Crush Techniques Research Articles

Coronary bifurcation lesions treated with simple or complex stenting: 5-year survival from patient-level pooled analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study.

Randomized trials of coronary bifurcation stenting have shown better outcomes from a simple (provisional) strategy rather than a complex (planned two-stent) strategy in terms of short-term efficacy and safety. Here, we report the 5-year all-cause mortality based on pooled patient-level data from two large bifurcation coronary stenting trials with similar methodology: the Nordic Bifurcation Study (NORDIC I) and the British Bifurcation Coronary Study: old, new, and evolving strategies (BBC ONE). Both multicentre randomized trials compared simple (provisional T-stenting) vs. complex (culotte, crush, and T-stenting) techniques, using drug-eluting stents. We analysed all-cause death at 5 years. Data were collected from phone follow-up, hospital records, and national mortality tracking. Follow-up was complete for 890 out of 913 patients (97%). Both Simple and Complex groups were similar in terms of patient and lesion characteristics. Five-year mortality was lower among patients who underwent a simple strategy rather than a complex strategy [17 patients (3.8%) vs. 31 patients (7.0%); P = 0.04]. For coronary bifurcation lesions, a provisional single-stent approach appears to be associated with lower long-term mortality than a systematic dual stenting technique.

Clinical Outcome After Crush Versus Culotte Stenting of Coronary Artery Bifurcation Lesions: The Nordic Stent Technique Study 36-Month Follow-Up Results

The aim of the study was to compare long-term follow-up results of crush versus culotte stent techniques in coronary bifurcation lesions. The randomized Nordic Stent Technique Study showed similar 6-month clinical and 8-month angiographic results with the crush and culotte stent techniques of de novo coronary artery bifurcation lesions using sirolimus-eluting stents. Here, we report the 36-month efficacy and safety of the Nordic Stent Technique Study. A total of 424 patients with a bifurcation lesion were randomized to stenting of both main vessel and side branch with the crush or the culotte technique and followed for 36 months. Major adverse cardiac events-the composite of cardiac death, myocardial infarction, stent thrombosis, ortarget vessel revascularization-were the primary endpoint. Follow-up was complete for all patients. At 36 months, the rates of the primary endpoint were 20.6% versus 16.7% (p= 0.32), index lesion restenosis 11.5% versus 6.5% (p= 0.09), and definitestent thrombosis 1.4% versus 4.7% (p= 0.09) in the crush and the culotte groups, respectively. At 36-month follow-up, the clinical outcomes were similar for patients with coronary bifurcation lesions treated with the culotte or the crush stent technique. (Nordic Bifurcation Study. How to Use Drug Eluting Stents [DES] in Bifurcation Lesions? NCT00376571).

The crush and culotte: Two different stent techniques but same results in coronary bifurcations

We deeply appreciate the recently published article entitled “Long-term outcomes using a two-stent technique for the treatment of coronary bifurcations”. The study showed the efficacy and safety of the crush and culotte techniques for the treatment of bifurcated lesions at very long-term follow-up and found the importance of renal function, left ventricular ejection fraction, kissing balloon, bifurcation angle, main vessel reference diameter as well as the absence of differences between these two stenting strategies in overall long-term outcomes [ [1] Freixa X. Almasood A.A. Asif N. et al. Long-term outcomes using a two-stent technique for the treatment of coronary bifurcations. Int J Cardiol. Nov 2012; : 6-11 Google Scholar ]. The results of the current study displayed that the use of the crush and culotte techniques for the treatment of coronary bifurcation lesions continues to show efficacy and safety at very long-term follow-up. In addition, bifurcation angle, final kissing balloon inflation and main vessel reference diameter play a pivotal role in patient outcomes and should therefore be taken into account when one of the two techniques is anticipated. The absence of a difference in outcomes between crush and culotte must be interpreted with caution due to the non-randomized and unbalanced nature of the study with its successful design and results. We thank the authors for their contribution to the present study which is successfully designed and documented. We believe that these findings will enlighten further studies about the two-stent technique for the treatment of coronary bifurcations.

