Absence Of Revascularization Research Articles

Investigation of treatment outcomes for severe extremity trauma in an independent orthopedic trauma center: A case series

BackgroundSevere extremity trauma is one of the most challenging injuries to treat. Limb salvage after severe extremity trauma requires rapid revascularization, accurate and appropriate bone and soft tissue reconstruction, and appropriate management to address critical complications. The purpose of this study was to report the treatment outcomes for severe extremity trauma injuries at our independent orthopedic trauma center. MethodsThis study included patients with severe extremity trauma who underwent major vascular repair or soft tissue reconstruction. Bone reconstruction method, presence or absence of revascularization, and flap type were investigated. Complications were investigated, including revascularization failure, flap failure, infection, and ultimately, whether amputation was required. Additionally, we investigated the number of surgeries performed on each patient at the time of initial hospitalization. ResultsThirty-five patients who underwent revascularization or soft tissue reconstruction were included in this study. Plate fixation was performed in 18 patients, intramedullary nail fixation in 8, screw fixation in 1, pinning in 4, and without implant fixation in 4. Revascularization was performed in six patients, and no vascular complications occurred. Pedicled and free flaps were used in 17 and 16 patients, respectively. Partial flap necrosis occurred in four patients, and arterial occlusion occurred in one. Infection occurred in 10 patients who were treated with frequent irrigation and high-concentration antibiotics local infusion therapy. None of the 35 patients required limb amputation. Mean number of surgeries was 12.5. ConclusionsThe limb of all the 35 patients with severe extremity trauma treated at our independent orthopedic trauma center were salvaged.

ОСОБЕННОСТИ ПОРАЖЕНИЯ КОРОНАРНЫХ АРТЕРИЙ У МУЖЧИН МОЛОЖЕ 60 ЛЕТ С ОСТРОЙ ЗАДЕРЖКОЙ МОЧИ ПРИ ИНФАРКТЕ МИОКАРДА

Relevance. Acute urinary retention (AUR) adversely affects the the patient’s quality of life and the prognosis of myocardial infarction (MI). Aim. To evaluate features of the coronary arteries state in men under 60 years old with myocardial infarction complicated by AUR to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with MI were studied. The patients were divided into two age comparable groups: I - study group, with AUR - seven patients; II - control, without it - 132 patients. A comparative analysis of the coronary angiography indicators, AUR risk analysis (Pearson's Chi-square) were performed. Results. The study group did not differ from the control group in the numbers of affected arteries and the extent of the lesion, its localization and depth. The study group was characterized by complete occlusion of the coronary arteries (in the study group: 100%; control: 32.7%; p = 0.003), the absence of revascularization (0 and 17.0%; respectively; p = 0.03), re-current lesions (22.7 and 3.7%; p ˂ 0.0001), as well as a large maximum stenosis (100.0 ± 0 and 92.8 ± 10.6%; p = 0.03). The same parameters were associated with the risk of AUR development. Conclusions. Men under than 60 years old with AUR in MI are characterized by a higher incidence of complete occlusions of the coronary arteries and failure to perform revascularization. These angiographic parameters indicate that the patient belongs to the high-risk group for severe MI and the development of AUR. It is advisable to use them for the timely imple-mentation of preventive measures and for predictive modeling.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia.

