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If the same-day discharge after simple coronary angioplasty (PTCA) is a safe procedure, we don't know if such an alternative could be attempt in patients (pts) with complex PTCA. To evaluate safety of same-day discharge after coronary angioplaty of complex lesions. Over a 11 months period, all pts referred to our center for a staged PTCA or coronary angiogram and ad-hoc angioplasty of complex coronary artery lesions were prospectively included. Exclusion criteria were pts with acute coronary syndromes, or complicated PTCA. 131 pts (among 328 ambulatory pts with PTCA, 40%), were included, (median age 70, IQR 61-76), (107 men, 81%) (84 pts with ad-hoc PTCA, 64.1%). Median home location to the hospital was 30 kms, (IQR1-3: 10-59) with a median delay of 30 mns, (IQR1-3: 15-50). Procedure was performed through a trans-radial approach in 128 pts (97.7%). PTCA was attempted in 1.54 vessels per pt, 1.79 lesions per pt, with 1.7 stent per pt. 19 pts (14.5%) underwent left main PTCA, 18 (13.7%) total coronary occlusion, 19 (14.5%) bifurcation lesions, and 7 (5.3%) saphenous by pass grafts. Rotablator and shockwave techniques were used in 10 pts, (7.6%). Early ambulation was performed at 1 hour, and discharge at a median time of 5 hours. A call phone was systematically done between 24 and 72 hours after discharge: 20 pts did not answer, (15.3%), and there were no major complication in the 111 remaining pts, (no death, infarction, revascularization or stroke). Same-day discharge after PTCA in pts with complex coronary artery lesions appears to be a very safe procedure and alternative strategy. [ABSTRACT FROM AUTHOR]

The optimization of pharmacological therapies and coronary stents leads to simplification of the coronary angioplaty procedures with very low complications rate. To evaluate feasibility and safety of routine ambulatory coronary angioplasty (PTCA) in all coming patients (pts) Since June 2020, all pts undergoing staged PTCA or coronary angiogram with ad-hoc PTCA were included. Exclusion criteria were: pts with acute coronary syndroms, or complicated PTCA procedures. 328 pts were included, (33% of all PTCA procedures), median age 69, (IQR 61-76), (259 men, 79%). Ad-hoc PTCA was performed in 224 pts, (68.3%), with a radial approach in 322 pts, (98.2%). Median distance between home and hospital was 34 kms, (IQR 10-59), with a median delay of 30 mns, (IQR 20-50). 28 pts were alone at home, (8.5%). 184 pts had 1 vessel disease (VD), (56.1%), 94 (28.7%) 2 VD, 47 (14.3%) 3 VD, and 25 (7.6%) had a left main stenosis. 26 pts, (8%), had no previous anti-agregant therapy, and 133 (40.5%) had only 1 anti-agregant. PTCA concerned 1 vessel in 260 pts (79.3%), 2 vessels in 61 (18.6%) and 3 or more in 7 pts (2.1%) and left main in 19 pts, (5.8%). Mean number of vessels per pt was 1.23, lesions 1.42 per pt, and stents 1.36 per pt. Early ambulation was achieved at 1 hour, and discharge at 5 hours, (IQR 4-6). All patients were contacted between 24 and 72 hours, with no response in 61 (18.6%), and with no major complications in all others pts, (death, myocardial revascularization, myocardial infarction or stroke). Same day discharge after PTCA in all coming pts is a quite feasible and safe procedure. [ABSTRACT FROM AUTHOR]

Malignant hypertension (MHT) still exists, leading young people to a poor prognosis. Yet, we lack clear guidelines, mainly because data are scarce. We initiated the first MHT multicentric network to assess these issues. We built a 28 centers network so far, aiming for 40–50 French centers end 2020, and European participation in 2021. We prospectively recruit patients with severe hypertension (> 180/110) and severe hypertensive retinopathy (common definition) or 3-target organ damage among heart, kidney, brain and thrombotic microangiopathy (MOD HTN definition). We hope to recruit 500 patients in 5 years, with a 5 years follow up. We currently collect clinical and examination data, aiming for building a biobank and a target organ damage corelab to entirely reconsider the disease. During the first 6 months, we recruited as planned 58 patients, 41% were male, 49.1 ± 15 years old. Half of them were not known hypertensive, and one third presented a secondary hypertension. Non-observance was reported in 25% of patients as a trigger. Mean blood pressure was 219 ± 29//119 ± 20 mmHg. Patient care pathway was very different according to initial symptoms, target organ damage and centers: hypertension, neurology, nephrology, cardiology, internal medicine, intensive care unit and emergency department. Target organ damage was respectively 70%, 33%, 25% and 25% for kidney, heart, brain and thrombotic microangiopathy, mostly improving during follow up. Most of patients (70%) benefited from intravenous antihypertensive treatment and saline infusion. Length of stay was on average 8 days. Malignant Hypertension clearly didn't disappear, but was diluted between the different specialities and forgotten. This most severe presentation has to be considered once again to better manage our patients. The unique HAMA network should make it possible to gather high-quality data to improve our knowledge and rediscover the disease. [ABSTRACT FROM AUTHOR]

Malignant hypertension, the most severe form of hypertension, is characterized by acute and diffuse microvascular damage. The ophthalmological, renal and cardiological consequences are well described. Brain damage is considered rare and poorly known, although it is one of the main causes of death. We performed a systematic cerebral MRI on patients of the Bordeaux cohort with malignant hypertension between 2008 and 2018, regardless of their neurological symptoms. A subgroup of patients benefited from a second cerebral MRI. All MRI were analysed by the same trained operator. 92 patients were included, 67.5% male, mean age 47.8 ± 12 years. On admission, 41.5% of the patients were totally asymptomatic from a neurological aspect. Cerebral MRI was normal in 18.5% of patients. A posterior reversible encephalopathy syndrom was found in 16.5% of patients, 33.5% had an ischemic or hemorrhagic stroke. Patients had marked microvascular impairment (SVD score 2 or higher) in 59% of cases. In asymptomatic patients or patients with headaches only, MRI found PRES in 15.5% of cases, recent ischemic or hemorrhagic stroke in 29% of cases, and SVD score 2 or higher in 51.5% of cases. Most patients with malignant hypertension have brain injuries, regardless of their symptoms. This warrants systematic cerebral MRI, as the results may impact on their management. The consequences of these severe lesions, which are disproportionately severe for young patients, raise questions about the need for cognitive assessment and management. [ABSTRACT FROM AUTHOR]