Crush, Culotte, T and Protrusion: Which 2-Stent Technique for Treatment of True Bifurcation Lesions?

Percutaneous coronary intervention of complex true bifurcation lesions often fails to ensure continuous stent coverage and strut apposition in both the side branch and main vessel. Struts left unopposed floating in the lumen disturb blood flow and are increasingly recognized as increasing the risk of stent thrombosis. In this study, we compared the results of different bifurcation treatment strategies: Crush (n=5); Culotte (n=3); T-/T with Protrusion (TAP) (n=4) using drug-eluting stents deployed in-vitro in representative coronary bifurcation models. After final kissing balloon post-dilatation, the rate of malapposition within the bifurcation quantified from micro-computed tomography scanning was on average 41.5 ± 8.2% with the Crush technique, reduced to respectively 31.4 ± 5.2% with Culotte and 36.7 ± 8.0% with T-/TAP approach. Overlaying layers of struts in the Crush and Culotte techniques lead to a significantly higher rate of strut malapposition in the proximal vessel than with the T-/TAP technique (Crush: 39.1 ± 10.7%, Culotte: 26.1 ± 7.7%, TAP: 4.2 ± 7.2%, P<0.01). Maximal wall-malapposed strut distance was also found on average to be higher with the Crush (1.36 ± 0.4mm) and Culotte techniques (1.32 ± 0.1mm) than with T-/TAP (1.08 ± 0.1mm, P=0.04). In this model, the Crush technique resulted in a higher risk of malapposition than either the Culotte or T-/TAP technique.

Long-term outcomes using a two-stent technique for the treatment of coronary bifurcations

BackgroundThe crush and culotte are probably the most common two-stent techniques utilized for percutaneous coronary intervention (PCI) of complex bifurcation lesions. Long-term outcome associated with the utilization of these techniques is unknown. Our objective was to evaluate the long-term outcomes after bifurcation PCI utilizing these 2 techniques with a prospective PCI registry. MethodsBetween 11/1/2003 and 12/31/2007, 360 patients were treated with either crush (n=304) or culotte (n=56). Primary outcome was the occurrence of major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction and target vessel revascularization. The major secondary outcome measure was MACE or occurrence of CCS Class ≥2 angina. ResultsAfter a median follow-up of 4.1years (3.0–5.1), the occurrence of MACE was 23.9%. MACE or CCS Class ≥2 angina occurred in 27.5% of patients. Multivariable analysis revealed that creatinine clearance <60ml/min (odds-ratio [OR]=1.71, 95% CI 1.08–2.71; p=0.022) and left ventricular ejection fraction <40% (OR=2.14, 95% CI 1.21–3.79; p=0.008) were independent predictors of MACE or CCS Class ≥2 angina. A larger main vessel reference diameter (OR=0.57, 95% CI 0.61–0.92), bifurcation angle <50% (OR=0.59, 95% CI 0.35–0.92) and a final kissing-balloon inflation (OR=0.75, 95% CI 0.35–0.99) were associated with a lower risk of MACE or CCS Class ≥2 angina. ConclusionsApplication of the crush and culotte techniques is associated with efficacy and safety at long-term follow-up. Bifurcation angle, a final kissing balloon inflation and vessel reference diameter are important variables that impact on very long-term outcomes.

Five-year clinical follow-up of unprotected left main bifurcation lesion stenting: one-stent versus two-stent techniques versus double-kissing crush technique

