Candidates For Revascularization Research Articles

Long-term limb salvage and functional outcomes for patients undergoing partial calcanectomy.

Partial calcanectomy (PC) can be performed to treat chronic heel ulcers in patients with calcaneal osteomyelitis. Patients undergoing PC often have multiple comorbidities, limited mobility, and face high risk of major limb amputation. This study examined the extent of vascular diagnostic testing and interventions as well as long-term outcomes in patients undergoing PC. A retrospective analysis was performed on patients who underwent PC for non-healing calcaneal ulcer over a ten-year period. Demographics, comorbidities, vascular testing, and procedural data were recorded. Additional subgroup analysis was performed according to presence or absence of peripheral arterial disease (PAD). Primary outcomes were major limb amputation (above or below the knee) and mortality. Secondary outcomes included successful wound healing, time to complete wound healing, re-interventions, and change in ambulatory status. A total of 157 patients underwent partial calcanectomies on 162 limbs. 78.3% of patients had diabetes mellitus and 47.8% were diagnosed with PAD. Ankle brachial index with pulse volume recording (ABI/PVR) was performed for 46.5% (73/157) of patients, arterial duplex in 44.6% (70/157), and 19.7% (31/157) had a computed tomography angiogram. Lower extremity revascularization was performed in 28.4% of limbs (46/162). Independent ambulatory status was reported in 40.1% prior to PC and decreased to 17.9% by the time of last recorded follow-up (p < .00001). Long-term amputation-free survival was significantly higher in patients without PAD at 7 years (78.4% vs 57.1%, p = .02). Multivariate logistic regression analysis demonstrated that PAD and end-stage renal disease (ESRD) increased the odds of major limb amputation (OR 3.5 and 2.8, respectively), whereas ESRD and adjuvant podiatric procedures were associated with increased mortality (OR 4.8 and 4.8, respectively). Non-invasive vascular testing should be obtained in all patients undergoing PC, in order to stratify risk of amputation and identify candidates for revascularization. Over the long-term, patients undergoing PC face significant risk of prolonged wound healing, decline in ambulatory status, and major limb amputation.

Treatment options for patients with chronic limb-threatening ischaemia who are not candidates for revascularization.

Treatment options for patients with chronic limb-threatening ischaemia who are not candidates for revascularization.

Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia.

Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Application of simple ultrasound Doppler hemodynamic parameters in the diagnosis of severe renal artery stenosis in routine clinical practice.

Doppler ultrasound (DUS) is recommended in first-line imaging for the diagnosis of renal artery stenosis (RAS). However, the correct selection of Doppler direct or indirect parameters and their optimal thresholds remain controversial. This study explored simple ultrasound Doppler parameters to diagnose severe RAS (RAS ≥70%) in routine clinical practice. In this retrospective study, patients with clinically suspected renovascular hypertension who first underwent renal artery DUS and contrast-enhanced ultrasound (CEUS) and subsequent digital subtraction angiography (DSA) or computed tomography angiography (CTA) were consecutively included. Clinical characteristics and ultrasound Doppler hemodynamic parameters were collected, including peak systolic velocity (PSV), the ratio of the peak velocities in the renal artery and the aorta (RAR), the ratio of the peak velocities in the renal artery and the segmental artery (RSR), and the ratio of the peak velocities in the renal artery and the interlobar artery (RIR). All enrolled patients were divided into two groups based on the degree of diameter reduction: a severe stenosis group (diameter reduction ≥70%) and a non-severe stenosis group (diameter reduction <70%). Logistic regression analysis was performed to determine the independent predictors for severe stenosis. Receiver operating characteristic curves and areas under the curve were used to evaluate the diagnostic performance of the ultrasound Doppler parameters. A total of 85 patients (106 renal arteries) with RAS were included in this study. The optimal thresholds of PSV in the main renal artery and the PSV ratios for diagnosing severe RAS obtained via receiver operating characteristic curves were 249.5 cm/s for PSV, 2.94 for RAR, 5.1 for RSR, and 7.5 for RIR. The areas under the curve of PSV and the ratios all exhibited good diagnostic efficiency (all >0.8). The combination of these four Doppler variables demonstrated a significant benefit to the overall diagnostic value compared with any factor alone [area under the curve (AUC) =0.962; 95% confidence interval (CI): 0.906-0.989; P<0.05]. The combination of PSV and RSR (AUC =0.925; 95% CI: 0.858-0.967) exhibited comparable diagnostic efficiency to the combination of four ultrasonographic variables (z statistic =1.882; P=0.06). This simple and accurate method to evaluate severe RAS based on the velocity obtained via basic DUS may facilitate the detection of severe RAS in the majority of medical institutions and provide a reliable basis for the selection of proper candidates for further angiography or revascularization.

