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Background and ObjectivesThe effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice.MethodsIn a pooled patient-level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II, and SELECT, EVT functional outcomes (modified Rankin Scale score distribution) were compared between general anesthesia (GA) vs non-GA in a propensity-matched sample. Furthermore, we evaluated the association of collateral flow on perfusion imaging, assessed by hypoperfusion intensity ratio (HIR) – Tmax > 10 seconds/Tmax > 6 seconds (good collaterals – HIR < 0.4, poor collaterals – HIR ≥ 0.4) on the association between anesthesia type and EVT outcomes.ResultsOf 725 treated with EVT, 299 (41%) received GA and 426 (59%) non-GA. The baseline characteristics differed in presentation National Institutes of Health Stroke Scale score (median [interquartile range] GA: 18 [13–22], non-GA: 16 [11–20],p< 0.001) and ischemic core volume (GA: 15.0 mL [3.2–38.0] vs non-GA: 9.0 mL [0.0–31.0],p< 0.001). In addition, GA was associated with longer last known well to arterial access (203 minutes [157–267] vs 186 minutes [138–252],p= 0.002), but similar procedural time (35.5 minutes [23–59] vs 34 minutes [22–54],p= 0.51). Of 182 matched pairs using propensity scores, baseline characteristics were similar. In the propensity score–matched pairs, GA was independently associated with worse functional outcomes (adjusted common odds ratio [adj. cOR]: 0.64, 95% CI: 0.44–0.93,p= 0.021) and higher neurologic worsening (GA: 14.9% vs non-GA: 8.9%, aOR: 2.10, 95% CI: 1.02–4.33,p= 0.045). Patients with poor collaterals had worse functional outcomes with GA (adj. cOR: 0.47, 95% CI: 0.29–0.76,p= 0.002), whereas no difference was observed in those with good collaterals (adj. cOR: 0.93, 95% CI: 0.50–1.74,p= 0.82),pinteraction: 0.07. No difference was observed in infarct growth overall and in patients with good collaterals, whereas patients with poor collaterals demonstrated larger infarct growth with GA with a significant interaction between collaterals and anesthesia type on infarct growth rate (pinteraction: 0.020).DiscussionGA was associated with worse functional outcomes after EVT, particularly in patients with poor collaterals in a propensity score–matched analysis from a pooled patient-level cohort from 3 randomized trials and 1 prospective cohort study. The confounding by indication may persist despite the doubly robust nature of the analysis. These findings have implications for randomized trials of GA vs non-GA and may be of utility for clinicians when making anesthesia type choice.Classification of EvidenceThis study provides Class III evidence that use of GA is associated with worse functional outcome in patients undergoing EVT.Trial Registration InformationEXTEND-IA: ClinicalTrials.gov (NCT01492725); EXTEND-IA TNK: ClinicalTrials.gov (NCT02388061); EXTEND-IA TNK part II: ClinicalTrials.gov (NCT03340493); and SELECT: ClinicalTrials.gov (NCT02446587).

We present results of 131 geomagnetic storm simulations using the University of Michigan Space Weather Modeling Framework Geospace configuration. We compare the geomagnetic indices derived from the simulation with those observed, and use 2D cuts in the noon-midnight planes to compare the magnetopause locations with empirical models. We identify the location of the current sheet center and look at the plasma parameters to deduce tail dynamics. We show that the simulation produces geomagnetic index distributions similar to those observed, and that their relationship to the solar wind driver is similar to that observed. While the magnitudes of the Dst and polar cap potentials are close to those observed, the simulated AL index is consistently underestimated. Analysis of the magnetopause position reveals that the subsolar position agrees well with an empirical model, but that the tail flaring in the simulation is much smaller than that in the empirical model. The magnetotail and ring currents are closely correlated with the Dst index, and reveal a strong contribution of the tail current beyond 8REto the Dst index during the storm main phase.

How can we use topic modelling to study early modern handwritten news sheets? This is a blog post that addresses this question.