The present study aimed to compare the long-term (five-year) safety and efficacy between the one-stent, two-stent and double-kissing (DK) crush strategies, utilising drug-eluting stents, for unprotected left main coronary artery (ULMCA) bifurcation lesions. Between March 2004 and April 2007, 633 consecutive patients with ULMCA bifurcation lesions (232 in the one-stent group and 401 in the two-stent group) were prospectively enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularisation (TVR), at five-year follow-up. Patients in the the two-stent group were classified as DK crush (n=155) and other two-stent techniques (culotte, T-stenting, kissing stenting and classical crush, n=246). Forty-seven (16.8%) patients in the one-stent group crossed over to the two-stent group. The one-stent group was associated with an increased incidence of MI compared to the two-stent approach (10.5% vs. 5.5%, p=0.025). The crude rate of MACE at five years was 28.0% in the one-stent group and 28.4% in the two-stent group (p=0.927). DK crush was associated with a significantly decreased five-year MACE compared to the other two-stent approaches or the one-stent approach (DK crush: 14.8% vs. other two-stent approaches: 37.0%, one-stent approach: 28.0%, p<0.001). The main benefit of DK crush primarily appeared to be secondary to a reduction in TVR (7.7% vs. 30.5% vs. 18.1%, p<0.001). By Cox regression analyses, the non-DK crush two-stent technique, a high SYNTAX Score (≥33) or New Risk Stratification (NERS) score (>20), and incomplete revascularisation were shown to be independent predictors of MACE at five-year follow-up. With distal left main true bifurcations, the two-stent technique (excluding DK crush) is an independent predictor of long-term MACE. DK crush is associated with more favourable long-term clinical outcomes. Confirmation of these findings is required from randomised controlled trials.

Bifurcations – What Have we Learned from Randomised Trials?

In percutaneous coronary intervention, bifurcations are a challenging lesion subset and treatment results are dependent on lesion assessment and operator experience. In recent years, a number of well designed and performed randomised clinical trials have dealt with different aspects of the bifurcation lesion procedure. Results from these trials may be helpful in planning a successful bifurcation treatment. Balloon angioplasty and use of bare metal stents are associated with high rates of restenosis in bifurcation lesions. Drug-eluting stents reduce restenosis in these procedures to levels close to non-bifurcation lesion treatment and should be used, if possible. It may be recommended to use the simple strategy of optional stenting of the side branch. The fundamental safety and efficacy of this strategy has been extensively documented in a number of randomised clinical trials. Typically, this strategy may be implemented as the so called ‘step-by-step approach’. However, using drug-eluting stents, also two-stent bifurcation treatment using the culotte or different T-stenting techniques or crush techniques, are associated with excellent short- and long-term results. When two-stent techniques are used, the procedure should always be finalised with a kissing balloon dilatation. However, in the one-stent bifurcation treatment, kissing balloon dilation does not seem to be mandatory, but may be recommended in genuine bifurcations. It must be borne in mind that the general applicability of randomised clinical trials may be limited by inclusion of selected patients. Using drug-eluting stents and a variety of stenting techniques, the randomised bifurcation trails have documented excellent clinical results in the treatment of this complex lesion subset. Therefore, the results from these trials leave room for operator judgement in the selection of the specific bifurcation treatment based on patient and lesion characteristics and personal experience.

Randomized Trial of Simple Versus Complex Drug-Eluting Stenting for Bifurcation Lesions

Background— The optimal strategy for treating coronary bifurcation lesions remains a subject of debate. With bare-metal stents, single-stent approaches appear to be superior to systematic 2-stent strategies. Drug-eluting stents, however, have low rates of restenosis and might offer improved outcomes with complex stenting techniques. Methods and Results— Patients with significant coronary bifurcation lesions were randomized to either a simple or complex stenting strategy with drug-eluting stents. In the simple strategy, the main vessel was stented, followed by optional kissing balloon dilatation/T-stent. In the complex strategy, both vessels were systematically stented (culotte or crush techniques) with mandatory kissing balloon dilatation. Five hundred patients 64±10 years old were randomized; 77% were male. Eighty-two percent of lesions were true bifurcations (&gt;50% narrowing in both vessels). In the simple group (n=250), 66 patients (26%) had kissing balloons in addition to main-vessel stenting, and 7 (3%) had T stenting. In the complex group (n=250), 89% of culotte (n=75) and 72% of crush (n=169) cases were completed successfully with final kissing balloon inflations. The primary end point (a composite at 9 months of death, myocardial infarction, and target-vessel failure) occurred in 8.0% of the simple group versus 15.2% of the complex group (hazard ratio 2.02, 95% confidence interval 1.17 to 3.47, P =0.009). Myocardial infarction occurred in 3.6% versus 11.2%, respectively ( P =0.001), and in-hospital major adverse cardiovascular events occurred in 2.0% versus 8.0% ( P =0.002), respectively. Procedure duration and x-ray dose favored the simple approach. Conclusions— When coronary bifurcation lesions are treated, a systematic 2-stent technique results in higher rates of in-hospital and 9-month major adverse cardiovascular events. This difference is largely driven by periprocedural myocardial infarction. Procedure duration is longer, and x-ray dose is higher. The provisional technique should remain the preferred strategy in the majority of cases. Clinical Trial Registration Information— URL: http://www.clinicaltrials.gov. Unique identifier: NCT 00351260.

