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Popolo Rubbio A, Testa L, Pivato CA, Regazzoli D, Piccolo R, Esposito G, Musto C, Scalia L, Pacchioni A, Briguori C, Lucisano L, De Luca L, Conrotto F, Tartaglia F, Latini AC, Stankowski K, Chiarito M, Sardella G, Indolfi C, Bedogni F, Reimers B, Condorelli G, Stefanini GG. Application of the Academic Research Consortium High Bleeding Risk criteria in patients treated with coronary bioresorbable polymer everolimus-eluting stents: Insights from the POEM trial. Cardiovasc Revasc Med 2024:S1553-8389(24)00174-X. [PMID: 38702260 DOI: 10.1016/j.carrev.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/16/2024] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Previous studies have investigated a 1 to 6-month short dual antiplatelet therapy (S-DAPT) after percutaneous coronary intervention (PCI) with modern drug eluting-stents to reduce bleeding events. OBJECTIVES To investigate cardiovascular outcomes in patients at high bleeding risk (HBR) according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria after PCI with the Synergy bioresorbable-polymer everolimus-eluting stents (EES). METHODS We applied ARC-HBR criteria in the population of the prospective, single-arm, multicenter POEM (Performance of Bioresorbable Polymer-Coated Everolimus-Eluting Synergy Stent in Patients at HBR Undergoing Percutaneous Coronary Revascularization Followed by 1-Month Dual Antiplatelet Therapy) trial. The primary endpoint was a composite of cardiac death, myocardial infarction, or definite or probable stent thrombosis at 12 months. RESULTS The original POEM cohort included 356 patients (80.4 %) fulfilling ARC-HBR criteria. Oral anticoagulant (OAC) usage and age ≥75 years were the most frequent major and minor ARC-HBR criteria, respectively. The ARC-HBR group was mainly represented by men (71.1 %), with 74.4 ± 9.3 years and a high burden of cardiovascular risk factors. DAPT was prescribed in 79.3 %, and single antiplatelet (SAPT) with OAC in 18.7 %. 12-month follow-up was completed in 96.2 %. The primary endpoint occurred in 5.2 % (95 % CI 3.29-8.10) of patients, whereas bleeding Academic Research Consortium type 3-5 occurred in 2.7 % (95 % CI, 1.39 %-5.05 %). CONCLUSION Previous results of the POEM trial showed positive outcomes regarding ischemic and bleeding events with an S-DAPT regimen after Synergy EES. These results are also confirmed in sub-group analysis when ARC-HBR criteria are applied.
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Affiliation(s)
- Antonio Popolo Rubbio
- IRCCS Policlinico San Donato, Department of Clinical and Interventional Cardiology, San Donato Milanese, Milan, Italy
| | - Luca Testa
- IRCCS Policlinico San Donato, Department of Clinical and Interventional Cardiology, San Donato Milanese, Milan, Italy.
| | - Carlo A Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Italy
| | - Carmine Musto
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Lorenzo Scalia
- IRCCS Policlinico San Donato, Department of Clinical and Interventional Cardiology, San Donato Milanese, Milan, Italy
| | | | | | | | - Leonardo De Luca
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Francesco Tartaglia
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessia C Latini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Francesco Bedogni
- IRCCS Policlinico San Donato, Department of Clinical and Interventional Cardiology, San Donato Milanese, Milan, Italy
| | | | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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2
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Pellegrini P, Conte L, Angheben C, Pacchioni A. A right wire in the wrong place. Intern Emerg Med 2024; 19:577-579. [PMID: 37751085 DOI: 10.1007/s11739-023-03429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Paolo Pellegrini
- Outpatient Cardiology Clinic, Azienda ULSS9 Scaligera, Verona, Italy.
| | - Luca Conte
- Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Carlo Angheben
- Division of Cardiology, Santa Maria del Carmine Hospital, Rovereto, Italy
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Musto C, Paolucci L, Pivato CA, Testa L, Pacchioni A, Briguori C, Esposito G, Piccolo R, Lucisano L, De Luca L, Conrotto F, Sanz-Sanchez J, Cesario V, De Felice F, Latini AC, Regazzoli D, Sardella G, Indolfi C, Reimers B, Condorelli G, Stefanini G. One-Month Dual Antiplatelet Therapy in Patients With Chronic and Acute Coronary Syndromes Treated With Bioresorbable Polymer Everolimus-Eluting Stents. Am J Cardiol 2023; 207:170-178. [PMID: 37741107 DOI: 10.1016/j.amjcard.2023.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/25/2023]
Abstract
There is a paucity of data regarding the safety of a 1-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) presenting with acute coronary syndromes (ACS). We aimed to compare the clinical outcomes of patients at HBR with chronic coronary syndrome (CCS) or ACS treated with PCI using bioresorbable polymer everolimus-eluting stent (BP-EES) followed by 1-month DAPT. Patients at HBR who underwent PCI with BP-EES were prospectively enrolled in 10 Italian centers. All patients were treated with 1-month DAPT. In case of need for anticoagulation, patients received an oral anticoagulant in addition to a P2Y12 inhibitor for 1 month, followed by oral anticoagulation only after that. The primary end point was a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis at 12 months. Overall, 263 patients (59.4%) with CCS and 180 patients (40.6%) with ACS were enrolled. No significant difference was evident between patients with CCS and ACS for the primary end point (4.3% vs 5.6%, respectively, p = 0.497) and for each isolated component. The risk for Bleeding Academic Research Consortium (BARC) type 1 to 5 or type 3 to 5 bleedings was also similar between patients with CCS and ACS (4.3% vs 5.2%, p = 0.677, and 1.6% vs 2.9%, p = 0.351, respectively). In conclusion, among HBR patients with ACS who underwent PCI with BP-EES, a 1-month DAPT strategy is associated with a similar risk of ischemic and bleeding events compared with those with CCS.