A blog post published on https://www.euronewsproject.org/2022/01/12/sampling

A Maxwell-like formulation of linearized gravity in flat background, based on the Fierz tensor as the analogue of the electromagnetic field strength, is discussed in detail and used to study fundamental properties of the linearized gravitational field. In particular, the linearized Einstein equations are formulated as first order partial differential equations in terms of the Fierz tensor, in analogy with the first order Maxwell equations. An energy-momentum tensor ($T_{\mathrm{lg}}^{ab}$) is found for the linearized gravitational field, with properties that allow it to be regarded as a unique analogue of the standard energy-momentum tensor of the electromagnetic field. $T_{\mathrm{lg}}^{ab}$ is quadratic in the Fierz tensor (which is constructed from the first derivatives of the linearized metric), traceless, and satisfies the dominant energy condition in a gauge that contains the transverse traceless gauge. In generalized harmonic gauges two additional symmetric energy-momentum tensors are found that are analogous to some extent to the energy-momentum tensor of the electromagnetic field. It is further shown that in suitable gauges, including the transverse traceless gauge, linearized gravity in the absence of matter has a duality symmetry that maps the Fierz tensor, which is antisymmetric in its first two indices, into its dual. Conserved currents associated with the gauge and duality symmetries of linearized gravity are also determined. These currents show good analogy with the corresponding currents in electrodynamics., 45 pages, minor corrections in the text, 2 references added, results unchanged

Background and purposeStent-assisted coil embolization using the new generation Neuroform Atlas Stent System has shown promising safety and efficacy. The primary study results of the anterior circulation aneurysm cohort of the treatment of wide-neck, saccular, intracranial, aneurysms with the Neuroform Atlas Stent System (ATLAS trial [Safety and Effectiveness of the Treatment of Wide Neck, Saccular Intracranial Aneurysms With the Neuroform Atlas Stent System]) are presented.MethodsATLAS IDE trial (Investigational Device Exemption) is a prospective, multicenter, single-arm, open-label study of wide-neck (neck ≥4 mm or dome-to-neck ratio 50%) at the target location. The primary safety end point was any major stroke or ipsilateral stroke or neurological death within 12 months. Adjudication of the primary end points was performed by an independent Imaging Core Laboratory and the Clinical Events Committee.ResultsA total of 182 patients with wide-neck anterior circulation aneurysms at 25 US centers were enrolled. The mean age was 60.3±11.4 years, 73.1% (133/182) women, and 80.8% (147/182) white. Mean aneurysm size was 6.1±2.2 mm, mean neck width was 4.1±1.2 mm, and mean dome-to-neck ratio was 1.2±0.3. The most frequent aneurysm locations were the anterior communicating artery (64/182, 35.2%), internal carotid artery ophthalmic artery segment (29/182, 15.9%), and middle cerebral artery bifurcation (27/182, 14.8%). Stents were placed in the anticipated anatomic location in all patients. The study met both primary safety and efficacy end points. The composite primary efficacy end point of complete aneurysm occlusion (Raymond-Roy 1) without parent artery stenosis or aneurysm retreatment was achieved in 84.7% (95% CI, 78.6%-90.9%) of patients. Overall, 4.4% (8/182, 95% CI, 1.9%-8.5%) of patients experienced a primary safety end point of major ipsilateral stroke or neurological death.ConclusionsIn the ATLAS IDE anterior circulation aneurysm cohort premarket approval study, the Neuroform Atlas stent with adjunctive coiling met the primary end points and demonstrated high rates of long-term complete aneurysm occlusion at 12 months, with 100% technical success and

Neutral hydrogen has been shown to greatly impact the plasma flow in the heliopshere and the location of the heliospheric boundaries. We present the results of the Solar-wind with Hydrogen Ion Exchange and Large-scale Dynamics (SHIELD) model, a new, self-consistent, kinetic-MHD model of the outer heliosphere within the Space Weather Modeling Framework. The charge-exchange mean free path is on order of the size of the heliosphere; therefore, the neutral atoms cannot be described as a fluid. The SHIELD model couples the MHD solution for a single plasma fluid to the kinetic solution from for neutral hydrogen atoms streaming through the system. The kinetic code is based on the Adaptive Mesh Particle Simulator (AMPS), a Monte Carlo method for solving the Boltzmann equation. The SHIELD model accurately predicts the increased filtration of interstellar neutrals into the heliosphere. In order to verify the correct implementation within the model, we compare the results of the SHIELD model to other, well-established kinetic-MHD models. The SHIELD model matches the neutral hydrogen solution of these studies as well as the shift in all heliospheric boundaries closer to the Sun in comparison the the multi-fluid treatment of the neutral hydrogen atoms. Overall the SHIELD model shows excellent agreement to these models and is a significant improvement to the fluid treatment of interstellar hydrogen., Comment: 21 pages, 6 figures. ApJS submitted