Three‐year outcome of drug‐eluting stent implantation for coronary artery bifurcation lesions

To compare the very long-term clinical outcomes of bifurcation lesions using the crush and the simultaneous kissing stent (SKS) techniques. A variety of two-stent techniques have been used to treat coronary artery bifurcation lesions in the drug-eluting stent era, but the long-term clinical outcome of these approaches is not known. A total of 74 consecutive patients underwent bifurcation stenting using either the crush or SKS techniques. Mean patient age was 66.91 + or - 11.3 years; 26% were diabetic, and the left anterior descending/diagonal bifurcation was the most frequently treated lesion (68%). In-hospital outcomes were not significantly different between groups. Over a median follow-up of 3.3 years, 1 patient in the SKS group and 3 patients in the crush group died (P = ns). Probable stent thrombosis leading to death according to the Academic Research Consortium definition occurred in 1 patient in the crush group. Mortality in the remaining 3 patients was noncardiac. Target lesion revascularization (TLR) occurred in 14 patients (40%) in the SKS group and 5 patients (12.8%) in the crush group (P = 0.015). Survival free from major adverse cardiac events (MACE) was significantly less in the SKS group and predominantly driven by TLR (60 vs. 88%, P = 0.001). In conclusion, over a median of 3.3 years of follow-up, TLR and MACE are significantly lower in bifurcation lesions treated with the crush technique when compared with the SKS technique. Definite or probable stent thrombosis is rare with either technique.

Two‐Year Outcomes of the Sirolimus‐Eluting Stent According to Unprotected Left Main Lesion

The data of long-term outcomes of sirolimus-eluting stent (SES) according to lesion location of unprotected left main coronary artery (LMCA) is scarce. The purpose of this study was to evaluate the long-term outcomes after implantation of the SES in LMCA. A total of 84 patients (51 males) who had undergone SES implantation for the treatment of native LMCA stenosis were enrolled. The patients were divided into 2 groups based on angiographic lesion location: those with significant stenosis in the ostium and/or body (group 1; n = 39) and those involving bifurcation (group 2; n = 45). All of the group 1 patients were treated with simple lesion coverage while different stenting techniques were used in group 2 (cross-over: 44.8%, T: 6.7%, kissing: 37.8%, and crush techniques: 11.1%). The 8-month quantitative angiographic findings and in-hospital and 2 year rates of major adverse cardiac events (MACE) were compared between the 2 groups. Although angiographic success and in-hospital MACE rates were similar in both groups with 1 cardiac death due to acute stent thrombosis in group 2, at 2-year follow-up, the MACE rate was significantly higher in group 2 than in group 1 at 2 years (22.2% vs 2.6%, respectively, P = 0.008). Coronary angiography revealed a significantly higher binary restenosis rate in group 2 compared with group 1 (20% vs 0%, respectively, P = 0.003). Interventional treatment using SES in left main lesions showed favorable short-term and long-term outcomes in selected patients with lesion location being an important determinant of clinical and angiographic outcomes.

