Developed in the late 1980s, rotational atherectomy has raised a lot of hope for its innovative principle of selective ablation, allowing volume reduction (instead of redistribution) of atherosclerotic plaque, while sparing healthy tissue. Long shunned for its disappointing results on restenosis, the Rotablator finally reasserted itself in the 2000s; era of drug eluting stents and coronary angioplasty boom, thus generating emergence of complex lesions. Indeed, the Rotablator has demonstrated an undeniable benefit in complex (type C) and calcified lesions preparation (before stenting), with a procedural success rate of 95%. Although these lesions only represent a small amount (2-3%) of percutaneous coronary interventions (PCI), they remain a technical impasse for plain-old balloon angioplasty strategy, making the Rotablator more suitable for these resistant lesions' treatment. Registry data attest the safety of this therapy, with a rate of peri-procedural complications and in-hospital mortality comparable to conventional angioplasty (France PCI register). However, certain specific, rare but serious complications (burr entrapment, broken Rotawire, coronary perforation) justify trained teams, perfect knowledge of the equipment, and strict compliance with good practice guidelines. In 2018, the rise of a new method of atherectomy by intra-vascular lithotripsy (Shockwave) has coincided with Rotablator decreasing activity (this finding being biased by a general decrease in PCI activity due to Covid pandemic). This therapeutic range's enhancement revolutionizes calcified lesions treatment, tending towards precise targeting of each indication, depending in particular on calcium distribution's anatomy in the plaque.

Catheterization and Cardiovascular InterventionsVolume 94, Issue 6 p. 903-904 CORONARY ARTERY DISEASE Radial is better, smaller is better, distal radial is even better! Thierry Corcos MD, Corresponding Author Thierry Corcos MD tcorcos@free.fr orcid.org/0000-0001-6658-7973 Cardiology, American Hospital of Paris, France Correspondence Thierry Corcos, Cardiology, American Hospital of Paris and Hôpital Foch, Suresnes, France. Email: tcorcos@free.frSearch for more papers by this author Thierry Corcos MD, Corresponding Author Thierry Corcos MD tcorcos@free.fr orcid.org/0000-0001-6658-7973 Cardiology, American Hospital of Paris, France Correspondence Thierry Corcos, Cardiology, American Hospital of Paris and Hôpital Foch, Suresnes, France. Email: tcorcos@free.frSearch for more papers by this author First published: 31 July 2019 https://doi.org/10.1002/ccd.28406Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume94, Issue6November 15, 2019Pages 903-904 SCAI Member Sign in RelatedInformation

Since its introduction by Lucien Campeau three decades ago, percutaneous radial artery approach at the forearm has been shown to provide advantages over the femoral approach and has become the standard approach for coronary angiography and intervention. Though infrequent, vascular complications still remain, mainly radial artery occlusion. Therefore, a more distal radial approach at the snuffbox or at the dorsum of hand has been suggested, initially by anethesiologists for perioperative patient monitoring, and more recently by Babunashvili et al. for retrograde radial artery recanalization of radial artery occlusion and then for coronary angiography and intervention. This distal radial approach has been advocated to reduce the risk of radial artery occlusion at the forearm (which precludes reintervention through the same access site) and bleeding and vascular access site complications, as well as to improve operator and patient comfort, especially when using left radial approach. This review describes in detail the anatomy of the radial artery at the wrist and the hand, the history of distal radial access, the rationale underlying use of this technique, the results published by experienced operators, the technique, the limitations, and potential role of this approach. This journey from the very proximal to the very distal part of the radial artery was indeed initiated and conceptualized by Lucien Campeau himself.

Mechanical debulking of coronary plaques with rotational atherectomy (RA) has been used for more than 20 years during percutaneous coronary interventions (PCI). Modification of plaque characteristics may be accomplished with selective ablation of inelastic fibrocalcific tissue. The use of RA, though reduced with the development of bare-metal stents (BMS) and even more with drug-eluting stents (DES), has never been completely abandoned. The present review will analyze reasons for conflicting results obtained in large series and randomized trials on this topic in the past, and will identify criteria for an appropriate use in current times.

L’obésité est un problème mondial de santé publique en expansion, responsable d’une épidémie mondiale. Elle est associée à de nombreuses comorbidités, telles que l’hypertension artérielle, le diabète de type 2, les dyslipidémies, l’apnée du sommeil, certains cancers et des maladies cardiovasculaires majeures. Par ses effets sur différents facteurs de risque et sur la structure et la fonction cardiovasculaire, l’obésité a un impact majeur sur les maladies cardiovasculaires, telles que l’insuffisance cardiaque, la maladie coronaire, la mort subite et la fibrillation auriculaire, et est associée à une augmentation de la mortalité globale.

Mechanical debulking of coronary plaques with rotational atherectomy (RA) has been used for more than 20years during percutaneous coronary interventions (PCI). Modification of plaque characteristics may be accomplished with selective ablation of inelastic fibrocalcific tissue. The use of RA, though reduced with the development of bare-metal stents (BMS) and even more with drug-eluting stents (DES), has never been completely abandoned. The present review will analyze reasons for conflicting results obtained in large series and randomized trials on this topic in the past, and will identify criteria for an appropriate use in current times.