Acute Limb Ischemia (ALI) of the lower limb is defined as a sudden drop in arterial limb perfusion, which is a medical emergency requiring prompt intervention with high amputation and mortality rates in the absence of revascularization. This observational, analytical, and retrospective cohort study with longitudinal follow-up aimed to confirm the relevance of the preoperative inflammatory biomarkers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting the 30-day poor prognosis of patients with Rutherford classification (RC) grades II and III ALI. The ROC analysis found a strong association of an NLR > 4.33 with all studied outcomes, while a PLR > 143.34 was associated with all studied outcomes, except the composite endpoint in all RC stages. Depending on the optimal cut-off value, the ROC analysis found a higher incidence of all adverse outcomes in all high NLR (>4.33) and high PLR (>143.34) groups. A multivariate analysis showed that a high baseline value for NLR and PLR was an independent predictor of amputation (OR:11.09; 95% CI: 5.48–22.42; p < 0.0001; and OR:8.97; 95% CI: 4.44–18.16; p < 0.0001), mortality (OR:22.24; 95% CI: 9.61–51.47; p < 0.0001; and OR:8.32; 95% CI: 3.90–17.73; p < 0.0001), and composite endpoint (OR:21.93; 95% CI: 7.91–60.79; p < 0.0001; and OR:9.98; 95% CI: 3.89–25.55; p < 0.0001), respectively. Furthermore, for all hospitalized patients, the RC grade III (OR:7.33; 95% CI: 3.73–14.26; p < 0.0001) was an independent predictor of amputation (OR:7.33; 95% CI: 3.73–14.26; p < 0.0001), mortality (OR:8.40; 95% CI: 4.08–17.31; p < 0.0001), and composite endpoint (OR: 10.70; 95% CI: 4.48–25.56; p < 0.0001), respectively. The NLR and PLR are excellent predictors of risks associated with ALI for primary and secondary prevention. Our study showed that increased pre-operative values for NLR and PLR are indicators of a poor outcome in patients with RC grades II and III ALI.

Analysis of adverse events in the elderly after acute myocardial infarction with reduced left ventricular ejection fraction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Contract (CM19/00055) supported by the Instituto de Salud Carlos III in Spain (Co-funded by European Social Fund "Investing in your future"). Background Elderly patients present higher risk for developing complications after an acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (rLVEF) constitutes an adverse prognostic factor. Purpose The main objective was to characterize elderly population with AMI and rLVEF and analyze prognostic factors. Methods Retrospective analysis of hospitalized elderly patients (&amp;gt; 75 years old) with AMI and rLVEF &amp;lt;40% between January 2018 and December 2019. We analyze the occurrence of adverse outcomes in the follow-up: combined event (death from any cause and/or hospitalization from heart failure (HF) and/or AMI and/or ventricular arrhythmias) and its relationship with different variables (Figure 1). Results Out of 179 patients, 100 &amp;gt;75 years old patients (55.9%) were included (Figure 1). After a mean follow-up of 3.8 [18.4] months, the combined event happened in 52% of them (figure 1, figure 2). Older age was associated with the combined event (86.8+8 years occurrence of event vs. 82.6+5.1 event-free, p=0.003). Variables significantly related with the occurrence of the combined event were chronic kidney disease (CKD) (72.7% occurrence of event vs. 46.2% event-free, p=0.032), higher values of creatinine (1.6+1 vs. 1.1+0.3, p=0.002), the presentation with acute pulmonary oedema (APO) (91.7% vs. 39.5%, p&amp;lt;0.001) and cardiogenic shock (93.2% vs. 41%, p&amp;lt;0.001), the need for noradrenaline (92.9% vs. 45.3%, p=0.001) and dobutamine (100% vs. 46.7%, p=0.001), the revascularization (completely percutaneous 43.5% of combined event, partial percutaneous 41.4%, partial surgical 100%, absence of revascularization 78.6%, p=0.034) and the presence of associated severe valvular disease (84.6% vs. 42%, p&amp;lt;0.001). We observed a trend although not statistically significant, to present higher values of NT-proBNP at the admission (16850 vs. 9044, p=0.71) and the initial presentation of non-ST elevation-acute coronary syndrome (NSTE-ACS) (28.6% of event in ST segment elevation myocardial infarction (STEMI) vs. 58.6% in NSTE-ACS, p=0.088) in patients who suffered the combined event in the follow-up. Conclusions More than half the patients with 75 years old or higher presented adverse outcomes in the short term after a hospitalization for AMI with rLVEF. The most advanced age, the presentation as APO or cardiogenic shock, CKD, absence of revascularization, need for drugs and the presence of concomitant severe valvular disease were related with the appearance of the combined event (death, HF, AMI, ventricular arrhythmias).

