Victor Alfonso Jiménez

A randomized comparison of novel bioresorbable polymer sirolimus-eluting stent and durable polymer everolimus-eluting stent in patients with acute coronary syndromes: The CENTURY II high risk ACS substudy

BACKGROUND To investigate clinical outcomes of percutaneous coronary intervention using a sirolimus-eluting stent with bioresorbable polymer, Ultimaster (BP-SES) compared with a permanent polymer everolimus-eluting stent, Xience (PP-EES) in patients with high risk (ST-segment elevation and non-ST-segment elevation myocardial infarction) acute coronary syndromes (ACS) enrolled in the CENTURY II trial. METHODS CENTURY II is a prospective, multicenter, randomized, single blind, controlled trial comparing BP-SES and PP-EES, with primary endpoint of target lesion failure (TLF) at 9month post-stent implantation. Out of 1123 patients enrolled in CENTURY II trial, 264 high risk ACS patients were included in this subgroup analysis, and the clinical outcomes including target lesion failure (TLF), target vessel failure (TVF), cardiac death, myocardial infarction, and stent thrombosis were evaluated at 24months. RESULTS The baseline clinical, angiographic and procedural characteristics were similar between two groups. At 24months, TLF occurred in 6.3% of patients receiving a BP-SES and 6.5% of patients receiving a PP-EES (P=0.95); TVF was 6.3% in patients receiving a BP-SES and 9.4% in patients receiving a PP-EES (P=0.36). There were no significant differences in cardiac death, myocardial infarction and stent thrombosis rate. CONCLUSIONS BP-SES achieved similar safety and efficacy outcomes as PP-EES in this ACS subgroup of CENTURY II study, at 24-month follow-up. This finding is hypothesis-generating and needs to be confirmed in larger trials with longer follow-up.

Unintentional Extraction of an Endothelized Coronary Stent With an Aspiration Catheter During Primary Percutaneous Coronary Intervention

A 58-year-old patient presented to our hospital with an anterior ST-segment–elevation myocardial infarction. His medical history included placement of 2 overlapped stents in the left anterior descending coronary artery, and 1 in the first diagonal branch (DG) 3 years before. Current coronary angiography revealed thrombotic occlusion of the first DG stent, patency of the remaining stents, and absence of de novo lesions (Figure 1A, 1, asterisk; Movie I in the Data Supplement). Thromboaspiration with Pronto thrombectomy catheter (Vascular Solutions, Inc, Minneapolis, MN) was attempted with no success because of inability of passing the device through the proximal portion of first DG. During its removal, the thrombectomy catheter was hooked with the endothelized left anterior …

It's just a coronary milking-like effect … or maybe not: posterolateral artery compression caused by a ventricle pseudoaneurysm.

A 57-year-old man was referred to our catheterization laboratory due to angina complaints on exertion and an inconclusive treadmill stress test. He had a history of stent implantations in the right coronary artery (RCA) and left anterior descending (LAD) artery 2 years before. Current coronary angiography (see Supplementary data online, Video S1 ) showed neither de novo coronary stenosis nor stent restenosis. Instead, a large posterolateral branch …

An Aortic Root Geometric Model, Based on Transesophageal Echocardiographic Image Sequences (TEE), for Biomechanical Simulation

Aortic valve (AoV) stenosis is one of the most common valvular diseases. Assessing the aortic valve function could provide crucial information towards a better understanding of the disease, where numerical simulation will have an important role to play. The main scope of this work is to find an aortic root (AR) patient specific geometric model, which could be used for simulation purposes. Several models were followed to obtain an AR geometry implementing them in open source tools. Necessary parameters were obtained from 2D echo images. In order to test the obtained AR geometry, a finite element study was performed solving a fixed mesh fluid structure interaction (FSI) model. The fluid was supposed to be laminar and the tissues were modeled as St. Venant-Kirchhoff materials. Obtained results for the 1-way FSI study are compared with the published ones for structural and 2-way FSI studies showing similar results. An AR geometric reconstruction from clinic data is suited for numerical simulation.

A Hybrid Model for Extracting the Aortic Valve in 3D Computerized Tomography and Its Application to Calculate a New Calcium Score Index

In this paper a new scheme for automatic segmentation of the Aortic Valve in 3D computed tomography image sequences is presented. The algorithm is based on a new approach that uses a combination of Region Growing and Mathematical Morphology techniques in a hybrid framework. The output of the algorithm is used to assess the Aortic Valve Calcium Score in a new way that calculates the Agatston Score separately in both Sinuses and Leaflets, deriving a new index based on their ratios. Aortic Valve borders and leaflets identification is still a challenging task, and commonly based on intensive user interaction that limits its applicability. In this paper a fast and accurate model-free, automated method for segmenting and extracting morphological parameters with Score Calcium calculation is presented. Results of the proposed method are also provided showing a high correlation with the expected values.

Results after 6 years of the health care network for coronary reperfusion in patients with acute myocardial infarction in the southern area of Galicia (PROGALIAM-South).

The treatment strategy in acute myocardial infarction (AMI) has changed substantially in recent decades. After the enormous impact of fibrinolysis in the 1980s, the situation was further improved in the 1990s by the high level of efficacy and the safety of primary angioplasty, which significantly reduced the rate of in-hospital mortality. However, despite the available evidence, the performance of this intervention has not become widespread, and it is associated with a very marked clinical variability. Along the lines of the recommendations of the European and Spanish societies of cardiology, online programs have been set up in Spain to increase the use of and improve access to primary angioplasty for AMI patients, first in a singleprovince autonomous community (Murcia) in 2001, and later in an autonomous community consisting of 4 provinces (Galicia) in mid-2005. This project was the PROgrama GALlego de Atención al Infarto Agudo del Miocardio (PROGALIAM [Galician Program for Acute Myocardial Infarction Care]). The purpose of PROGALIAM is to promote and facilitate access to primary angioplasty, establishing a single protocol for AMI care at the different health care levels. These efforts are consolidated under an online organizational model, with its node for the southern region of Galicia in the Complejo Hospitalario Universitario de Vigo (CHUVI). The process is coordinated by the center of operations of the 061 emergency transport and medical care service (the 061 service), which organizes the care and transport of patients from the out-of-hospital and in-hospital setting to the CHUVI and, depending on their clinical stability, returns them to the center from which they were referred. The implementation of PROGALIAM was especially complex because Galicia is a multiprovince community with a widely scattered population of 2 737 370 and poor geographic access.