Search

Since the first balloon angioplasty in 1977, remarkable advances in catheter-based technology have been achieved with the use of stents and intracoronary devices. However, despite these developments, visual assessment of a 2-dimensional lumenogram of the coronary vessels remains the predominant method of assessing coronary disease and guiding angioplasty worldwide. It is an enigma that there is still such a low uptake in the use of intravascular imaging, whether in the form of intravascular ultrasound (IVUS) or optical coherence tomography (OCT), with both techniques providing cross-sectional imaging of the coronary vessels with a resolution at the microscopic scale. The intracoronary imaging community tends to focus on the academic aspects of IVUS and OCT, often highlighting the evidence-based benefits in lesion subsets, such as left main stem or bifurcation percutaneous coronary intervention. However, this does not impart crucial practical-related aspects pertaining to IVUS or OCT, which can improve outcomes and achieve optimal results for operators and patients. Here, the authors present a case-based approach to IVUS and OCT use in contemporary clinical practice, with the hope of providing useful, practical insights for the busy interventionalist and prompting the consideration of intracoronary imaging catheters as an essential part of their percutaneous coronary intervention toolbox.

Percutaneous coronary intervention (PCI) has become an integral step in the management of patients with ischaemic heart disease. Bifurcation lesions are commonly encountered in PCI and are regarded as the most technically challenging lesions to treat. The literature is saturated with studies that explore the best way to treat these lesions, with a variety of techniques introduced to enable stenting of both vessels. However, the optimal method is still undetermined. In this state-of-the-art review, we discuss the various strategies that are currently regarded as ideal, particularly those which involve one or two-stent techniques. Moreover, dedicated bifurcation devices have been developed to facilitate bifurcation stenting and improve outcomes. The role of these devices in this context is also uncertain, therefore we will discuss the current evidence for their use. Finally, a road map on the ‘tips and tricks’ to successfully perform bifurcation PCI is mentioned, which will aid any interventionist performing this procedure in an optimal manner.

Objective: Pregnancy complicated by diabetes is associated with maternal complications and fetal abnormalities. Animal models of diabetes suggest that heightened free radical production may be implicated in the pathogenesis of this condition. The purpose of this investigation was to evaluate oxidative stress in plasma from diabetic rats and their fetuses through measurement of concentrations of 8-isoprostaglandin F2α, a stable marker of lipid peroxidation. Study Design: Diabetes was induced in virgin and pregnant rats with streptozotocin. Blood samples were collected after 20 days of diabetes. Adult and fetal plasma 8-isoprostaglandin F2α concentrations were determined by gas chromatography–mass spectroscopy. Results: Significantly higher plasma 8-isoprostaglandin F2α concentrations were observed in the virgin rats with diabetes and in both the pregnant dams with diabetes and their fetuses when compared with their respective control groups without diabetes (P < .001). Conclusion: Oxidative stress was induced in both mother and fetus in rodent pregnancy complicated by diabetes. This finding may have implications for fetal dysmorphogenesis and in fetal programming for adulthood disease. (Am J Obstet Gynecol 2000;183:1035-40.)

1. Western diets high in saturated fat are associated with an increased incidence of cardiovascular diseases. In this study we have evaluated vascular endothelial function and oxidative stress in virgin rats fed a normal (VC) or high in saturated fat diet (VHF) (20 % lard and corn oil w/w) from weaning until adulthood, and throughout subsequent pregnancy (PC and PHF, respectively). 2. The saturated fat diet was associated with enhanced noradrenaline sensitivity in small mesenteric arteries from VHF rats (VHF vs. VC, P < 0.05) and blunted endothelium-dependent relaxation in VHF and PHF rats (VHF vs. VC, P < 0.001; PHF vs. PC, P < 0.05). Endothelial dysfunction was attributable to a reduced nitric oxide component of relaxation in VHF rats, and blunted prostacyclin and endothelium-derived hyperpolarizing factor components in PHF rats. 3. Other than plasma cholesterol, which was reduced in VHF and PHF rats, plasma lipids were normal. Fasting plasma insulin and glucose concentrations were raised in VHF rats (P < 0.05) and the plasma marker of oxidative stress, 8-iso PGF2alpha, was increased in PHF animals (P < 0.01). 4. These findings suggest that endothelial dysfunction induced by a saturated fat diet is cholesterol independent and likely to be of different mechanistic origin in virgin and pregnant rats.

We conducted the "TAXUS Woman" analysis to assess the influence of sex on long-term outcomes after percutaneous coronary intervention using paclitaxel-eluting stents (PES) in a broad spectrum of patients.Previous studies indicate that the sex gap suggesting worse outcomes in women has narrowed. However, limited data are available on long-term sex-based outcomes with drug-eluting stents despite their extensive use in current practice.We analyzed 2,271 PES-treated patients (women = 665), from 5 randomized trials and 7,492 PES-treated patients (women = 2,449) from 2 "real-world" registries. The trial and registry datasets were stratified by sex to compare long-term outcomes. Additionally, the outcomes in PES-treated women were compared with bare-metal stent-treated women (n = 395) in the randomized trials.In the randomized trials, PES-treated women had a lower target lesion revascularization (TLR) rate (11.5% vs. 22.6%, p0.001) than bare-metal stent-treated women, with no significant sex-based differences in death, myocardial infarction, stent thrombosis, or TLR through 5 years. In both the trials and the registries, although women had more adverse baseline characteristics including advanced age, hypertension, and diabetes, they had similar outcomes to men. In expanded-use patients, however, women showed significantly higher rates of death and TLR, although only the higher TLR rate was confirmed by multivariate analysis.This study of nearly 10,000 patients including more than 3,000 women demonstrates that despite their higher-risk profile, women have comparable benefits to men from percutaneous coronary intervention with PES except for a slightly higher revascularization rate in the high-risk cohort.