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Resume Introduction La presente etude s’attache a comparer la prevalence des violences subies a l’âge adulte d’un echantillon de 91 femmes criminelles en comparaison a la population generale feminine afin d’offrir une meilleure comprehension de la criminalite feminine. Materiel A partir de dossier d’expertises penales de femmes âgees de plus de 15 ans, d’un expert pres la cour d’appel de Rennes, entre 2014 et 2019, il a ete recueilli les donnees concernant les violences subies par ces femmes selon les criteres OMS. Resultats Quatre-vingt-onze dossiers d’expertise penale ont ete inclus. La prevalence des violences subies a l’âge adulte etait de 57,1 %, prevalence significativement superieure a la population generale feminine. Par ailleurs, ces femmes rapportaient des vecus de violences independamment de l’âge dans 76,1 % des cas. Conclusion Notre etude met en evidence une preponderance des violences dans le parcours de vie de ces femmes criminelles en comparaison a la population generale feminine. Cette victimisation semble etre etroitement liee a la criminalite feminine et semble etre un point cle dans la comprehension de cette derniere. Par ailleurs, les troubles psychiatriques sont frequents et sont surrepresentes par les dependances aux substances et les troubles de la personnalite. Ces deux troubles associes a la criminalite semblent accroitre le risque de passage a l’acte violent et etre conditionnes par les experiences de violences vecues. Dans ce contexte, les vecus de violences semblent donc etre un facteur d’evolution defavorable de risque medico-legal.

It is unclear whether deviations in brain and behavioral development, which may underpin elevated substance use during adolescence, are predispositions for or consequences of substance use initiation. Here, we examine behavioral and neuroimaging indices at early and mid-adolescence in drug-naive youths to identify possible predisposing factors for substance use initiation and its possible consequences.Among 304 drug-naive adolescents at baseline (age 14 years) from the IMAGEN dataset, 83 stayed drug-naive, 133 used alcohol on 1 to 9 occasions, 42 on 10 to 19 occasions, 27 on 20 to 39 occasions, and 19 on40 occasions at follow-up (age 16 years). Baseline measures included brain activation during the Monetary Incentive Delay task. Data at both baseline and follow-up included measures of trait impulsivity and delay discounting.From baseline to follow-up, impulsivity decreased in the 0 and 1- to 9-occasions groups (p .004), did not change in the 10- to 19-occasions and 20- to 29-occasions groups (p.294), and uncharacteristically increased in the40-occasions group (p = .046). Furthermore, blunted medial orbitofrontal cortex activation during reward outcome at baseline significantly predicted higher alcohol use frequency at follow-up, above and beyond behavioral and clinical variables (p = .008).These results suggest that the transition from no use to frequent drinking in early to mid-adolescence may disrupt normative developmental changes in behavioral control. In addition, blunted activity of the medial orbitofrontal cortex during reward outcome may underscore a predisposition toward the development of more severe alcohol use in adolescents. This distinction is clinically important, as it informs early intervention efforts in preventing the onset of substance use disorder in adolescents.

Objective Irritable mood, a common and impairing symptom in psychopathology, has been proposed to underlie the developmental link between oppositional problems in youth and depression in adulthood. We examined the neural correlates of adolescent irritability in IMAGEN, a sample of 2,024 14-year-old adolescents from 5 European countries. Method The Development and Well-Being Assessment (DAWBA) was used to assess attention-deficit/hyperactivity disorder, major depressive disorder, oppositional defiant disorder, and generalized anxiety disorder. Three items from the DAWBA, selected as close matches to the Affective Reactivity Index, were used to assess irritability. Structural magnetic resonance imaging was examined using whole-brain voxel-based morphometry analysis, and functional magnetic resonance imaging was examined during a stop signal task of inhibitory control. Imaging data were included in structural equation models to examine the direct and indirect associations between irritable mood and comorbid DSM diagnoses. Results Whole-brain voxelwise analysis showed that adolescent irritable mood was associated with less gray matter volume and less neural activation underlying inhibitory control in frontal and temporal cortical areas (cluster-correction at p Conclusion This study identifies adolescent irritability as an independent construct and points to a neurobiological correlate to irritability that is an important contributing feature to many psychopathological disorders.

Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) emerged has a less invasive treatment than surgery for patients with degenerated bioprosthesis. However, few data are currently available regarding results of ViV versus TAVI in native aortic valve. We aimed to compare hemodynamic performances and 1-year outcomes between patients who underwent ViV procedure and patients who underwent non-ViV TAVI. This bicentric study included all patients who underwent aortic ViV procedure for surgical bioprosthetic aortic failure between 2013 and 2017. All patients who underwent TAVI were included in the analysis during the same period. ViV and non-ViV patients were matched with 1:2 ratio according to size, type of TAVI device, age (±5 years), sex, and STS score. Primary end point was hemodynamic performance including mean aortic gradient and aortic regurgitation at 1-year follow-up. A total of 132 patients were included, 49 in the ViV group and 83 in the non-ViV group. Mean age was 82.8 ± 5.9 years, 55.3% were female. Mean STS score was 5.2% ± 3.1%. Self-expandable valves were implanted in 78.8% of patients. At 1-year follow-up, aortic mean gradient was significantly higher in ViV group (18.1 ± 9.4 mm Hg vs 11.4 ± 5.4 mm Hg; p0.0001) and 17 (38.6%) patients had a mean aortic gradient ≥20 mm Hg vs 6 (7.8%) in the non-ViV group (p = 0.0001). Aortic regurgitationgrade 2 were similar in both groups (p = 0.71). In the ViV group, new pacemaker implantation was less frequent (p = 0.01) and coronary occlusions occurred only in ViV group (n = 2 [4.1%]). At 1-year follow-up, 3 patients (2.3%) died from cardiac cause, 1 (2.1%) in the ViV group vs 2 (2.4%) in the non-ViV group (p = 0.9). There was no stroke. In conclusion, compared with TAVI in native aortic stenosis, ViV appears as a safe and feasible strategy in patients with impaired bioprosthesis. As 1-year hemodynamic performances seem better in native TAVI procedure, long-term follow-up should be assessed to determinate the impact of residual stenosis on outcomes and durability.

Background Ever since it was first defined, apathy has been described as a transnosographic entity, involved in many neuropsychiatric disorders not least depression. Owing to its impact on therapeutic outcomes and morbidity, this clinical dimension is of considerable interest in the pathophysiology of depression. However, the literature does not adequately emphasize the links between depression and apathy. Methods In a prospective open-cohort study of 70 depressed patients (from November 2014 to June 2015), we sought to compare the clinical and neuropsychological profiles of apathetic versus nonapathetic depressed patients. Results After controlling for confounding factors (age, duration of disease, Selective Serotonin Reuptake Inhibitor, Post Traumatic Stress Disorder comorbidity, Forward Span), we found negative link between apathy and anhedonia ( t -value = −2.56; p = .014). Thus, we found a close to significance link between anxiety and apathy ( t -value = −1.89; p = .065). Furthermore, apathetic depressed patients had cognitive deficits, notably in verbal working memory ( F = 5.875, p = .04). Conclusions The link between anhedonia and apathy highlights the difference between the consumption and programming of pleasure. The cognitive impairments of apathetic depressed patients may have an impact on their ability to allocate resources appropriately. The relationship between anxiety and apathy has been discussed in light of lack of insight. Taken together, results indicate that the apathy dimension subtends two clinical profiles of depression, which can be viewed as different pathophysiological clusters, as they probably affect two distinct networks. Further studies are needed to test this clinical hypothesis in the light of neurobiology.

