M. Boukhris

Coronary perforation with tamponade successfully managed by retrograde and antegrade coil embolization

In recent years, retrograde approach for chronic total occlusions has rapidly evolved, enabling a higher rate of revascularization success. Compared to septal channels, epicardial collaterals tend to be more tortuous, more difficult to negotiate, and more prone to rupture. Coronary perforation is a rare but potentially life-threatening complication of coronary angioplasty, often leading to emergency cardiac surgery. We report a case of a retrograde chronic total occlusion revascularization through epicardial collaterals, complicated by both retrograde and antegrade coronary perforation with tamponade, and successfully managed by coil embolization.

An algorithmic approach for the management of ostial right coronary artery chronic total occlusions

Treatment of ostial chronic total occlusions (CTOs) of the right coronary artery (RCA) can be challenging. We present an algorithmic approach to the management of such lesions that incorporates all contemporary equipment and techniques. If the RCA ostium can be engaged with a guide catheter then antegrade crossing attempts should be performed. If the antegrade guidewire enters the subintimal space, re‐entry into the distal true lumen is performed provided that the antegrade guide catheter provides enough support. If re‐entry cannot be achieved, the antegrade wire is left in place to facilitate retrograde recanalization attempts (usually performed using the reverse controlled antegrade and retrograde tracking and dissection—reverse CART—technique). If the RCA ostium cannot be engaged with a guide catheter (for example in flush ostial occlusions) or if the guide catheter does not provide sufficient support, a primary retrograde approach is required, aiming for retrograde guidewire puncture into the aorta, followed by snaring and externalization. Retrograde guidewire puncture can be challenging, requiring use of stiff, highly penetrating guidewires or occasionally use of the Carlino technique. The aforementioned algorithm can facilitate crossing of ostial RCA CTOs.

Update on Coronary Chronic Total Occlusion Percutaneous Coronary Intervention

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved during recent years. High success rates are being achieved by experienced centers and operators, but not at less-experienced centers. Use of CTO crossing algorithms can help improve the success and efficiency of these potentially lengthy procedures. There is a paucity of clinical trial data examining clinical outcomes of CTO PCI, which is critical for further adoption and refinement of the procedure. We provide a detailed overview of the clinical evidence and current available crossing strategies, with emphasis on recent developments and techniques.

Balloon anchoring intraluminal tracking technique: a new application of an old technique for coronary artery chronic total occlusion percutaneous intervention.

Luca Grancini, Alessandro Lualdi, Marouane Boukhris, Giovanni Teruzzi, Giovanni Monizzi, Alfredo R. Galassi, Hazem Khamis, Stefano Galli, Piero Montorsi, Paolo Ravagnani, Daniela Trabattoni and Antonio L. Bartorelli, Centro Cardiologico Monzino, IRCCS, Milan, Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Department of Experimental and Clinical Medicine, University of Catania, Catania, Italy, Faculty of Medicine, Tunis University, Tunis El Manar, Tunisia and Department of Cardiology, October 6th University, Cairo, Egypt

Évaluation du risque du syndrome d’apnées-hypopnées obstructives du sommeil chez les patients ayant des comorbidités cardiovasculaires

Objectif Le syndrome d’apnee obstructive du sommeil (SAHOS) est reconnu comme un facteur de risque cardiovasculaire. Evaluer le risque du (SAHOS) chez des patients presentant des comorbidites cardiovasculaires. Methodes Il s’agit d’une etude transversale realisee chez 50xa0patients ayant consulte durant le mois de septembre 2017xa0au service de cardiologie du CHU Abderrahmen Mami. Ont ete inclus, les patients suivis pour un trouble du rythme et/ou une hypertension arterielle et/ou une insuffisance coronaire et/ou une insuffisance cardiaque. Tous les patients ont repondu au questionnaire de Berlin. Deux groupes ont ete colligesxa0: le groupe 1 (G1xa0; nxa0=xa032) a inclus patients ayant un faible risque de SAHOS (score de Berlin egal a 0xa0ou 1xa0categorie positive) et le groupe 2 (G2xa0; nxa0=xa019) a inclus les patients ayant un haut risque de SAHOS (score de Berlinxa0>xa01xa0categorie positive). Resultats L’âge moyen etait comparable entre les deux groupes (63,16xa0contre 64,74). Le ronflement etait plus note dans le G2 (22xa0% dans le G1xa0contre 78xa0% dans le G2xa0; pxa0=xa00,01). Le poids moyen (71xa0kg contre 87xa0kgxa0; pxa0=xa00,01) et l’indice de masse corporelle moyen (24,23xa0kg/cm2xa0contre 30,64xa0kg/cm2xa0; pxa0=xa00,01) etaient plus eleves dans le G2. De meme, L’insuffisance coronaire (25xa0% contre 11xa0%xa0; pxa0=xa00,01) et l’insuffisance cardiaque (42xa0% contre 12xa0%xa0; pxa0=xa00,001) etaient plus retrouvees dans le G2. La fraction d’ejection moyenne du ventricule gauche etait plus elevee dans le G1xa0mais sans difference significative (45xa0% contre 52xa0%xa0; pxa0>xa00,05). Conclusion Le risque du SAHOS augmente chez les patients ronfleurs en surpoids et insuffisants cardiaque ou coronaire.