Dedicated Bifurcation Stents Strategy

Coronary bifurcation lesions represent an area of ongoing challenges in interventional cardiology, mainly due to the higher rate of residual stenosis and restenosis at the side branch ostium. Multiple two-stent bifurcation strategies, including T-stenting, V-stenting, simultaneuos kissing stenting, culotte stenting and classic crush techniques, have no advantages over one-stent techniques. This led to provisional stenting being considered as a mainstream approach, based on the results of numerous randomised trials. Dedicated bifurcation stents have been designed specifically to treat coronary bifurcations with the aim of addressing some of the shortcomings of the conventional percutaneous approach and facilitating the provisional approach. The development of more drug-eluting platforms and larger studies with control groups demonstrating their clinical applicability, efficacy and safety are required before these stents are widely incorporated into daily practice.

COMPARATIVE STUDY OF SHELL SWAB AND SHELL CRUSH METHODS FOR THE RECOVERY OF SALMONELLA FROM SHELL EGGS

ABSTRACT Swabbing is the standard methodology for the recovery of resident microorganism from shell eggs in Japan. A comparative study of shell swab (SW) and shell crush (CR) techniques was performed to recover the laboratory‐inoculated Salmonella from shell eggs. It was found that the recovery of Salmonella by CR methods was significantly higher (4.5–7.5 log cfu/egg) than that of SW methods (3.1–6.3 log cfu/egg). However, analyses with quantitative real‐time polymerase chain reaction (invA as a target gene), fluorescent microscopic and quantitative analyses with a Live/Dead BacLight bacterial viability kit revealed that not all of the inoculated Salmonella spp. populations were recovered as intact cells by either method. The chemiluminescent bacterial viability assay showed that chemiluminescence intensity (CI) began to increase after 30 min in CR samples; on the other hand, SW samples did not show any increase in CI for 2 h. These results suggest that SW might cause more damage and lethality to cells than CR. In addition, to determine the most appropriate method for recovering resident aerobic bacteria, coliforms and Salmonella spp from shell eggs, 4,000 commercial eggs were collected and sampled by shell rinse (SR) and CR techniques using phosphate‐buffered saline (PBS) warmed to different temperatures. PBS at 37C was found to be the best recovery solution and temperature, respectively, for recovering aerobic microorganisms from shell eggs by both methods and the CR methods recovered a higher population than did the SR methods (4.9 versus 5.8 log cfu/egg for SR and CR methods, respectively; n = 500 eggs/method). Therefore, the CR method along with recovery buffer (PBS) at 37C could be an effective technique for the recovery of microorganisms from post‐processed shell eggs. PRACTICAL APPLICATIONSThere is a need to develop a rapid and highly sensitive method for the recovery of microorganisms from shell eggs. Such recovery methods are also useful for evaluating the efficacy of newly developed shell egg disinfection techniques. Many methods involving rinsing, swabbing, and crushing of shell eggs have been reported; however, we performed a comparative study of the method used to recover the Salmonella from shell eggs. We found that the shell crush method (CR) was superior to the shell swab method (SW) for the recovery of Salmonella spp., and phosphate‐buffered saline (PBS) at 37C was found to be the best recovery solution and temperature, respectively, for recovering microorganisms from shell eggs by both methods. Therefore, the CR method along with recovery buffer (PBS) at 37C could be an effective technique for the recovery of microorganisms from post‐processed shells. Use of this method could be recommended for the microbial evaluation of post‐processed shell eggs in industries.

