Andreas Grüntzig, an ardent angiologist crafted an indeflatable sausage-shaped dual-lumen balloon- catheter, designed its delivery to the heart, launched minimally invasive coronary intervention and taught by beaming live demonstration. Subsequent advances are just incremental tweaks and tinkers around this fully formed framework from 1978. The near-immediate or instant feedback learning process by which the heart responds to any new invasive procedural variation facilitates each new change; be it drug- eluting stent, drug-coated balloon, or both in different combinations and permutations. Now with Grüntzig\'s balloon armed with an antiproliferative drug, it could dominate the field once more, as he originally envisaged.

BACKGROUND: Crossing Y-stent-assisted coiling (CYSAC) is a feasible yet technically challenging technique for the treatment of wide-neck bifurcation aneurysms (WNBAs).
OBJECTIVE: To present mid-term results of Y-stent-assisted coiling (YSAC) using the LVIS EVO stent and to describe our \"drill turn\" technique for stent crossing.
METHODS: This retrospective, observational study included 37 consecutive patients treated with YSAC using LVIS EVO stents at five centres between September 2020 and March 2023.
RESULTS: Immediately after treatment, 31 of the 37 patients (83.8%) achieved Raymond-Roy occlusion classification (RROC) Class I occlusion, while 5 patients (13.5%) had Class II and 1 patient (2.7%) had Class III occlusion. The mean follow-up period was 32.8 months (range: 11-41 months), and all patients underwent follow-up imaging after ≥ 6 months. On follow-up imaging, 34 patients (92%), including all those with immediate RROC Class I occlusion, 2 with Class II, and 1 with Class III, showed Class I occlusion. One patient with RROC Class II occlusion demonstrated a gradual decrease in residual filling, while one large partially thrombosed middle cerebral artery aneurysm and one large basilar tip aneurysm (8%) with residual neck filling remained unchanged on the 6-month digital subtraction angiograph.
CONCLUSIONS: Utilizing the described drill turn technique, CYSAC with LVIS EVO stents was found to be feasible and safe for WNBA treatment, with high and stable occlusion rates observed during mid-term follow-up.

The use of plastic is very widespread in the world and the spread of plastic waste has also reached the oceans. Observing marine debris is a serious threat to the management system of this pollution. Because it takes years to recycle the current wastes, while their amount increases every day. The importance of mathematical models for plastic waste management is that it provides a framework for understanding the dynamics of this waste in the ocean and helps to identify effective strategies for its management. A mathematical model consisting of three compartments plastic waste, marine debris, and recycle is studied in the form of a system of ordinary differential equations. After describing the formulation of the model, some properties of the model are given. Then the equilibria of the model and the basic reproduction number are obtained by the next generation matrix method. In addition, the global stability of the model are proved at the equilibria. The bifurcations of the model and sensitivity analysis are also used for better understanding of the dynamics of the model. Finally, the numerical simulations of discussed models are given and the model is examined in several aspects. It is proven that the solutions of the system are positive if initial values are positive. It is shown that there are two equilibria E 0 and E ∗ and if B R < 1 , it is proven that E 0 is globally stable, while when B R > 1 , the equilibrium E ∗ exists and it is globally stable. Also, at B R = 1 the model exhibits a forward bifurcation. The sensitivity analysis of B R concludes that the rates of waste to marine, new waste, and the recycle rate have most effect on the amount of marine debris.

The microvasculature, which makes up the majority of the cardiovascular system, plays a crucial role in the process of thrombosis, with the pathological formation of blood clots inside blood vessels. Since blood microflow conditions significantly influence platelet activation and thrombosis, accurately mimicking the structure of bifurcating microvascular networks and emulating local physiological blood flow conditions are valuable for understanding blood clot formation. In this work, we present an in vitro model for blood clotting in microvessels, focusing on 3D bifurcations that align with Murray\'s law, which guides vascular networks by maintaining a constant wall shear rate throughout. Using these models, we demonstrate that microvascular bifurcations act as sites facilitating thrombus formation compared to straight models. Additionally, by culturing endothelial cells on the luminal surfaces of the models, we show the potential of using our in vitro platforms to recapitulate the initial clotting in diseases involving endothelial dysfunction, such as Thrombotic Thrombocytopenic Purpura.

BACKGROUND: Endovascular treatment of the common femoral artery (CFA) and its branches is often challenging. Sometimes, stent placement cannot be avoided. Furthermore, stent placement in this area carries several risks for complications. We present a challenging case in which we used a rotational atherectomy device percutaneously in cross-over-technique to recanalize the external iliac artery in combination with the femoral bifurcation, all in one session - and - without the need for a femoral stent in a multimorbid patient. We also tried to gain more insights in the patient\'s perspective and we took a validated health status evaluation into account.
METHODS: The patient was presented due to chronic open wounds on the left foot for months (Stadium Fontaine IV). Duplex sonography and CT angiography showed a complete occlusion of the left external iliac artery with involvement of the left common femoral artery. Due to the pre-existing chronic diseases and the high risk of prolonged anesthesia, the patient was not suitable for open reconstruction of the common femoral artery. We aimed for endovascular therapy using a crossover maneuver to minimize anesthesia time as much as possible. The percutaneous treatment was performed with a rotational atherectomy device and drug-coated balloon angioplasty with satisfying angiographic results and complete blood-flow restoration. No peri-procedural complications occurred. We gained experience with this endovascular-treatment-device in our teaching hospital and more difficult cases can now be treated. The patient\'s perspective and health status were assessed during follow-up visit.
CONCLUSIONS: The endovascular treatment of severe calcifications in peripheral arterial occlusive disease (PAOD) seems to be a good solution for selected patients, significantly minimizing surgical trauma. The newly combined rotational atherectomy and thrombectomy devices have demonstrated positive outcomes in areas where conventional treatment has traditionally been the standard. The groin types of peripheral arterial occlusive disease (PAOD) are quite often challenging to operate. Open treatment of the common femoral artery has been the standard procedure until modern endovascular possibilities provide a new concept in this treatment, emphasizing a minimal invasive approach in multi morbid patients. The case description results in an illustrated follow up period of 6 months and is presented in line with the recommendations of the consensus-based surgical case reporting guideline development.
CONCLUSIONS: Managing peripheral arterial occlusive disease in the groin region poses a continual challenge. Traditionally, open treatment of the common femoral artery has been - and is - the established procedure. However, contemporary endovascular options now introduce a new paradigm in this treatment, highlighting minimally invasive approaches in multi morbid patients and its patient satisfaction.