Brain plasticity after rehabilitation in a severe case of artery of Percheron stroke assessed with multimodal MR imaging

ABSTRACT Artery of Percheron (AOP) stroke is a rare event. We describe an AOP stroke involving both thalami and the midbrain, resulting in a multifunctional clinical impairment. Intensive inpatient multidisciplinary rehabilitation favored the recovery of motor deficits, together with the improvement of cognitive dysfunctions. MRI assessment in the chronic post-stroke phase showed structural and functional reorganization in response to the extended thalamic tissue damage and absence of revascularization. Thalamo-cortical networks involving frontal and prefrontal regions, as well as parietal areas were disrupted, whereas increased functional thalamo-occipital connectivity was found. This report sheds light on brain reorganization following AOP stroke after rehabilitation..

Cardiogenic Shock Among Patients with and without Acute Myocardial Infarction in a Latin American Country: A Single-Institution Study.

Background:Latin America has limited information about the full spectrum cardiogenic shock (CS) and its hospital outcome. This study sought to examine the temporal trends, clinical features and outcomes of patients with CS in a coronary care unit of single Mexican institution.Methods:This was a retrospective study of consecutive patients hospitalized with CS in a Mexican teaching hospital between 2006–2019. Patients were classified according to the presence or absence of acute myocardial infarction (AMI).Results:Of 22,747 admissions, 833 (3.7%) exhibited CS. Among patients with AMI (n = 12,438), 5% had AMI–CS, and in patients without AMI (n = 10,309), 2.3% developed CS (non-AMI–CS). Their median age was 63 years and 70.5% were men. Cardiovascular risk factors were more frequent among the AMI–CS group, whereas a history of heart failure was greater in non-AMI–CS patients (70.1%). In AMI-CS patients, the median delay time was 17.2 hours from the onset of AMI symptoms to hospital admission. Overall, the median left ventricular ejection fraction (LVEF) was 30%. Patients with CS at admission showed end-organ dysfunction, evidenced by lactic acidosis, renal impairment, and elevated liver transaminases. Of the 620 AMI–CS patients, the main cause was left ventricular dysfunction in 71.3%, mechanical complications in 15.2% and right ventricular infarction in 13.5%. Among the 213 non-AMI–CS patients, valvular heart disease (49.3%) and cardiomyopathies (42.3%) were the most frequent etiologies. In-hospital all-cause mortality rates were 69.7% and 72.3% in the AMI–CS and non-AMI–CS groups, respectively. Among AMI–CS patients, renal dysfunction, diabetes, older age, depressed LVEF, absence of revascularization and the use of mechanical ventilation were independent predictors of in-hospital mortality. However, in the non-AMI–CS group, only low LVEF and high lactate levels proved significant.Conclusions:This study demonstrates differences in the epidemiology of CS compared to high-income countries; the high mortality reflects critically ill patients and the lack of contemporary effective therapies in the population studied.

Mechanical complications in ST-elevation myocardial infarction: The impact of pre-hospital delay

AimsMechanical complications (MC) (i.e., free wall rupture (FWR), papillary muscle rupture (PMR) and ventricular septal rupture (VSR)) are rare complications of ST- elevation acute myocardial infarction (STEMI). Incidence of MC according to pre-hospital delay remains unknown. We aimed to determine the rates of MC according to pre-hospital delay. MethodsAnalysis was conducted on the MODIF registry data. Patients were allocated to four groups according to pre-hospital delay: 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h. Results6185 patients with complete data were analyzed. Mean age was 64.1 years old and 75.7% of patients were males. Eighty-three patients (1.34%) presented with MC: 44 (0.71%) experienced a FWR, 17 (0.27%) a PMR, and 22 (0.36%) a VSR. Global rates of MC were 0.82%, 1.43%, 1.24% and 5.07% in the four groups of pre-hospital delays - 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h - respectively (p < 0.001). In-hospital mortality rates were high: 44.2%, 47.1% and 54.6% for FWR, PMR and VSR, respectively. In multivariate analysis, factors independently related to the occurrence of MC were older age, female sex, simultaneous COVID-19 infection, absence of dyslipidemia, initial TIMI flow 0 or 1 in the culprit artery, 36 to 48 h-pre-hospital delay and absence of revascularization by percutaneous coronary intervention (PCI) with stent implantation. ConclusionThe probability of MC in STEMI increases with pre-hospital delay. Mechanical complications of STEMI remain associated with a very poor prognosis.