Study comparing the double kissing (DK) crush with classical crush for the treatment of coronary bifurcation lesions: the DKCRUSH‐1 Bifurcation Study with drug‐eluting stents

BackgroundClassical crush has a lower rate of final kissing balloon inflation (FKBI) immediately after percutaneous coronary intervention (PCI). The double kissing (DK) crush technique has the potential to increase the FKBI rate, and no prospective studies on the comparison of classical with DK crush techniques have been reported.Materials and methodsThree hundred and eleven patients with true bifurcation lesions were randomly divided into classical (n = 156) and DK crush (n = 155) groups. Clinical and angiographic details at follow-up at 8 months were indexed. The primary end point was major adverse cardiac events (MACE) including myocardial infarction, cardiac death and target lesion revascularization (TLR) at 8 months.ResultsFKBI was 76% in the classical crush group and 100% in the DK group (P < 0·001). The incidence of stent thrombosis was 3·2% in the classical crush group (5·1% in without- and 1·7% in with-FKBI) and 1·3% in the DK crush group. Cumulative 8 month MACE was 24·4% in the classical crush group and 11·4% in the DK crush group (P = 0·02). The TLR-free survival rate was 75·4% in the classical crush group and 89·5% in the DK crush group (P = 0·002).ConclusionsDK crush technique has the potential of increasing FKBI rate and reducing stent thrombosis, with a further reduction of TLR and cumulative MACE rate at 8 months.Eur J Clin Invest 2008; 38 (6): 361–371

More modified crush techniques for coronary bifurcation lesions: Which one is better?

More modified crush techniques for coronary bifurcation lesions: Which one is better?

Lesion Location: Its Impacts on the Procedural and Postprocedural Outcomes of Unprotected Left Main Coronary Stenting

Background and Objectives:Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) stenosis is a promising technique in the drug-eluting stent era. However, there is a lack of data as to the impact of the lesion location in the LMCA on the procedural and postprocedural outcomes. The aim of this study is to evaluate the effect of lesion location on the procedural and postprocedural outcomes. Subjects and Methods: From July 2003 to January 2006, we enrolled 82 patients (Males: n=49), who underwent PCI for unprotected LMCA stenosis at Yeungnam University Medical Center, Keimyung University Dong-san Hospital and In-je University Baik Hospital in Busan. The patients were divided into two groups according to the lesion location. Group 1 (n= 38) was defined as those patients who had a significant stenosis in the ostium and/or body. Group 2 (n=44) was defined as those patients had a left main coronary lesion involving a bifurcation. All the patients had a sirolimus eluting stent (Cypher, Cordis) deployed into the LMCA stenosis. Stenting techniques such as the T, crush and kissing stent techniques for treating the LMCA were used at the discretion of the operator and according to the characteristics of the lesion location. The in-hospital outcomes were compared between the two groups and followup coronary angiography was performed after 6 months; the major adverse cardiac events (MACE) and restenosis were analyzed between the two groups. Results:The baseline characteristics between the two groups were not statistically different. The procedural outcomes showed that for the stenting methods, the conventional stent technique was the only one used in all cases of Group 1, but the kissing, T stenting and Crush techniques were also used in Group 2 (p=0.001). The clinical outcomes showed that that there was no statistical difference for the in-hospital MACEs between the two groups, but for the out-of hospital MACEs at 6 month, the target lesion revascularizatin rates, including PCI or bypass graft operation, in Group 1 were higher than those in Group 2 (0% vs 13.6%, respectively p=0.043). Both groups had one cardiac death each (2.3% vs 2.6% respectively) and there was 1 MACE in Group 1 and 7 MACEs in Group 2 (2.6% vs 16%, respectively, p=0.045). The angiographic outcomes at 6 month showed that all 8 significant restenosis cases were included in Group 2 (18%, 9.7% in the total population); the restenosis site was the left circumflex artery in all cases. Conclusion:PCI with using drug eluting stents in the left main lesion showed favorable short term outcomes in selected patients. The lesion location is also an important factor for the clinical and angiographical outcomes. (Korean Circulation J 2007;37:419-424)

