Carmen León

Coronary Bifurcation Lesions Treated With Simple Approach (from the Cordoba & Las Palmas [CORPAL] Kiss Trial)

The present report compared the incidence of 1-year clinical events in patients with bifurcation lesions that had been treated with a simple approach who were randomized to either a simultaneous final kissing balloon (KB) or an isolated side-branch (SB) balloon post-dilation. From February 2007 to December 2008, 293 patients with all types of Medina bifurcation lesions were enrolled in a prospective study. All patients underwent implantation of a sirolimus- or everolimus-eluting stent across the bifurcation and provisional SB stenting. Patients with no SB ostial compromise or those needing a second stent were excluded from the present study (n = 49). The eligible patients were randomly assigned to treatment with final KB inflation (n = 124, KB group) or isolated balloon after dilation (n = 120, non-KB group). No significant differences were found between the patients from the KB and non-KB groups in terms of age, risk factors, clinical status, or location of the bifurcation lesions. The angiographic data and immediate results were also similar in both groups. Four patients experienced a non-Q-wave acute myocardial infarction in the hospital: three (2%) from the KB group and one (1%) from the non-KB group. Two in-hospital deaths occurred in the non-KB group. Target lesion revascularization was required in 7 patients (3%): 5 from the KB group and 2 from the non-KB group. Late mortality occurred in 3 patients from the KB group and 2 patients from the non-KB group. The incidence of major events at 1 year (death, target lesion revascularization, or acute myocardial infarction) was similar in both groups: 11 (9%) from the KB group and 7 (6%) from the non-KB group (p = NS). In conclusion, no differences in the clinical outcome at 1 year of follow-up were observed between the patients with bifurcation lesions treated with a simple approach and either a simultaneous final KB or an isolated SB balloon post-dilation.

Prevalence of Patent Foramen Ovale Determined by Transesophageal Echocardiography in Patients With Cryptogenic Stroke Aged 55 Years or Older. Same as Younger Patients

INTRODUCTION AND OBJECTIVES To investigate the relationship between patent foramen ovale and cryptogenic stroke in patients aged > or =55 years. METHODS This prospective study determined the presence of patent foramen ovale and atrial septal aneurysm using transesophageal echocardiography in 262 consecutive patients with a diagnosis of probable cryptogenic stroke. Data from 44 patients aged > or =55 years with cryptogenic stroke (Group A) were compared with those from two other groups: 194 patients aged <55 years with cryptogenic stroke (Group B) and 24 control patients aged > or =55 years with stroke of known origin, namely grade III-V aortic atheromatosis (Group C). RESULTS The frequency of patent foramen ovale in Group A was similar to that in Group B (38% vs. 36%; P=.85) but significantly higher than that in Group C (38% vs. 8%; P=.029). The frequency of patent foramen ovale with concomitant atrial septal aneurysm was significantly higher in the study group (Group A) than in the control Group C (18% vs. 0; P=.039) and non-significantly higher than in Group B (18% vs. 11%; P=.11). CONCLUSIONS The frequency of patent foramen ovale alone or in association with atrial septal aneurysm in patients with cryptogenic stroke aged > or =55 years was similar to that in those aged <55 years, but higher than that in patients aged > or =55 years with stroke of atherosclerotic origin. These data suggest that paradoxical embolism could be a cause of stroke in both age groups.