International audience; The effects of Parkinson's disease (PD) on the dynamics of impulsive action selection and suppression have recently been studied using distributional analyses, but with mixed results, especially for selection. Furthermore, some authors have suggested that impulsivity, regarded as a personality trait, shares common features with behavioral tasks' measures. The current study was designed to clarify the impact of PD on impulsive action selection and suppression, and investigate the link between cognitive action control and self-reported impulsivity. We administered an oculomotor version of the Simon task to 32 patients with PD and 32 matched healthy controls (HC), and conducted distributional analyses in accordance with the activation-suppression model. Patients and HC also filled out the Barratt Impulsiveness Scale (BIS) questionnaire. Results showed that patients with PD were faster overall and exhibited a greater congruence effect than HC. They also displayed enhanced impulsive action selection. By contrast, the suppression of impulsive responses was similar across both groups. Furthermore, patients had higher impulsivity scores, which were correlated with higher impulsive action selection and higher suppression. Our study yielded two interesting findings. First, PD resulted in a higher number of fast errors. The activation-suppression model suggests that patients with PD are more susceptible to the impulsive action selection induced by the irrelevant stimulus dimension. Second, impulsive action selection and suppression were both associated with trait impulsivity, as measured by the BIS, indicating that these two aspects of impulsivity share common features.

Introduction Patients with advanced Parkinson's disease (PD) and contraindications for subthalamic nucleus deep brain stimulation (DBS) could particularly benefit from subcutaneous infusion therapy with apomorphine. This original study was designed to evaluate the general efficacy of add-on apomorphine in motor and nonmotor symptoms in advanced PD, while characterizing the changes induced in brain glucose metabolism. The aim was to look at the underlying anatomical-functional pathways. Methods 12 patients with advanced PD were assessed before and after 6 months of add-on apomorphine, using resting-state 18 F-fluorodeoxyglucose positron emission tomography and exhaustive clinical assessments. Results After 6 months of therapy, oral treatment was significantly reduced. Both motor and nonmotor scores improved, with a beneficial effect on executive functions, quality of life and apathy. Significant metabolic changes were observed, with overall increases in the right fusiform gyrus and hippocampus, alongside a decrease in the left middle frontal gyrus. Consistent correlations between significant changes in clinical scores and metabolism were established. Conclusion Well tolerated, add-on apomorphine appears to be an interesting option for patients with fluctuations and contra-indications for DBS. Changes in brain metabolism, with beneficial effects on motor and nonmotor symptoms were observed after 6 months. These preliminary results have to be confirmed by further studies.

Background Valve-in-valve (ViV) transcatheter aortic-valve implantation (TAVI) emerged has a less invasive treatment than repeated surgery for patients with degenerated bioprosthesis. However, few data are currently available regarding results of ViV vs. native valve TAVI. Purpose We aimed to compare hemodynamic performances and 1-year outcomes between patients undergoing ViV procedure and patients undergoing non-ViV TAVI. Methods This bicentric study included all patients undergoing aortic ViV procedure for surgical bioprosthetic aortic failure between 2013 and 2017. All patients undergoing TAVI were included in the analysis during the same period. ViV and non-ViV patients were matched with 1:2 ratio according to size, type of TAVI device, age (± 5 years), sex and STS score. Primary endpoint was hemodynamic performance including mean aortic gradient and aortic regurgitation at 1-year follow-up. Results A total of 132 patients were included, 49 in the ViV group and 83 in the non-ViV group. Mean age was 82.8 ± 5.9 years, 55.3% were female. Mean STS score was 5.2 ± 3.1%. Self-expandable valves were implanted in 78.8% of patients. At 1-year follow-up, aortic mean gradient was significantly higher in ViV group (18.1 ± 9.4 mmHg vs. 11.4 ± 5.4 mmHg; P 20 mmHg vs. 6 (7.8%) in the non-ViV group (P = 0.0001). Aortic regurgitations > grade 2 were similar in both groups (P = 0.71). In the ViV group new pacemaker implantation were less frequent (P = 0.01) and coronary occlusions occurred only in ViV group (n = 2 (4.1%)) ( Fig. 1 ). Conclusion ViV is a promising alternative to repeated cardiac surgery in patients with failed bioprosthesis. As 1-year hemodynamic performances seem better in native TAVI procedure, long-term follow-up should be assessed to determinate the impact of residual stenosis on outcomes and durability.