Left Main Coronary Revascularization at the Crossroads

Percutaneous revascularization of left main coronary artery (LMCA) disease has remained controversial for more than 25 years, since LMCA balloon angioplasty was first performed by Andreas Gruentzig in 1978. Summarizing his experience, Gruentzig concluded, “We have not been too successful with dilating left main stems…although the procedure is relatively simple, the potential complications are both sudden and serious.”1 Following the evolution of percutaneous catheter-based therapies to include both bare metal stent and, more recently, drug-eluting stent (DES) platforms in conjunction with advances in periprocedural and postprocedural adjunctive pharmacotherapies, interest in percutaneous LMCA revascularization, particularly unprotected left main, has been renewed. Although studies performed with bare metal stents demonstrated a low rate of in-hospital mortality, the incidence of late coronary restenosis remained high.2–6 In the Unprotected Left Main Trunk Intervention Multi-Center Assessment (ULTIMA) registry, which enrolled 279 patients with unprotected LMCA disease who had percutaneous coronary revascularization (69% bare metal stent), mortality at a 1-year follow-up was proportional to clinical risk stratification (40% in high-risk versus 3.5% in low-risk patient cohorts), and repeated revascularization was required in 34% of cases.6 The experience gleaned from these studies continued to support the American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations that in reasonable surgical candidates with LMCA disease, coronary bypass surgery is the preferred therapeutic option.7 After the introduction of DES, several small clinical series demonstrated the feasibility and short-term safety of LMCA stenting, while late clinical/angiographic outcomes appeared favorable as compared with historical (nonrandomized) patient cohorts treated with bare metal stents.3,8–11 The cumulative experience with DES treatment for LMCA demonstrated an apparent marked reduction in major adverse cardiovascular events, including target vessel revascularization, during 6 to 12 months of follow-up as compared with the precedent experience after bare metal stent deployment. Article p 2542 The clinical …

Comparison of Simple and Complex Stenting Techniques in the Treatment of Unprotected Left Main Coronary Artery Bifurcation Stenosis

We assessed the safety and feasibility of various stenting techniques using the sirolimus-eluting stent (SES) in the treatment of unprotected left main coronary artery (LMCA) bifurcation stenoses. One hundred sixteen patients with unprotected LMCA bifurcation stenoses underwent SES implantation. A simple stenting technique (simple group, n = 67) across the left circumflex artery (LCx) and a complex technique (complex group) comprising "kissing" stenting (n = 24) or a "crush" (n = 25) technique were used. Baseline clinical and angiographic characteristics were similar for the 2 groups, except for more multivessel involvement and narrower LCxs in the complex group. The procedural success rate was 100%. Angiographic restenosis rate at 6 months was lower in the simple group (5.3%) than in the complex group (24.4%, p = 0.024). In the complex group, restenosis rates were similar for the kissing (25.0%) and crush (23.8%) techniques (p = 1.0). There were no incidents of death or myocardial infarction during follow-up (median 18.6 months). Target lesion revascularization was performed in 6 patients only in the complex group (0% vs 12.2%, p = 0.005). At 18 months, survival rates without target lesion revascularization were 100 +/- 0% in the simple group and 85.7 +/- 5.6% in the complex group (p = 0.004). In conclusion, SES implantation for unprotected LMCA bifurcation stenoses appears to be safe and effective. Compared with the complex stenting technique, the simple technique was technically easier and appeared to be more effective in improving long-term outcomes in patients with normal LCxs.

Recovery of Salmonella from commercial shell eggs by shell rinse and shell crush methodologies

Salmonella is the most important human pathogen associated with shell eggs. Salmonella Enteritidis is the serotype most often implicated in outbreaks, although other serotypes have been recovered from eggs and from the commercial shell egg washing environment. Many sample methods are used to recover microorganisms from eggshells and membranes. A shell rinse and modified shell-and-membrane crush method for recovery of Salmonella were compared. Eggs were collected from 3 commercial shell-washing facilities (X, Y, and Z) during 3 visits. Twelve eggs were collected from each of 10 to 12 locations along the egg processing chain. After being transported back to the laboratory, each egg was sampled first by a shell rinse method and then by a shell crush method. For each technique (rinse or crush), 2 pools of 5 eggs per location sampled were selectively enriched for the recovery of Salmonella. Presumptive samples positive for Salmonella were confirmed serologically. Overall, there were 10.1% (40/396) Salmonella-positive pooled samples. Salmonella were recovered by the shell rinse and shell crush techniques (4.8 vs. 5.3%, respectively). Plant X yielded 21.5% Salmonella positives, whereas less than 5% of samples from plants Y and Z were found to be contaminated with the organism (4.2 and 4.5%, respectively). Salmonella was recovered more often from unwashed eggs (15.8%) than from washed eggs (8.3%). For some eggs, Salmonella was only recovered by one of the methods. Use of both approaches in the same experiment increased sampling sensitivity, although in most cases, crushing provided more sensitive Salmonella recovery.