UNASSIGNED: In complex bifurcation percutaneous coronary intervention, 2-stent strategies are often required. Commonly used 2-stent techniques can lead to suboptimal results due to their complexity. We developed the balloon-assisted double-kissing T-stenting (DKT) technique, which uses balloons to optimize stent placement, delivery, and final architecture.
UNASSIGNED: With the balloon-assisted DKT technique, a balloon is inflated into the main branch (MB) to identify the best position of the side-branch (SB) stent instead of relying on angiography. DKT aims at supporting the SB ostium with stent crowns instead of distorted open cell(s), by achieving a longitudinal deformation with minimal crush of the SB stent upon implantation of the MB stent. This hypothesis was tested on a bench model. We report how the technique was performed in 2 cases and provide intracoronary imaging of the results.
UNASSIGNED: As hypothesized, DKT resulted in a longitudinal accordion-like deformation and minimal crush effect on bench. The SB ostium was supported by stent crowns. The SB wall opposed to the carina was well covered with crowns from the MB stent after proximal optimization technique and final kissing. The technique was successfully used in 2 complex left main cases with perfect coverage of the SB ostium as assessed with intracoronary imaging.
UNASSIGNED: The balloon-assisted DKT is a simple technique that combines strengths of double-kissing crush and culotte techniques, results in appropriate SB ostium coverage, and deserves further investigation.

暂无摘要。

UNASSIGNED: For bifurcating coronary lesions, a provisional stent technique is recommended compared with a routine 2-stent strategy. However, much of these data are from trials involving first-generation drug-eluting stents (DES) or bare-metal stents where the risk of restenosis with the 2-stent technique is higher. We investigated the efficacy of various 2-stent techniques versus a provisional stent technique for bifurcation lesions with newer-generation DES.
UNASSIGNED: PubMed and Embase were searched through May 2022 for randomized control trials investigating bifurcation percutaneous coronary intervention techniques using newer-generation DES, and a meta-analysis was conducted. The primary end point was major adverse cardiovascular events (MACE) at the longest reported follow-up time.
UNASSIGNED: Our study identified 13 randomized control trials including 4041 patients. Compared with the provisional technique, 2-stent techniques significantly decreased MACE (hazard ratio [HR], 0.76; 95% CI, 0.59-0.97; P = .03), target vessel myocardial infarction (HR, 0.38; 95% CI, 0.20-0.71; P = .002), and target vessel revascularization (HR, 0.66; 95% CI, 0.47-0.93; P = .02). There were no significant differences in all-cause mortality (HR, 0.94; 95% CI, 0.62-1.45; P = .79), cardiovascular mortality (HR, 0.82; 95% CI, 0.49-1.38; P = .45), myocardial infarction (HR, 1.00; 95% CI, 0.73-1.37; P = .99), and stent thrombosis (HR, 0.86; 95% CI, 0.52-1.44; P = .58). Of the 2-stent techniques, the double kissing crush technique significantly decreased MACE and target lesion revascularization than other 2-stent techniques.
UNASSIGNED: In this era of newer-generation DES, a 2-stent approach, especially the double kissing crush technique, is superior to a provisional stenting technique for a bifurcation lesion, with a significant reduction in MACE, target vessel myocardial infarction, and revascularization.

暂无摘要。

UNASSIGNED: Bifurcation represents a challenging lesion subset for percutaneous coronary intervention.
UNASSIGNED: In this prospective study of the Resolute Onyx zotarolimus-eluting stent (ZES), patients with a single bifurcation target lesion who underwent planned treatment using a provisional stenting technique were enrolled at 25 centers in the United States and Europe. The primary end point was target-vessel failure (TVF) at 1 year, and follow-up was performed through 3 years.
UNASSIGNED: A total of 205 patients were enrolled. Mean age was 66.6 ± 10.7 years, 21.5% of patients were female, and diabetes mellitus was present in 30.2%. A provisional approach with a single stent was performed in 96.6% of patients. The rate of TVF at 1 year was 7.4%, fulfilling the prespecified performance criterion (upper 1-sided 95% CI of 11.1%, compared with the performance goal of 24.5%). At 3-year follow-up, the rate of TVF was 12.1%, the rate of clinically driven target-lesion revascularization was 6.0%, and there were no episodes of stent thrombosis related to the target lesion. Event rates were consistent among the cohort of patients with angiographic core laboratory-confirmed bifurcation lesions.
UNASSIGNED: In this prospective, multicenter study, bifurcation lesion treatment with Resolute Onyx ZES using a planned provisional stent approach was associated with favorable clinical outcomes through 3 years. These results support the longer-term safety and effectiveness of Resolute Onyx ZES to treat bifurcation lesions that are amenable to a planned provisional stenting technique.