Les anomalies de connexion des artères coronaires (ANOCOR) sont des anomalies congénitales avec de nombreuses formes anatomiques. Un traitement percutané peut être proposé dans certaines situations, soit le plus souvent pour traiter une atteinte athéromateuse associée, soit plus rarement pour corriger une sténose congénitale. En raison des difficultés fréquentes de cathétérisme, les angioplasties des ANOCOR sont reconnues comme complexes. Une bonne connaissance anatomique facilite l'identification du site de connexion et du trajet ectopique initial d'une ANOCOR au cours d'une coronarographie. Le choix d'un cathéter adéquat est une étape importante de la procédure. Il existe une prévalence plus élevée de la maladie athéromateuse sur les trajets rétroaortiques par rapport aux autres trajets ectopiques. En cas de traitement d'une sténose athéromateuse en aval d'un trajet ectopique, on peut s'aider des techniques utilisées habituellement pour les procédures coronaires complexes. L'angioplastie de sténoses congénitales est possible techniquement, mais sa place dans les algorithmes de prise en charge reste à préciser. Ce type de traitement percutané peut être ciblé aujourd'hui sur les ANOCOR droites interartérielles chez l'adulte de plus de 35 ans avec une symptomatologie ischémique ou une ischémie myocardique.

Coronary artery anomalies (ANOCOR) are congenital anomalies with various anatomical forms. Percutaneous treatment can be offered in certain situations, most often to address associated atherosclerotic disease or, more rarely, to correct a congenital stenosis. Due to the frequent difficulties of catheterization, percutaneous coronary interventions for ANOCOR are recognized as complex procedures. A thorough anatomical understanding facilitates the identification of the connection site and the initial ectopic course of an ANOCOR during coronary angiography. Selecting an appropriate catheter is a crucial step in the procedure. There is a higher prevalence of atherosclerotic disease along retroaortic courses compared to other ectopic courses. When treating atherosclerotic stenosis downstream of an ectopic course, techniques typically used for complex coronary procedures can be helpful. While angioplasty for congenital stenosis is technically feasible, its role in management algorithms remains to be defined. Currently, this type of percutaneous treatment may be offered to right ANOCOR with interarterial course in adults over 35 years old and with ischemic symptoms or myocardial ischemia.

Anomalous connections of the coronary arteries (ANOCOR) with an interarterial course raise therapeutic problems. Current guidelines recommend a surgical repair regardless of age for right ANOCOR with ischemic symptoms or documented myocardial ischemia. The lack of controlled studies explain some therapeutic reluctances. A percutaneous approach may provide an interesting alternative in a selected adult population. To assess the feasibility and safety of interarterial segment stenting in right ANOCOR. Stenting was proposed according to predefined criteria (age > 20 years, ischemic symptoms or documented myocardial ischemia, slit-like ostium) for patients referred to an expert group. All patients underwent selective coronary angiography and coronary computed tomography (CT). Evaluation by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was recommended. A systematic coronary CT and functional test were proposed at 6-12 months. Clinical follow-up was scheduled at 6, 12 and 60 months. Sixteen patients (mean age 52 years) were prospectively included between 2014 and 2019. Fourteen patients were symptomatic and two patients were asymptomatic with documented myocardial ischemia. Stenting was successful in all procedures with mean stent diameter of 3.4 mm, mean stent length of 25 mm, mean fluoroscopy time of 19 min, > 80% of IVUS or OCT guidance, and mean troponin at 24 hours of 0.51 μg/L. No in-hospital complication occurred. No extrinsic stent compression was observed on coronary CT follow-up. Clinical follow-up at 12 months was uneventful in all but three patients: one patient with persistent angina reported to vasospastic angina and two patients with intrastent restenosis treated by balloon angioplasty. Interarterial segment stenting appears feasible and safe. More important population and longer follow-up are needed to include this approach in a future management algorithm for patients with ANOCOR.

Ischemic heart disease is a leading cause of death in Europe. At the same time, older patients are at high risk for coronary heart disease and represent an increasing proportion of patients in the catheterization laboratory in the context of an ageing population. The elderly patients are also at higher bleeding risk, and were poorly represented in major randomized trials. Duration of dual antiplatelet therapy (DAPT), after percutaneous coronary intervention (PCI) should be modulated in a personalized way taking into account hemorrhagic and ischemic risk factors, using risk scores based on the latest recommendations of the European Society of Cardiology. Even if the optimal duration of DAPT after PCI is 6 months in case of stable coronary disease and 12 months in case of an acute coronary syndrome, it can be drastically reduced, up to one month in case of high hemorrhagic risk, or can be prolonged for more than 12 months in case of high ischemic risk. The use of latest generation drug eluting stents associated with a short duration of DAPT has thus demonstrated its safety compared to these durations. In case of triple therapy treatment, associating DAPT and anticoagulation therapy, DAPT is recommended to be as short as possible, potentially reduced to 1 month. Finally, the concomitant prescription of proton pump inhibitor is essential to prevent gastrointestinal bleedings. This literature review will discuss the hemorrhagic risk stratification and choice of DAPT in elderly patients.