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Affiliation(s)
- Carmine Musto
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Paolucci
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Testa
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | | | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Italy
| | | | - Leonardo De Luca
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Jorge Sanz-Sanchez
- Cardiology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Vincenzo Cesario
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesco De Felice
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Alessia Chiara Latini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | | | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
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Pacchioni A, Pesarini G, Sanz-Sanchez J, Sgueglia GA, Bellamoli M, Ferro J, Mugnolo A, Morandin R, Penzo C, Turri R, Guiducci V, Benfari G, Giovannini D, Saccà S, Ribichini FL, Versaci F, Biondi-Zoccai G, Reimers B. Radial artery occlusion after transradial procedures: impact on 1-year adverse events. Minerva Cardiol Angiol 2023; 71:414-420. [PMID: 36468762 DOI: 10.23736/s2724-5683.22.06112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Radial artery occlusion after transradial procedures is a frequent iatrogenic thrombotic process. The impact on prognosis has not been investigated. This study sought to investigate whether radial artery occlusion is related to increased risk of major adverse cardiac and cerebrovascular events, defined as death, myocardial infarction, stroke and coronary revascularization. METHODS Eight hundred thirty-seven consecutive patients who underwent a transradial coronary procedure had patency of radial artery checked at 24 hours. Radial artery occlusion occurred in 41 over 837 patients (4.8%); 764 (91.2%) were available for planned follow-up at 1 year and were included in the analysis. Event-free survival rate between patients with and without radial artery occlusion was calculated using Kaplan-Meier estimates, and Cox proportional-hazards models were used to identify independent risk factors. RESULTS At a median 370-day follow-up (IQR: 366-375 days), adverse events occurred in 37 patients (4.8%), 2 in patients with radial artery occlusion and 35 in patients without. One-year survival rate was 94.9% vs. 95% (unadjusted HR=1.026, 95% CI: 0.24 to 4.6, P=0.9). After multivariable modeling, age and coronary artery disease extension was associated with increased risk of adverse events. CONCLUSIONS Age and coronary artery disease extension were independent predictors of adverse events at follow-up. RAO had no prognostic impact.
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Affiliation(s)
- Andrea Pacchioni
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy -
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jorge Sanz-Sanchez
- Division of Cardiology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Division of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Centro de Investigation Biomedica en Red (CIBERCV), Madrid, Spain
| | | | - Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jayme Ferro
- Arcispedale Santa Maria, Reggio Emilia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Riccardo Morandin
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Penzo
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Riccardo Turri
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | | | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Giovannini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Salvatore Saccà
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Versaci
- UOC of Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Bernhard Reimers
- Division of Cardiology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
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Cacia M, Cozzi O, Gohar A, Mangieri A, Sorropago G, Pacchioni A, Saccà S, Favero L, Regazzoli D, Reimers B. Different Degrees of Degeneration of Transcatheter Valves Implanted in the Aortic Position or Embolized Distally: A Case Report. Cardiovasc Revasc Med 2023; 53S:S144-S148. [PMID: 36402699 DOI: 10.1016/j.carrev.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Michele Cacia
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ottavia Cozzi
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Aisha Gohar
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antonio Mangieri
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | - Luca Favero
- Cardiology, ULSS2 Treviso Hospital, Treviso, Italy
| | - Damiano Regazzoli
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Clinical and Interventional Cardiology, Cardiac Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
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Gasparini GL, Bollati M, Chiarito M, Cacia M, Roccasalva F, Ungureanu C, Colletti G, Muraglia S, Merella P, Ugo F, Pacchioni A, Colangelo S, Sanz Sanchez J, Leone PP, Latib A, Mazzarotto P. SUOH 03 Guidewire for the Management of Coronary Artery Dissection: Insights from a Multicenter Registry. J Interv Cardiol 2023; 2023:7958808. [PMID: 37560012 PMCID: PMC10409579 DOI: 10.1155/2023/7958808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND In the setting of coronary artery dissection, both spontaneous and iatrogenic, fixing the intimal tear, usually with stent implantation, can be extremely challenging if the distal wire position has been lost. Common complications are mainly related to the inadvertent subintimal tracking of the guidewire while attempting to gain the distal true lumen. AIMS To report the registry results of using the SUOH 0.3 guidewire for managing coronary artery dissection in a real-world multicenter setting. METHODS The study population in this retrospective, multicenter, international registry included 75 consecutive patients who underwent PCI and required an antegrade wiring of a dissected coronary artery. RESULTS Successful use of SUOH 0.3 was achieved in 69 (92%) patients. The use of a microcatheter was associated with a significantly higher rate of TIMI 3 flow at the end of the procedure (no microcatheter: n = 17, 81%; microcatheter: n = 52, 96.3%; p = 0.017). The first recanalization attempt was made with the SUOH 03 guidewire in 48 (64%) cases, and it was successful in 42 (87%). The overall PCI success rate was reported in 72 (96%) patients, with no significant differences among patients with different origins, mechanisms, and locations of dissection. CONCLUSIONS In this setting, the SUOH 0.3 guidewire provides high procedural success without additional complex techniques.
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Affiliation(s)
| | | | - Mauro Chiarito
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Jorge Sanz Sanchez
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investicacion Biomedica en Red Efermedades Coardiovasculares (CIBERCV), Madrid, Spain
| | - Pier Pasquale Leone
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- Montefiore Health System, Bronx, New York City, NY, USA
| | - Azeem Latib
- Montefiore Health System, Bronx, New York City, NY, USA
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Pivato CA, Reimers B, Testa L, Pacchioni A, Briguori C, Musto C, Esposito G, Piccolo R, Lucisano L, De Luca L, Conrotto F, De Marco A, Franzone A, Presbitero P, Ferrante G, Condorelli G, Paradies V, Sardella G, Indolfi C, Condorelli G, Stefanini GG. One-Month Dual Antiplatelet Therapy After Bioresorbable Polymer Everolimus-Eluting Stents in High Bleeding Risk Patients. J Am Heart Assoc 2022; 11:e023454. [PMID: 35114814 PMCID: PMC9075308 DOI: 10.1161/jaha.121.023454] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background It is unknown whether contemporary drug‐eluting stents have a similar safety profile in high bleeding risk patients treated with 1‐month dual antiplatelet therapy following percutaneous coronary interventions. Methods and Results We performed an interventional, prospective, multicenter, single‐arm trial, powered for noninferiority with respect to an objective performance criterion to evaluate the safety of percutaneous coronary interventions with Synergy bioresorbable‐polymer everolimus‐eluting stent followed by 1‐month dual antiplatelet therapy in patients with high bleeding risk. In case of need for an oral anticoagulant, patients received an oral anticoagulant in addition to a P2Y12 inhibitor for 1 month, followed by an oral anticoagulant only. The primary end point was the composite of cardiac death, myocardial infarction, or definite or probable stent thrombosis at 1‐year follow‐up. The study was prematurely interrupted because of slow recruitment. From April 2017 to October 2019, 443 patients (age, 74.8±9.2 years; women, 29.1%) at 10 Italian centers were included. The 1‐year primary outcome occurred in 4.82% (95% CI, 3.17%–7.31%) of patients, meeting the noninferiority compared with the predefined objective performance criterion of 9.4% and the noninferiority margin of 3.85% (Pnoninferiority<0.001) notwithstanding the lower‐than‐expected sample size. The rates of cardiac death, myocardial infarction, and definite or probable stent thrombosis were 1.88% (95% CI, 0.36%–2.50%), 3.42% (95% CI, 2.08%–5.62%), and 0.94% (95% CI, 0.35%–2.49%), respectively. Conclusions Among high bleeding risk patients undergoing percutaneous coronary interventions with the Synergy bioresorbable‐polymer everolimus‐eluting stent, a 1‐month dual antiplatelet therapy regimen is safe, with low rates of ischemic and bleeding events. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03112707.