Multimodal Prehabilitation for Peripheral Arterial Disease Patients with Intermittent Claudication—A Pilot Randomized Controlled Trial

To establish the feasibility and safety of multimodal prehabilitation (MP), and to obtain pilot data on the change in quality of life, functional walking capacity, and the need for surgery for a full-scale trial. Pilot randomized controlled trial that included patients older than 50 years old suffering from moderate to severe intermittent claudication and who were candidates for endovascular revascularization (ER). Participants were excluded if they presented with ischemic rest pain, gangrene or ulceration of the index leg, significant lesions in the iliac vessels, planned surgical bypass, comorbidities in which exercise was contraindicated or if they were unable to speak English or French. Participants were randomized in a 1:1 ratio to 12 weeks of MP or institutional standard of care (unsupervised walking advice). MP consisted of i)1 weekly supervised exercise session; ii) home-based exercise prescription; iii) nutritional counseling and supplementation iv) smoking cessation therapy and v) psychosocial support. Feasibility and safety were measured with recruitment and retention rates, as well as the occurrence of any adverse events. In addition, barriers to attend supervised sessions and compliance to each component were assessed. Change in functional walking capacity, health-related quality of life, and the rates of patients deciding not to undergo ER were collected and analyzed throughout the follow-up period of 12 months. Of the 37 patients referred for eligibility, 27 (73%) accepted to participate in the trial and were randomized. Of the 27 patients included, 24 completed the 12-week program. Adherence to each prehabilitation component was 83% IQR [72,93] for supervised exercise, 90% [83,96] for home-based exercise and 69% [45,93] for nutritional sessions. 50% of patients were referred for and underwent psychosocial intervention and 40% of the active smokers enrolled in the smoking cessation program. No adverse events were observed during the program. The two main barriers for not fully adhering to the intervention were excessive pain while performing the exercises and the difficulty to keep up with the prescribed exercises. A statistically significant mean change (SD) was seen in the MP group vs standard of care for functional capacity, mean (SD) 6MWT 60 (74) vs -11 (40) meters p<0.05, and quality of life mean (SD) VascuQol 1.15 (0.54) vs -0.3 (1.09) points p<0.05. There was no statistically significant difference between groups in the rates of patients deciding to undergo ER during the 1-year follow-up period. The results of this pilot trial demonstrate that MP is safe and feasible. A 12-week MP program seems to improve quality of life and functional walking capacity to a greater extent than unsupervised walking advice. There is a need for a large-scale trial to investigate the effectiveness of MP at improving quality of life and assessing its impact on the rates of patients deciding not to undergo or delay ER. The long-term functional and quality of life outcomes of the patients deciding to undergo ER after prehabilitation also needs to be assessed.

Cell Therapy of Severe Ischemia in People with Diabetic Foot Ulcers-Do We Have Enough Evidence?

This current opinion article critically evaluates the efficacy of autologous cell therapy (ACT) for chronic limb-threatening ischemia (CLTI), especially in people with diabetes who are not candidates for standard revascularization. This treatment approach has been used in 'no-option' CLTI in the last two decades and more than 1700 patients have received ACT worldwide. Here we analyze the level of published evidence of ACT as well as our experience with this treatment method. Many studies have shown that ACT is safe and an effective method for patients with the most severe lower limb ischemia. However, some trials did not show any benefit of ACT, and there is some heterogeneity in the types of injected cells, route of administration and assessed endpoints. Nevertheless, we believe that ACT plays an important role in a comprehensive treatment of patients with diabetic foot and severe ischemia.