Prognostic impact of iron deficiency in acute coronary syndromes.

Iron deficiency (IDef) is a prevalent condition in patients with heart disease and in those with heart failure (HF). Evidence has shown that this deficit is associated with worse prognosis. Data in literature are scarce on the prognostic impact of IDef in acute coronary syndromes (ACS), which is the main objective of this study. Observational, retrospective study which included 817 patients admitted for ACS. Two groups were defined according to the presence (n=298) or absence of IDef (n=519) on admission. The clinical event under study was the occurrence of death or severe HF in the long term. Independent predictors of prognosis were determined with logistic regression analysis. Thirty-six percent of patients had IDef. There was higher mortality (p=0.004), higher incidence of HF (p=0.011) during follow-up and a higher rate of hospital readmissions (p=0.048) in this group. IDef was an independent predictor of death or severe HF in follow-up, along with anemia, left ventricular dysfunction, renal dysfunction and the absence of revascularization. IDef also enabled us to further stratify the prognosis of patients without anemia based on the occurrence of death or severe HF and those with lower Killip classes (≤2) based on the occurrence of death. IDef was an independent predictor of death or severe HF in patients admitted with ACS and enabled additional stratification for those without anemia on admission and in those with Killip classes ≤2.

Regenerative Endodontics: A Paradigm Shift in Clinical Endodontics.

ABSTRACTPreserving the natural dentition in its normal form and function is one of the major goals of endodontic treatment. Re-establishing the lost vitality and development of root maturation in immature permanent teeth with pulp necrosis/apical periodontitis is quiet challenging clinically. The very basis of regenerative endodontics relies on the concept of tissue engineering using stem cells, biomimetic scaffold, and bioactive growth factors to regenerate the pulp tissue damaged by microbial infection, injury, or developmental defects. In clinical endodontics, this approach is referred to as a “paradigm shift.” Even though repair instead of true regeneration is achieved with current protocols, it is hoped that further research in the area of stem-cell-based tissue engineering will allow for true regeneration and improved treatment outcomes. The aim of this review is to discuss about the various aspects of regenerative endodontics, current clinical protocols, and the future of pulp regeneration techniques.

Characteristics and in-hospital mortality of patients with myocardial infarction in the absence of obstructive coronary artery disease in super-aging society

BackgroundMyocardial infarction with nonobstructive coronary arteries (MINOCA) is a common presentation of acute myocardial infarction (AMI) and has a better prognosis. However, there were few reports on large-scale, high aged population. The aim of this study was to determine the differences in the clinical characteristics and short-term prognosis between MINOCA and myocardial infarction with obstructive coronary artery disease (MI-CAD) using a nationwide administrative database in the super-aging society, Japan. MethodsThis was an observational study using data of 137,678 AMI patients who underwent angiography between April 2012 through March 2016. Using the international classification of diseases 10th revision, AMI patients were divided into two groups based on the presence or absence of revascularization and coronary atherosclerosis, identifying 123,633 MI-CAD and 14,045 working diagnosis of MINOCA patients. The true MINOCA (n = 13,022) was defined as the MINOCA excluding non-ischemic causes. We assessed in-hospital mortality within 30 days. ResultsBoth MINOCA groups were typically found in non-obese, non-smoker young females, with a low grade on Killip classification, and non-low ADL status. Compared to MI-CAD, chronic pulmonary diseases, peripheral vascular diseases, liver diseases, renal diseases, and cerebrovascular diseases were more common, whereas diabetes was less common in the MINOCA groups. In-hospital mortality within 30 days was higher in both MINOCA groups than in MI-CAD. Multivariate frailty model identified both MINOCA groups as an independent risk factor for in-hospital mortality. ConclusionsOur large-population study demonstrated that MINOCA was associated with a high risk of in-hospital mortality compared with MI-CAD in the super-aging society.