Background Major depressive disorder (MDD) is a highly disabling disease of which is related to chronic course. Currently, there is no robust prognosis biomarker. Cognitive dysfunction associated with the disease has been shown to predict treatment outcome. However, its cerebral substrate is poorly known. Verbal fluency (VF), which are broadly used neuropsychological test, assess the production of words according to a required criterion within a constrained time frame. During this task, subjects produce words within subcategories or “clusters” and occasionally “switch” to other clusters. The measurement of the cluster size and number of switches are relevant cognitive markers. Deep learning-based computational analysis method have been shown to improve the reproducibility and scalability of this measurement. The main objective of the current study was to characterize the cortical thickness (CT) surface-based morphometry (SBM) correlates of the switching and clustering scores in patients with MDD using an artificial intelligence empowered speech analysis system. The secondary objective was to compare those cognitive scores with the ones of the control group. Method The study included 26 depressed women and 25 matched in age and education level healthy females’ controls. All subjects underwent VF tests and had a structural Magnetic Resonance Imaging (MRI). The clustering and switching scores were assessed using the computational analysis method introduced by Linz et al ( https://ki-elements.de ). SBM was performed using SPM and CAT12 toolbox. Results In the depressed group, we observed a positive correlation between the switching score in semantic VF test and the CT, in few cortical areas. The main significant correlation was found in the left lingual gyrus (P = 0.003). The switching scores were lower in the depressed group in each VF task (P = 0.019 and P = 0.007). There was no difference between the two groups concerning the cluster size. Conclusion Our study revealed the relationship existing between the number of switches produced by depressed subjects in a semantic VF task and the CT in prefrontal regions and in more posterior areas. These results possibly suggest that switching and clustering scores assessment in VF tasks, and its cerebral correlates, may constitute potential prognosis biomarkers for depression. Although much work is still required, the establishment of such biomarkers has substantial implications for reducing the burden of the disease.

Aujourd’hui, il y a un besoin croissant d’harmonisation et d’innovation dans les evaluations cognitives et comportementales. Les outils actuels sont parfois trop invasifs, couteux ou demande des temps de realisations trop important dans le cadre d’une simple consultation. De ce faite de nouvelles methodes ecologiquement valides et sensibles pourraient etre utiles pour ameliorer l’accessibilite en tant que depistage de premiere ligne dans la population souffrant de troubles neuropsychiatriques. Les technologies de l’information et de la communication (TIC) sont des solutions non invasives et qui ont montrees une utilite pour identifier les sujets aux premiers stades cliniques des maladies neurodegeneratives [1] , [2] . Les recherches actuelles s’orientent sur l’interet des ICT a un stade pre clinique, comme marqueur d’evolution, au cours des essais therapeutiques et dans les troubles psychiatriques [3] , [4] . Cette session a pour objectif d’illustrer les scenario d’utilisation d’outils numeriques novateurs, qui pourraient etre utilises pour le depistage a grande echelle et pour le suivi des patients dans les essais cliniques. Lea Domain, interne de psychiatrie au centre hospitalier Guillaume-Regnier de Rennes presentera les resultats preliminaires de l’etude DEFLUENCE. Cette etude a pour objectif de determiner si les alterations qualitatives aux tests de fluences verbales mesurees de facon automatisee peuvent constituer un bio marqueur pronostic de l’evolution de la depression. Alexandra Konig, neuropsychologue et chercheuse au laboratoire CoBTeK presentera l’application Δelta sur tablette qui permet aux cliniciens de faire passer et d’analyser automatiquement des tests neuropsychologiques classiques meme a distance a l’aide de l’intelligence artificielle (IA), de l’analyse automatisee de l’expression faciale et de la voix. Un exemple d’une analyse psycholinguistique informatisee d’une entrevue clinique sera egalement presentee. Clement Abi Nader, doctorant dans l’equipe Epione INRIA presentera les travaux portant sur la modelisation de l’evolution de la maladie d’Alzheimer a partir de donnees cliniques longitudinales acquises. Cette approche consiste a developper des algorithmes integrant des donnees heterogenes (imagerie, donnees biologiques, capteurs, donnees cliniques).