1120 Time to Revascularisation for Chronic Limb Threatening Ischaemia – Audit of a Major UK Vascular Service

Abstract Aim Chronic Limb Threatening Ischaemia (CLTI) is severe peripheral arterial disease where arterial supply is sufficiently compromised to threaten tissue viability. CLTI has a prevalence of 1-2% and carries significant morbidity and mortality. Early revascularisation is essential for tissue preservation. Recent guidance from CQUIN 2022/23 set national targets for time to revascularisation based on VSGBI guidelines. This audit assessed one major vascular centre’s compliance. Method Audit standards were taken from VSGBI Peripheral Arterial Disease Quality Improvement Framework (PAD-QIF 2019). Data from Imperial College Healthcare NHS Trust was collected from February-April 2022 for inpatients and outpatients presenting with new CLTI. The primary outcome was time to revascularisation from referral. Secondary inpatient outcomes included time to referral, specialist reviews, imaging and discussion at MDT. Results 59 inpatients and 33 outpatients were included. 54% of inpatients and 83% of outpatients who were candidates for revascularisation breached targets: 5 days and 14 days respectively. Of those breaching most inpatients were re-vascularised within 6-10 days; whilst for outpatients the majority were re-vascularised within 46-75 days. At the time of data collection 7 outpatients were awaiting revascularisation, all &amp;gt;5 months since CLTI onset. Conclusions A significant portion of patients are breaching revascularisation targets, increasing risk of poor outcomes. In both pathways delays are multi-factorial. Contributing factors for inpatients include delays in pre-surgery optimisation and bed/theatre slot pressures. For outpatients’ pre-assessment, surgical optimisation, MDT discussion and/or investigations all contribute to delays. Implementation of early anaesthetic optimisation or outpatient one-stop clinics could be considered.

Understanding the role of coronary artery revascularization in patients with left ventricular dysfunction and multivessel disease.

Coronary artery disease (CAD) is the most common cause of heart failure with reduced ejection fraction (HFrEF). Advances and innovations in medical therapy have been shown to play a crucial role in improving the prognosis of patients with CAD and HFrEF; however, mortality rate in these patients remains high, and the role of surgical and/or percutaneous revascularization strategy is still debated. The Surgical Treatment for Ischemic Heart Failure (STICH) trial and the Revascularization for Ischemic Ventricular Dysfunction (REVIVED) trial have attempted to provide an answer to this issue. Nevertheless, the results of these two trials have generated further uncertainties. Their findings do not provide a definitive answer about the ideal clinical phenotype for surgical or percutaneous coronary revascularization and dispute the historical dogma on myocardial viability and the theory of myocardial hibernation, raising new questions about the proper selection of patients who are candidates for coronary revascularization. The aim of this review is to provide an overview on the actual available evidence of coronary artery revascularization in patients with CAD and left ventricular dysfunction and to suggest new insights on the proper selection and management strategies in this high-risk clinical setting.

Performance of machine learning-based coronary computed tomography angiography for selecting revascularization candidates.

