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Goal The aim of the study is to assess the incidence, risk factors and prognosis of definite stent thrombosis (ST) at 1 year in the France PCI multicenter prospective registry. Patients and methods Only patients who underwent coronary angioplasty with at least one stent implantation between 1st January 2014 and 31 December 2019 were included. The population was separated into 2 groups: the "ST" group with stent thrombosis and the "control" group without stent thrombosis. Results 35,435 patients were included. 256 patients (0.72%) presented a ST at 1 year. The rate of ST decreased significantly in acute coronary syndrome (1.5% in 2014 vs. 0.73% in 2019; p = 0.05) but not in chronic coronary syndrome (0.46% in 2014 vs 0.40%; p = 0.98). The risk factors are young age (65.8 years vs 68.2; p = 0.002), clinical context (35.27% vs 16.68%; p = 0.0001), diabetes (35.2 % vs 26.4%; p = 0.002), renal failure (11.7% vs 8%; p = 0.009) and history of coronary angioplasty (28.63% vs 21.86%; p = 0.009) and peripheral arterial disease (14.5% vs 10.1%; p = 0.021), LV dysfunction (37% vs 27.5%; p = 0.003), mean length (39.6 mm vs 31, 7mm; p Conclusion Since 2014, the incidence of ST at 1 year has been decreasing but remains stuck at a floor level of 0.54% in 2019. The battle for ST seems to have been partly won and its risk factors well identified, but its mortality is still high.

Coronary calcifications are frequently identified within coronary lesions as their incidence increases with age and cardiovascular risk factors. Their location can be superficial or deep, according to different pathological process. In all cases, the presence of calcifications within the vascular wall predicts poor clinical prognosis and unfavorable evolution after percutaneous revascularization. Coronary calcifications can be analyzed by angiography, CT or intracoronary imaging (IVUS or OCT) with variable accuracies. Angiography is the most frequently used method but is not very sensitive (sensitivity close to 50%) and insufficient for their precise quantification. The CT scan is a more effective non-invasive method leading to an accurate analysis of the lesion before coronary angiography. IVUS and OCT have an excellent spatial resolution and are the most sensitive methods for the identification (present in nearly 75-80% of lesions) and quantification of calcifications. These intracoronary imaging techniques offer interesting perspectives for identification of the highest-risk lesions, PCI procedures planning (including the choice of an optimal dedicated plaque preparation devices), the monitoring of their execution and the evaluation of the immediate post-stenting results.

Transcatheter aortic valve implantation (TAVI) has become the major approach to manage the severe aortic stenosis in inoperable patients that frequently present a coronary artery disease. To date, the available data related to the impact of these coronary lesions on survival is conflicting. When indicated, coronary revascularization could be beneficial for proximal lesions when performed before or during TAVI. The per-procedure coronary artery occlusion is rare, but with a bad prognosis. The coronary occlusion is more frequent with short distance of the coronary implantation and the small aortic sinuses, mostly occurring in the left main coronary. The scan analysis to identify high-risk cases is therefore important before the procedure in order to anticipate and prevent complications by specific techniques. Recently, late occlusion cases have been described and linked to thrombus or fibrosis mechanisms. The rate of success of percutaneous coronary intervention (PCI) after TAVI approach is weak, because of the difficulties of selective catheterization due to the stent of prosthesis. The different techniques of PCI have been outlined according to the type of the prosthesis.

Intrastent restenosis (ISR) remains a common problem in interventional cardiology. Angiographic data are limited in assessing ISR. Optical coherence tomography (OCT) is a high-resolution endocoronary imaging technique. It allows individualization of the stent struts and thus reveals stent under-expansion or fracture, which are sometimes difficult to demonstrate on angiography. Restenotic tissue is also identified and can be classified as homogeneous neointima, heterogeneous neointima or neoatherosclerosis. OCT therefore helps guide the treatment of ISR, which varies depending on the etiology. This imaging technique also allows us to verify that the criteria for successful angioplasty have been met and thus to correct a potential risk factor for recurrence of ISR. These remarks are illustrated by two clinical cases. OCT is now validated in this indication, it remains to validate the interest of the technique on the follow-up of the patients and to integrate the new tools at our disposal.

