Internet data traffic capadty is rapidly reaching limits imposed by optical fiber nonlinear effects. Having almost exhausted available degrees of freedom to orthogonally multiplex data, the ...possibility is now being explored of using spatial modes of fibers to enhance data capadty. We demonstrate the viability of using the orbital angular momentum (OAM) of light to create orthogonal, spatially distinct streams of data-transmitting channels that are multiplexed in a single fiber. Over 1.1 kilometers of a specially designed optical fiber that minimizes mode coupling, we achieved 400-gigabits-per-second data transmission using four angular momentum modes at a single wavelength, and 1.6 terabits per second using two OAM modes over 10 wavelengths. These demonstrations suggest that OAM could provide an additional degree of freedom for data multiplexing in future fiber networks.
Abstract
Background
The recent development and widespread adoption of antegrade dissection re‐entry (ADR) techniques have been underlined as one of the antegrade strategies in all worldwide CTO ...consensus documents. However, historical wire‐based ADR experience has suffered from disappointing long‐term outcomes.
Aims
Compare technical success, procedural success, and long‐term outcome of patients who underwent wire‐based ADR technique versus antegrade wiring (AW).
Methods
One thousand seven hundred and ten patients, from the prospective European Registry of Chronic Total Occlusions (ERCTO), underwent 1806 CTO procedures between January 2018 and December 2021, at 13 high‐volume ADR centers. Among all 1806 lesions attempted by the antegrade approach, 72% were approached with AW techniques and 28% with wire‐based ADR techniques.
Results
Technical and procedural success rates were lower in wire‐based ADR than in AW (90.3% vs. 96.4%,
p
< 0.001; 87.7% vs. 95.4%,
p
< 0.001, respectively); however, wire‐based ADR was used successfully more often in complex lesions as compared to AW (
p
= 0.017). Wire‐based ADR was used in most cases (85%) after failure of AW or retrograde procedures. At a mean clinical follow‐up of 21 ± 15 months, major adverse cardiac and cerebrovascular events (MACCEs) did not differ between AW and wire‐based ADR (12% vs. 15.1%,
p
= 0.106); both AW and wire‐based ADR procedures were associated with significant symptom improvements.
Conclusions
As compared to AW, wire‐based ADR is a reliable and effective strategy successfully used in more complex lesions and often after the failure of other techniques. At long‐term follow‐up, patient's MACCEs and symptoms improvement were similar in both antegrade techniques.
PERSPECTIVES
What is known?
CTO PCI revascularization by wire‐based antegrade dissection re‐entry (ADR) techniques has been underlined as one of the antegrade strategies in all worldwide recent CTO consensus documents. However, the guidewire's behavior as first described in the STAR technique cannot be fully controlled, making this technique difficult to be standardized.
What is new?
Nowadays, new refined wire‐based ADR techniques might be a reliable alternative strategy for the treatment of most complex CTO lesions that are uncrossable by other antegrade or retrograde technique, achieving high procedural success rate, low occurrence of procedural adverse events, and similar MACCE rate at follow‐up as compared to antegrade wiring.
What is next?
Additional data are needed to definitively determine the impact of ADR techniques on CTO PCI strategy; second, it will be crucial to compare wire‐based ADR to device‐based strategy, hopefully in a prospective multicentre experience.
Background
Gender‐specific data addressing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in female patients are scarce and based on small sample size studies.
Aims
We ...aimed to analyze gender‐differences regarding in‐hospital clinical outcomes after CTO‐PCI.
Methods
Data from 35,449 patients enrolled in the prospective European Registry of CTOs were analyzed. The primary outcome was the comparison of procedural success rate in the two cohorts (women vs. men), defined as a final residual stenosis less than 20%, with Thrombolysis In Myocardial Infarction grade flow = 3. In‐hospital major adverse cardiac and cerebrovascular events (MACCEs) and procedural complications were deemed secondary outcomes.
Results
Women represented 15.2% of the entire study population. They were older and more likely to have hypertension, diabetes, and renal failure, with an overall lower J‐CTO score. Women showed a higher procedural success rate (adjusted OR aOR = 1.115, confidence interval CI: 1.011–1.230, p = 0.030). Apart from previous myocardial infarction and surgical revascularization, no other significant gender differences were found among predictors of procedural success. Antegrade approach with true‐to‐true lumen techniques was more commonly used than retrograde approach in females. No gender differences were found regarding in‐hospital MACCEs (0.9% vs. 0.9%, p = 0.766), although a higher rate of procedural complications was observed in women, such as coronary perforation (3.7% vs. 2.9%, p < 0.001) and vascular complications (1.0% vs. 0.6%, p < 0.001).