Limited studies have investigated the accuracy of therapeutic decision-making using machine learning-based coronary computed tomography angiography (ML-CCTA) compared with CCTA. To investigate the performance of ML-CCTA for therapeutic decision compared with CCTA. The study population consisted of 322 consecutive patients with stable coronary artery disease. The SYNTAX score was calculated with an online calculator based on ML-CCTA results. Therapeutic decision-making was determined by ML-CCTA results and the ML-CCTA-based SYNTAX score. The therapeutic strategy and the appropriate revascularization procedure were selected using ML-CCTA, CCTA, and invasive coronary angiography (ICA) independently. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy of ML-CCTA and CCTA for selecting revascularization candidates were 87.01%, 96.43%, 95.71%, 89.01%, 91.93%, and 85.71%, 87.50%, 86.27%, 86.98%, 86.65%, respectively, using ICA as the standard reference. The area under the receiver operating characteristic curve (AUC) of ML-CCTA for selecting revascularization candidates was significantly higher than CCTA (0.917 vs. 0.866, P = 0.016). Subgroup analysis showed the AUC of ML-CCTA for selecting percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) candidates was significantly higher than CCTA (0.883 vs. 0.777, P < 0.001, 0.912 vs. 0.826, P = 0.003, respectively). ML-CCTA could distinguish between patients who need revascularization and those who do not. In addition, ML-CCTA showed a slightly superior to CCTA in making an appropriate decision for patients and selecting a suitable revascularization strategy.

Improved Performance of PET Myocardial Perfusion Imaging Compared to SPECT in the Evaluation of Suspected CAD.

Myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) has played a central role in the non-invasive evaluation of patients with obstructive coronary artery disease (CAD) for decades. In this review, we discuss the key differences and advantages of positron emission tomography (PET) MPI over SPECT MPI as it relates to the diagnosis, prognosis, as well as clinical decision-making in patients with suspected CAD. Stress-induced perfusion abnormalities on SPECT help estimate presence, extent, and location of ischemia and flow-limiting obstructive CAD, help with risk stratification, and serve as a gatekeeper to identify patients who will benefit from downstream revascularization versus medical management. Some of the major limitations of SPECT include soft-tissue attenuation artifacts, underestimation of ischemia due to reliance on relative perfusion assessment, and longer protocols with higher radiation dose when performed with traditional equipment. PET MPI addresses most of these limitations and offers better quality images, higher diagnostic accuracy along with shorter protocols and lower radiation dose to the patient. A special advantage of PET scanning lies in the ability to quantify absolute myocardial blood flow and assess true extent of epicardial involvement along with identifying non-obstructive phenotypes of CAD such as diffuse atherosclerosis and microvascular dysfunction. In addition, stress acquisition at/near peak stress with PET allows us to measure left ventricular ejection fraction reserve and myocardial blood flow reserve, which help with identifying patients at a higher risk of future cardiac events and optimally select candidates for revascularization. The several technical advantages of PET MPI position as a superior method to diagnose obstructive and non-obstructive phenotypes of ischemic heart disease affecting the entirety of the coronary circulation offer incremental value for risk stratification and guide post-test management strategy for patients with suspected CAD.

Effect of low-level laser physiotherapy on left ventricular function among patients with chronic systolic heart failure

BackgroundLow-level laser therapy (LLLT) is a promising noninvasive physiotherapeutic approach that has been demonstrated to improve cardiac performance. This study aimed to assess the impact of low-level laser therapy on cardiac functions and clinical status in patients with chronic left ventricular systolic heart failure who were not candidates for cardiac revascularization or resynchronization. A case series of 27 patients received a course of low-level laser physiotherapy, the clinical outcomes, echocardiographic parameters, and serum nitric oxide levels were evaluated before and after LLLT.ResultsOf the total patients enrolled in the study, 21 (or 77.8%) were male, with a mean age of 57.7 ± 6.89 years. NYHA classification significantly improved after low-level laser therapy, 15 patients were in class III,12 were in class IV, and no one was in class II before laser therapy while after laser therapy; 25 patients shifted to class II, two patients were in class III with P < 0.001, Six-minute walk distance test was performed, and the results showed that the mean of 6MWT was less than 200 m (148.556 ± 39.092) before the study but increased to more than 300 after laser therapy (385.074 ± 61.740), left ventricular ejection fraction before laser therapy was 26 ± 7.5 while after laser therapy it became 30 ± 8.6 but diastolic function did not change after low-level laser therapy, the mean peak TR pressure was 40.0 ± 9.0 mmHg and 33.0 ± 7.0 before and after laser therapy respectively P < 0.001. A significant change was observed in NO level from 4.1 ± 1.4 IU/ml before laser therapy to 5.2 ± 1.7 IU/ml after laser therapy P < 0.001.ConclusionsLow-level laser therapy may add benefits to improve symptoms, clinical condition, and quality of life in patients with left ventricular systolic dysfunction, further studies are necessary to evaluate the changes in cardiac functions at a longer follow-up duration.