Resume Les hematomes et dissections coronaires non atheromateux, regroupes dans la litterature sous l’acronyme anglo-saxon SCAD (spontaneous coronary artery dissection), sont des entites meconnues et sous-estimees de syndrome coronarien aigu de la femme, souvent jeune. Des series relativement importantes ont ete publiees ces 5 dernieres permettant de mettre en lumiere cette affection jusqu’a present consideree comme rare. De fait la physiopathologie, l’histoire naturelle, les modes de presentation clinique, le profil des patientes, les modalites diagnostiques et therapeutiques ainsi que l’evolution au long cours des SCAD sont de mieux en mieux apprehendes. L’objectif de cette mise au point est de presenter un « etat de l’art » concis des SCAD en 2016 afin d’aider les cliniciens confrontes au management de cette pathologie.

Resume Introduction Les patients aux antecedents de pontage aorto-coronarien et presentant une valvulopathie aortique sont un groupe a risque eleve pour la chirurgie conventionnelle redux. L’implantation de valve aortique par voie trans-catheter (TAVI) pourrait etre une alternative pour leur prise en charge. Le but de cette etude est d’evaluer l’impact des TAVI dans la prise en charge des valvulopathies aortiques apres une revascularisation coronaire chirurgicale prealable. Methodes Il s’agit d’une etude retrospective, observationnelle monocentrique incluant 87 patients ayant beneficie d’une chirurgie traditionnelle ou d’un TAVI dans le periode allant de janvier 2007 a decembre 2013. Les abords pour le TAVI etait trans-femoral, trans-apical et par l’artere sous-claviere. Resultats L’introduction des techniques interventionnelles a multiplie par deux le nombre de patients redux de pontage traites pour une valvulopathie aortique. Sur la deuxieme periode 30 % de moins de patients ont ete operes par la chirurgie conventionnelle, ce qui a permis une amelioration des resultats postoperatoires. Cette etude nous a permis de remarquer une difference des populations de patients traites en termes de facteurs de risques operatoires n’autorisant dans cette serie aucune comparaison sans biais entre les deux techniques. La mortalite hospitaliere etait de 6,4 % pour la chirurgie conventionnelle aortique et de 20 % pour les implantations aortiques trans-catheter. Conclusion La chirurgie conventionnelle reste le traitement de reference pour la prise en charge des valvulopathies mais le TAVI devient un complement indispensable pour permettre de mieux selectionner les patients avant la chirurgie offrant des perspectives therapeutiques nouvelles pour les autres.

Aims We investigated the feasibility of thrombus quantification by frequency-domain optical coherence tomography (FD-OCT) methods in patients with highly thrombotic acute coronary syndrome (ACS) treated by deferred stenting strategy. Methods and results Patients were suitable for inclusion if they presented (i) an ACS that was successfully revascularized by manual thrombo-aspiration and (ii) a large residual thrombus on coronary angiography and initial FD-OCT analysis. These patients underwent a second procedure including FD-OCT analysis after several days of optimal antithrombotic therapy. Serial area measurements within the athero-thrombotic culprit lesion were performed to evaluate the OCT-thrombus score, volume, and length. Sixteen patients (88% men/age = 59.3 ± 4.1 years/94% STEMI) were included in the study. The mean delay between OCT analyses was 3.9 ± 0.3 day. No adverse event was observed during this interval. We observed a reduction of thrombus burden between the two analyses, as assessed by the significant reductions in OCT-thrombus score (22.3 ± 2.6 vs. 10.3 ± 1.3, P < 0.001), OCT-thrombus volume (9.6 ± 2.3 vs. 3.6 ± 0.9 mm3, P = 0.003), and OCT-thrombus length (11.1 ± 1.4 vs. 7.4 ± 0.8 mm, P = 0.01). The percentages of OCT-thrombus score and volume reduction were highly correlated with the inter-OCT analyses delay (respectively ρ = 0.65 and ρ = 0.84, P < 0.01 for both). Conclusion FD-OCT assessment of thrombus volume in selected ACS patients is feasible, safe, and could allow clot regression monitoring in vivo .