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Affiliation(s)
- Carlo A Pivato
- Department of Biomedical Sciences Humanitas University Pieve Emanuele-Milan Italy.,Humanitas Research Hospital IRCCS Rozzano-Milan Italy
| | | | - Luca Testa
- IRCCS Policlinico San Donato Milan Italy
| | | | | | - Carmine Musto
- Department of Cardiosciences A.O. San Camillo-Forlanini Hospital Rome Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences "Federico II" University of Naples Naples Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences "Federico II" University of Naples Naples Italy
| | | | - Leonardo De Luca
- Department of Cardiosciences A.O. San Camillo-Forlanini Hospital Rome Italy
| | | | - Andrea De Marco
- Department of Biomedical Sciences Humanitas University Pieve Emanuele-Milan Italy.,Humanitas Research Hospital IRCCS Rozzano-Milan Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences "Federico II" University of Naples Naples Italy
| | | | - Giuseppe Ferrante
- Department of Biomedical Sciences Humanitas University Pieve Emanuele-Milan Italy.,Humanitas Research Hospital IRCCS Rozzano-Milan Italy
| | - Gerolama Condorelli
- Department of Molecular Medicine and Medical Biotechnology "Federico II" University of Naples Naples Italy.,IRCCS Neuromed-Istituto Neurologico Mediterraneo Pozzilli Pozzilli Italy
| | - Valeria Paradies
- Department of Cardiology Maasstad Hospital Rotterdam The Netherlands
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences "Magna Graecia" University Catanzaro Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences Humanitas University Pieve Emanuele-Milan Italy.,Humanitas Research Hospital IRCCS Rozzano-Milan Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences Humanitas University Pieve Emanuele-Milan Italy.,Humanitas Research Hospital IRCCS Rozzano-Milan Italy
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Pacchioni A, Mugnolo A, Sanz Sanchez J, Sgueglia GA, Pesarini G, Bellamoli M, Saccà S, Ribichini F, Reimers B, Gasparini GL. Radial artery occlusion after conventional and distal radial access: Impact of preserved flow and time-to-hemostasis in a propensity-score matching analysis of 1163 patients. Catheter Cardiovasc Interv 2021; 99:827-835. [PMID: 34783423 DOI: 10.1002/ccd.30005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/01/2021] [Accepted: 10/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare incidence of forearm radial artery occlusion (RAO) and hemostasis characteristics between distal and conventional transradial approach (DRA and TRA, respectively). BACKGROUND DRA has the potential advantage of reducing RAO. DRA effectively reduces time-to-hemostasis, however its role on preserving flow in the radial artery (PF) during hemostasis and consequent impact on RAO remains speculative. METHODS Eight hundred thirty-seven patients with TRA were previously enrolled in a prospective registry investigating the relationship of residual anticoagulation and RAO. Three hundred twenty-six additional patients with DRA were added to the cohort and matched to the original cohort by propensity score. The composite end-point of RAO at forearm and distal site of puncture (dRAO) was evaluated as secondary end-point. RESULTS RAO occurred in 4.8% (41 of 837) of patients undergoing TRA and in 0% (0 of 326) of those undergoing DRA (p < 0.0001). DRA was associated with higher percentage of PF (97.2% vs. 78.5% in TRA group, p < 0.0001) and reduced time-to-hemostasis (147 ± 99 min vs. 285 ± 138 min, p < 0.0001). After matching, hemostasis characteristics were still significant different (PF 95.7% vs. 90.1%, p = 0.023, and 190 ± 92 vs. 323 ± 162 min, p < 0.0001) with reduction in the incidence of RAO (0 of 213, 0% vs. 7 of 213, 3.3%, p = 0.0015). dRAO occurred in one case (0.3% and 0.5% after matching, p < 0.0001 and p = 0.032 compared to TRA). CONCLUSIONS DRA was associated with lower rates of RAO compared to TRA. This effect is potentially explained by reduced time-to-hemostasis and maintained flow at the wrist during hemostasis.
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Affiliation(s)
| | - Antonio Mugnolo
- Division of Cardiology, Ospedale Mater Salutis, Legnago, Italy
| | - Jorge Sanz Sanchez
- Division of Cardiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.,Division of Cardiology, Hospital Universitario y Politecnico La Fe, Valencia, Spain.,Centro de Investigacion Biomedica en Red (CIBERCV), Madrid, Spain
| | | | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | - Michele Bellamoli
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | - Bernhard Reimers
- Division of Cardiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
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10
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Pacchioni A, Sanz Sanchez J, Gasparini GL. Digital Ischemia After Snuffbox Radial Approach. JACC Cardiovasc Interv 2020; 13:2940-2942. [PMID: 33248985 DOI: 10.1016/j.jcin.2020.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 01/24/2023]
Affiliation(s)
| | - Jorge Sanz Sanchez
- Department of Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Gabriele Luigi Gasparini
- Department of Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
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11
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Bellamoli M, Venturi G, Pighi M, Pacchioni A. Transradial artery access for percutaneous cardiovascular procedures: state of the art and future directions. Minerva Cardiol Angiol 2020. [PMID: 33146480 DOI: 10.23736/s0026-4725.20.05391-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The transradial access (TRA) for cardiac catheterization and percutaneous coronary intervention (PCI) has been widely adopted in the last decades since its first description in the late 40s. The transradial approach has been associated with favorable outcomes as compared with transfemoral access (TFA) in several registries and randomized clinical trials, mainly due to the lower incidence of access-site bleedings, vascular complications and improved patient comfort. This review aimed to summarize the body of evidence supporting the use of TRA, to discuss clinical implications, possible technical limitations and future directions, such as the implementation of TRA as the primary access for complex procedures and structural interventions.