Functional and Morphological Assessment of a Standardized Rat Sciatic Nerve Crush Injury with a Non-Serrated Clamp

Peripheral nerve researchers frequently use the rat sciatic nerve crush as a model for axonotmesis. Unfortunately, studies from various research groups report results from different crush techniques and by using a variety of evaluation tools, making comparisons between studies difficult. The purpose of this investigation was to determine the sequence of functional and morphologic changes after an acute sciatic nerve crush injury with a non-serrated clamp, giving a final standardized pressure of p = 9 MPa. Functional recovery was evaluated using the sciatic functional index (SFI), the extensor postural thrust (EPT) and the withdrawal reflex latency (WRL), before injury, and then at weekly intervals until week 8 postoperatively. The rats were also evaluated preoperatively and at weeks 2, 4, and 8 by ankle kinematics, toe out angle (TOA), and gait-stance duration. In addition, the motor nerve conduction velocity (MNCV) and the gastrocnemius-soleus weight parameters were measured just before euthanasia. Finally, structural, ultrastructural and histomorphometric analyses were carried out on regenerated nerve fibers. At 8 weeks after the crush injury, a full functional recovery was predicted by SFI, EPT, TOA, and gait-stance duration, while all the other parameters were still recovering their original values. On the other hand, only two of the histomorphometric parameters of regenerated nerve fibers, namely myelin thickness/axon diameter ratio and fiber/axon diameter ratio, returned to normal values while all other parameters were significantly different from normal values. The employment of traditional methods of functional evaluation in conjunction with the modern techniques of computerized analysis of gait and histomorphometric analysis should thus be recommended for an overall assessment of recovery in the rat sciatic nerve crush model.

Functional and Morphological Assessment of a Standardized Rat Sciatic Nerve Crush Injury with a Non-Serrated Clamp

Peripheral nerve researchers frequently use the rat sciatic nerve crush as a model for axonotmesis. Unfortunately, studies from various research groups report results from different crush techniques and by using a variety of evaluation tools, making comparisons between studies difficult. The purpose of this investigation was to determine the sequence of functional and morphologic changes after an acute sciatic nerve crush injury with a non-serrated clamp, giving a final standardized pressure of p = 9 MPa. Functional recovery was evaluated using the sciatic functional index (SFI), the extensor postural thrust (EPT) and the withdrawal reflex latency (WRL), before injury, and then at weekly intervals until week 8 postoperatively. The rats were also evaluated preoperatively and at weeks 2, 4, and 8 by ankle kinematics, toe out angle (TOA), and gait-stance duration. In addition, the motor nerve conduction velocity (MNCV) and the gastrocnemius-soleus weight parameters were measured just before euthanasia. Finally, structural, ultrastructural and histomorphometric analyses were carried out on regenerated nerve fibers. At 8 weeks after the crush injury, a full functional recovery was predicted by SFI, EPT, TOA, and gait-stance duration, while all the other parameters were still recovering their original values. On the other hand, only two of the histomorphometric parameters of regenerated nerve fibers, namely myelin thickness/axon diameter ratio and fiber/axon diameter ratio, returned to normal values while all other parameters were significantly different from normal values. The employment of traditional methods of functional evaluation in conjunction with the modern techniques of computerized analysis of gait and histomorphometric analysis should thus be recommended for an overall assessment of recovery in the rat sciatic nerve crush model.