Significant developments have occurred in the field of percutaneous interventions for structural heart disease over the last decade. The introduction of several innovations has expanded significantly ...the spectrum of therapeutic applications of structural interventional cardiology. However, the translation of the most recent scientific evidence into clinical practice and the adoption of new technologies may be susceptible to large variability, even within the same geographic area. This study aimed at describing current status and changing trends of structural heart interventions within 6 Regions in Italy.
Between July 2015 and October 2015, 6 regional delegations of the Italian Society of Interventional Cardiology (SICI-GISE) promoted a web-based multicenter survey concerning structural heart interventions. An ad hoc questionnaire was administered to head physicians of the cath-labs of 4 Regions of Northern Italy (Tuscany, Lombardy, Veneto and Emilia-Romagna) and 2 Regions of Southern Italy (Puglia and Campania). Also, in this study we considered previous data from a similar survey that involved Tuscany, Lombardy, Veneto and Emilia-Romagna between April 2014 and May 2014. Data from the two surveys were compared, observing the changing trends between 2014 and 2015.
The 2015 survey was completed in more than two thirds (68%) of the 145 eligible cath-labs. According to the survey, the application of percutaneous structural heart interventions and the availability of devices were wide and homogeneous within the 6 Regions involved. The main factors perceived as limiting the execution of structural heart interventions resulted economic (e.g. cost of procedures and devices) or organizational (e.g. limited diffusion of hybrid operating rooms).
In this study, which was based on the results of a recent survey conducted in 6 Italian Regions, structural heart interventions resulted widely growing throughout the investigated area. The indications for treatment and the availability of devices were relatively homogeneous between the regions involved, as well as the limiting factors, which appear to be mainly economic-organizational.
Purpose:
To determine the safety, feasibility, and efficacy of carotid artery stenting (CAS) in patients with acute stroke who underwent angioplasty of the extracranial internal carotid artery (ICA).
...Methods:
Patients were eligible for CAS if they presented within 6 hours of symptom onset and had a National Institutes of Health Stroke Scale (NIHSS) score >4. The records of all 18 acute stroke patients (11 men; mean age 68.3±14.3 years) who underwent endovascular intervention in the stroke-related extracranial ICA between May 2003 and February 2006 were reviewed. Fourteen (77.8%) had atheromatous obstructions and 4 (22.2%) had dissection of the extracranial ICA. Major adverse cerebral and cardiac events (MACCEs) and neurological status, including NIHSS and the modified Rankin Scale (mRS) scores, were recorded for all patients.
Results:
Successful revascularization was achieved in 83.3% (15/18) of the patients. Cerebral protection devices were applied successfully in 13 (72.2%). At discharge, a neurological improvement (NIHSS reduction ≥4) was observed in 77.8% (14/18) of patients. The clinical success rate was 72.2% (13/18). The median NIHSS was 8.5 on admission versus 4.5 at discharge (p<0.01). The 30-day death and stroke rate was 11.1%. During the 14.6±9.3-month followup, the MACCE and the death/stroke rates were 33.3% and 27.8%, respectively. The median mRS scores at 30 days and at midterm followup were 1 and 2.5, respectively (p=NS).
Conclusion:
Endovascular revascularization of the extracranial ICA in patients with acute ischemic stroke is associated with high procedural success rates and favorable midterm outcome.
Purpose:
To evaluate the immediate and midterm outcome and analyze the debris captured after repeat endovascular intervention for the treatment of in-stent restenosis after carotid artery stenting ...(CAS).
Methods:
Thirty-one consecutive patients (27 men; mean age 63.7±13.0 years, range 53–81) underwent repeat endovascular intervention (balloon angioplasty and provisional stenting) for the treatment of 32 in-stent restenoses following CAS.
Results:
Procedural success was achieved in all patients. An additional stent was implanted in 10 (31%) cases. No procedural complication was observed. Filter analysis was performed in 17 (53%) procedures; on 12 (71%), macroscopically visible material was captured. The histomorphometric analysis performed on 6 (19%) filters showed fibrin nets entrapping erythrocytes, leucocytes, platelets, and in 2 cases, fibrous hypercellular tissue fragments. At 30 days and during follow-up (mean 17±5 months), no deaths, transient ischemic attacks, or strokes were observed. In 1 (3.1%) patient, asymptomatic recurrence of ISR was found on Doppler ultrasonography and successfully treated with balloon angioplasty.