We use the MHD with embedded particle-in-cell model (MHD-EPIC) to study the Geospace Environment Modeling (GEM) dayside kinetic processes challenge event at 01:50-03:00 UT on 2015-11-18, when the magnetosphere was driven by a steady southward IMF. In the MHD-EPIC simulation, the dayside magnetopause is covered by a PIC code so that the dayside reconnection is properly handled. We compare the magnetic fields and the plasma profiles of the magnetopause crossing with the MMS3 spacecraft observations. Most variables match the observations well in the magnetosphere, in the magnetosheath, and also during the current sheet crossing. The MHD-EPIC simulation produces flux ropes, and we demonstrate that some magnetic field and plasma features observed by the MMS3 spacecraft can be reproduced by a flux rope crossing event. We use an algorithm to automatically identify the reconnection sites from the simulation results. It turns out that there are usually multiple X-lines at the magnetopause. By tracing the locations of the X-lines, we find the typical moving speed of the X-line endpoints is about 70~km/s, which is higher than but still comparable with the ground-based observations.

Next generation sequencing has revealed the presence of numerous RNA viruses in animal reservoir hosts, including many closely related to known human pathogens. Despite their zoonotic potential, most of these viruses remain understudied due to not yet being cultured. While reverse genetic systems can facilitate virus rescue, this is often hindered by missing viral genome ends. A prime example is Lloviu virus (LLOV), an uncultured filovirus that is closely related to the highly pathogenic Ebola virus. Using minigenome systems, we complemented the missing LLOV genomic ends and identified cis-acting elements required for LLOV replication that were lacking in the published sequence. We leveraged these data to generate recombinant full-length LLOV clones and rescue infectious virus. Similar to other filoviruses, recombinant LLOV (rLLOV) forms filamentous virions and induces the formation of characteristic inclusions in the cytoplasm of the infected cells, as shown by electron microscopy. Known target cells of Ebola virus, including macrophages and hepatocytes, are permissive to rLLOV infection, suggesting that humans could be potential hosts. However, inflammatory responses in human macrophages, a hallmark of Ebola virus disease, are not induced by rLLOV. Additional tropism testing identified pneumocytes as capable of robust rLLOV and Ebola virus infection. We also used rLLOV to test antivirals targeting multiple facets of the replication cycle. Rescue of uncultured viruses of pathogenic concern represents a valuable tool in our arsenal for pandemic preparedness.

The relations between two construction methods (called multiplier and embedding methods) for conserved currents of general systems of ordinary or partial differential equations (DEs) are investigated. Recent studies indicate that the multiplier method, which is a generalization of Noether's theorem, has significant advantages in comparison with the embedding method, which uses adjoint-symmetry/symmetry pairs and is based on embedding the original system of DEs in a larger one that follows from a Lagrangian. In particular, the multiplier method can generally give a wider range of conserved currents than the embedding method. In this paper simple extended forms of general systems of DEs, obtained by treating parameters present in the equations or introduced into them as dependent variables, are studied. A variant of a fundamental result on the connection between the embedding method and the action of symmetries on conserved currents that correspond to a multiplier is derived for the extended systems of DEs. Using this connection and by considering particular extensions that endow the extended DEs with scaling symmetry, it is shown that the embedding method becomes significantly stronger if it is also allowed to be applied to the extended forms of the original DEs. It is also shown that up to equivalence the multipliers of an extended DE system contain the parametric multipliers of the original system together with the derivatives of the corresponding conserved currents with respect to the parameters., Comment: 21 pages, changes in the presentation, minor corrections, 3 references added

We introduce and study a sequence of geometric invariants for convex bodies in finite-dimensional spaces, which is in a sense dual to the sequence of mean Minkowski measures of symmetry proposed by the second author. It turns out that the sequence introduced in this paper shares many nice properties with the sequence of mean Minkowski measures, such as the sub-arithmeticity and the upper-additivity. More meaningfully, it is shown that this new sequence of geometric invariants, in contrast to the sequence of mean Minkowski measures which provides information on the shapes of lower dimensional sections of a convex body, provides information on the shapes of orthogonal projections of a convex body. The relations of these new invariants to the well-known Minkowski measure of asymmetry and their further applications are discussed as well.