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Affiliation(s)
- Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Pacchioni
- Department of Cardiology, Civil Hospital, Mirano, Venice, Italy -
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Bellamoli M, Venturi G, Pighi M, Pacchioni A. Transradial artery access for percutaneous cardiovascular procedures: state of the art and future directions. Minerva Cardiol Angiol 2020; 69:557-578. [PMID: 33146480 DOI: 10.23736/s2724-5683.20.05391-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The transradial access (TRA) for cardiac catheterization and percutaneous coronary intervention (PCI) has been widely adopted in the last decades since its first description in the late 40s. The transradial approach has been associated with favorable outcomes as compared with transfemoral access (TFA) in several registries and randomized clinical trials, mainly due to the lower incidence of access-site bleedings, vascular complications and improved patient comfort. This review aimed to summarize the body of evidence supporting the use of TRA, to discuss clinical implications, possible technical limitations and future directions, such as the implementation of TRA as the primary access for complex procedures and structural interventions.
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Affiliation(s)
- Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Pacchioni
- Department of Cardiology, Civil Hospital, Mirano, Venice, Italy -
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Pacchioni A, Bellamoli M, Mugnolo A, Ferro J, Pesarini G, Turri R, Ribichini F, Saccà S, Versaci F, Reimers B. Predictors of patent and occlusive hemostasis after transradial coronary procedures. Catheter Cardiovasc Interv 2020; 97:1369-1376. [PMID: 32761864 DOI: 10.1002/ccd.29066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/09/2020] [Accepted: 05/24/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess the independent predictors of patent and occlusive hemostasis (PH and OH, respectively) during radial hemostasis after coronary procedures. BACKGROUND Radial artery occlusion (RAO) is a thrombotic complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Sheath-vessel diameter ratio, postprocedure compression time, occlusive hemostasis, inadequate, and excessive anticoagulation are all predictors of RAO. METHODS As a part of a previously published study investigating the relationship between residual anticoagulation and risk of RAO, 837 patients undergoing transradial diagnostic coronary angiography or percutaneous coronary interventions were enrolled. Cumulative heparin dose used during the procedure and ACT measured before sheath removal were recorded. PH with reverse Barbeau test was attempted in all patients (NCT02762344). RESULTS PH was less frequently obtained for increasing cumulative heparin dose and ACT values (p < .0001 and p = .0034, respectively). At logistic regression analysis both cumulative heparin dose and ACT values were independent predictors of OH (OR 1.017, 95% IC 1.011-1.023 p < .0001 and OR 1.004, 95% IC 1.001-1.006, p = .0004) while adjusted probability for RAO showed exponential relationship with both parameters. CONCLUSIONS The level of anticoagulation is strongly related to the incidence of RAO, and should be taken into account when choosing hemostasis protocol.
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Affiliation(s)
| | - Michele Bellamoli
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | | | - Jayme Ferro
- Division of Cardiology, IRCCS Arcispedale Santa Maria, Reggio Emilia, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy
| | | | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy
| | - Bernhard Reimers
- Division of Cardiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
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Pacchioni A, Ferro J, Pesarini G, Mantovani R, Mugnolo A, Bellamoli M, Penzo C, Marchese G, Benedetto D, Turri R, Fede A, Benfari G, Saccà S, Ribichini F, Versaci F, Reimers B. The Activated Clotting Time Paradox. Circ Cardiovasc Interv 2019; 12:e008045. [DOI: 10.1161/circinterventions.119.008045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Radial artery occlusion (RAO) is a thrombotic complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Sheath-vessel diameter ratio, postprocedure compression time, occlusive hemostasis, and insufficient anticoagulation are all predictors of RAO. However, excessive anticoagulation can lead to longer time to achieve complete hemostasis and less patent hemostasis rate. This study was designed to assess the relationship among residual anticoagulation at the end of a percutaneous coronary procedure and the risk of RAO.
Methods:
Eight hundred thirty-seven patients undergoing transradial catheterization were enrolled. Activated clotting time (ACT) was measured before sheath removal. Patients were divided into 3 groups according to ACT values (ACT <150 s, ACT between 150 and 249 s, ACT >250 s), patent hemostasis with reverse Barbeau test was attempted in all patients, and compression device removed as soon as possible. Within 24 hours, patency of radial artery was checked by Doppler using reverse Barbeau technique.
Results:
Incidence of RAO was higher for the extreme ACT values. Patent hemostasis were less frequently obtained and time to hemostasis significantly longer for increasing ACT values (
P
=0.004 for trend and <0.0001 for trend, respectively). At logistic regression analysis, ACT values <150 s were an independent predictor of RAO (odds ratio, 3.53; 95% IC, 1.677–7.43;
P
=0.001) while adjusted probability for RAO confirmed U-shaped relationship with ACT values.
Conclusions:
The level of anticoagulation is strongly related to incidence of RAO and should be measured objectively by ACT.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02762344.
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Affiliation(s)
- Andrea Pacchioni
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Jayme Ferro
- Department of Cardiology, Arcispedale Santa Maria, Reggio Emilia, Italy (J.F.)
| | - Gabriele Pesarini
- Department of Cardiology, Università di Verona, Italy (G.P., M.B., G.B., F.R.)
| | - Riccardo Mantovani
- Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy (R.M., B.R.)
| | - Antonio Mugnolo
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Michele Bellamoli
- Department of Cardiology, Università di Verona, Italy (G.P., M.B., G.B., F.R.)
| | - Carlo Penzo
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Giuseppe Marchese
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Daniela Benedetto
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Riccardo Turri
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Alfredo Fede
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Giovanni Benfari
- Department of Cardiology, Università di Verona, Italy (G.P., M.B., G.B., F.R.)
| | - Salvatore Saccà
- Department of Cardiology, Ospedale Civile, Mirano, Italy (A.P., A.M., C.P., G.M., D.B., R.T., A.F., S.S.)
| | - Flavio Ribichini
- Department of Cardiology, Università di Verona, Italy (G.P., M.B., G.B., F.R.)
| | - Francesco Versaci
- Department of Cardiology, Università di Tor Vergata, Roma, Italy (F.V.)
| | - Bernhard Reimers
- Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy (R.M., B.R.)
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Fede A, Pacchioni A, Penzo C, Turri R, Marchese G, Benedetto D, Saccà S. [Endovascular treatment of symptomatic carotid artery dissection]. G Ital Cardiol (Rome) 2018; 19:62-66. [PMID: 29451511 DOI: 10.1714/2852.28780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Internal carotid artery dissection is one of the possible causes of stroke in young adults. The effectiveness of medical therapy alone is often limited and endovascular strategy should be considered, particularly in the presence of persisting neurological symptoms. Currently, there is no general consensus on the most appropriate therapeutic strategy to follow in symptomatic carotid artery dissection. We here report a case of symptomatic carotid artery dissection treated with an endovascular approach, and we review the recent literature regarding this therapeutic strategy. Materials and methods for performing endovascular treatment are also described, along with the possible steps to follow. Data in the literature and our clinical experience suggest that stenting is promising in patients with internal carotid artery dissection and should be considered as a valid therapeutic strategy in case of failure of medical therapy in highly experienced centers.