Endovascular management of Critical Limb Ischaemia: Study of 100 Cases

Background: Critical limb ischemia (CLI) is the most severe form of Peripheral Artery Disease (PAD) and represents approximately 1% of the total number of patients with PAD. CLI is associated with a higher risk of limb loss in the absence of revascularization. Objectives of the study are to find out the modality of treatment in CLI, different types of endovascular therapy in CLI and their outcome.&#x0D; Methods: A retrospective study evaluated 100 patients with CLI reported to cardiovascular surgery department in Combined Military Hospital (CMH), Dhaka between July 2016 to June 2018. Patients with disabling claudication or rest pain and tissue loss are included in the study. All patients were evaluated by peripheral angiogram and revascularisation of limbs was done by endovascular procedure in 79 patients, by surgical intervention in 12 patients.&#x0D; Results: Forty-four patients (44%) presented with rest pain and disabling claudication, 56 patients (56%) presented with tissue loss. Revascularization of limbs was done in 91 patients (93%). No intervention could be done in 9 patients (9%). Endovascular interventions were done in 79 patients (87%). Twelve patients (13%) underwent surgical bypass. All patients with rest pain remains asymptomatic in 6 months follow up; 2 patients developed reocclusion within 1 year. No major amputation in patients with only rest pain.&#x0D; Conclusion: Revascularization is the main modality of treatment in CLI. Most of the patient can be treated by endovascular percuteneous procedure. Early intervention in CLI patient without tissue loss carries excellent outcome.&#x0D; Cardiovasc. j. 2019; 12(1): 40-44

Clinical-functional features in the course of a silent ischemic heart disease form depending on stenting

Objective: to analyze the remote prediction of reperfusion therapy by stenting on the indicators of myocardial ischemia in patients with painless coronary heart disease (CHD) with postinfarction cardiosclerosis. Material and methods. The subject of the study was the study of 67 patients with painless myocardial ischemia (BIM), which occurred in people with postinfarction cardiosclerosis, among which 29 patients with BIM who had myocardial infarction (MI) with revascularization in the acute period by stenting (Group I) and 38 patients with BIM who had experienced the MI without a stenting (II group). Results. The absence of revascularization in the acute period of MI can negatively affect the state of myocardial perfusion and provoke ischemic heart muscle in patients with SMI. This is manifested by more intense manifestations of ischemic changes detected during Holter monitoring of electrocardiography (HM ECG). These studies allow SMI to be considered as a disease, which leads to a decrease in the electrical stability of the myocardium. It was established that for patients with SMI without stenting, characterized by higher average daily values of the number of ischemic episodes per day, the total daily duration of depression of the segment ST, the total amplitude of depression ST, the average duration of one ischemic episode compared with individuals after the conducted stenting (p<0,05). Conclusions. The absence of revascularization in the acute period of myocardial infarction can negatively affect the state of myocardial perfusion and predispose to ischemic heart muscle in patients with painless ischemia of the myocardium.

UTILIZING ENOXAPARIN IN THE MANAGEMENT OF ACUTE CORONARY SYNDROME

Anticoagulant therapy is widely used in all forms of acute coronary syndrome (ACS) to inhibit the formation of thrombin and/or to inhibit its activity to reduce the risk of thrombotic events (both in primary percutaneous coronary intervention and in the absence of revascularization). Of the entire range of anticoagulants offered by the domestic and foreign pharmaceutical industry, a limited number of drugs of this group are used in the treatment of ACS, in particular, unfractionated heparin and low molecular weight heparin – enoxaparin. Enoxaparin has a safety profile and clinical efficacy at least comparable to that of unfractionated heparin, and at the same time has a number of obvious advantages, such as a simpler protocol of administration and dosing, does not require routine monitoring of the parameters of the blood coagulation system. In patients with ACS with ST-segment elevation the routine administration of enoxaparin should be considered as an alternative to the standard regimen of unfractionated heparin therapy. In patients with ACS without ST-segment elevation enoxaparin should be used when fondaparinux is unavailable.