Conclusions
Women are understudied in contemporary CTO‐PCI practice. Female sex is associated with higher procedural success after CTO‐PCI, yet no sex differences were found in terms of in‐hospital MACCEs. Female sex was associated with a higher rate of procedural complications.
Spontaneous coronary artery dissection (SCAD) is a non-traumatic, non-atherosclerotic layering of the coronary artery wall due to the presence of a subintimal hematoma or an intimal tear with the ...creation of a false lumen that compresses the true lumen and restricts or obstructs the flow. Patients with SCAD and preserved coronary flow are treated conservatively according to the general recommendations. However, percutaneous coronary intervention should be considered in patients with artery occlusion and/or refractory ischemia. Stenting is associated with increased risks comprising stenting in the false lumen, in-stent thrombosis, and/or stent malappositon as well as antegrade or retrograde propagation of the intramural hematoma. Intracoronary imaging is of great value both for the diagnosis and treatment of SCAD. There is rising scrutiny on the use of cutting balloons in acute coronary syndrome caused by SCAD. The idea of using cutting balloons is to fenestrate the intima and drain the intramural hematoma. Our review presents an analysis of 17 published cases of cutting balloon (CB) use in SCAD. What is encouraging is that of the 12 published cases, in 11 Thrombolysis in Myocardial Infarction (TIMI) 3 flow was established with this technique, and TIMI 2 flow in one, without subsequent stent implantation. Four patients received a stent after the CB use, while one patient underwent CB angioplasty after hematoma propagation caused by stent implantation. In all cases, patients were asymptomatic at follow-up, with TIMI 3 flow.Spontaneous coronary artery dissection (SCAD) is a non-traumatic, non-atherosclerotic layering of the coronary artery wall due to the presence of a subintimal hematoma or an intimal tear with the creation of a false lumen that compresses the true lumen and restricts or obstructs the flow. Patients with SCAD and preserved coronary flow are treated conservatively according to the general recommendations. However, percutaneous coronary intervention should be considered in patients with artery occlusion and/or refractory ischemia. Stenting is associated with increased risks comprising stenting in the false lumen, in-stent thrombosis, and/or stent malappositon as well as antegrade or retrograde propagation of the intramural hematoma. Intracoronary imaging is of great value both for the diagnosis and treatment of SCAD. There is rising scrutiny on the use of cutting balloons in acute coronary syndrome caused by SCAD. The idea of using cutting balloons is to fenestrate the intima and drain the intramural hematoma. Our review presents an analysis of 17 published cases of cutting balloon (CB) use in SCAD. What is encouraging is that of the 12 published cases, in 11 Thrombolysis in Myocardial Infarction (TIMI) 3 flow was established with this technique, and TIMI 2 flow in one, without subsequent stent implantation. Four patients received a stent after the CB use, while one patient underwent CB angioplasty after hematoma propagation caused by stent implantation. In all cases, patients were asymptomatic at follow-up, with TIMI 3 flow.
In this study, the hepatoprotective effect of aminoguanidine in acute liver damage caused by carbon tetrachloride-CCl4 at a dose of 1 mL/kg, i.p. was investigated in experimental rats. Ten days of ...preventive treatment with aminoguanidine before exposure to toxic CCl4, at a dose of 150 mg/kg, i.p., led to significant reduction in biochemical markers of acute liver injury-AST(p < 0.001), ALT (p < 0.01), SDH (p < 0.05) and reduction in pro-oxidative markers-H2O2 (p < 0.05), TOS (p < 0.01), TBARS, and LOOH (p < 0.001) in relation to rats treated only CCl4. Treatment with aminoguanidine resulted in a significant reduction in the consumption of antioxidant-GR (p < 0.01), GST, GPx, GSH (p < 0.001), and a decrease in pro-inflammatory-TNF-α (p < 0.01), IL-1β, IL-6, NO and NGAL (p < 0.001) markers relative to animals exposed to CCl4 alone. Also, aminoguanidine pre-treatment leads to an increase in arginase activity (p < 0.001), and a decrease in citrulline concentration (p < 0.01), as well as polyamine catabolism enzyme activity-putrescin oxidase and spermine oxidase (p < 0.001) in comparison to the CCl4 group. Aminoguanidine led to a striking reduction of the necrotic field (p < 0.001), and a significant increase in the number of apoptotic hepatocytes (p < 0.001), as well as the proapoptotic markers-BAX and Caspase-3 (p < 0.05), compared to CCl4. The hepatoprotective mechanisms in CCl4 induce hepatotoxicity of aminoguanidine are based on the strong antioxidant effects, inhibition of pro-oxidative and pro-inflammatory mediators, as well as induction of damaged hepatocytes into apoptosis.
