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We sought to assess if the medullary diameter to cortical width ratio (MD:CW), canal flair index (CFI), and canal fill (CF) of the proximal radius were associated with the presence of stress shielding (SS) after a MoPyC radial head arthroplasty. We conducted a retrospective, international, multicenter (4 centers) study. A total of 100 radial head arthroplasties in 64 women and 36 men with a mean age of 58.40 years ± 14.90 (range, 25.00-91.00) were included. Radiographic measurements, including MD:CW, CFI, CF, and postoperative SS were captured at a mean follow-up of 3.9 years ± 2.8 (range, 0.5-11). SS was identified in 60 patients. Mean preoperative MD:CW, CFI, and CF were 0.55 ± 0.09, 1.05 ± 0.18, and 0.79 ± 0.11, respectively. The presence of SS was significantly associated with MD:CW (adjusted odds ratio = 13.66; P =.001), and expansion of the stem (adjusted odds ratio = 3.78; P =.001). The amount of the SS was significantly correlated with expansion of the stem (aβ 4.58; P <.001). Our study found that MD:CW was an independent risk factor of SS after MoPyc radial head arthroplasty. Autoexpansion of the MoPyc stem significantly increased the risk of SS and its extent. Further studies involving multiple implants designs are needed to confirm the preliminary observations presented in the current study. [ABSTRACT FROM AUTHOR]

This study investigated whether left ventricular (LV) stimulation via a guidewire-reduced procedure duration while maintaining efficacy and safety compared with standard right ventricular (RV) stimulation. Rapid ventricular pacing is necessary to ensure cardiac standstill during transcatheter aortic valve replacement (TAVR). This is a prospective, multicenter, single-blinded, superiority, randomized controlled trial. Patients undergoing transfemoral TAVR with a SAPIEN valve (Edwards Lifesciences, Irvine, California) were allocated to LV or RV stimulation. The primary endpoint was procedure duration. Secondary endpoints included efficacy, safety, and cost at 30 days. Between May 2017 and May 2018, 307 patients were randomized, but 4 were excluded because they did not receive the intended treatment: 303 patients were analyzed in the LV (n = 151) or RV (n = 152) stimulation groups. Mean procedure duration was significantly shorter in the LV stimulation group (48.4 ± 16.9 min vs. 55.6 ± 26.9 min; p = 0.0013), with a difference of –0.12 (95% confidence interval: –0.20 to –0.05) in the log-transformed procedure duration (p = 0.0012). Effective stimulation was similar in the LV and RV stimulation groups: 124 (84.9%) versus 128 (87.1%) (p = 0.60). Safety of stimulation was also similar in the LV and RV stimulation groups: procedural success occurred in 151 (100%) versus 151 (99.3%) patients (p = 0.99); 30-day MACE-TAVR (major adverse cardiovascular event-transcatheter aortic valve replacement) occurred in 21 (13.9%) versus 26 (17.1%) patients (p = 0.44); fluoroscopy time (min) was lower in the LV stimulation group (13.48 ± 5.98 vs. 14.60 ± 5.59; p = 0.02), as was cost (€18,807 ± 1,318 vs. €19,437 ± 2,318; p = 0.001). Compared with RV stimulation, LV stimulation during TAVR was associated with significantly reduced procedure duration, fluoroscopy time, and cost, with similar efficacy and safety. (Direct Left Ventricular Rapid Pacing Via the Valve Delivery Guide-wire in TAVR [EASY TAVI]; NCT02781896) [ABSTRACT FROM AUTHOR]

This paper studies the existence and the uniqueness of solutions for a coupled system of nonlinear fractional integro-differential equations. New existence and uniqueness results are established using Banach theorem. Other results are obtained using Schaefer fixed point theorem. Some concrete examples are also presented. [ABSTRACT FROM AUTHOR]

Background A sizeable proportion of patients treated with PCI are unable to take dual antiplatelet therapy (DAPT) for the guideline-recommended time period of 6-12 months. Optimal treatment of pts at high bleeding risk thus remains uncertain. The BioFreedom™ DCS (Biosensors, Europe SA, Morges, Switzerland) is polymer- and carrier-free, releases Biolimus A9 into the vessel wall over a period of 4 weeks, and then technically becomes a BMS. Methods 2,466 pts at high bleeding risk from 68 centers in Europe, Asia, and Canada were enrolled over an 18 months period in a double-blinded randomized 1:1 comparison of the Gazelle™ BMS vs. the BioFreedom DCS (both Biosensors, Morges, CH) with a 1 month course of DAPT only in both arms. At 1 year, the primary endpoints are: safety: a composite of cardiovascular death, MI and stent thrombosis, and efficacy: the rate of ci-TLR. Current results In the trial population, the most frequently used inclusion criteria were: advanced age (64%), need for long term oral anticoagulation (36%), anemia, recent bleeding or transfusion (20%), renal insufficiency (18%), planned surgery (15%) and concomitant cancer (9%). When compared to those included in ‘all-comer’ trials, pts were markedly older (75 years) and had more co-morbidiites (diabetes 33%, atrial fibrillation 33%, peripheral vascular disease 15%, heart failure 13%, prior stroke 9% and COPD 11%) 1.5 lesions/pts were treated and 1.7 stents/pts were implanted for a total stent length of 32mm/patient. Technical procedure success was 95%. 71% of pts were discharged on DAPT alone, 27% of DAPT+oral anticoagulation and 2% on a single antiplatelet agent + oral anticoagulation. Conclusion The trial focuses on a never previously studied high bleeding risk population characterized by advanced age and more comorbid conditions. It is the 1st evaluation of a DCS with clinical endpoints and comprises the shortest ever DAPT course with an active stent to be evaluated for both safety and efficacy. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the safety of extended-delay stenting (>7 days between procedures) in the setting of percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods This ongoing prospective observational study is being conducted in STEMI patients with a high thrombus burden in the infarct-related artery (IRA). Patients are enrolled if the operator decides to try to restore the best TIMI flow with the thinnest tool and defer stent implantation for >7 days under optimal anticoagulation to reduce thrombus burden. The primary endpoint is the composite of reocclusion of the IRA or sudden death between the two procedures, and deterioration of the flow (from the final flow achieved after the first procedure to the initial flow at the second procedure). Results Between January 2014 and January 2015, 127 patients (of 135 we will enroll) were enrolled at 14 centres: 110 were men and the mean age±SD was 57.1±13.0 years. 98 patients underwent a primary PCI as the first procedure and 29 patients underwent PCI after fibrinolysis. The final TIMI flow at the first procedure was 3 in 119 patients, 2 in 7 patients, and 1 in 1 patient and the residual culprit lesion was 61±24%. Glycoprotein IIb/IIIa inhibitor in 42 patients. The second procedure was performed between 7 and 26 days after the first. None of the patients died between the two procedures; 1 patient experienced a reocclusion of the IRA In all cases, initial TIMI flow in the IRA (at the start of the second procedure) was the same as or better than the final flow after the first procedure. A stent was implanted in 80 patients, whereas no significant lesion was documented in 47 patients. Final results will be presented at the meeting. Conclusions In PCI for acute STEMI, when the thrombus burden is high, stenting delayed by 7-26 days with intensive antithrombotic cover appears safe, with only 1 of 130 patients developing an IRA reocclusion. [ABSTRACT FROM AUTHOR]