Background: Despite the evolution of stent technology, there is a non-negligible risk of in-stent restenosis (ISR) after Percutaneous coronary intervention (PCI). Large-scale registry data on the prevalence and clinical manage-ment of ISR is lacking.Methods: The aim was to describe the epidemiology and management of patients with & GE;1 ISR lesions treated with PCI (ISR PCI). Data on characteristics, management and clinical outcomes were analyzed for patients undergoing ISR PCI in the France-PCI all-comers registry.Results: Between January 2014 and December 2018, 31,892 lesions were treated in 22,592 patients, 7.3 % of whom underwent ISR PCI. Patients undergoing ISR PCI were older (68.5 vs 67.8; p < 0.001), and more likely to have diabetes (32.7 % vs 25.4 %, p < 0.001), chronic coronary syndrome or multivessel disease. ISR PCI concerned drug eluting stents (DES) ISR in 48.8 % of cases. Patients with ISR lesions were more frequently treated with DES than drug eluting balloon or balloon angioplasty (74.2 %, 11.6 % and 12.9 %, respectively). Intravascular imaging was rarely used. At 1 year, patients with ISR had higher target lesion revascularization rates (4.3 % vs. 1.6 %; HR 2.24 [1.64-3.06]; p < 0.001).Conclusions: In a large all-comers registry, ISR PCI was not infrequent and associated with worse prognosis than non-ISR PCI. Further studies and technical improvements are warranted to improve the outcomes of ISR PCI.& COPY; 2023 Elsevier Inc. All rights reserved.

Intra coronary thrombus is  frequently encountered during acute coronary syndromes revascularisation procedures. It can also be encountered during angioplasty procedures in a stable angina context, although at a much lesser frequency.In both situations, it harbors a risk of poor angiographic result and poor prognosis. Intracoronnary thrombus may cause coronary occlusion at the angioplasty site or distal embolic  flow obstruction. Per procedure thrombus prevention rests on an prior optimal anti thrombotic treatment and in some circumstances the choice to defer the revascularisation procedure in the complex high risk setting. Treating the initiated thrombus remains controversial concerning thrombectomy and GPIIBIIIa inhibitors which are still in use in common practice. No reflow phenomenon is a particularly complex setting during cornary angioplasties, partially but not solely related to a thrombotic complication. It's treatment remains unclear in the absence of related oriented studies.The current mechanical and pharmacological antithrombotic therapies must remain common practice and used appropriately as of the clinical and angiographic setting, until further scientific outbrakes.

La présence d'un thrombus coronaire ou sa majoration est fréquente lors de la revascularisation des patients ayant un syndrome coronarien aigu en particulier en cas d'infarctus du myocarde avec sus décalage du segment ST. Ce phénomène complique plus rarement l'angioplastie coronaire réalisée pour un angor stable. Dans ces deux présentations c'est un facteur de risque de mauvais résultat angiographique et de mauvais pronostic. Le thrombus coronaire peut être à l'origine d'une occlusion coronaire per procédure ou d'une perfusion distale altérée par micro embols distaux. Le traitement préventif de cette complication repose sur le respect d'un traitement anti thrombotique optimal et le choix parfois pertinent de revascularisation différée après mise en évidence de lésions angiographiquement complexes. Le traitement curatif en reste controversé avec une évolution des recommandations concernant les modalités de revascularisation comme l'usage de la thrombectomie. Cette dernière garde une place dans l'arsenal thérapeutique du cardiologue interventionnel de même que les inhibiteurs de la glycoprotéine IIb IIIa. L'existence d'un phénomène de no-reflow est une complication complexe de la revascularisation en partie mais non uniquement en rapport avec un phénomène thrombotique. Son traitement en reste imprécis faute d’études déterminantes. En raison de son mauvais pronostic les moyens thérapeutiques mécaniques et pharmacologiques actuellement à notre disposition doivent être connus et utilisés selon le contexte clinique et la présentation angiographique, dans l'attente de nouvelles avancées thérapeutiques.

Growing use of fractional flow reserve (FFR) and intracoronary imaging techniques by optical coherence tomography or intravascular ultrasound has raised concerns about additional exposure during coronary angiography and percutaneous coronary interventions (PCIs). Using data from the prospective CRAC-France PCI Prospective Multicentre registry, we sought to evaluate the effect of these new techniques on the radiation dose to patients undergoing coronary procedures. Data on Kerma Area Product (P-KA), total air kerma (KA(r)) and fluoroscopy time from 42 182 coronary procedures were retrospectively compared, using multivariable linear regression, according to whether they included FFR and intracoronary imaging. In coronary angiography, FFR was associated with longer fluoroscopy time and higher P-K(A) (21.0 vs. 18.9 Gy.cm(2)) and KA(r) (372 vs. 299 mGy) (all p < 0.001). Intracoronary imaging was associated with longer fluoroscopy time, higher contrast volume (both p < 0.001), lower P-KA (18.3 vs. 19.0 Gy.cm(2), p = 0.02) and similar KA(r). In PCI, FFR was associated with a moderate increase in KA(r) (682 vs. 626 mGy, p < 0.01) but not P-KA (35.9 vs. 33.7 Gy.cm(2), p = 0.34). For intracoronary imaging, there were no differences between groups, except for contrast volume. Increased patient exposure associated with FFR and intracoronary imaging is moderate in diagnostic coronary angiography and minimal or none in PCI, provided optimization techniques are used. It should not be a limitation on the use of these techniques given the important additional information they provide.

ObjectivesThe aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) outbreak on incidence, delays, and outcomes of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) in France. MethodsWe analyzed all patients undergoing PPCI <24 hours STEMI included in the prospective France PCI registry. The 2 groups were compared on mean monthly number of patients, delays in the pathway care, and in-hospital major adverse cardiac events (MACE: death, stent thrombosis, myocardial infarction, unplanned coronary revascularization, stroke, and major bleeding). ResultsFrom January 15, 2019 to April 14, 2020, 2064 STEMI patients undergoing PPCI were included: 1942 in the prelockdown group and 122 in the lockdown group. Only 2 cases in the lockdown group were positive for COVID-19. A significant drop (12%) in mean number of STEMI/month was observed in the lockdown group compared with prelockdown (139 vs 122, P < 0.04). A significant increase in "symptom onset to first medical contact" delay was found for patients who presented directly to the emergency department (ED) (238 minutes vs 450 minutes; P = 0.04). There were higher rates of in-hospital MACE (7.7% vs 12.3%; P = 0.06) and mortality (4.9% vs 8.2%; P = 0.11) in the lockdown group but the differences were not significant. ConclusionAccording to the multicenter France PCI registry, the COVID-19 outbreak in France was associated with a significant decline in STEMI undergoing PPCI and longer transfer time for patients who presented directly to the ED. Mortality rates doubled, but the difference was not statistically significant.