Üst Ekstremite Yaralanmalarına Bağlı Gelişen Dijital Amputasyonlar: Acil Servise Başvuran Hastaların Geriye Dönük Analizi

This study aimed to examine the characteristics of traumatic minor digital amputations in patients presenting to the emergency department, who were candidates for replantation and revascularization and to discuss the clinical outcomes of these patients. Upper extremity total/subtotal amputation cases presenting to Private Erzurum Buhara Hospital emergency department between January 1, 2018, and January 1, 2021, were retrospectively evaluated. The demographic characteristics, occupational status, etiology and type of injury, localization and level of injury, time to arrive at hospital and undergo surgery, length of hospital stay, and survival outcomes were recorded for a total of 134 patients. Of the patients, 88.1% were male, and the mean age was 36.45±20.87 years. Injuries were most commonly seen in those working in agriculture, at a rate of 61.4%. The most common injury type was avulsion (45.5%). The most common specific cause (16.4%) was related to throttle belt use. The mean time from the time of injury to arrival at the emergency department was calculated as 2.51±1.88 hours. It was found that, the survival rate was 71.6% for all the patients and 75.9% for the pediatric patients alone. In conclusion, it is found that the survival rate was higher in guillotine type injuries and in pediatric patients. It is determined that different mechanisms were involved in the etiology of these minor digital amputation cases due to the geographical region where the study was conducted. It is consider that it can be a guide for informing people working in agriculture in this region, and thus reducing the incidence of similar traumas.

A Systematic Review of CD34+ Stem Cell Therapy as an Innovative and Efficient Treatment for the Management of Refractory Angina.

Despite optimal medical treatment, many individuals suffering from severe coronary artery disease are not suitable candidates for further revascularization. Therapeutic angiogenesis has attracted continuous interest to increase myocardial perfusion. Cell therapy using autologous stem cells expressing Cluster of Differentiation 34 plus (CD34+) offers a special therapeutic choice for individuals with refractory angina, seeing as CD34+ stem cells can restore microcirculation. We searched PubMed, PubMed Central (PMC), and Google Scholar to find the relevant articles to write this systematic review about the role of CD34+ stem cell therapy in the management of refractory angina. Additionally, we provided a brief explanation of CD34+ cells and their mechanism of action. Along with the positive finding of other trials, a recent open-label, single-center intracoronary CD34+ cell therapy for the treatment of coronary endothelial dysfunction in patients with angina and nonobstructive coronary arteries (IMPROvE-CED) clinical trial published in 2022 concluded improvement in coronary blood flow, a significant reduction in daily as-needed sublingual nitroglycerin use and improvement in Canadian Cardiovascular Society (CCS) angina class were observed after autologous CD34+ cell treatment. In conclusion, refractory angina management and overall prognosis may be revolutionized once this treatment is approved.

Outcomes of Patients Undergoing Closed Traction CoronaryEndarterectomy: A Long-Term Single Center Study.