Introduction Regarding the extent of TAVI's indication to patients with intermediary risks, it seems essential to lower its complication. Conduction disturbances after TAVI remains a major complication without any standardized guidelines to help with its treatment. Purpose The primary end-point of this study is to confirm that standard criterion for pacing are reliable in post-TAVI conduction disorders and to analyze the contribution of a systematic electrophysiological study. Method In TAVI patients, indications for pacing were persistent high-degree atrioventricular block or bundle branch block appearance associated to HV interval longer than 70 ms, 24 hours after the procedure. After a two-month follow-up, clinical and ECG evaluation and 24-hour ECG Holter monitoring were realized in patients without pacemaker and compared to data obtained from the devices in pacemaker implanted patients (% of ventricular pacing > 1%; presence of more than 1 AVB episode). Results A total of 165 consecutive patients who underwent TAVI were prospectively included. Out of the 165 patients included, 157 were sampled: 20 in the high grade persistent AV block, 5 in the persistent bundle branch heart block with HV interval > 70 ms, 13 with HV interval Conclusion From this experimental protocol it appears that an HV based algorithm has a good specificity but a poor sensibility. Conduction disorders are stable at day 3 and allow to decide if pacing is needed. Besides QRS duration, PR interval might be of interest in predicting risk of AV block after TAVI.

International audience; Schizophrenia is a chronic illness with a progressive course that can be marked by resistance to antipsychotic treatment. This can make therapeutic support challenging for the practitioner, with results that are partial and unsatisfactory. In the literature, treatment with high-dose olanzapine (\textgreater20mg/day) appears to be a good alternative to clozapine, the gold standard for treatment-resistant schizophrenia. In the present observational prospective study, we studied the clinical and biological profiles of patients treated with olanzapine doses up to 100mg/day. In total, 50 patients were clinically and biologically assessed. We found a linear relationship between oral dose and serum concentration (Pearson's r=0.83, p\textless0.001) with effects of tobacco (p\textless0.05) and of coffee and tea consumption (p\textless0.01). Tolerance seemed to be good regardless of dose. No link was found between concentration and efficiency. Despite a nonexhaustive assessment of pharmacokinetic parameters, not least pharmacogenetic data (e.g., genotyping of cytochrome P450-1A2 or glycoprotein P Abcb1a), pharmacokinetic aspects alone cannot account for why the disease may sometimes be resistant to 20mg of olanzapine but respond to higher doses. A nuclear imaging study exploring brain occupancy by high-dose olanzapine, coupled with the abovementioned pharmacokinetic assessment, may prove a relevant experimental paradigm for studying the pathophysiological mechanisms of resistant schizophrenia.

Apathy is widely recognized as a lack of motivation, which expresses through the cognitive, behavioral and emotional dimensions of living. It is described within several neuropsychiatric syndromes such as degenerative disorder and is associated with poorer outcomes. In order to better understand the underpinnings of apathy and to develop specific treatment strategies, much research has been conducted to define its neural bases. In the present review, perfusion, metabolic, pathologic and functional results of apathy neural bases in Alzheimer's and Parkinson's diseases are displayed. Methods and strategies to control for confounding factors such as depression, cognitive impairments and other behavioral disorders are described. Results are not strictly identical between disorders and even within disorders. Variation of methods employed on assessment tools and control for confounding factors such as cognitive disorders, depression, other behavioral disorders and medical treatment is thought to be the main reason for this discrepancy. However, it seems that the inferior prefrontal cortex, especially the orbitofrontal cortex, the lateral prefrontal cortex and the anterior cingulate are of particular interest. The second part of the review discusses the literature in these three areas in conditional learning essentially via the reward characteristic encoding, auto-initiated and perseverance behaviors and emotional experience and its regulation.

