Search

A randomized, controlled trial, known as the Autologous Stem-Cell Transplantation in Acute Myocardial Infarction (ASTAMI) study, was conducted to investigate whether intracoronary injection of autologous mononuclear bone marrow (BMC) results in a clinically important improvement in left ventricular function as measured by the left ventricular ejection factor (LVEF). Results showed no effects of intracoronary injection of autologous mononuclear BMC on global left ventricular function.

Background Cardiac allograft vasculopathy (CAV) is an accelerated form of atherosclerosis unique to heart transplant (HTX) patients. Purpose To investigate the detection of significant coronary artery stenosis and CAV, determinants of image quality, and the radiation dose in coronary computed tomography angiography (CCTA) of HTX patients with 64-slice multidetector CT (64-MDCT). Material and Methods Fifty-two HTX recipients scheduled for invasive coronary angiography (ICA) were prospectively enrolled and underwent CCTA before ICA with intravascular ultrasound (IVUS). Results Interpretable CCTA images were acquired in 570 (95%) coronary artery segments ≥2 mm in diameter. Sensitivity, specificity, and positive and negative predictive values of CCTA for the detection of segments with significant stenosis (lumen reduction ≥50%) on ICA were 100%, 98%, 7.7%, and 100%, respectively. Twelve significant stenoses were located in segments with uninterpretable image quality or vessel diameter <2 mm; only one was eligible for intervention. IVUS detected CAV (maximal intimal thickness ≥0.5 mm) in 33/41 (81%) patients; CCTA and ICA identified CAV (any wall or luminal irregularity) in 18 (44%) and 14 (34%) of these 33 patients, respectively. The mean estimated radiation dose was 19.0 ± 3.4 mSv for CCTA and 5.7 ± 3.3 mSv for ICA ( P < 0.001). Conclusion CCTA with interpretable image quality had a high negative predictive value for ruling out significant stenoses suitable for intervention. The modest detection of CAV by CCTA implied a limited value in identifying subtle CAV. The high estimated radiation dose for 64-MDCT is of concern considering the need for repetitive examinations in the HTX population. [ABSTRACT FROM AUTHOR]

Background: Routine angio-guided stent deployment results in a relatively high restenosis rate, which is mostly due to stent sub-expansion. Several different intravascular ultrasound (IVUS) criteria for optimal stent deployment have been proposed. A minimal in-stent restenosis and a minimal in-stent lumen area of > or = 9 mm2 have been associated with low rates of restenosis and target lesion revascularization (TLR) at 6 months. The role of high-pressure stent deployment and/or upsizing the post-dilatation balloon has not yet been clarified. The aim of this study was to evaluate the possibility of achieving accepted IVUS criteria safely without IVUS guidance with the combination of high-pressure deployment and post-dilatation with a 0.25 mm oversized balloon., Methods: Thirty-four stents (26 NIR, 3 AVE GFX, 3 ACS GFX, 1 Bard, 1 Jostent) were implanted in 30 patients until optimal angiographical results were obtained (< 10% residual stenosis visually). Forty percent of the patients had unstable angina pectoris, forty-four percent had complex lesions (B2 and C) and 29% were occlusions. Mean inflation pressure was 12.6 +/- 1.6 atm, mean stent diameter was 3.2+/- 0.4 mm and mean stent length was 15.1+/- 5.4 mm. Post-dilatation was performed with the same stent using a short (compared to the angiographic reference segment), 0.25 mm oversized Scimed Maxxum Energy 3.5 +/- 0.4 mm balloon using high pressure (16.1 +/- 1.7 atm) followed by an off-line IVUS examination of the stents. There was clinical follow-up for 1 year. Results in patients with single-vessel disease were compared with those of non-randomized controls, who were stented with high pressure but without over-dilatation., Results: No stent achieved the nominal diameter, in spite of over-dilatation. Mean minimal stent diameter (MLD) according to IVUS was 2.9 +/- 0.4 mm (92% of the angiographic reference diameter). Mean minimal lumen area (MLA) was 7.7 +/- 2.2 mm2. An in-stent MLA > or = 90% of the distal reference segment (AVID criteria) and an MLA > or = 100% or > or = 90% of the smallest/average reference segment (MUSIC criteria) was found in 67% and 57%, respectively. MLA > or = 9 mm2 was achieved in 38%. All stents had good apposition and obtained a symmetry index > or = 0.7 mm. No acute perforations, dissections or other serious complications occurred during the over-dilatation. At 1 year, five patients had re-angina leading to a new coronary angiography; only 1 patient had a significant in-stent restenosis requiring re-PTCA. Compared to non-overdilated historical controls, the standardized over-dilatation seemed to give a larger MLD (3.0 +/- 0.4 mm vs. 2.7 +/- 0.4 mm; p = 0.03), more patients who fulfilled AVID criteria (70% vs. 32%; p = 0.048) and more stents with MLA > or = 9 mm2 (46% vs. 11%; p = 0.02)., Conclusion: A standardized 0.25 mm over-dilatation of stents never achieved nominal stent size, but did improve lumen gain and was associated with low target vessel revascularization without adding complications to the routine stenting procedure.