An iatrogenic intramural hematoma (IMH) localized in the ascending aorta is a rare and potentially life-threatening complication following percutaneous coronary intervention (PCI). We describe the case of an ascending aortic IMH after the PCI of an anomalous right coronary artery. Early extension of the hematoma was observed during transesophageal echocardiography; the patient underwent successful surgical repair.

This study aims to evaluate the sexual dimorphism in the body composition and somatotype of Polish elite judoists and comparison with untrained subjects.Twenty-two males and 12 female judoists have participated in this study. Their ages and judo experiences are respectively 23 vs. 22 years old and 12 vs. 11 years. Ten required measurements were taken to establish the individual's somatotypes (SiberHegner Machines SA, Zurich, Switzerland instruments). To compare the 165 males and 153 females untrained, abdominal skinfold thickness was measured with Skinfold Caliper. Mean height and weight, somatotype and body mass index, fat free mass index, fat mass index, and fat percentage were calculated. The two-step ratio of sexual dimorphism index (SDI) was used.Sixteen out of the 21 measurements and anthropometric indices showed a reduction of sexual dimorphism in judoists compared with the untrained subjects. Highest differences were found in the fat mass and fat percentage. Conversely, a very low difference of SDI was observed for height-weight ratio, ectomorphy, fat free mass percentage and calf girth. Average SDI in untrained subjects was higher than in judoists.Évaluer le dimorphisme sexuel de la composition corporelle et somatotype de l’elite polonaise de judo et les comparer avec des sédentaires.Trente-quatre judokas (22 hommes et et 12 femmes) ont participé à notre étude. Leur âge et leur éxperience sont respectivement de 23,1 versus 22,2 ans et 12,7 versus 11,0 ans. Afin de déterminer les somatotypes individuels et les comparer avec des sédentaires (165 hommes et 153 femmes), dix mesures ont été prises (SiberHegner Machines SA, Zurich, instruments Suisse), le pli cutané abdominal a aussi été mesuré. La moyenne de la taille et du poids, les somatotypes et l’indice de masse corporelle, l’indice de masse maigre, l’indice de masse grasse et le pourcentage de la masse grasse corporelle ainsi que les deux indices du dimorphisme sexuel (IDS) ont été calculés.Seize sur 21 mesures et indices anthropométriques calculées ont montré une réduction du dimorphisme sexuel chez les judokas versus sédentaires. Des différences significatives ont été observées pour la masse grasse et le pourcentage de graisse. Toutefois, une faible difference de l’IDS a été relevée pour le rapport taille-poids, ectomorphe, le pourcentage de la masse maigre et la circonférence du mollet. L’IDS est moins important chez les judokas que chez les sédentaires.

Drug-eluting stents were devised as an answer to restenosis, but research has shown that the eluting drug can interfere with the blood vessel's healing process, thus increasing the risk of stent thrombosis. A stent coated with the new proprietary polymer Polyzene-F, is a novel technical solution that promises to decrease in-stent restenosis and tackle the risk of thrombosis. Fifty-five patients were enrolled in the first clinical human study (ATLANTA registry), addressing the short-term follow-up results of the CATANIA stent with Polyzene-F. As a part of the study protocol, 15 patients were randomly assigned to optical coherence tomographic (OCT) examination at 6-month follow-up. Optical coherence tomograms were obtained using a Lightlab M2 system with a motorized pull-back at 2.0 mm/s. OCT images were acquired at 15.6 firames/s. A total of 1,904 cross-sectional images with 19,028 struts were analyzed. The rate of covered struts was 99.5%, whereas malapposed struts accounted for 0.15%. Area measurements were performed in 476 cross sections. Neointimal hyperplasia (NIH) area and percent NIH area were 3.2 +/- 1.4 mm(2) and 38 +/- 17%, respectively. Percent NIH area was comparable between diabetics and nondiabetics. Qualitative assessment of OCT images demonstrated neither occurrence of stent fractures nor thrombus. In conclusion, OCT assessment-of the Polyzene-F-covered stent at follow-up showed a small percentage of neointima. Also, almost complete stent strut coverage was revealed by optical coherence tomography. These figures indicate that the CATANIA stent with Polyzene-F is a promising solution for decreasing late stent restenosis and preventing thrombosis. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;103:1551-1555)

Bare metal stents are associated with a high rate of restenosis, whereas drug-eluting stents are associated with the need for prolonged dual antiplatelet therapy and the risk of late stent thrombosis. Recently, animal studies have shown that cobalt chromium stents with a nanothin surface treatment of Polyzene-F (poly[bis(trifluoromethoxy) phosphazene]) are effective in reducing in-stent restenosis compared with bare cobalt-chromium stents, and drug-eluting stents and have an optimal profile in terms of thromboresistance and inflammation.