While antidepressants are widely prescribed to humans for the treatment of anxiety, the results achieved with animal anxiety models are conflicting. The experimental procedure and the prior test history of the animals are critical parameters that are largely susceptible to influence the results and their interpretation. We compared the effect of 5mg fluoxetine administered to six groups of rats subjected to the psychopharmacological test of the elevated plus-maze, under experimental conditions designed to demonstrate the effect of handling and one daily injection on the response to fluoxetine. The results show that for animals with the same recent experience, fluoxetine, when administered once or over a period of 15 days, induces anxiogenic-like behaviour. On the other hand, our results also show that stressful handling has an anxiolytic-like effect modulating the anxiogenic-like effect of fluoxetine, without eliminating it altogether.

Objectifs Mettre en evidence une eventuelle difference du metabolisme glucidique cerebral obtenu par TEP FDG et des scores cliniques entre les patients parkinsoniens debutant leurs symptomes a droite (MPD) et ceux debutant a gauche (MPG). Materiels et methodes Les patients inclus etaient les patients parkinsoniens droitiers sans antecedents psychiatriques ni alteration cognitive qui consultaient dans le cadre du bilan preoperatoire d’une stimulation cerebrale profonde. Ils etaient classes selon la lateralite initiale de leurs symptomes. Dans la meme semaine, les patients beneficiaient d’une evaluation motrice, neuropsychologique, psychiatrique et d’une TEP FDG. Le metabolisme cerebral glucidique de chaque groupe de patients etait compare a celui d’un groupe de temoins sains (11 patients) par un test t a 2 echantillons pour chaque voxel avec l’âge comme covariable (analyse SPM). Resultats Le groupe des patients MPD etait constitue de 45 patients et le groupe des patients MPG etait constitue de 44 patients. Lors de l’evaluation, les patients presentaient toujours une asymetrie de leurs symptomes. Concernant l’âge, le sex-ratio et la duree de la maladie, aucune difference statistique n’etait observee entre les patients MPD et MPG. Concernant l’evaluation motrice, neuropsychologique et psychiatrique, aucune difference statistique n’etait observee non plus. Concernant l’evaluation metabolique par rapport aux temoins sains, pour les 2 groupes de patients, on observait un hypermetabolisme au sein du lobe frontal controlateral a l’hemisphere ou la degenerescence dopaminergique est le plus atteint. On observait egalement un hypometabolisme occipital des 2 groupes de patients par rapport aux temoins sains. Conclusion Un hypermetabolisme glucidique controlateral a l’hemisphere le plus atteint pourrait etre explique par un phenomene de compensation chez les patients presentant une maladie de Parkinson.

Balloon predilatation of the aortic valve has been regarded as an essential step during the transcatheter aortic valve implantation (TAVI) procedure but recent evidence has suggested that aortic valvuloplasty may induce complications. The purpose of the DIRECTAVI study was to evaluate the efficacy

Introduction Au-dela des symptomes moteurs, des troubles des fonctions executives et limbiques sont aussi maintenant bien decrits dans la maladie de Parkinson, en lien avec une tri-compartimentation fonctionnelle des noyaux gris centraux. Objectif Le but de cette etude est de confirmer l’hypothese d’une organisation fonctionnelle similaire du cervelet dans la maladie de Parkinson selon une tri-compartimentation, motrice, limbique et executive, mettant en evidence son role moteur mais egalement non-moteur selon un mode lesionnel et/ou compensateur. Materiels et methodes Nous avons etudie 90 patients parkinsoniens inclus dans un bilan pre-chirurgical pour une stimulation cerebrale profonde. Tous ont beneficie d’une imagerie metabolique avec une TEP cerebrale au 18 FDG realisee en condition ON-Dopa, ainsi qu’une exploration clinique exhaustive, motrice, neuropsychologique et psychiatrique. Une analyse en composante principale (PCA) a ete appliquee sur les variables cliniques afin de conserver un score composite refletant, respectivement, l’etat moteur, cognitif et limbique. Chacun des trois scores a ensuite ete correle au metabolisme cerebelleux, en utilisant un modele de regression lineaire dans Statistical Parametric Mapping 8 et un masque cerebelleux. L’âge du patient ainsi que la dose totale quotidienne d’equivalent dopaminergique (LEDD) ont ete integres comme co-variables. Resultats Une forte correlation positive entre le score de PCA motrice et la variation du metabolisme cerebelleux a ete mise en evidence dans un volumineux cluster, impliquant a la fois le lobe anterieur et posterieur, de maniere bilaterale, ainsi que le vermis (p