The Budapest Research Reactor is the first nuclear research facility in Hungary. The reactor is to remain in operation for at least another 13 years. At the same time, the development of a decommissioning plan is a mandatory requirement under national legislation. The present paper describes the current status of decommissioning planning which is aimed at a timely preparation for the forthcoming decommissioning of the reactor.

Background: Studies have suggested worse functional outcomes in women after acute ischemic stroke. Following intravenous thrombolysis, they have higher recanalization rates; however, sex-based differential outcomes are poorly studied in large vessel occlusion +− intra-arterial therapy. We sought to ascertain the correlation between infarcted brain tissue volume and functional outcome in women as compared to men who were potential neurointerventional therapy candidates. Methods: We retrospectively queried our prospectively maintained acute potential neurointerventional candidate and neuroimaging patient database (n=283) and correlated final DWI cerebral infarction volume with functional outcomes as measured by the modified Rankin Scale [MRS] at hospital discharge and 30 days. Results: Median age was 69 [56,79] and 185 patients received intra-arterial therapy including 103 women (55.7%). There were no differences in age or admission NIHSS score, initial or final DWI infarction volumes, premorbid MRS, site of large vessel occlusion, pre-intervention collateral grade, TIMI or TICI grade, or recanalization rate between the sexes. Spearman correlation coefficients (r 2 ) between final DWI infarction volume and functional outcomes for neurointerventionally treated men as compared to women were 0.45 [men, p=.0009] versus (vs) 0.12 [women, p=.41] for discharge MRS; 0.78 [men, p2 values were 0.53 [men, p Conclusions: Despite comparable baseline functional status, treatment rate, occlusion site, initial and final infarction volumes, and recanalization rates, final infarction volume correlates strongly with functional outcome in men but not in women. This data suggests fundamental differences in neurophysiological or social factors between men and women in response to acute large vessel stroke, the nature of which deserves to be more fully investigated.

Seliciclib, a cyclin-dependent kinase inhibitor, is a promising candidate to treat a variety of cancers. Pharmacokinetic studies have shown high oral bioavailability but limited brain exposure to the drug. This study shows that seliciclib is a high-affinity substrate of ATP-binding cassette B1 (ABCB1) because it activates the ATPase activity of the transporter with an EC50 of 4.2 mu M and shows vectorial transport in MDCKII-MDR1 cells, yielding an efflux ratio of 8. This interaction may be behind the drug's limited penetration of the blood-brain barrier. ABCB1 overexpression, on the other hand, does not confer resistance to the drug in the models tested. These findings should be considered when treatment strategies using seliciclib are designed.

We present the first representation of the general term of the Rayleigh-Schr��dinger series for quasidegenerate systems. Each term of the series is represented by a tree and there is a straightforward relation between the tree and the analytical expression of the corresponding term. The combinatorial and graphical techniques used in the proof of the series expansion allow us to derive various resummation formulas of the series. The relation with several combinatorial objects used for special cases (degenerate or non-degenerate systems) is established., 16 pages, 3 figures

We consider five-dimensional real linear spaces with a (otherwise well-known) linear action of the Galilei and the Poincare group on them, describe the geometry of these two spaces, and show, that these geometries comprise the notions of space-time, mass, momentum, force and physical dimensions in a natural way. In this way we geometrize the quantity of mass and integrate it together with space-time into two geometries in a natural way, so that these geometries are perfectly suitable for underlying the Newtonian and special relativistic mechanics of pointlike bodies., Comment: plain tex, 25 pages

The invention relates to an ion-conductive polymer membrane for a fuel cell, whereby the polymer membrane is configured from a polymer-forming hydrocarbon material and to a method for producing the same. The membrane also has a metal-containing gel which has been hydrolysed and/or condensed from a metal alkoxide starting material and which is deposited in the polymer and/or is chemically bonded to the polymer. The proportion of metal alkoxide by weight, in relation to the membrane, lies between 25 % and 1 %.