Conclusion:
Repeat endovascular intervention using balloon angioplasty with provisional stenting and routine cerebral protection appears to be a feasible, safe, and clinically effective strategy for the treatment of in-stent restenosis after CAS.
Abstract A 69-year-old female was hospitalized for acute coronary syndrome and received full antiplatelet and anticoagulant therapy. The patient underwent angioplasty and stent implantation on right ...coronary and left circumflex arteries with good angiographic result. After the procedure, the patient developed hemorrhagic shock due to massive left renal hemorrhage. An emergent digital subtraction angiography showed bleeding from a left segmental renal artery. The hemorrhage was successfully managed with transcatheter superselective embolization. The patient was discharged after 22 days in good general condition with normal renal function. One-year follow-up was uneventful.
We performed a percutaneous retrieval of a broken catheter from the left atrium in an adult patient using transseptal left heart catheterization and a helical basket guidewire. To our knowledge, this ...is the first description of such a therapeutical option for a foreign body lodged in the left atrium of an adult patient.
Background: There is very little known about the relationship between pre-intervention arterial pressure response to vasopressor therapy (PRV) and death rate, after primary angioplasty for immediate ...cardiogenic shock (CS) complicating acute myocardial infarction (AMI).
Methods: We examined data from 32 consecutive cases, admitted to our department within 12 h after the onset of MI and in CS, treated with direct PTCA, from May 1995 to March 2001. Intravenous administration of dobutamine and vasopressor agents was required in all patients before intervention.
Results: Ten patients, after vasopressor therapy, showed a significant improvement in systolic arterial pressure, invasively measured, (>90 mmHg, responders) before undergoing PTCA. Responders were younger and with less impaired pre-procedural LVEF (39.6%±10.7 vs. 30.9%±8.4,
P=0.02). After direct PTCA responders showed an improved final TIMI flow (2.8±0.6 vs. 2.2±0.7,
P=0.04) and blush grade (1.9±0.9 vs. 1±1,
P=0.03). The mortality rate was lower in responders compared with non-responders both in hospital (20% vs. 68%,
P=0.02) and at 3.5 years of follow-up (30% vs. 73%,
P=0.049). After adjustment by multivariate analysis older age and lower blush grade correlated with in hospital death, while age remained the only predictor of late death.
Conclusions: PRV was not an independent predictor of death after direct PTCA for CS. The association of no PRV with older age and lower post procedural blush grade may explain the difference in mortality rates between responders and non-responders.
BACKGROUNDThe optimal treatment of aneurysmal or ectatic culprit vessels in the setting of acute myocardial infarction is still matter of debate, as revascularization with either percutaneous ...intervention or surgery is associated with low procedural success and poor outcomes. CASE SUMMARYWe report the case of a 55-year-old male patient, admitted for inferior ST-elevation myocardial infarction, who underwent successful percutaneous implantation of a micro-mesh self-expanding nitinol carotid stent in a right coronary aneurysm with intravascular ultrasonography measured diameter of 9 mm and massive thrombus apposition. DISCUSSIONThe technical characteristics of the micro-mesh self-expanding nitinol carotid stent allow for adequate plaque coverage and good apposition even in large vessels, making this device particularly suitable for the treatment of coronary lesions with high thrombus burden, when severe coronary ectasia or aneurysms are present.
Questa tesi di dottorato ha per oggetto l’analisi della dimensione esterna della tutela dei dati personali, ossia lo studio dei meccanismi attraverso cui il diritto dell’Unione Europea assicura ai ...dati che vengono trasferiti verso Paesi terzi un elevato livello di protezione. In questo modo la tesi si propone di evidenziare i risultati conseguiti alla luce di quella che si rivela sempre più essere una vera e propria “politica estera legislativa” dell’Unione Europea volta alla protezione del diritto fondamentale alla tutela dei dati personali.
This doctoral thesis deals with the external dimension of personal data protection, thus with the mechanisms by which the law of the European Union ensures an adequate level of protection to the personal data that are transferred to third countries. Under this perspective, the aim of the thesis is to underline the achievements of what amounts to a “legislative foreign policy” of the European Union aimed at the protection of personal data as a fundamental right of the individuals.
PDF