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Affiliation(s)
- Alfredo Fede
- Divisione di Cardiologia, Ospedale Civile di Mirano (VE)
| | | | - Carlo Penzo
- Divisione di Cardiologia, Ospedale Civile di Mirano (VE)
| | - Riccardo Turri
- Divisione di Cardiologia, Ospedale Civile di Mirano (VE)
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Umemoto T, de Donato G, Pacchioni A, Reimers B, Ferrante G, Isobe M, Setacci C. Optical coherence tomography assessment of newgeneration mesh-covered stents after carotid stenting. EUROINTERVENTION 2017; 13:1347-1354. [DOI: 10.4244/eij-d-16-00866] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Scheinert D, Reimers B, Cremonesi A, Schmidt A, Sievert H, Rohde S, Schofer J, Mudra HG, Bosiers M, Zeller T, Pacchioni A, Rosenschein U. Independent Modular Filter for Embolic Protection in Carotid Stenting. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004244. [PMID: 28283511 DOI: 10.1161/circinterventions.116.004244] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 01/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Embolic protection during carotid artery stenting reduces the rate of thromboembolic events. The Wirion Embolic Protection System is used to deploy an independent distal filter using any 0.014″ guidewire. WISE study (Wirion Study Europe) evaluated the safety and performance of Wirion Embolic Protection System in patients undergoing carotid artery stenting. METHODS AND RESULTS A prospective, multicenter, nonrandomized, open-label, single-arm study of carotid artery stenting in high surgical risk patients was performed. The primary end point, a composite of death, stroke, and myocardial infarction at 30 days, was compared with performance goal derived from historical controls. Secondary end points were components of the primary end point and the device, angiographic, procedural, and clinical success rates. Preplanned interim analysis was performed on the first 120 patients. At interim analysis, the primary end point was significantly lower for the Wirion Embolic Protection System group, compared with historical data (3.3% versus 6.3%, respectively; P value =0.0008). Analysis of primary end point components in the WISE group, compared with the historical control group, shows numerically lower mortality (0% versus 1.7%, respectively; P=0.21), stroke (2.5% versus 4.6%, respectively; P=0.18), and myocardial infarction (0.8% versus 1.5%, respectively; P=0.50). Device, angiographic, procedural, and clinical success was achieved in 99.2%, 99.1%, 98.3%, and 96.6% of cases, respectively. CONCLUSIONS The data suggest that independent modular filter use in carotid artery stenting in high surgical risk patients is safe and effective. The outcomes suggest that use of an independent modular filter may be associated with a lower rate of embolic complications associated with carotid stent placement. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01783639.
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Affiliation(s)
- Dierk Scheinert
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Bernhard Reimers
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Alberto Cremonesi
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Andrej Schmidt
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Horst Sievert
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Stefan Rohde
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Joachim Schofer
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Harald G Mudra
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Marc Bosiers
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Thomas Zeller
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Andrea Pacchioni
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.)
| | - Uri Rosenschein
- From the Department of Interventional Angiology, Herzzentrum Leipzig GmbH and Park-Krankenhaus, Leipzig, Germany (D.S., A.S.); Department of Clinical and Invasive Cardiology, Humanitas Clinica and Research Center, Rozzano (Milan), Italy (B.R.); Department of Interventional Cardio-Angiology, Villa Maria Cecilia, Cotignola (RA), Italy (A.C.); Department Internal Medicine, Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany (H.S.); Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany (S.R.); Department of Cardiology, Hamburg University Cardiovascular Center, Hamburg, Germany (J.S.); Department of Cardiology, Klinikum Neuperlach, Munchen, Germany (H.G.M.); Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium (M.B.); Department Angiology Internist, Universitats Herzzentrum, Bad Krozingen, Germany (T.Z.); Department of Cardiology, Mirano Hospital, Italy (A.P.); and Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel (U.R.).
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Cuman M, Zivelonghi C, Benfari G, Ghione M, Fede A, Lunardi M, Cordone S, Botta M, Gambaro A, Maggio S, Zanetti C, Pacchioni A, Reimers B, Ribichini F. P6459Drug coating balloon: long-term outcome from a real world three-centers experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pacchioni A, Ferro J, Mantovani R, Mugnolo A, Pesarini G, Marchese G, Benedetto D, Fede A, Turri R, Penzo C, Bellamoli M, Sacca S, Ribichini F, Reimers B. P4302Role of residual anticoagulation in determining radial artery occlusion after transradial catheterization: preliminary results from a multicenter registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zivelonghi C, Ghione M, Benfari G, Cuman M, Fede A, Lunardi M, Cordone S, Botta M, Pacchioni A, Bellone P, Reimers B, Ribichini FL. Drug-coated balloon: Long-term outcome from a real world three-center experience. J Interv Cardiol 2017; 30:318-324. [DOI: 10.1111/joic.12391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/25/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Carlo Zivelonghi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Matteo Ghione
- Department of Cardiology; Ospedale San Paolo; Savona Italy
| | - Giovanni Benfari
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Magdalena Cuman
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Alfredo Fede
- Department of Cardiology; Mirano Hospital; Mirano Italy
| | - Mattia Lunardi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | | | - Marco Botta
- Department of Cardiology; Ospedale San Paolo; Savona Italy
| | | | - Pietro Bellone
- Department of Cardiology; Ospedale San Paolo; Savona Italy
| | | | - Flavio L. Ribichini
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
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De Donato G, Umemoto T, Reimers B, Pacchioni A, Ferrante G, Isobe M, Setacci C. FT10. Optical Coherence Tomography Assessment of New Generation, Mesh-Covered Stents After Carotid Stenting. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Saccà S, Ferro J, Umemoto T, Turri R, Penzo C, Pacchioni A. A New Strategy for Transcatheter Left Atrial Appendage Closure With Cerebral Embolic Protection in Patient With Left Auricular Thrombosis and Total Contraindication to Long-Term Anticoagulation. J Invasive Cardiol 2017; 29:E37-E38. [PMID: 28255107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, occurring in 1%-2% of the general population. An important aspect is the treatment of AF in terms of stroke prevention. In patients with absolute contraindication to long-term anticoagulation due to high bleeding risk, a valuable alternative exists in left atrial appendage (LAA) closure. Unfortunately, thrombus in the LAA is a contraindication to the procedure because of high risk of embolization. We describe a clinical case with permanent AF, absolute contraindication to long-term anticoagulation therapy, and persistent thrombus formation in the LAA that was treated with transcatheter LAA closure and supraaortic trunk protection system in order to avoid risk of periprocedural stroke.