Vascular access complication rate after PTCA is increased in elderly patients (pts). The goal of this study is to determine whether the use of the new trans radial approach (TRA) would decrease the rate of vascular complications. Between February and August 1994, 135 consecutive pts ≥ 70 years old underwent a coronary angioplasty via TRA using a 6F guiding catheter. There were 96 males, 39 females, with a mean age of 74.9 ± 3.8 years (70–87), 61% had unstable angina, 17% had a recent myocardial infarction, 73% had multivessel disease. Conventional balloon angioplasty was performed in 94 pts (70%), Palmaz-Schatz stent implantation in 29 pts (21%) and rotational ablation using the rotablator(l.25 or 1.5 mm burr diameter) in 12 pts (9%). In hospital major cardiac events occurred in 3 pts (2%): one acute closure after balloon angioplasty successfully recanalized, one non a-wave MI after rotablator procedure and one death three days after coronary stent implantation. Vascular access complications (2%) included 2 hematoma and one surgical repair for A V fistula. No bleeding requiring blood transfusion occurred. Conclusion This new TRA for coronary revascularization in elderly can be considered a safe and effective procedure, with a low rate of major cardiac and arterial puncture site complications.

Percutaneous Trans Radial Coronary Angioplasty (PTRCA) was attempted in 515 consecutive patients (pts): 428 males, 87 females, mean age of 62.6 ± 10.7 years (31–87). 57% of pts had unstable angina, mean LVEF was 61.2 ± 10.5% (25%–83%). 68% had multivessel disease. Failure to puncture the radial artery occurred in 8 pts (1.5%) and to catheterize selectively the coronary artery ostium in 7 pts (1.4%). These 15 pts underwent successful transfemoral PTCA and 500 pts effectively underwent PTRCA using a 6F catheter: 362 pts had conventional balloon angioplasty, 119 pts had coronary stenting and 19 had rotational ablation, No acute major complications occurred during the procedure. In hospital major cardiac events included one non Q-wave MI after rotablator procedure, one non Q-wave MI (side branch occlusion) after non elective stenting, and one death three days after non elective coronary stenting, Bleeding orvascular access complications occurred in 8 pts (l.6%): 6 hematoma, and 2 surgical repairs, one of which for AV fistula 22 days after procedure. No bleeding requiring blood transfusion occurred. Conclusion This new PTRCA is a safe and effective way to perform coronary revascularization with high initial success and low complication rate.

Benestent and Stress studies have demonstrated that the significant reduction of restenosis rate after Palmaz-Schatz stent(S) implantation of de novo lesions was associated with a longer hospital stay and a higher bleeding and vascular access complication rate due to the intensive anticoagulation. Therefore we have studied a new coronary stenting procedure using a 6F transradial approach and a new protocol based on antiplatelet drug combination (Aspirin = 250 mg/day ± Ticlopidin 500 mg/day), low molecular weight heparin and no Coumadin. One hundred and nineteen patients (101 males, 18 females, with a mean age of 61.8 ± 11.6 yrs (32–83) received 154 S in 127 vessels. Stenting was elective in 38% and non elective in 62%. No acute thrombosis occurred. Two major cardiac events were observed: one pt with low LVEF (37%1 and 3 vessel disease presented a sudden death 3 days after non elective LAD stent implantation and one pt had a non O-wave MI due to a side branch occlusion after non elective stenting. The 118 pts discharged 2.9 ± 1.5 days (1–8 days) after procedure and 75% of them within the first 3 days. Conclusion Trans radial coronary stenting is a safe and effective procedure. This new stent delivery procedure can certainly reduce vascular access complications and hospital stay.