Long term health outcomes in patients with a history of myocardial infarction: A population based cohort study.

BackgroundMyocardial infarction (MI) is associated with high morbidity and mortality, particularly in the first 12 months post-event. Interventions such as dual antiplatelet therapy can reduce the risk of major adverse cardiovascular events (MACE), but the duration of the high-risk time interval and the optimal prescription time frame for these interventions remains unknown.Design, setting, participants, and measurementsWe performed a retrospective cohort study using data from medical services and hospitalizations in Manitoba, Canada for patients admitted with a MI between April 2006 and March 2010, and followed until Nov 30, 2014. We used survival analysis to determine the cumulative incidence of death, subsequent MI, or stroke, and used Cox proportional hazards models to assess factors associated with these endpoints.ResultsThere were 8,493 patients in Manitoba admitted to hospital for a MI during the study period. Of those, 6,749 (79.5%) survived for at least 1 year without a recurrent MI or stroke. In the following year, this population remained at high risk, with 372 (5.5%) of the remaining patients dying in the next twelve months (48.1% cardiovascular deaths), 244 (3.6%) having a recurrent MI, and 74 (1.1%) having a stroke. Older age, male sex, diabetes, prior stroke, prior heart failure, prior unstable angina, and absence of revascularization were associated with worse long-term prognosis.ConclusionsThe risk of MACE remains elevated among post-MI patients after the first year. Interventions to more intensively monitor, evaluate, and treat these patients should be considered beyond the first year following myocardial infarction.

THE EFFICIENCY OF ANTI-COAGULANTS APPLIED DURING TRANSCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ELEVATION OF ST SEGMENT

The purpose of study. To evaluate efficiency of different coagulants used under transcutaneous coronary interventions in patients with acute coronary syndrome without elevation of ST segment.The methods. The sampling of 346 patients was randomized in two groups. In the group I (n=155) transcutaneous coronary intervention was implemented using bivalirudin and in group II (n = 191) - using unfractionated heparin. The additional randomization of patients of group I: in subgroup A (n = 77) infusion of bivalirudin continued during four hours after intervention and in subgroup B (n = 78) infusion was discontinued in X-ray operating room. The criteria of inclusion: patients with acute coronary syndrome without elevation of ST segment with multi-vascular affection of coronary channel (risk on SYNTAX score = 23-32); high and medium degree of risk according GRACE scale; absence of re-vascularization of myocardium in anamnesis. The criteria of exclusion: patients with very high risk according GRACE scale; affection of left coronary artery trunk. The results. During period of hospitalization, total rate of intra- and post-operative cardiovascular complications had no reliable differences in two groups and amounted to 7.1% and 8.4% correspondingly (p = 0.6423). The serious bleedings (BARC 3 and 5) occurred reliably more frequently in patients of group II. Also, the groups had no differences in rate of development of acute thrombosis of stents. In subgroup A reliably less frequently occurred serious cardiovascular complications as compared with patients of subgroup B (1,3% и 13% correspondingly; р = 0,001). At that, rate of bleeding reliably had no differences. At trans-radial access, in patients of group I rate of bleeding and cardiovascular complications amounted to 0% and 2.9% and at trans-femoral access these indices were reliably higher - 3,3% и 10% correspondingly (р &lt; 0,001). In group II a similar tendency is noted: at trans-radial access these indices amounted to 6% and 4.6% and at trans-femoral - 33.7% and 11.9% correspondingly (р

Abstract 13804: Differential Outcome of Medical Therapy Compared With Percutaneous and Surgical Coronary Revascularization in Individuals With Chronic Kidney Disease at Low, Medium, or High Cardiovascular Risk

