[Registry CARDIO-ARSIF - Database on coronary angiography and percutaneous coronary invasive performed in Île-de-France]

The CARDIO-ARSIF registry has been continuously collecting comprehensive data on coronary angiography and percutaneous coronary interventions (PCI) performed in the 36 catheterization laboratories across the Île-de-France region since 2000. Over the period from 2003 to 2022, this registry has recorded information from more than 330,000 patients, encompassing more than one million procedures. Among these procedures, 58% consisted of coronary angiography, 13% were percutaneous coronary interventions (PCI), and the remaining 28% were PCI performed on an ad-hoc basis. This extensive dataset serves as a valuable resource for both qualitative and quantitative assessments of practices and the relevance of procedures in the field of coronary invasive cardiology. The results of these analyses undergo annual validation by a dedicated scientific committee and are shared with the teams of investigators. The exploitation of this data has led to scientific publications, with one notable finding being a consistent reduction in the radiation doses received by patients, regardless of the type of procedure.

[Outcomes of early endoscopic realignment of post-traumatic posterior urethral ruptures]

INTRODUCTION

Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury.

PATIENTS AND METHODS

We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up.

RESULTS

Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23 patients (88.46%). The median time to endoscopic realignment was 8 days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25).

CONCLUSION

Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty.

LEVEL OF EVIDENCE: 3

Unrecognized digestive toxicities of radiation therapy

The aim of this article is to review unrecognized toxicities resulting from radiation therapy of digestive neoplasms. Due to their precocious occurrence, acute toxicities are well-known by radiation oncologist, and their treatment well-established. Thus, acute toxicities will not be described in this review. We will focus on incidence, diagnosis, and management of late and uncommon toxicities occurring in the digestive tract and digestive organs. Prevention, by respecting healthy tissues constraints, is the main tool to reduce incidence of those rare complications. Nonetheless, once installed, late toxicities remain a major burden in terms of quality of life and can even be life threatening. Hence, information and education about their diagnosis and management is important.

[Percutaneous angioplasty of renal artery stenosis: Short- and long-term results]

INTRODUCTION

Renal artery stenosis (RAS) may be symptomatic. The treatment of these lesions is primarily medical but may sometimes require surgical or endovascular revascularization. RAS angioplasty is well controlled but its results are discussed. The objective of this work was to report the short- and long-term results of the endovascular treatment of renal arteries in our center.

METHODS

We report a retrospective study between 2013 and 2018, including patients who received endovascular treatment for severe symptomatic RAS (≥75%).

RESULTS

Our population consisted of 17 patients. Mean age was 51.1 years [18-76], sex ratio 2.4. RAS was discovered during work-up for severe renovascular hypertension resistant to medical treatment for 16 patients and rapidly progressive renal failure for one patient. The etiology retained was: atherosclerosis (9 cases), fibromuscular dysplasia (6 cases) and Takayasu's disease (2 cases). The average stenosis rate was 85.9% [75-97%]. We performed simple angioplasty in 47% of the cases and stenting in 53%. The technical success rate was 100%. At 1 month, morbidity-mortality rates were zero. Mean follow-up was 12 months [6-36 months]. Patients with renovascular hypertension experienced a decrease in blood pressure, with discontinuation of antihypertensive therapy in 62.5% of cases and reduction of doses in 37.5% of cases. The permeability rate was 100% at 1 year, 94% at 2 years and 94% at 3 years. One patient had asymptomatic stent thrombosis at the 18th month. The restenosis rate was zero.

CONCLUSION

Angioplasty of symptomatic RAS may be indicated as first-line treatment. It is associated with satisfactory results in the short and long terms.

[Radiation-induced carotid stenosis: A personnalized approach]

INTRODUCTION

Surgical treatment of radio-induced carotid stenosis (RICS) is challenging and burdened by an elevated risk of local complications. Carotid artery stenting (CAS) may be a suitable alternative. The best approach is yet to be defined. We reviewed the results of both techniques following selection based on better-suitability characteristics (anatomic and clinical).

METHODS

We retrospectively reviewed 38 patients treated for 43 RICS from a group of 1230 patients who had carotid interventions between 2008 and 2015 (5 bilateral). Primary endpoints were morbidity and mortality at 30 days (transient ischemic attack, stroke, myocardial infarction, or death). Secondary endpoints were technical success, wound complications, cranial nerve injury (CNI), restenosis (≥50%) and recurrent symptoms.

RESULTS

RICS was symptomatic in 6 patients in the OR group and 3 in the CAS group. Lesions in the OR group were longer (P=0.02) and more calcified (P=0.08). Technical success rate was 100%. Cranial nerve injury rate was 14.2% (3/21). All injuries were completely resolved within several weeks. In the CAS group, technical success rate was 95% (21/22) with the one failure due to a residual stenosis exceeding 30%. Periprocedural stroke rates were 0% and 4.5% in the OR and CAS groups respectively (0/21 vs 1/22, P=0.32). There were no early deaths. Mean follow-up was 19.1 months (3-75). The restenosis rate was 9.5% (2/21) in the OR group and 9% (2/22) in the CAS group.

CONCLUSION

Our results do not support a preferred treatment strategy. The choice of treatment should be considered on an individual basis.

[Prevalence of carotid artery stenosis in nonagenarians: Survey in a primary care hospital]

AIM

Carotid artery stenosis increases with age and may cause brain ischemia if arterial hypotension occurs. We performed a monocentric pilot study to investigate its prevalence in the very elderly and to assess its potential influence on blood pressure (BP) goals during antihypertensive treatment.