Background-Coronary endarterectomy (CEA) is an option for treating severely diffused coronary artery diseases; however, many surgeons avoid performing it due to its complexity and reported controversial results. Therefore, we aimed to review the results of patients undergoing CEA within coronary artery bypass grafting (CABG). Methods-This is a retrospective observational study evaluating the results of patients undergoing CEA within CABG surgery between March 2003 and February 2018. Follow-up via active personal and/or telephone interviews was performed to evaluate long-term clinical outcomes. The study endpoints included early postoperative incidence of myocardial infarction or cardiac mortality, long-term survival, and freedom from major adverse cardiac and cerebrovascular events (MACCE). Results-A total of 326 patients were included in this study for evaluation. The patients' mean age was 67 years; 88% were male, and most presented with three-vessel disease, reporting a mean SYNTAX score of 33.1 ± 12. Approximately 5.5% (n = 18) of the patients had undergone previous CABG surgery. A total of 394 CEAs within a mean of 4.3 ± 1.1 grafts per patient were performed. The indication for CEA was either totally (n = 111, 28.2%) or sub-totally (n = 283, 71.8%) occluded coronary arteries. Early results included perioperative myocardial infarction in eight (2.4%), stroke in eight (2.4%), and in-hospital mortality in thirteen (4.0%) patients. Long-term clinical follow-up reported mortality in 27.6% and overall incidence of MACCE in 41.4% of the patients at the ten-year follow-up. Conclusions-Patients with severe and diffuse CAD are difficult candidates for surgical revascularization. CEA offers an option to allow complete revascularization, even in the case of chronic occlusion, when the myocardium is still viable. The closed traction CEA technique presented here is our preferred method; it achieves satisfactory short- and long-term results.

COMPARISON OF CORONARY ARTERY DISEASE SEVERITY AMONG DIABETIC AND NON DIABETIC PATIENTS ADMITTED TO KHYBER TEACHING HOSPITAL, PESHAWAR

Objectives: To compare the coronary artery disease severity in type-2 diabetic and non-diabetic patients suffering from coronary artery disease presenting to cardiology department of Khyber Teaching Hospital, Peshawar.&#x0D; Methodology: This cross sectional study was conducted at Cardiology department of Khyber Teaching Hospital, Peshawar from 29th August 2015 to 17th March 2016. Non probability convenience sampling technique was applied. All patients admitted with acute coronary syndrome or previous known coronary artery disease who were candidate for angiography and revascularization and given consent were included. Patient with type 1 diabetes mellitus, valvular heart diseases, chronic kidney disease, Connective tissue disease, previous percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) were excluded from study. Patient’s coronary angiograms were evaluated for lesions in coronary arteries, number of vessel involved and type of lesions, by two cardiologist with more than five year post fellowship experience first separately and then results were compared for final reporting in order to eliminate bias in reporting.&#x0D; Results: It was noted that male diabetic patients with more were ten years duration of diabetes, smokers with 10 pack years and sedentary life style were more prone to have severe disease in coronary arteries. In diabetic patients severe disease was significantly higher in LAD (55.2% vs. 43%, p &lt;0.01), RCA (63.3% vs. 38 %, p &lt;0.002) and Left Circumflex (62% vs. 35%, p &lt;0.003). Diabetic patients were found to have more extensive disease as compared to non-diabetics, so multi vessel disease was more common in diabetics as compared to non-diabetics (55.7% vs. 21.3 %, p &lt;0.001) . It was noted that Type C lesions were more common in diabetics (33.7% vs. 13.9 %, p &lt;0.001). Diabetic patients were having more severe, diffuse disease multivessel disease in our study population as compared to non-diabetics.&#x0D; Conclusion: Coronary artery disease is more severe, diffuse, aggressive with complicated lesions in diabetic patients having more than 10 years duration of diabetes along with ten pack years history of smoking, with sedentary life style.

Immunomodulatory effect of first-in-human PeriCord cardiac bioimplant: preliminary data of the PERISCOPE clinical trial