Background: The potential for the CATANIA (CAT) stent to be an alternative to both bare-metal stents (BMS) and drug-eluting stents (DES) has been recently demonstrated in the Assessment of The LAtest Non-Thrombogenic Angioplasty stent (ATLANTA) first-in-human study. The aim of the present study was to compare short-term outcomes of patients treated with the CAT stent with those treated with BMS.Methods: Based on an internal registry, the 30-day and 6-month risk-adjusted outcomes for patients who received the CAT stent (n=254) were compared against outcomes of a historical cohort of patients who received BMS (n=552) between January 2001 and December 2001.Results: At 30 days, use of BMS vs. the CAT stent resulted in borderline significant differences with respect to major adverse cardiac and cerebrovascular events (MACCE) and cardiac death or myocardial infarction. At 6 months, BMS showed a statistically significant higher adjusted risk of MACCE (HR 2.79, 95% CIs 1.20-6.48, P-.017) and no differences with respect to the subcomponent end points. The cumulative incidence of definite stent thrombosis (Academic Research Consortium defined) at 6 months was 0.39% for the CAT stent and 2.35% for the BMS.Conclusions: This study confirms the favorable early and mid-term safety profile and the high-level efficacy of the CAT stent in the treatment of de novo coronary lesions seen in the ATLANTA trial. The use of stents with a nanothin Polyzene-F surface treatment provided improved results with respect to BMS and lower risk of acute and subacute stent thrombosis. (C) 2009 Elsevier Inc. All rights reserved.

Objectives This study sought to assess safety and efficacy of implantation of the Catania Coronary Stent System with Nanothin Polyzene-F (CeloNova BioSciences, Newnan, Georgia) in human coronary arteries with clinical data and comprehensive intracoronary imaging.Background Novel approaches to modify stents (e.g., bioactive agents, coatings) have been developed to address the limitations of bare-metal and drug-eluting stents (e.g., restenosis, target lesion revascularization [TLR], late thrombosis).Methods This first-in-man study using the Catania stent is a prospective, single center, nonrandomized, single-arm study of 55 patients with symptomatic ischemic heart disease with de novo, obstructive lesions of native coronary arteries.Results Acute angiographic success was 100%. A core laboratory analyzed quantitative coronary angiography and intravascular ultrasound data immediately after stenting and at 6-month follow-up. Late lumen loss was 0.60 +/- 0.48 mm and the percent neointimal hyperplasia volume was 27.9 +/- 16.1%. In 15 of 55 randomly selected patients, 1,904 cross-sections (19,028 struts) were analyzed at 6 months by optical coherence tomography. Overall, 99.5% of struts were covered. Only 29 of 19,028 struts (0.15%) were malapposed. Binary angiographic restenosis was 6.8%. No death, myocardial infarction, or Academic Research Consortium-defined stent thrombosis was observed at 12 months. The incidence of TLR at 12 months was clinically driven TLR 3.6% (2 of 55) and nonclinically driven TLR 7.3% (4 of 55).Conclusions This first-in-man showed an excellent early and mid-term safety profile and high-level efficacy of the new Catania stent in the treatment of de novo coronary lesions in a fairly complex population. Polyzene-F coated stents may be an alternative to both bare-metal and drug-eluting stents with reduced late loss, restenosis, and the TLR without long-term dual antiplatelet therapy. (J Am Coll Cardiol Inty 2009;2:197-204) (C) 2009 by the American College of Cardiology Foundation

Most physicians know that alcohol drinking during pregnancy is criminal. Drinking before driving is just as criminal. We all know that chronic heavy drinking can result in liver cirrhosis or Wernicke–Korsakoff syndrome, and that even exceptional binge drinking can result in violence, unsafe sex, and cardiac death. On the other hand, the medical and scientific literature shows that moderate drinking (1–2 drinks/day for women and 2–4 drinks/day for men) is associated with a better life expectancy in the general population as well as in patients with established coronary heart disease (CHD).1–3 The study by Janszky et al. 4 is an additional report showing the protective effect of moderate drinking in Swedish patients after acute myocardial infarction (AMI). In the absence of a controlled trial, which is neither technically nor ethically feasible, the main question for physicians remains whether the inverse association between moderate drinking and CHD complications is a cause–effect relationship. If it is, what should cardiologists do with their patients at risk of dying from AMI? This editorial focuses on patients at high risk of dying from a recurrent heart attack. The authors do not intend to discuss the alcohol issue in the general population or the established fact that patients at very high risk need an implantable cardiac defibrillator (ICD). Some scientists and physicians think that most studies reporting alcohol-induced protection are biased. The main bias is called ‘sick quitter bias’, meaning that non-drinkers (the referent group in most studies) include former drinkers who have recently stopped drinking due to illness.4 That disease in former drinkers may explain the higher risk among the whole group of non-drinkers as compared … *Corresponding author. Tel: +33 476 63 74 71; fax: +33 476 63 71 52. E-mail: michel.delorgeril{at}ujf-grenoble.fr