Triemli Hospital, also known in German as Stadtspital Triemli or Triemlispital, is a major hospital in the Swiss city of Zürich. The hospital is located in the western suburbs of the city, in the Friesenberg quarter and the Wiedikon district.Triemli Hospital is a municipal central hospital owned and run by the city of Zürich. It offers its services to patients with all classes of medical insurance. Besides accepting patients from within the city, as a central hospital it also accepts patients forwarded from neighbouring hospitals in the cantons of Glarus, Grisons, Schaffhausen, Schwyz, Uri, Zug and Zürich.
Although the Woven EndoBridge (WEB) device is increasingly used for the treatment of wide-neck intracranial aneurysms, including in the acute rupture setting, comparative evidence assessing the impact of rupture status remains limited. This study compared angiographic, safety, and clinical outcomes between ruptured and unruptured intracranial aneurysms treated with WEB. We conducted a retrospective analysis of prospectively collected data from the multicenter cohort registry WorldWideWEB, including consecutive adult patients with intracranial aneurysms treated with the WEB. Patients were stratified into groups of ruptured and unruptured aneurysms. Propensity score matching was used to balance baseline characteristics between both groups. Retreatment rate was the primary outcome. Secondary outcomes included mRS, safety events (thromboembolic complications) and angiographic outcomes (periprocedurally and last follow-up). Among 1,220 patients, 342 (28.0
INTRODUCTION:With wide-spread use of computed tomography and magnetic resonance imaging studies, numbers of incidentally found adrenal tumors are rising. All adrenal tumors should be evaluated for dignity and hormonal activity. In our case report, we present a patient with a rare, but highly aggressive adrenal malignoma.
Abstract Aims Leadless pacemaker therapy eliminates lead- and pocket-related complications inherent to conventional transvenous systems. While femoral venous access remains the standard approach, it is associated with significant inguinal-site morbidity including vascular complications, hematomas, and prolonged patient discomfort. The jugular vein (JV) approach has been studied and described as a safe alternative for passive fixation leadless pacemakers. This study evaluated the implantation of an active fixation leadless pacemaker (AVEIRTM VR, Abbott) using a JV access and compared it to implantation using a femoral vein (FV) access. Methods and Results Consecutive leadless pacemaker implantations from a single tertiary cardiac center throughout the same time period were prospectively included and analyzed for safety, efficacy, and electrical parameters (13 JVA, 14 FVA). Median procedure time did not significantly differ (30 min JVA, 24min FVA, p=0.19). Median fluoroscopy time was longer in the JV group (6.2 min JVA, 2.5min FVA, p=0.019). Only one complication occurred in the JVA group (transient asystole during implantation, managed successfully). Device parameters (threshold, sensing, impedance) did not significantly differ between groups. Conclusion The jugular approach represents a safe and efficient alternative to femoral vein access for leadless pacemaker implantation with an active fixation when performed by experienced operators. However, fluoroscopy time may be longer, especially during the learning curve.
AIMS:Patients at high bleeding risk (HBR) and acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) are at high risk of adverse outcomes. We investigated the clinical outcomes and their consistency after biodegradable polymer sirolimus-eluting (BP-SES) or durable polymer zotarolimus-eluting stent (DP-ZES) implantation in HBR patients with or without ACS. METHODS AND RESULTS:The per-protocol population of the BIOFLOW-DAPT randomized control trial (RCT) consisted of HBR patients with (n = 541) or without ACS (n = 1245) who were randomized to BP-SES or DP-ZES and underwent 1 month dual antiplatelet therapy (DAPT). The primary efficacy and safety endpoints were target lesion failure (TLF), defined as the composite endpoint of cardiac death, target vessel myocardial infarction (TV-MI), or clinically driven target lesion revascularization (cd-TLR) as well as major bleeding defined as BARC 3 or 5 (according to Bleeding Academic Research Consortium classification) and definite/probable stent thrombosis (ST). At 1 year, patients with ACS suffered from higher cardiac death rates (3.4 vs. 1.3%, log-rank P = 0.004) but similar TLF (6.8 vs. 6.7%, P = 0.992), TV-MI (2.8 vs. 4.5%, P = 0.100), cd-TLR (1.4 vs. 2.1%, P = 0.300), major bleeding (4.2 vs. 3.1%, P = 0.266), and ST (0.2 vs. 0.9%, P = 0.098) compared with no ACS patients. The rate of TLF and of all secondary endpoints was consistent with BP-SES or DP-ZES across ACS strata. CONCLUSION:HBR patients with ACS are at higher risk of cardiac death than those without ACS and experience a consistent outcome with BP-SES or DP-ZES followed by 1 month DAPT at 1 year follow-up. CLINICAL TRIAL REGISTRATION:NCT04137510.
BACKGROUND:Longer total stent length (TSL) increases the risk of target lesion failure (TLF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention with second-generation drug-eluting stents (DES). We aimed to assess the long-term impact of TSL on patient- and stent-related outcomes in STEMI patients treated with different newer-generation DES designs. METHODS:We performed a post hoc subgroup analysis of the BIOSTEMI Extended Survival randomized trial (NCT05484310). Patients undergoing primary percutaneous coronary intervention for STEMI were randomized to ultrathin-strut biodegradable-polymer sirolimus-eluting stents (BP-SES) or thin-strut durable-polymer everolimus-eluting stents (DP-EES) and categorized according to TSL implanted at the culprit site (≤40 vs >40 mm). The device-oriented composite endpoint (TLF) was the composite of cardiac death, target-vessel myocardial reinfarction, or clinically indicated target lesion revascularization, and the patient-oriented composite endpoint was the composite of all-cause death, any myocardial reinfarction, any revascularization, or any stroke, at 5 years. RESULTS:A total of 1,686 STEMI patients were included (mean age, 62.4 years; female, 23%; mean TSL, 33.8 mm), of whom 423 (25%) were treated with TSL >40 mm. At 5 years, TSL >40 mm was associated with a significantly higher risk of patient-oriented composite endpoint compared with TSL ≤40 mm (31.7% vs 27.4%; hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.03-1.64; P = .029), whereas no difference was observed in TLF. However, there was a significant interaction between DES type and TSL for TLF at 5 years. Among patients with TSL >40 mm, BP-SES were associated with a lower risk of TLF compared with DP-EES (7.3% vs 17.1%; HR, 0.39; 95% CI, 0.21-0.74; P = .004; P for interaction = .032), a difference primarily driven by a lower rate of target vessel myocardial reinfarction. No significant differences between BP-SES and DP-EES were observed in patients with TSL ≤40 mm. After adjustment for multivessel treatment, increasing TSL with DP-EES, but not BP-SES, was independently associated with a higher risk of TLF (adjusted HR per 5-mm increase, 1.07; 95% CI, 1.02-1.11; P = .003). CONCLUSION:In STEMI patients treated with contemporary DES, TSL >40 mm was associated with an increased risk of patient-oriented, but not device-related, adverse outcomes at 5 years. Among patients requiring TSL >40 mm, ultrathin-strut BP-SES significantly reduced the risk of TLF compared with DP-EES, whereas no between-DES differences were observed in patients treated with TSL ≤40 mm. TRIAL REGISTRATION:The BIOSTEMI ES trial is registered at ClinicalTrials.gov (NCT05484310).