Introduction: Comparisons of medical therapy (MT) and percutaneous (PCI) or surgical coronary revascularization (CABG) for the treatment of coronary artery disease (CAD) in the setting of chronic kidney disease (CKD) have suggested that MT is inferior, but may be confounded by failure to adequately account for baseline cardiovascular disease (CVD) risk and by the nihilistic definition of MT as absence of revascularization rather than active titration of MT. Hypothesis: MT is superior to revascularization in CKD pts at low CV risk but PCI and CABG are superior to MT when CV risk is high. Methods: The 20% Medicare sample was used to identify pts in 2007-2012 with CKD, assess outcomes, and define risk groups: Low risk: angiography or stress testing in the absence of prior CVD; Medium risk: stress test or angiography with prior CVD history; High risk: admission for acute coronary syndrome (ACS). PCI and CABG were defined on the basis of procedures within 60 days of risk group entry. MT included non-PCI/CABG pts with addition of new CV medication during the same time frame. R esults: For low risk pts 1000 had PCI, 571 CABG, and 6848 MT. For medium risk 1751 PCI, 718 CABG and 9670 MT pts. For high risk 4542 PCI, 1481 CABG and 8287 MT pts. All-cause mortality rates increased across risk groups, consistent with excellent performance of our classification metric. Mortality rates per hundred pt years were lowest with MT in the low risk group—PCI 9.1, CABG 8.9, MT 8.1--and medium risk groups—PCI 13.5, CABG 14.6, MT 13.2. In contrast, survival was markedly better with CABG or PCI in high risk pts—PCI 18.4, CABG 13.1, MT 33.5 ( Table ). Conclusions: The relative benefits of MT and coronary revascularization in the setting of CKD vary according to pre-treatment CV risk. For pts at low or moderate risk, MT, PCI, and CABG have similar survival. In contrast, revascularization, particularly CABG, is associated with markedly improved survival (and higher ESRD rate) compared to MT after ACS.

Technical Feasibility and Clinical Outcomes of Interventional Endovascular Treatment for Hepatic Artery Thrombosis After Living-donor Liver Transplantation

ObjectivesHepatic artery thrombosis (HAT) is a serious complication after living-donor liver transplantation (LDLT) leading to patient death in the absence of revascularization. With the recent advances in interventional radiology, interventional endovascular techniques have been used as alternative therapeutic options for HAT. This study evaluates the feasibility and clinical outcomes of endovascular treatment for HAT after LDLT. MethodsThe medical records of 120 patients who underwent adult-to-adult LDLT between February 2002 and February 2015 in our hospital were retrospectively reviewed to evaluate the frequency of HAT and outcomes of endovascular treatment. ResultsA total of nine patients (7.5%) developed HAT after LDLT, and the all patients underwent endovascular treatment. Overall technical success with endovascular treatment was achieved in 77.8% (7 of 9) of the patients. Intra-arterial thrombolysis was successful in one patient. Further intervention after intra-arterial thrombolysis was performed in the form of percutaneous transluminal angioplasty in six patients, and percutaneous transluminal angioplasty with stenting in two patients. Two patients with failure of revascularization by endovascular treatment were treated conservatively and developed hepatic arterial collaterals, and the both patients could avoid the graft failure. The overall survival rates did not differ significantly between the patients without HAT (n = 111) and those with HAT (n = 9) (1-, 3-, and 5-year overall survival rates of the patients without HAT vs. with HAT: 78.1%, 67.8%, and 65.3% vs. 66.7%, 66.7%, and 66.7%, respectively; P = .77). ConclusionInterventional endovascular treatment of HAT in LDLT is a feasible and reliable procedure in avoiding early graft failure with acceptable long-term patient outcome.