Pressure wire-based fractional flow reserve is considered the standard of reference for evaluation of the ischemic potential of coronary stenoses and the expected benefit from revascularization. Accordingly, its application in daily practice or for research purposes has to be as standardized as possible to avoid technical or operator-related artifacts in pressure recordings. This document proposes a standardized way of acquiring, recording, interpreting, and archiving the pressure tracings for daily practice and for the purpose of clinical research involving a core laboratory. Proposed standardized steps enhance the uniformity of clinical practices and data interpretation. (C) 2016 by the American College of Cardiology Foundation. Dr. Toth has a consultancy agreement with St. Jude Medical. Dr. Johnson has received internal funding from the Weatherhead PET Center for Preventing and Reversing Atherosclerosis; has received significant institutional research support from St. Jude Medical and Volcano/Philips outside of the submitted work; and has an institutional licensing and consulting agreement with Boston Scientific. Dr. Jeremias has reported speaker and consultant fees from Volcano Inc. and St. Jude Medical Inc. outside of the submitted work. Dr. Pellicano has been supported by a research grant provided by the Cardiopath PhD program. Dr. Vranckx has received speaking or consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi-Sankyo, and The Medicines Co. outside of the submitted work. Dr. Fearon has received research support from Medtronic and St. Jude Medical outside of the submitted work; and has received consultant fees from Medtronic, HeartFlow, and Cathworks. Dr. Barbato has received institutional research grants and speakers fees from St. Jude Medical outside of the submitted work. Dr. Kern has received consultant and speaker fees from St. Jude Medical, Volcano, Opsens, ACIST Medical, and Heartflow outside of the submitted work. Dr. Pijls is a consultant for St. Jude Medical, Opsens, and Boston Scientific outside of the submitted work; has received research grants from Medtronic; and is a shareholder for Philips, ASML, General Electric, and Heartflow. Dr. De Bruyne is a shareholder for Siemens, GE, Bayer, Philips, HeartFlow, Edwards Life Sciences, Sanofi, and Omega Pharma; and his institution has received grant support from Abbott, Boston Scientific, Biotronik, and St. Jude Medical and receives consulting fees on his behalf from St. Jude Medical, Opsens, and Boston Scientific outside of the submitted work.

We evaluated the clinical outcome of patients with moderate/severe aortic stenosis and significant coronary disease not treated according to guidelines, recommending combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). From 2002 to 2010, we assessed death up to 5 years in 650 patients with moderate/severe aortic stenosis and at least one coronary lesion (>50 %): 23 % were treated conservatively (MT), 17 % with percutaneous coronary intervention (PCI), 11 % with AVR, and 49 % with combined CABG and AVR. At a median follow-up of 58 months, overall death decreased over the groups (MT, 68 % vs. PCI, 44 % vs. AVR, 34 % vs. CABG and AVR, 23 %, p