Residual SYNTAX Score II: a Combination of the Assessment of the Revascularization Degree and the Clinical Evaluation after Percutaneous Coronary Intervention

Please cite this article in press as: Boukhris M. et al., Residual SYNTAX score II: A combination of the assessment of the revascularization and the clinical evaluation after percutaneous coronary intervention, J Saudi Heart Assoc (2017), https://doi.org/10.1016/j.jsha.2017.11.003 Marouane Boukhris a,⇑, Farouk Abcha , Salvatore D. Tomasello , Simona Giubilato , Salvatore Azzarelli , Alfred R Galassi c,d

Which diuretic for which hypertensive patient

We have read with great interest the editorial by Mishra. Diuretics represent a heterogeneous class of drugs, differing from each other by structure, site and mechanism of action. They are largely prescribed in different cardiovascular diseases, particularly in hypertension and heart failure. However, despite the available data on their efficacy, diuretics are still underused in the management of hypertension. Formerly, diuretics were considered to be one of the most potent antihypertensive treatments. Nowadays, after the onset of new efficient anti-hypertensive drugs, diuretics may be no longer considered the most privileged first-line strategy. Indeed, most of the current guidelines downgraded the place of thiazide diuretics in themanagement of hypertension from the preferential initial therapy to one of the possible first-line alternatives among a large armamentarium of anti-hypertensive drugs. Interestingly, thiazide and thiazide like diuretics are those recommended as first-line strategy for primary hypertensive treatment in different guidelines. Thiazide and thiazide like diureticsneitherhave the same structure nor the same site of action, and that would explain the huge disparities concerning their efficiency and side effects. However, despite their differences, the recommendations generally do not favor any agent on the other. Whereas, other types of diuretics are barely mentioned in different guidelines and therebyare evermore underutilized indaily practice. Hence, although recommendations encouraged a treatment approach based on considering patients characteristics, the majority of guidelines are based on evidence for drug classes rather than individual drugs. Only NICE recommendations encourage when initiating or changing treatment, to prescribe a thiazide-like diuretic, such as chlorthalidone or indapamide in preference to a conventional thiazide diuretics. For the above reasons, we should not think any more if patient with hypertension needs or not a diuretic. Indeed, a new question should arise in light: which diuretic for which patient? Much evidence support the inferiority of hydrochlorothiazide compared to other thiazide like agents. In fact, hydrochlorothiazide duration of antihypertensive action is less than 24h, while indapamide has even in the immediate release form, at least 24-h duration of action for blood pressure reduction. In addition, a network analysis demonstrated that hydrochlorothiazide was less effective in preventing cardiovascular events as compared with chlorthalidone and the association hydrochlorothiazide-amiloride. Moreover, it is inferior to indapamide in improving endothelial function and longitudinal strain in patients with hypertension and diabetes. Hydrochlorothiazide is also inferior to spironolactone in improving coronary flow reserve. Many authors suggest that indapamide is by far the most efficient and tolerable diuretic for hypertensive patients. Compared to hydrochlorothiazide, it was demonstrated to be more efficient in improving micro-albuminuria (in diabetics), reducing left ventricular mass index, inhibiting platelet aggregation, and reducing oxidative stress. Indapamide was also shown to reduce left ventricular hypertrophy more than enalapril. Importantly, indapamide do not share with thiazide diuretics their adverse effects on lipid and glucide metabolism, thereby it can be safely prescribed in diabetic [64_TD

Late mitral restenosis after percutaneous commissurotomy: Predictive value of inflammation and extracellular matrix remodeling biomarkers

DIFF]patients. However, despite this strong evidence, one of the reasons explaining the huge disparities of thiazide/thiazide like diuretics prescription may be due to that chlorthalidone is only commercialized with atenolol and azilsartan. Likewise, indapamide is only combined with perindopril. The only [65_TD

Vitamine C + sérum bicarbonaté versus sérum bicarbonaté seul dans la prévention de la néphropathie induite par les produits de contraste

DIFF]advantages of hydrochlorothiazide seem [66_TD

Insomnie chez les patients ayant des comorbidités cardiovasculaires

DIFF][63_TD