Gennaro Maresca

Endovascular Therapy for Infrainguinal Artery Disease With Coronary Devices A Retrospective Observational Study Comparing Drug-Eluting Stents Versus Bioresorbable Vascular Scaffolds

Several devices are available for infrainguinal endovascular therapy, with drug-eluting stents (DES) among the most promising. Bioresorbable vascular scaffolds (BVS) may further improve outcomes. We have liberally used in our practice coronary DES and BVS for infrainguinal endovascular therapy and hereby report our preliminary results. We conducted an observational study by retrospectively identifying characteristics of patients undergoing infrainguinal implantation of coronary DES or BVS. We compared the risk of major adverse events (MAE: death, amputation, or target vessel revascularization [TVR]) and components of MAE in the overall sample and after propensity matching. We included a total of 204 patients (207 limbs), 148 (72.5%) treated with DES and 56 (27.5%) with BVS. Bivariate analysis showed that TVR was less common in the DES group (41.9% vs 18.4%, P = .014). However, propensity-matched analysis showed nearly identical risks of MAE, amputation, TVR, or symptom burden with DES and BVS (all P > .05). In conclusion, the present pilot experience with coronary BVS suggests that they could provide acceptable results for infrainguinal endovascular procedures, comparable to those obtained by their metallic counterpart.

Transesophageal echocardiograpy in patients with persistent atrial fibrillation undergoing electrical cardioversion on new oral anticoagulants: A multi center registry☆

Increased risk of thrombo-embolism following cardioversion foratrial fibrillation (AF) is well recognized. Therefore, anticoagulation isconsidered mandatory before elective cardioversion for AF of N48 h orAF of unknown duration. Vitamin K antagonists (VKAs) (INR 2.0 to3.0) are recommended for at least 3 weeks prior to and 4 weeks aftercardioversion, regardless of the CHA2DS2-VASc score and the method(electrical or pharmacological) used to restore sinus rhythm [1,2].Therisk of thromboembolic events is high (up to 7%) if anticoagulation isinadequate, and is reduced to less than 1% if adequate anticoagulationis achieved [3]. Recently, new oral anticoagulants (NOACs) have beenintroduced intheclinical practiceandsuggestedalso inpatientsunder-going electrical cardioversion for AF. In this context compliance andadherence to treatment are crucial, as these drugs have a relativelyshort half-life. In fact patients missing more than one drug assumptioncannotbeconsideredunderanadequatetherapeuticregimen.Moreover,differently from VKA treatment, that can be followed through INRmeasurements,there are no effective hemoreological tests to assessther-apeutic anticoagulation. One way to assess the ef ficacy of anticoagulationtherapy is the direct search for left atrial thrombus by means oftransesophageal echocardiography (TEE). The aim of our study was toevaluate the incidence of left atrial (LA) thrombus in patients referredfor electrical cardioversion, while on treatment with NOACs, using apre-procedural TEE.Between January 2014 and December 2014 we collected the TEEdata of 219 consecutive patients with persistent AF referred to sevenItalian centers for elective electrical cardioversion, while on NOACs forat least 3 weeks before electrical cardioversion. This study followedtheprinciplesoutlinedinthelatestupdateoftheDeclarationofHelsinkiand all patients signed informed consent. This study was approved byour Institutional Review Boards. Main exclusion criteria were a historyof thromboembolic events, a history of LA thrombus diagnosed byTEE, a TEE procedure performed in the 21 days before starting NOACtherapy, and the need for anticoagulation other than AF. TEE wasperformed with a 5–7-MHz multiplane transducer connected to anultrasoundsystem.Multiplestandardtomographicplaneswereimaged.TheLAappendagepeakflowvelocity,presenceofthrombiintheLA,andseverityofspontaneousechocontrastintheLAweredetermined.Atrialcavityorappendagethrombiwereconsideredtobepresentwhenwell-circumscribed, echodense, intracavitary masses that were acousticallydistinct from the underlying endocardium and pectinate muscles wereidentified.The clinical characteristics of the study population are summarizedin Table 1. The mean duration of AF was 6.2 ± 4.3 months, and themean duration of NOAC therapy was 4.1 ± 3 months. NOACs usedwere dabigatran (86 patients, 39%), rivaroxaban (61 patients, 28%),and apixaban (73 patients, 33%). The daily dabigratan dose was220mgin21patients,and300mgin65patients;thedailyrivaroxabandose was 15 mg in 2 patients, and 20 mg in 59 patients; the dailyapixaban dose was 5 mg in 1 patient, and 10 mg in 72 patients. The

Infantile facial haemangioma and subclinical left ventricular dysfunction: the importance of z score in the diagnostic and therapeutic process.