Item does not contain fulltext BACKGROUND: The FIREHAWK is a drug-eluting stent with a fully biodegradable sirolimus-containing polymer coating localised to recessed abluminal grooves on the stent surface. We investigated clinical outcomes with this targeted, low-dose, biodegradable polymer, sirolimus-eluting stent compared with XIENCE durable polymer, everolimus-eluting stents in an all-comers population. METHODS: The TARGET All Comers study was a prospective, multicentre, open-label randomised non-inferiority trial done at 21 centres in ten European countries. Patients with symptomatic or asymptomatic coronary artery disease and objective evidence of myocardial ischaemia who qualified for percutaneous coronary intervention were randomised 1:1 to undergo implantation of a FIREHAWK or XIENCE. Randomisation was web-based, with random block allocation and stratification by centre and ST elevation myocardial infarction. Outcome assessors were masked to treatment allocation, but treating physicians and patients were not. The primary endpoint was target lesion failure at 12 months, a composite of cardiac death, target vessel myocardial infarction, or ischaemia-driven target lesion revascularisation. The control event rate for XIENCE was assumed to be 7%, the non-inferiority margin was 3.5%, and the primary analysis was in the intention-to-treat population, censoring patients who did not have either an event before 365 days or contact beyond 365 days. Late lumen loss was the primary endpoint of an angiographic substudy designed to investigate the non-inferiority of the FIREHAWK compared with the XIENCE stent. This trial is registered with ClinicalTrials.gov, number NCT02520180. FINDINGS: From Dec 17, 2015, to Oct 14, 2016, 1653 patients were randomly assigned to implantation of the FIREHAWK (n=823) or XIENCE (n=830). 65 patients in the FIREHAWK group and 66 in the XIENCE group had insufficient follow-up data and were excluded from the analyses. At 12 months, target lesion failure occurred in 46 (6.1%) of 758 patients in the FIREHAWK group and in 45 (5.9%) of 764 patients in the XIENCE group (difference 0.2%, 90% CI -1.9 to 2.2, pnon-inferiority=0.004, 95% CI -2.2 to 2.6, psuperiority=0.88). There were no differences in ischaemia-driven revascularisation or stent thrombosis rates at 12 months. 176 patients were included in the angiographic substudy, in which in-stent late lumen loss was 0.17 mm (SD 0.48) in the FIREHAWK group and 0.11 mm (0.52) in the XIENCE group (p=0.48), with an absolute difference of 0.05 mm (95% CI -0.09 to 0.18, pnon-inferiority=0.024). INTERPRETATION: In a broad all-comers population of patients requiring stent implantation for myocardial ischaemia, the FIREHAWK was non-inferior to the XIENCE as assessed with the primary endpoint of target lesion failure at 12 months and in-stent late lumen loss at 13 months. The FIREHAWK is a safe and effective alternative stent to treat patients with ischaemic coronary artery disease in clinical practice. FUNDING: Shanghai Microport Medical.

In this article we provide a very interesting and challenging PCI of unrecognized anomalous left circumflex coronary artery (LCx) arising from right sinus of Valsalva (RSV) after aortic valve replacement (AVR).This case presentation focuses the attention on important criteria for recognition of abnormal LCx coronary artery, that is the most frequent congenital coronary variant. Failure to demonstrate the anomaly can lead to erroneous interpretation of coronary anatomy with fatal complication in case of aortic valve replacement, as a consequence of accidental ligation or compression of the anomalous vessel. This procedure, especially in the presence of a bioprosthesis aortic valve just implanted, constitutes a challenge for the interventional cardiologist and at the same time a question mark regarding the strategy, choice of guiding catheter, guide wire, and type of stent to use.

We sought to assess in-stent variations in fractional flow reserve (FFR) in patients with previous percutaneous coronary intervention (PCI) and to associate any drop in FFR with findings by optical coherence tomography (OCT) imaging. Suboptimal post-PCI FFR values were previously associated with poor outcomes. It is not known to which extent in-stent pressure loss contributes to reduced FFR. In this single-arm observational study, 26 patients who previously underwent PCI with drug-eluting stent or scaffold implantation were enrolled. Motorized FFR pullback during continuous intravenous adenosine infusion and OCT assessments was performed. Post-PCI FFR 0.03 was associated with suboptimal FFR. In patients with suboptimal FFR, the OCT analyses revealed higher mean neointimal area (respectively: 1.06 ± 0.80 vs. 0.51 ± 0.23 mm2; p = 0.018) and higher neointimal thickness of covered struts (respectively 0.11 ± 0.07 vs. 0.06 ± 0.01 mm; p = 0.021). Suboptimal FFR values following stent-implantation are mainly caused by significant in-stent pressure loss during hyperemia. This finding is associated to a larger neointimal proliferation.