Regenerative potential following revascularization of immature permanent teeth with necrotic pulps

To assess the regenerative potential of immature teeth with necrotic pulps following revascularization procedure in dogs. Necrotic pulps and periapical pathosis were created by infecting 108 immature teeth, with 216 root canals in nine mongrel dogs. Teeth were divided into three equal groups according to the evaluation period. Each group was further subdivided into six subgroups according to the treatment protocol including MTA apical plug, revascularization protocol, revascularization enhanced with injectable scaffold, MTA over empty canal. All root canals were disinfected with a triple antibiotic paste prior to revascularization with the exception of control subgroups. After disinfection, the root length, thickness and apical diameter were measured from radiographs. Histological evaluation was used to assess the inflammatory reaction, soft and hard tissue formation. In the absence of revascularization, the length and thickness of the root canals did not change over time. The injectable scaffold and growth factor was no more effective than a revascularization procedure to promote tooth development following root canal revascularization. The tissues formed in the root canals resembled periodontal tissues. The revascularization procedure allowed the continued development of roots in teeth with necrotic pulps.

Hepatic Artery Thrombosis After Orthotopic Liver Transplantation: 3 Patients With Collateral Formation and Conservative Treatment

Hepatic artery thrombosis (HAT), a serious complication after orthotopic liver transplantation (OLT), can lead to patient death in the absence of revascularization or retransplantation. Herein we have presented clinical characteristics, imaging findings, and long-term outcomes of 3 OLT patients with HAT who were treated conservatively and developed hepatic arterial collaterals. These patients underwent transplantation due to hepatitis B cirrhosis, cryptogenic cirrhosis, or hepatitis C infection and alcoholic disease. They presented with bile duct stenosis and/or a bile leak at 1, 3, and 36 months after transplantation, respectively, and were treated with percutaneous drainage and stent placement, endoscopic retrograde cholangio-pancreatography (ERCP), or reanastomosis of the bile duct over a T tube. HAT was confirmed using multidetector computed tomography (MDCT) 3-dimensional (3D) angiography and Doppler sonography. They survive in good condition with normal liver function at 30, 50, and 42 months after OLT, respectively. Development of collateral arterial circulation to the liver graft was detected with MDCT 3D angiography and Doppler sonography. From our experience with 3 patients and a literature review, we believe that there are a number of patients who experience long-term survival after the diagnosis of irreversible HAT and the development of collaterals. Although this group is at high risk for sepsis and biliary complications, these are usually self-limiting complications due to improved treatment regimens. The development of collateral arterial flow may also be beneficial.

The Cornucopia of “Pleiotropic” Actions of Statins

See related article, pages 255–264 Initially described in patients with coronary artery disease undergoing coronary artery bypass graft (CABG) surgery, myocardial “hibernation” denotes a state of adaptive reduction in myocardial contractile function in response to limited energy supply caused by reduced blood flow.1,2 In this precarious equilibrium, the myocardium can remain viable for sustained periods of time (although not indefinitely) and slowly resumes contractile activity on restoration of perfusion.2,3 Hibernating myocardium resulting from a flow-limiting coronary artery stenosis is a common clinical entity that contributes to myocardial dysfunction in many patients with ischemic heart disease1,2; its clinical importance stems from the fact that is it is potentially reversible. The pathophysiological basis of this syndrome was proposed as a conceptual framework in 19924 and subsequently tested in various animal models5–8: it is likely to involve recurrent brief episodes of ischemia, which initially result in repetitive “stunning” with normal resting flow and eventually cause a persistent decrease in resting function and flow.2,4–6,8 Over time, these changes lead to myocyte loss resulting from degenerative changes and apoptosis.2,8 Because mechanical dysfunction is caused by a restriction in blood flow, revascularization has traditionally been the cornerstone of therapy for myocardial hibernation. Indeed, restoration of blood flow via CABG or percutaneous coronary interventions often improves the mechanical performance of hibernating myocardium.1–3,8,9 In those cases in which these procedures are not feasible, however, there is a need for alternative approaches. Direct transmyocardial laser revascularization10 and intramyocardial gene transfer of phVEGF16511 or fibroblast growth factor-57 have been reported to enhance perfusion and contractile reserve and improve regional function in experimental models of hibernation. Transplantation of circulating progenitor cells following revascularization has also been reported to attenuate hibernation (ie, to increase coronary flow reserve …