METHODS

All patients≥90 years of a primary care medical ward were prospectively included over 15 months. Ultrasound exams of the precerebral arteries were offered to all elderly patients for routine evaluation of their cardiovascular risk. Frequencies of stenosed common, internal and external carotid arteries (CCA, ICA, ECA) were analyzed together with clinical BP and antihypertensive therapy. Patients with circulatory shock and readmissions were excluded.

RESULTS

Sixty-three patients aged 92±3 years (78% female) hospitalized for a median of 11 days were included. On admission, 76% were on antihypertensive drugs vs. 86% at discharge. Mean admission BP was 149/77 vs. 129/72mmHg at discharge; systolic BP<140mmHg 36% vs 64% (P<0.05). Mean intima-media thickness (ACC, right/left) was 8.7/9.4mm. Prevalence of plaque or stenosis<60% was: CCA 19.0%, ICA 19.0%, ECA 31.7%, bulb 74.6%; of stenosis≥60%: CCA 0%, ICA 7.9%, ECA 19.0%, ICA bilateral 1.6% (unilateral occlusion 3.1%, no bilateral). Coincidence of systolic BP<120mmHg and ACI stenosis≥60% had a probability of 1-2%.

CONCLUSION

Concerning the risk of brain ischemia due to carotid artery stenosis, a BP goal<140mmHg should be safe for most nonagenarians. If individual BP goals are lower, searching for significant stenosis by ultrasound may be useful.

[The Allium ureteral stent in the management of ureteral stenoses, a retrospective, multicenter study]

OBJECTIVE

To evaluate the performance of the Allium ureteral stent in the management of patients initially treated with double J stents for the long-term treatment of stenoses.

MATERIALS AND METHODS

We performed a retrospective multicenter study involving 36 patients who received 37 Allium ureteral stents (metallic 24 Fr) between September 2011 and January 2015 in one of three French teaching hospital centers. The mean age of the patients was 63.8 years (min-max: 33-88 years) and most were women (70%). Of these patients, 5.6% had ureteral fistulae and 94.4% stenoses. Mean stenosis length was 4.15cm (min-max: 0.5-12cm). All analyses were two-tailed with an alpha risk of 0.05. Statistical significance was set at P<0.05. Results were expressed as hazard ratios (HR) with 95% confidence intervals and P-values.

RESULTS

During the follow-up period, 37% of the stents were removed due to migration (complication occurring in 18.9% of the studied population), infection (10.8%) or intolerance (8.1%). The other stents were removed after 1 year. Clinical effectiveness, defined as a lack of stenosis or fistula recurrence, was 52.8% after a mean follow-up of 7.1 months.

CONCLUSION

Clinically effective in more than 50% of cases, the Allium ureteral stent appears to be an alternative to indwelling double J stents.

LEVEL OF EVIDENCE

4.

[Fibromuscular dysplasia of renal arteries]

Fibromuscular dysplasia is non-atherosclerotic, non-inflammatory disease of the medium caliber arteries causing segmental stenosis, and sometimes aneurysm and/or dissection. Renal involvement is either asymptomatic or revealed by hypertension, rarely acute complications (renal infarction/hemorrhage). Cross-sectional imaging or angiography differentiates multifocal fibromuscular dysplasia (pearl necklace appearance) and focal fibromuscular dysplasia (tubular stenosis). Several differential diagnoses are to be mentioned. Carotid and vertebral involvement are possible. Smoking cessation must be encouraged. Selected patients benefit from renal revascularization. The best indications are recent or resistant hypertension, and progressive renal atrophy. Angioplasty without stent revascularization is the technique of choice in purely stenotic forms.

[Comparison of 3T dacryo-MRI by instillation with dacryo-CT scan for evaluation of epiphora]

OBJECTIVES

Epiphora is frequently related to stenosis of the lacrimal drainage pathways. In the evaluation of stenosis, dacryo-CT scan remains the gold standard, despite the need for radiation and catheterization of the lacrimal passages. Evaluation by high field 3T MRI compared to the gold standard in the morphological study of the lacrimal passages and quantification of the stenosis is attractive considering the lack of radiation and non-invasive nature of the technique.

METHODS

Twenty-four patients were included, including 9 with bilateral epiphora, representing 33 pathological drainage systems out of 48. Twenty-three drainage systems underwent subsequent surgery (18 patients, 5 patients bilaterally).

RESULTS

The average diameter on CT scan images of the superior canaliculus was 0.70 mm (± 0.46), of the inferior canaliculus 0.69 (±0.42), the common canaliculus 0.68 (± 0.58), the lacrimal sac 4.32 (± 2.10), and the nasolacrimal duct 1.15 mm (±1.42). 3T dacryo-MRI overestimated the diameters by 0.35 to 1mm (up to 20 % of the lacrimal sac size), and the concordance between dacryo-CT scan and 3T dacryo-MRI was of average value (kappa 0.5, P<0.05) concerning the diagnosis of stenosis. Furthermore, dacryo-CT scan demonstrated higher sensitivity (72.7 %) than 3T dacryo-MRI (42.4 %).

CONCLUSIONS

The two techniques are not equivalent in the diagnosis of stenosis. An optimization of protocols and an evaluation on a larger cohort remain necessary before dacryo-CT scan can be replaced by dacryo-MRI in routine practice.