Some anomalous connections of the coronary arteries may be associated with a risk of sudden cardiac death. In opposite with others cardiac diseases at risk of sudden cardiac death, the relationship between these congenital abnormalities and the risk of sudden cardiac death are not well understood. A correction of the anomaly is generally indicated after an aborted sudden cardiac death. Primary prevention strategy after the discovery of an anomaly at risk is debated. Even if the absolute risk of sudden death is very low, a pre-participation screening in young athletes may be discussed due to a non-rare incidence.

Certaines connections coronaires anormales peuvent être responsables d’une mort subite. Contrairement à d’autres cardiopathies congénitales à risque de mort subite, les relations entre les connections coronaires anormales et la mort subite sont mal connues. Une correction de l’anomalie est généralement proposée après un arrêt cardiaque récupéré. Après la découverte d’une anomalie à risque, la stratégie reste débattue en prévention primaire. Même si le risque absolu de mort subite est très faible, la question du dépistage se pose chez les jeunes sportifs en raison de la prévalence de ces anomalies.

Pituitary adenylate cyclase activating polypeptide (PACAP) is a neuropeptide, exerting diverse effects. One of its frequently examined functions is cell protection, which is achieved mainly via inhibiting apoptotic, inflammatory and oxidative processes. All its three receptors (PAC1, VPAC1, VPAC2) are expressed in the kidney and PACAP has been shown to have protective effects against different renal pathologies. Diabetic nephropathy is the leading cause of end stage renal disease. The aim of the present study was to investigate the possible ameliorative effect of PACAP in streptozotocin-induced diabetic nephropathy and to evaluate its anti-inflammatory effect in this model. Diabetes was induced by a single intravenous injection of streptozotocin (65 mg/kg) in male Wistar rats. PACAP-treated animals were administered ip. 20 μg PACAP every second day, while untreated animals were given vehicle. Kidneys were removed after 8-weeks survival. Besides the complex histological analysis (glomerular PAS positive area/glomerulus area, tubular damage, arteriolar hyalinosis), expression of several cytokines was evaluated by cytokine array and Luminex assay. Histological analysis revealed severe diabetic changes in kidneys of control diabetic animals (glomerular PAS-positive area expansion, tubular damage, Armanni-Ebstein phenomenon). PACAP treatment significantly diminished the damage. Diabetic kidneys showed significant cytokine activation compared to their healthy controls. PACAP was effective in downregulation of several cytokines including CINC-1, TIMP-1, LIX, MIG, s-ICAM. To conclude, PACAP is effective in ameliorating diabetic nephropathy at least partly through its well-known anti-inflammatory effect. These results raise the opportunity for the use of PACAP as a possible therapeutic or preventive method in treating the complications of diabetes.

OBJECTIVE:We studied the protective effects of postconditioning (PS) in healthy and hypercholesterolemic rats after renal ischaemia-reperfusion (IR) injury. We aimed to examine cytokine expression and apoptosis in tissue damage after revascularisation (TNF-α levels in serum and tissue).METHODS:Male Wistar rats (n = 32) were divided into four groups. The animals of normal feed groups (NF) were fed with normal rat chow and the cholesterol feed groups (CF) were fed with 1.5% cholesterol containing diet for 8 weeks. Anaesthetized rats underwent a 45-min cross-clamping in both kidney pedicles. Ischaemia was followed by 120-min reperfusion with or without PS protocol (group PS vs. IR). Postconditioning was induced by four intermittent periods of ischaemia-reperfusion of 15-s duration each. Serum cholesterol, triglyceride, urea and creatinine levels were determined. Proinflammation was characterized by the measurement of serum TNF-α. Tissue injury in kidney was determined by formaline-fixed, paraffin-embedded tissue sections. Tissue TNF-α levels were determined by immunohistochemistry.RESULTS:Significant elevation was observed in serum TNF-α level after IR injury in normal feed groups, which was reduced by PS. In CF group neither the elevation nor the postconditioning induced reduction were as significant as in the NF groups. In normal feed group PS caused a significant reduction in tissue TNF-α level which was significantly higher in CF.CONCLUSIONS:Ischaemic postconditioning proved to be an effective defense against IR in NF groups, but it was ineffective in CF groups in kidney tissue.