article specifically focuses on five of these lists, which include: 1) the genealogy of Cain, son of Adam, as described in the fourth and fifth chapters of Genesis; 2) the genealogy presented in the book of Chronicles, spanning chapters 1.1 to 9.44; 3) the genealogy of Jesus outlined in the Gospel of Matthew; 4) the genealogy of Jesus as recorded in the Gospel of Luke; and 5) the concise repetition found throughout the Bible: «I am the God of Abraham, Isaac, and Jacob.» The underlying question this text seeks to address is: what purpose do these extensive lists of anthroponyms serve in a text that is meant to convey a divine revelation? To explore this query, the article delves into two significant aspects of Judeo-Christian religions. Firstly, the prohibition on pronouncing the name of God, and secondly, the covenant of alliance between God and His people. These two aspects of the relationship between humans and God may appear contradictory. However, it is suggested that these lists of anthroponyms, which serve as the starting point of the research, may help reconcile this contradiction. The faithful, unable to directly invoke the name of God, can instead invoke Him through the names of His sons. This is because the 'Holy Spirit' is believed to have been infused by God into the spirit of Adam, and subsequently transmitted from one generation to another, dwelling within the spirits of those descended from Adam. The paper concludes by proposing the hypothesis that these extensive series of anthroponyms constitute the formula that enables the naming of the unutterable, representing an infinite periphrasis for the unpronounceable name of God. [ABSTRACT FROM AUTHOR]

The scope of this analysis is to reconstruct, with a brief look to the Italian case, the 'frame of reference' within which the rulings of the ECtHR on the Art. 6 of the ECHR, due to the particular strength that Article 46 of the Convention attributes to them, are made, to understand, at the outcome, how, and to what extent, the sanctioning activity of public bodies can be influenced by the principles of the ECHR as enforced by the Judges of Strasbourg. To this aim the focus will be addressed on the following, and more complex, profiles: (a) independence, impartiality and separation of functions; (b) sanctioning activity and discretionary powers; (c) sufficient judicial review and full jurisdiction, to conclude the investigation trying to verify, in the light of the latest directions taken by the ECtHR; (d) whether, and how, the types of sanctions can affect the conditions of the judicial protection. [ABSTRACT FROM AUTHOR]

Although the science of the occult properties of the Qurʾān (ʿilm ḫawāṣṣ al-Qurʾān) has been regarded by Muslim intellectuals as an independent discipline within the classification of the sciences and has generated an independent literary genre over the centuries, it has never been the subject of a specific survey within Islamic Studies. Often wrongly considered simply as a component of related disciplines, the most important texts belonging to this genre remain understudied and are not critically edited. Many reasons suggest that the study of the genesis of this concept, of the homonymous discipline and of its literary corpus represent an important desideratum for the history of magic and of the occult sciences in Islam. Based on philological examination of numerous primary sources, this article aims to situate the science of the occult properties of the Qurʾān and its literature within the History of ideas in the Muslim world. [ABSTRACT FROM AUTHOR]