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Affiliation(s)
| | - Jayme Ferro
- Cardiology Department, Mirano General Hospital, via Mariutto 13, Mirano, Venice, Italy.
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Nikas DN, Makos X, Umemoto T, Liappas G, Pacchioni A, Zakarian N, Reimers B. Update on new stents and protection devices for carotid artery stenting: what we know, what we learnt recently and what we need to know. J Cardiovasc Surg 2017; 58:13-24. [DOI: 10.23736/s0021-9509.16.09810-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Compared with conventional angiogram-guided procedure, intravascular imaging modalities give us a lot of useful information to make the procedure better. Intravascular imaging modalities give us the information about lesion characters, reference vessel diameter and the interaction between the stent strut and the plaque such as stent strut malapposition or plaque prolapse in real time during the procedure. We can change our strategy according to this information. Intravascular ultrasound (IVUS) is a most common intravascular imaging modality during carotid artery stenting (CAS) in these days. Its advantage is easy to use compared with optical coherence tomograpy (OCT) which has been reported recently in some case reports or case series. However, due to its high resolution, OCT provides more detailed information especially about plaque prolapse and strut malapposition. IVUS and OCT have a potential to improve acute result and reduce the procedural complication by providing the data of lesion character, reference vessel diameter and the interaction of stent strut and vessel wall. Interventionalists who perform CAS procedure should acquire proficiency in imaging modalities during CAS procedure.
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Affiliation(s)
- Tomoyuki Umemoto
- Department of Cardiovascular Medicine, Tokyo Medical and Detal University, Tokyo, Japan -
| | - Andrea Pacchioni
- Department of Cardiology, Ospedale Civile Mirano, Mirano, Venice, Italy
| | - Dimitrios Nikas
- Department of Cardiology, Ioannina University Hospital, Ioannina Medical School, Ioannina, Greece
| | - Bernhard Reimers
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
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Pacchioni A, Umemoto T, Penzo C, Saccà S, Ferro J, Fede A, Turri R, Reimers B. Successful Endovascular Treatment of Unbenign Spontaneous Dissection of the Left Internal Carotid Artery Combining Advanced Carotid and Coronary Techniques. JACC Cardiovasc Interv 2015; 8:e233-5. [PMID: 26718524 DOI: 10.1016/j.jcin.2015.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/19/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Carlo Penzo
- Division of Cardiology, Ospedale Civile, Mirano, Italy
| | | | - Jayme Ferro
- Division of Cardiology, Ospedale Civile, Mirano, Italy
| | - Alfredo Fede
- Division of Cardiology, Ospedale Civile, Mirano, Italy
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26
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Christou GA, Rizos EC, Mpechlioulis A, Penzo C, Pacchioni A, Nikas DN. Confronting the residual cardiovascular risk beyond statins: the role of fibrates, omega-3 fatty acids, or niacin, in diabetic patients. Curr Pharm Des 2015; 20:3675-88. [PMID: 24040868 DOI: 10.2174/13816128113196660674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/10/2013] [Indexed: 11/22/2022]
Abstract
Diabetics are regarded a special category of patients known to experience higher rates of cardiovascular complications as compared to the non-diabetic ones. Despite substantial efforts to minimize these risks, with aggressive antiplatelet and lipid lowering therapy, some of the diabetic patients still have a considerable residual risk for cardiovascular adverse events. Important preclinical data with potent lipid-lowering agents, like fibrates, omega-3-fatty acids, and niacin, have shown that they can provide sufficient help in reducing rates of cardiovascular events. In the present review, we are aim to explain their basic mechanisms of action, to present all the available clinical data regarding the efficacy of those agents, and to identify specific diabetic patients' subsets, in whom supplementary therapy with those agents could provide substantial benefit in terms of clinical outcome and not only lipid profile improvement.
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Affiliation(s)
| | | | | | | | | | - Dimitrios N Nikas
- Cardiology Department, Ioannina University Hospital, St. Niarchos Av, 45500, Ioannina, Greece.
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Castriota F, Tomai F, Gabrio Secco G, Reimers B, Piccoli A, De Persio G, Pesarini G, Schiavina G, Borioni R, Pacchioni A, Cremonesi A, Vassanelli C, Ribichini F. Early and late clinical outcomes of endovascular, surgical, and hybrid revascularization strategies of combined carotid and coronary artery diseases: the FRIENDS study group (Finalized Research In ENDovascular Strategies). Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pacchioni A, Mugnolo A, Parizi ST, Versaci F, Saccà S, Turri R, Reimers B. TCT-551 Randomized Comparison of Flow Reversal vs Distal Filter for Cerebral Protection During Carotid Artery Stenting in Patients With Stable Carotid Disease. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Rouchaud A, Klein I, Amarenco P, Mazighi M, Pacchioni A, Torsello G, Reimers B, van Sambeek MRHM, Tielbeek AV, Teijink JAW, Cuypers PW. How should I treat a symptomatic post dissection carotid aneurysm? EUROINTERVENTION 2014; 9:1121-3. [PMID: 24457283 DOI: 10.4244/eijv9i9a187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Aymeric Rouchaud
- INSERM U-698 and Denis Diderot University-Paris VII, Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France
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30
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Pacchioni A, Mugnolo A, Penzo C, Nikas D, Saccà S, Agostoni P, Garami Z, Versaci F, Reimers B. Cerebral microembolism during transradial coronary angiography: Comparison between single and double catheter strategy. Int J Cardiol 2014; 170:438-9. [DOI: 10.1016/j.ijcard.2013.11.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/18/2013] [Accepted: 11/23/2013] [Indexed: 11/16/2022]
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31
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Pacchioni A, Versaci F, Mugnolo A, Penzo C, Nikas D, Saccà S, Favero L, Agostoni PF, Garami Z, Prati F, Reimers B. Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach. Int J Cardiol 2013; 167:3021-6. [DOI: 10.1016/j.ijcard.2012.09.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/19/2012] [Accepted: 09/12/2012] [Indexed: 11/25/2022]
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32
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Pacchioni A, Rossi A, Benfari G, Cicoira M, Pellegrini P, Bonapace S, Vassanelli C. A higher body mass index is associated with reduced prevalence of unstable atherosclerotic plaque: a possible explanation of the obesity paradox. Int J Cardiol 2013; 168:2912-3. [PMID: 23608399 DOI: 10.1016/j.ijcard.2013.03.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/30/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Andrea Pacchioni
- Section of Cardiology, Department of Medicine, University of Verona, Italy
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Versaci F, Saccà S, Mugnolo A, Pacchioni A, Reimers B. Simultaneous patent foramen ovale and left atrial appendage closure. J Cardiovasc Med (Hagerstown) 2013; 13:663-4. [PMID: 22011553 DOI: 10.2459/jcm.0b013e32834cad8d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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34
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Nikas DN, Sacca S, Penzo C, Pacchioni A, Torsello G, Reimers B. Late cerebral embolization after emboli-protected carotid artery stenting. J Cardiovasc Surg (Torino) 2013; 54:83-91. [PMID: 23418641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Carotid artery stenting (CAS) is nowadays considered as alternative therapeutic option to carotid endarterectomy for patients suffering from carotid artery disease. Recent studies and meta-analyses have demonstrated equal performance of carotid stenting to endarterectomy as regard as the overall adverse events (death/stroke rates), especially when periprocedural myocardial infarction and nerve pulses are also included. However, carotid stenting was inferior to endarterectomy when compared in terms of acute and late embolic events. In the present review, we collect all studies available in the published literature regarding the late embolic events. We mainly attempted to gather data regarding the silent embolic events occurring after the acute post-procedural period. We analyzed the results and reported the incidence of the problem. Finally, we aimed to identify possible causes and propose effective solutions to reduce the incidence of late embolic events.