Abstract Background The PERISCOPE is a first-in-human, phase I, double blind, one centre clinical trial to test the safety of the PeriCord, an advanced therapy medicinal product (PEI18–140), for the treatment of patients with infarcted myocardial tissue. The PeriCord is a GMP-complying allogeneic engineered tissue graft consisting on a decellularised pericardial matrix colonised with umbilical cord Wharton's jelly mesenchymal stromal cells. The PeriCord implantation has shown to promote damaged tissue revascularisation, reduce infarct size, adverse remodelling and fibrosis, and ultimately improve cardiac function preclinically. Purpose To assess the safety and monitor the monocyte and cytokine response after PeriCord implantation in patients with infarcted myocardial tissue. Methods The PERISCOPE clinical trial has been approved by AEMPS and the Local Ethics Committee of our institution (Eudra-CT 2018–001964–49). Twelve patients with transmural myocardial infarction (&amp;gt;50% by MRI) who were candidates for surgical revascularisation were included: two roll-in and 10 randomised into a Control group (n=5; CABG) or Treatment group (n=5; n=7 in total; CABG and PeriCord implantation over the transmural myocardial scar). In conjunction with clinical follow-up, whole blood was sampled at baseline and 3-, 6-, and 9-days post-surgery for monocyte populations analysis by flow cytometry and plasma cytokine and monocyte chemoattractant chemokine levels by multiplex ELISA. Results The target patient enrolment has been met and no adverse effects related to PeriCord implantation were observed so far. Recruitment of CCR2+ activated monocytes in peripheral blood peaked on day 3 post-surgery in both groups (increase in the %CCR2+ monocytes of 6.1±5.7% in Control, p=0.38; and 6.5±1.8% in PeriCord Treated patients, p=0.0004), concomitant with a surge in the monocyte chemoattractant CCL2 plasma levels. At the same time, there was a decrease in the number of “non-classical” monocytes regardless of treatment (decrease in CD14-/CD16+ monocytes of 16.7±11.1% in Control, p&amp;lt;0.01; and 24.0±15.0% in PeriCord Treated patients, p&amp;lt;0.001) and a marked reduction in CX3CR1 expression in monocytes of PeriCord treated patients (decrease of 53.2±20.6% in mean fluorescence intensity at day 3, p&amp;lt;0.01), while plasma CX3CL1 levels were undetectable. Both populations recovered on day 9 only in treated patients (p&amp;lt;0.05). Conclusions Implantation of the PeriCord in myocardial infarction patients did not promote adverse reactions and modulated circulating monocyte subsets that have been associated with post-infarction myocardial tissue healing (CCR2 and CX3CR1). These results will be analysed for correlation with therapeutic benefits by the end of patient follow-up. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto Carlos III, Generalitat de Catalunya

Results of percutaneous treatment of the left main coronary artery in elderly patients

Abstract Introduction and objectives Surgical revascularization of the left main (LM) coronary lesions has been the most accepted strategy. However, elderly and frailty patients are not represented in the specific trials that compared surgical versus percutaneous revascularization. Conservative treatment does not seem to be a feasible option due to high major cardiac adverse event rate at short term follow-up. The objective of the study was to analyze the results of percutaneous treatment of the LM in elderly patients who were not candidates for surgical revascularization due to high surgical risk or medical decision. Methods We performed an unicentric, retrospective and descriptive study. We included patients aged 75 years or older who presented with an LM lesion (isolated or associated with other coronary lesions) between between 2017 and 2021 underwent percutaneous treatment. Results During this time period, a total of 140 patients who met the inclusion criteria were treated in our center. The mean age was 81±4 years and 64% (89 patients) were male. Acute coronary syndrome was the clinical presentation in 59% of patients. Seventy-five patients (54%) met criteria of frailty or high comorbidity. The use of nonsteroidal anti-inflammatory drugs were predominated risk factor associated (94 patients, 67%). Immediate success of the procedure was obtained in 97%, with an in-hospital mortality of 7%. The remaining variables are described in Figure 1. With a median follow-up of 19 months, 29 adverse cardiac events (20%) were recorded: 3 (2%) patients suffered a nonfatal myocardial infarction, 7 (5%) patients required a new revascularization, and 19 (14%) patients died of cardiac causes. However, up to 11% (15 patients) died of non-cardiac causes at follow-up (Figure 1 and 2a). A non-significant trend was found for a worse prognosis in terms of survival in frail patients (HR: 1.6 (0.76–3.3), p: 0.212) (Figure 2b). Conclusions Percutaneous treatment of left main coronary artery in elderly patients with multiple associated comorbidities could be considered a feasible option in this special population. The rate of cardiac events at follow-up seems acceptable. Funding Acknowledgement Type of funding sources: None.