Background— The correlation between angiographic assessment of coronary stenoses and fractional flow reserve (FFR) is weak. Whether and how risk factors impact the diagnostic accuracy of angiography is unknown. We sought to evaluate the diagnostic accuracy of angiography by visual estimate and by quantitative coronary angiography when compared with FFR and evaluate the influence of risk factors (RF) on this accuracy. Methods and Results— In 1382 coronary stenoses (1104 patients), percent diameter stenosis by visual estimation (DS VE ) and by quantitative coronary angiography (DS QCA ) was compared with FFR. Patients were divided into 4 subgroups, according to the presence of RFs, and the relationship between DS VE , DS QCA , and FFR was analyzed. Overall, DS VE was significantly higher than DS QCA ( P VE was significantly smaller than DS QCA in mild stenoses, although the reverse held true for severe stenoses. Compared with FFR, a large scatter was observed for both DS VE and DS QCA . When using a dichotomous FFR value of 0.80, C statistic was significantly higher for DS VE than for DS QCA (0.712 versus 0.640, respectively; P VE decreased progressively as RFs accumulated (0.776 for ≤1 RF, 0.750 for 2 RFs, 0.713 for 3 RFs and 0.627 for ≥4 RFs; P =0.0053). In addition, in diabetics, the relationship between FFR and angiographic indices was particularly weak (C statistics: 0.524 for DS VE and 0.511 for DS QCA ). Conclusions— Overall, DS VE has a better diagnostic accuracy than DS QCA to predict the functional significance of coronary stenosis. The predictive accuracy of angiography is moderate in patients with ≤1 RFs, but weakens as RFs accumulate, especially in diabetics.

The aim of this review is to highlight the role of invasive functional evaluation in patients in whom coronary artery bypass graft (CABG) is indicated, and to examine the clinical evidence available in favour of fractional flow reserve (FFR) adoption in these patients, outline appropriate use, as well as point out potential pitfalls. FFR after CABG will also be reviewed, highlighting its correct interpretation and adoption when applied to both native coronary arteries and bypass grafts. Practice European guidelines support the use of FFR to complement coronary angiography with the highest degree of recommendation (Class IA) for the assessment of coronary stenosis before undertaking myocardial revascularization when previous non-invasive functional evaluation is unavailable or not conclusive. As a result, FFR has been adopted in routine clinical practice to guide clinicians decision as to whether or not perform a revascularization. Of note, due to the increasing confidence of the interventional cardiologists, FFR guidance is also being implemented to indicate or guide CABG. This is in anticipation of supportive clear-cut evidence, since recommendations for FFR adoption were based on randomized clinical trials investigating percutaneous coronary intervention (PCI) strategies in which patients with typical indications for CABG were excluded (e.g. left main disease, valvular disease, and coronary anatomy unsuitable for PCI). Based on the critical appraisal of the literature, FFR can play an important role in risk stratification and determining management strategy of patients either before or after CABG.

Toth et al1 performed a well-organized, web-based, international survey on interventional strategies in patients with stable angina and intermediate coronary lesions. After a total of 4421 lesion evaluations, interventional cardiologists relied solely on angiographic appearance in 71% of cases. Importantly, such a behavior resulted in discordance with known fractional flow reserve (FFR) in 47% of them. Conversely, FFR and other imaging modalities were used only in a minority of cases. The authors concluded that, despite current recommendations, visual estimation continues to dominate treatment decisions for intermediate coronary …

AIM: To assess ACEF (age, creatinine, and ejection fraction) and Clinical SYNTAX (CSS) score in the risk stratification of patients with heavily calcified stenosis undergoing rotational atherectomy with stent implantation (rota-stenting). METHODS AND RESULTS: ACEF and CSS were calculated in 221 consecutive patients with stable angina undergoing rota-stenting. Mean age of the patients was 74 ± 10 years, left ventricular ejection fraction was 61 ± 18%, and final burr size 1.78 ± 0.24 mm, with 2.6 ± 0.9 burrs used for each patient. Primary end-point was MACE at one-year defined as the composite of cardiac death, myocardial infarction, and target vessel revascularization. Post-hoc analysis was performed by stratifying the clinical outcome according to ACEF and CSS tertiles. At 1 year there was a significantly higher MACE rate in the high tertile of ACEF (24% for ACEFHigh vs. 13% for ACEFMid vs. 9% for ACEFLow; P = 0.017) and CSS (25% for CSSHigh vs. 12% for CSSMid vs. 8% for CSSLow; P = 0.008). The predictive accuracy for both ACEF and CSS was moderate (c-statistics, 0.629 and 0.638, respectively). CONCLUSION: Both ACEF and CSS predict with moderate accuracy MACE at 1-year in patients with heavily calcified coronary stenosis undergoing rotational atherectomy with stent implantation