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Affiliation(s)
- D N Nikas
- Cardiology Department, Ioannina University Hospital, Ioannina Medical School, Ioannina, Greece.
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35
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Pacchioni A, Mugnolo A, Penzo C, Nikas D, Saccà S, Favero L, Reimers B, Versaci F. RISK OF BRAIN INJURY RELATED TO SILENT CEREBRAL EMBOLIZATION DURING DIAGNOSTIC CORONARY ANGIOGRAPHY: DIRECT COMPARISON BETWEEN RIGHT RADIAL AND LEFT RADIAL APPROACH. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Versaci F, Reimers B, Prati F, Gaspardone A, Del Giudice C, Pacchioni A, Mauriello A, Cortese C, Nardi P, De Fazio A, Chiariello GA, Proietti I, Chiariello L. Prediction of cardiovascular events by inflammatory markers in patients undergoing carotid stenting. Mayo Clin Proc 2012; 87:50-8. [PMID: 22212968 PMCID: PMC3498377 DOI: 10.1016/j.mayocp.2011.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/20/2011] [Accepted: 10/07/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess whether inflammatory markers predict atherosclerotic disease activity after carotid treatment in patients with severe carotid stenosis and nonsignificant coronary artery disease undergoing carotid stenting. PATIENTS AND METHODS From March 1, 2004, to September 30, 2005, a total of 55 consecutive patients (mean ± SD age, 69±8.3 years; 26 men) with severe carotid stenosis and nonsignificant coronary artery disease were treated with carotid stent implantation. Patients were followed up for a period of 5 years for the occurrence of cardiovascular events. RESULTS A significant correlation between quantitative analysis of debris entrapped in the filters and inflammatory markers was found. Moreover, the number of particles per filter, the total particles area, and the mean particle axis per filter were significantly higher in patients with clinical events at the follow-up compared with patients without events (87 vs 32, P=.006; 50,118.7 vs 17,782, P=.002; 33.9 vs 30.2, P=.03). At 5-year follow-up we recorded cardiovascular or neurologic events in 11 of the 55 patients (20%). Higher preprocedural levels of high-sensitivity C-reactive protein, interleukin 6 soluble receptor, and interleukin 6 were significantly associated with clinical events at follow-up (P<.001, P=.05, and P=.02, respectively). In particular high-sensitivity C-reactive protein measured at 24 and 48 hours after carotid stenting showed a significant correlation with clinical events (P=.001). Also preprocedural intracellular adhesion molecule 1 and circulating vascular cell adhesion molecule 1 blood concentrations were significantly correlated with a worse prognosis at follow-up (P=.04 and P=.03, respectively). CONCLUSION In patients with severe carotid stenosis and nonsignificant coronary artery disease, inflammation is associated with atherosclerotic disease activity and a worse prognosis. Interleukin 6, interleukin 6 soluble receptor, intracellular adhesion molecule 1, vascular cell adhesion molecule 1, and high-sensitivity C-reactive protein levels at baseline and 24 and 48 hours after carotid stenting are predictive of neurologic and cardiovascular events at follow-up.
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Affiliation(s)
- Francesco Versaci
- Dipartimento di Cardiologia Ospedale Civile di Mirano, Università Tor Vergata, Rome, Italy.
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Saccà S, Pacchioni A, Nikas D. Coil embolization for distal left main aneurysm: a new approach to coronary artery aneurysm treatment. Catheter Cardiovasc Interv 2011; 79:1000-3. [PMID: 21735516 DOI: 10.1002/ccd.23195] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 04/01/2011] [Indexed: 12/16/2022]
Abstract
Coronary artery aneurysm is an uncommon disease, whose natural history and therapeutic approach are still controversial: medical therapy, surgical revascularization with or without aneurysm ligation or excision, and endovascular exclusion with membrane covered stents are all accepted and viable options, according to anatomic characteristics. Intracranial aneurysms are adequately treated by means of coil embolization, an option that, to our knowledge, has never been tested in coronary interventions. We report the first case of a coronary aneurysm involving the distal left main and the proximal left anterior descending artery treated with "stent-assisted" coil embolization.