In hospital outcomes among diabetics undergoing transcarotid artery revascularisation vs transfemoral carotid artery stenting &amp; carotid endarterectomy

Abstract Background Transcarotid artery revascularisation (TCAR) is a novel procedure to intervene on carotid artery stenosis. It has previously shown to have lower rates of periprocedural adverse events compared to transfemoral carotid artery stenting (TFCAS) and carotid endartectomy (CEA). To date, no study has examined outcomes among diabetics undergoing TCAR compared to TFCAS and CEA. Purpose We sought to determine the rates of adverse periprocedural outcomes related to TCAR, TFCAS and CEA in diabetics. Methods The Vascular Quality Initiative Database was queried for all patients from March 2009 to April 2021 for diabetic patients undergoing carotid artery revascularisation via TCAR, TFCAS or CEA. Baseline demographic information as well as periprocedural outcomes were obtained. Results A total of 57,716 diabetic patients underwent carotid artery revascularisation. Of these 11.3% underwent TCAR (n=6569), 8.1% (n=4703) underwent TFCAS, and 80.4% (n=46,444) underwent CEA. 39% (n=22,528) were female and 87.3% (n=50,377) were white. Compared to TFCAS, TCAR demonstrated lower rates of stroke (1.6% vs 2.2%, p=0.026), stroke/transient ischemic attack (2.2% vs 3.0%, p&amp;lt;0.001), and death (0.4% vs 1.3%, p&amp;lt;0.001) but remained higher than CEA for both stroke (1.6% vs 1.3%), stroke/TIA (2.2% vs 1.9%) and death (0.4% vs 0.3%). Conclusions TCAR appears to be a safe revascularisation procedure for carotid artery stenosis with lower rates of stroke, stroke/TIA, and death in diabetics compared to TFCAS. However, rates remain higher than CEA. TCAR may thus be a viable alternative in diabetics who otherwise would be poor candidates for revascularisation via CEA. Funding Acknowledgement Type of funding sources: None.

Diabetic foot salvage: breaking paradigms through a case report

Diabetic foot (DF) is one of the most frequent and disabling complications of diabetes mellitus 2 (DM2). This study presents the case of a 66-year-old female patient with DM2 and DF complicated by extensive infected necrosis involving more than 50% of the foot. She was not a candidate for revascularization and, due to the poorly controlled septic focus and the extent of necrosis, infracondylar amputation was indicated. However, as the patient refused to undergo amputation, the case was re evaluated at another health institution and a multidisciplinary therapeutic plan for DF salvage was proposed. The protocol included antibiotic therapy, surgical debridement, periodic outpatient dressing, and negative pressure wound therapy (NPWT). After ten months of treatment, the limb showed almost complete healing, and amputation was not necessary. Management of complicated DF is currently one of the greatest clinical-surgical challenges, requiring a highly trained multidisciplinary team to propose an optimal limb salvage program. Level of Evidence V; Case Report; Expert Opinion.

Antibiofilm and immunomodulatory resorbable nanofibrous filing for dental pulp regenerative procedures

Multifunctional scaffolds with host defense peptides designed for regenerative endodontics are desirable nanobiotechnological tools for dentistry. Here, different scaffolds were tested for use during the pulp revascularization process, including poly(vinyl alcohol)-PVA hydrogels or resins, collagen hydrogels and poly(vinyl alcohol) PVA/Chitosan (PVA/CS) nanofibers. Based on time to degradation (21 days), nanofibers were chosen to be incorporated with ciprofloxacin and IDR-1002 (each at 50 mg/g). Nanofibers containing ciprofloxacin and IDR-1002 had anti-biofilm activity against Enterococcus faecalis, Staphylococcus aureus and a multispecies oral biofilm, besides anti-inflammatory activities. The in vivo subcutaneous tissue response to tooth fragments filled with nanofibers demonstrated a pulp-like tissue formation, when compared to empty teeth fragments. Thus, we designed a strong antimicrobial, immunomodulatory and regenerative candidate for pulp revascularization and regeneration procedures.