Large facial haemangiomas have a high rate of complications and can be associated with neurological, ophthalmological and cardiac abnormalities (PHACE syndrome; Posterior fossa malformations, Haemangiomas, Arterial anomalies, Coarctation of the aorta and cardiac defects, and Eye abnormalities). However, a thorough clinical examination is absolutely necessary. In fact, even in the absence of a PHACE syndrome, large haemangiomas can induce important complications. In the present brief report we describe a case of left ventricular dilatation in a 6-month-old girl due to a giant facial haemangioma. Left ventricular dilatation has been evaluated by two-dimensional echocardiography. Studies to identify other major arteriovenous malformations were negative. Medical therapy with diuretics, angiotensin-converting enzyme (ACE) inhibitors and steroids was able to halt the progression towards left ventricular dysfunction, avoiding an early surgical approach for a disease that very often is self-limiting.

An imbalance between protective and detrimental molecular pathways is associated with right ventricular dysfunction in congenital heart diseases with outflow obstruction

An imbalance between protective and detrimentalmolecular pathways is associatedwith right ventricular dysfunction in congenital heart diseases with outflow obstruction Elisa di Pietro , Maria Carmen De Angelis , Francesca Esposito , Gennaro Maresca , Alessia Agresta , Annunziata Cerrone , Ovidio De Filippo , Philip J. Kilner , Gaetano Palma , Gennaro Galasso , Dario Leosco , Carlo Vosa , Bruno Trimarco , Antonio Rapacciuolo a,⁎

Subclinical hypothyroidism: a reversible cause of complete loss of ventricular lead capture.

A 77-year-old male former smoker with hypertension, dyslipidemia, and diabetes mellitus was admitted to our institution for recurrent syncope. He had a history of previous non–Q-wave inferior myocardial infarction in 1980, which had never been investigated by coronary angiography. Echocardiogram showed left ventricular dilation, inferior akinesia, and hypokinesia of the remaining segments with severe left ventricular dysfunction (left ventricular ejection fraction, 30%). Twenty-four–hour Holter ECG recording revealed 3 episodes of self-terminating sustained ventricular tachycardia. The patient underwent a coronary angiography that evidenced multivessel disease with chronic total occlusion of the proximal right coronary artery and of the mid left circumflex artery and diffuse disease of the left anterior descending artery without critical stenosis. Collateral flow ran from left anterior descending artery to left circumflex artery via diagonal branches (Rentrop 2); mid-distal right coronary artery was supplied by homo- contralateral vessel circulation via left circumflex artery collateral channels (Rentrop 3). No revascularization therapy was performed because both mid-distal right coronary artery and left circumflex artery were supplied by valid collateral flow and the patient was asymptomatic for …

Multiple MGuard stent implantation to treat massive right coronary artery dissection during primary coronary angioplasty.

Here we report a case of a 79-year-old woman with inferior myocardial infarction, transferred to our cath lab to perform a primary percutaneous coronary intervention (PPCI). During the procedure, a massive dissection complicated the thrombotic lesion of the right coronary artery (RCA). In this case, we decided to use the MGuard stent to treat both the large dissection and the thrombotic lesion. MGuard stent is a combination of a coronary stent merged with an embolic protection device. After multiple MGuard stent implantation we obtained a complete resolution of the coronary dissection obtaining a patent RCA with normal antegrade flow.

Hemostasis After Brachial Artery Access With the MynxGrip Device: A Case Report:

Purpose: Brachial access is occasionally used for endovascular procedures when other more established or safer ones (eg, femoral or radial) are contraindicated. Although manual compression is the standard of care after brachial arteriotomy, suboptimal compression may lead to bleeding or thrombosis. Arteriotomy closure devices have thus been proposed as an alternative means to achieve hemostasis after brachial arteriotomy. Yet, there is a paucity of evidence and a limited spectrum of devices suitable for brachial arteriotomy closure. We present the use of the MynxGrip closure device after brachial arteriotomy. Case: A 70-year-old gentleman underwent brachial arteriotomy followed by iliac artery stenting with a 7F compatible device. Hemostasis was then achieved with the MynxGrip device, uneventfully. Conclusions: This clinical vignette highlights the feasibility and safety of brachial use of the MynxGrip device in experienced hands, suggesting that it can represent a useful adjunct to the armamentarium of the endovascular specialist.