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•Aminoguanidine ameliorates the acute hepatotoxicdamage caused by CCl4.•Aminoguanidine prevents lipid peroxidation anddecreases oxidative stress.•Aminoguanidine prevents the diversion of the arginine metabolism towards citrulline.•Aminoguanidine decreases the pro-inflammatory markers (NGAL, TNF-α, IL-1β, IL-6, NO).•Aminoguanidine induces cell damage into apoptosis in CCl4 acute liver damage.
Introduction. Myocarditis is not a rare diagnosis, but its etiology often remains unknown as it requires extensive diagnostic work. Eosinophilic granulomatosis with polyangiitis (EGPA) or ...Churg-Strauss syndrome is a very rare systemic disease that is not easy to diagnose. Myocarditis in EGPA is uncommon and usually occurs in the late stages of the disease. Case report. A 22-year-old man was admitted with acute coronary syndrome. Using coronary angiography, the presence of stenoses on the epicardial coronary arteries was ruled out, and a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) was established. Then, we found inflammatory syndrome, eosinophilia, and a lot of systemic symptoms and signs. The diagnostic work included extensive laboratory tests, which ruled out infectious agents. Then, immunological tests, a computed tomography scan of the chest, cardiac magnetic reso-nance imaging (MRI) and a biopsy of the bone marrow, nasal mucosa, and skin were performed. We managed to establish the diagnosis of myopericarditis by cardiac MRI. The cause of myocarditis ? EGPA, was found only after the histopathological finding of the skin biopsy, which enabled ad-equate immunosuppressive therapy. Conclusion. The accurate diagnosis was crucial for the correct, causal treatment of the patient, especially because he needed life-long immunosuppressive therapy. In order for such complex patients to receive adequate treatment, a multidisciplinary approach and perseverance in the diagnostic evaluation of the etiology of myocarditis are necessary.
Arterial Hypertension (HTN) is a key risk factor for left ventricular hypertrophy (LVH) and a cause of ischemic heart disease (IHD). The association between myocardial ischemia and HTN LVH is strong ...because myocardial ischemia can occur in HTN LVH even in the absence of significant stenoses of epicardial coronary arteries.
To analyze pathophysiological characteristics/co-morbidities precipitating myocardial ischemia in patients with HTN LVH and provide a rationale for recommending beta-blockers (BBs) to prevent/treat ischemia in LVH.
We searched PubMed, SCOPUS, PubMed, Elsevier, Springer Verlag, and Google Scholar for review articles and guidelines on hypertension from 01/01/2000 until 01/05/2022. The search was limited to publications written in English.
HTN LVH worsens ischemia in coronary artery disease (CAD) patients. Even without obstructive CAD, several pathophysiological mechanisms in HTN LVH can lead to myocardial ischemia. In the same guidelines that recommend BBs for patients with HTN and CAD, we could not find a single recommendation for BBs in patients with HTN LVH but without proven CAD. There are several reasons for the proposal of using some BBs to control ischemia in patients with HTN and LVH (even in the absence of obstructive CAD).
Some BBs ought to be considered to prevent/treat ischemia in patients with HTN LVH (even in the absence of obstructive CAD). Furthermore, LVH and ischemic events are important causes of ventricular tachycardia, ventricular fibrillation, and sudden cardiac death; these events are another reason for recommending certain BBs for HTN LVH.
Although selective coronary angiography is the gold standard diagnostic technique for coronary lesions, this method does not provide all information regarding pathophysiologic mechanisms. We herein ...describe a patient in their early 60s with a 3-month history of pronounced angina. Coronary angiography revealed a central line of illumination in the proximomedial segment of the right coronary artery, suggesting a chronic coronary dissection/recanalized thrombus, along with positive remodeling and TIMI grade 2 flow. Optical coherence tomography showed a recanalized thrombus and multiple lumens separated by thin septa. Because of the significantly reduced flow and signs of ischemia in the right coronary artery irrigation territory, we decided to perform percutaneous coronary intervention. Post-treatment optical coherence tomography indicated optimal apposition and expansion of the stents with positive remodeling of the blood vessel. We believe that decisions regarding treatment modalities should be guided by the presence or absence of ischemia. Lesions that are causing myocardial ischemia should be revascularized; otherwise, medical treatment can be utilized.
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion ...segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
Global Chronic Total Occlusion Crossing Algorithm Wu, Eugene B.; Mashayekhi, Kambis; Tsuchikane, Etsuo ...
Journal of the American College of Cardiology,
08/2021, Letnik:
78, Številka:
8
Journal Article
Recenzirano
Odprti dostop
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion ...segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
Display omitted
•Several regional crossing algorithms for chronic total coronary artery occlusive lesions (CTO) have been published.•The authors of these regional algorithms from 50 countries have collaborated in developing a global CTO crossing algorithm.•This algorithm can encourage discussion, promote research collaboration, facilitate training and improve outcomes of percutaneous revascularization for patients with CTO.
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