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Affiliation(s)
- Salvatore Saccà
- Cardiology Department, Ospedale Civile di Mirano, Mirano, Venice, Italy
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Tomai F, Pesarini G, Castriota F, Reimers B, De Luca L, De Persio G, Spartà D, Aurigemma C, Pacchioni A, Spagnolo B, Cremonesi A, Ribichini F. Early and long-term outcomes after combined percutaneous revascularization in patients with carotid and coronary artery stenoses. JACC Cardiovasc Interv 2011; 4:560-8. [PMID: 21596330 DOI: 10.1016/j.jcin.2011.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 12/23/2010] [Accepted: 01/20/2011] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study sought to evaluate the 30-day and long-term clinical outcomes of patients with carotid obstructive disease (COD) and concomitant coronary artery disease (CAD) undergoing a combined percutaneous revascularization, in 4 high-volume centers skilled for the treatment of multilevel vascular disease. BACKGROUND The optimal management of patients with COD and concomitant CAD remains controversial. A variety of therapeutic strategies, including coronary artery bypass grafting, alone or in combination with carotid artery revascularization, have been reported. METHODS Between January 2006 and April 2010, 239 consecutive patients with COD (symptomatic carotid stenosis in 20.5%) and concomitant CAD were treated with staged or simultaneous carotid artery stenting and percutaneous coronary intervention, and enrolled in this prospective registry. The primary endpoint was the incidence of major cardiac and cerebrovascular events, including any death, myocardial infarction, or stroke occurring between the first revascularization procedure and 30 days after treatment of the second vascular territory affected. RESULTS The incidence of the primary endpoint at 30 days was 4.2% (95% confidence interval [CI]: 2.02 to 7.56). The rate of death, myocardial infarction, and stroke at long-term follow-up (median 520 days) was 4.2%, 2.1%, and 3.8%, respectively. At long-term follow-up, patients with previous cardiovascular disease had significantly higher rates of major cardiac and cerebrovascular events than did patients with a first clinical episode (17% vs. 6%, hazard ratio: 3.34; 95% CI: 1.46 to 7.63; p = 0.004). CONCLUSIONS In patients with COD and concomitant CAD, a combined percutaneous treatment compares favorably with previous surgical or hybrid experiences. Such strategy may be particularly suited to complex patients at high surgical risk.
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Affiliation(s)
- Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy.
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39
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Ribichini F, Reimers B, Russo P, Borioni R, Spartà D, Pacchioni A, Pesarini G, Spagnolo B, De Persio G, Cremonesi A, Castriota F, Tomai F. Clinical outcome after endovascular, surgical or hybrid revascularisation in patients with combined carotid and coronary artery disease: the Finalised Research In ENDovascular Strategies Study Group (FRIENDS). EUROINTERVENTION 2010; 6:328-35. [DOI: 10.4244/eijv6i3a55] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Favero L, Penzo C, Nikas D, Pacchioni A, Pasquetto G, Saccà S, Reimers B. Cardiac and extracardiac complications during CTO interventions: prevention and management. Interv Cardiol 2010. [DOI: 10.2217/ica.10.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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41
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Pacchioni A, Nikas D, Penzo C, Saccà S, Favero L, Pasquetto G, Reimers B. Management and Prevention of Vascular Complications Related to Transcatheter Aortic Valve Implantation and Aortic Aneurysm Repair Procedures – A Technical Note. Interv Cardiol 2010. [DOI: 10.15420/icr.2010.5.1.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR) are increasingly being used as therapeutic options for patients with severe aortic stenosis who are ineligible for surgery and who have aortic aneurysm with suitable anatomical features. These procedures can be associated with severe complications, especially related to vascular access and the use of a large introducer sheath (from 18 to 24 French [Fr]). In this article we describe possible vascular complications emerging during TAVI and EVAR and their appropriate management, beginning with patient selection, the correct way to perform vessel puncture and the use of a vascular closure device, up to the recently proposed cross-over technique, which is thought to minimise the risk of dangerous consequences of vascular damage.
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42
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Inama G, Pedrinazzi C, Gazzaniga P, Reduzzi C, Donato G, Munoz CV, Pacchioni A, Inama L, Della Frera W, Durin O. [Current limitations and new perspectives in the diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia]. G Ital Cardiol (Rome) 2008; 9:83S-89S. [PMID: 19195313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a genetic cardiomyopathy characterized by ventricular arrhythmias and structural abnormalities of the right ventricle. In ARVC/D there is a progressive replacement of right ventricular myocardium with fatty and fibrous tissue and ventricular arrhythmias of right ventricular origin. The precise prevalence of ARVC/D has been estimated to vary between 1 in 1000 to 1 in 5000 of the general population. ARVC accounts for approximately 3-10% of sudden deaths in young people under the age of 65 years. The purpose of this paper is to review the current knowledge of ARVC/D and its management. Particular attention will be focused on some of the recent advances in the understanding of the genetic basis of ARVC/D. Increasing evidence suggests that ARVC/D is a disease of desmosomal dysfunction. Attention will also be focused on the new and somewhat controversial concept that ARVC/D may present primarily as a left ventricular disease. In our experience ARVC/D typically presents as a right ventricular disease, unless a patient has advanced disease. Diagnosis of ARVC/D is challenging and requires a comprehensive evaluation with both non-invasive and invasive testing.
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Affiliation(s)
- Giuseppe Inama
- U.O. di Cardiologia, A.O. Ospedale Maggiore, Crema (CR).
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Gioino G, Hansen C, Pacchioni A, Rocca F, Barrios SM, Brocca E, Cancela LM. Use of high-performance liquid chromatography with diode-array detection after a primary drug screening in patients admitted to the emergency department. Ther Drug Monit 2003; 25:99-106. [PMID: 12548152 DOI: 10.1097/00007691-200302000-00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two hundred fifty samples of patients admitted to the Emergency Department at the Hospital Municipal de Urgencias, Córdoba, Argentina for a drug screening by HPTLC, FPIA, spectrophotometric methods, and HPLC/DAD were randomly selected. The rate of positive screens was 34.0% with the following rate distribution: 12.0% alcohol, 13.6% nonsteroid antiinflammatory drugs (NSAIDs), 2.0% anticonvulsants, 0.8% barbiturates, 0.4% narcotics, 0.4% antidepressants, 2.8% cocaine, and 2.0% cannabinoids. Psychoactive drugs (alcohol, cocaine, and cannabinoids) were detected in 43.9% of the patients admitted for traffic accidents, namely 35.71% alcohol, 2.38% alcohol-cocaine, 2.38% alcohol-cannabinoids, 2.38% cocaine-cannabinoids, and 2.38% alcohol-cocaine-cannabinoids. These results help identify the trend of use and/or abuse of drugs and its relationship with different causes of admission (accidents, overdose, and other pathologies), age, and gender.
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Affiliation(s)
- G Gioino
- Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Ciudad Universitaria, Argentina
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Gabelli C, Anzolin F, Codemo A, Barbato G, Martini S, Donazzan S, Cortella I, Cester A, Pacchioni A, Baggio G. Apolipoprotein E allele polymorphism and ageing: Decreased prevalence of apolipoprotein ε4 allele in old individuals. Atherosclerosis 1995. [DOI: 10.1016/0021-9150(95)96681-h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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De Leo D, Ceola A, Magni G, Renesto V, Pacchioni A. [Viloxazine in the treatment of depression in the aged. Double-blind placebo study]. Minerva Psichiatr 1984; 25:127-30. [PMID: 6387360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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