ABSTRACT Background The management of patients with chronic total occlusion (CTO) poses a persistent challenge, necessitating a tailored treatment strategy. Aims This study aimed to investigate the intricate interplay between treatment selection, ischemia burden reduction, and symptom relief in patients with isolated CTO lesions. Methods The Prospective Evaluation of Treatment Strategies in patients presenting with Chronic Total Occlusion (PETS‐CTO) registry is a prospective, non‐randomized study that evaluated patients at enrollment and follow‐up using the Seattle Angina questionnaire (SAQ) and stress ischemia tests. Patients were allocated into three treatment arms: optimal medical therapy (OMT), percutaneous coronary intervention (C TO‐PCI), or coronary artery bypass grafting (CABG). Changes in the angina symptoms and ischemic burden were the primary endpoints, while a clinical composite of death, myocardial infarction, and angina‐related rehospitalization was considered as the secondary outcome. Results Among 157 patients, 45% were in the CTO‐PCI group, 45% in the OMT group, and 10% underwent CABG. CTO‐PCI group demonstrated favorable changes in summary SAQ score (12.3%, 95% CI: 3.4%−21.5%, p = 0.008) compared to OMT. CTO‐PCI patients more frequently shifted from an ischemic to a nonischemic stress test at follow‐up compared to OMT (60% vs. 5.6%, p < 0.001). No correlation was observed between angina scores and proven ischemia at baseline and follow‐up assessments. Conclusions Effective management of CTO requires comprehensive evaluation, and although angina relief and ischemic burden are individually influential, our findings reveal a lack of correlation between these factors, emphasizing the complexity in guiding treatment decisions (PETS‐CTO; NCT04145167).
ABSTRACT Background Percutaneous left atrial appendage closure (LAAC) is usually performed after a pre‐procedural evaluation by transesophageal echocardiography (TOE) or cardiac computed tomography angiography (CCTA). Nevertheless, these ad‐hoc examinations imply an additional use of hospital resources and time spending. Aims To investigate long‐term clinical outcomes, effectiveness and safety of performing LAAC procedures without pre‐procedural imaging assessment in patients with high and very high thromboembolic risk based on CHA 2 DS 2 ‐VASc score. Methods From January 2016 to January 2023, 227 consecutive patients undergoing LAAC following an optimized pathway that removed the use of pre‐procedural TOE or CCTA imaging assessment, were enrolled in this single‐center, retrospective study. Patients were divided into two groups based on thromboembolic risk: 94 had CHA 2 DS 2 ‐VASc scores ≥ 5 and 133 had CHA 2 DS 2 ‐VASc scores < 5). The primary endpoint was a composite of all‐cause death, stroke, systemic embolization, or bleeding events at 2 years. Co‐primary endpoints were device success, device‐related thrombosis (DRT) and peri‐device leaks (PDL) ≥ 3 mm at TOE follow‐up. Results At 2 years, no significant differences were observed between groups in the primary composite endpoint (KM est. 24.81% vs. 20.21%, p log‐rank = 0.7; aHR 0.85, CI: 0.48−1.50, p = 0.58). Device success was 98.7% overall, with no significant differences between groups (aOR 0.32% CI: 0.03−3.80; p = 0.37). DRT and PDL ≥ 3 mm rates were low (4.3% vs. 1.5%, p = 0.26% and 3.2% vs. 2.3%, p = 0.75, respectively). In‐hospital complications were low and comparable in both groups. Conclusions In a consecutive series of patients undergoing LAAC, a simplified approach without pre‐operative imaging assessment showed comparable results at 2‐year for the primary composite endpoint of all‐cause death, stroke, systemic embolization, or bleeding events in patients with CHA 2 DS 2 ‐VASc score ≥ 5 and those with CHA 2 DS 2 ‐VASc score < 5.
ABSTRACT Background Left atrial appendage closure (LAAC) is a well‐established alternative for stroke prevention in patients with atrial fibrillation (AF) who are not suitable for long‐term anticoagulation. The WATCHMAN FLX Pro 40 mm device is a novel advancement featuring a fluoropolymer coating to enhance thromboresistance and a size expansion to accommodate larger left atrial appendages (LAA). However, clinical data on this new device remains limited. Objective This study presents the first case series evaluating the procedural success, safety, and early outcomes of the 40 mm WATCHMAN FLX Pro device. Methods A total of nine patients underwent LAAC with the 40 mm WATCHMAN FLX Pro between July and November 2024. Pre‐procedural imaging, intraoperative guidance, procedural outcomes, and follow‐up imaging were analyzed. Procedural success was defined by the successful deployment of the device meeting “PASS” criteria, with no major complications. Results The study demonstrated a 100% procedural success rate, with all patients undergoing same‐day discharge. No procedural or periprocedural complications were observed. Follow‐up imaging at 4 months (available for 88.9% of patients) revealed no high‐grade device‐related thrombus (DRT), though some cases exhibited peridevice leaks, predominantly minor subfabric leaks. Conclusion The 40 mm WATCHMAN FLX Pro expands LAAC treatment options for patients with larger LAA anatomy, demonstrating a favorable safety and efficacy profile in this early experience. Larger studies with long‐term follow‐up are needed to validate these findings.
ABSTRACT This case series examines mechanical thrombectomy (MT) with thromboaspiration in two infants under 1 year, a rarely performed procedure due to ethical challenges and limited data. Both cases involved thromboembolic complications during intra‐arterial chemotherapy for retinoblastoma. An 11‐month‐old with left posterior inferior cerebellar artery occlusion and a 5‐month‐old with basilar artery occlusion underwent MT, achieving full recanalization (eTICI = 3) without infarction or hemorrhage. Postoperative imaging confirmed no complications, and both patients had normal neurological outcomes (pedNIHSS = 0). These cases highlight the feasibility and safety of MT in infants, demonstrating its potential to achieve excellent outcomes in high‐risk situations. Further research is needed to establish standardized guidelines and expand MT's use in pediatric stroke management.
ABSTRACT A 12‐month‐old dog was diagnosed with cutaneous pythiosis after presenting with a nonhealing metatarsal wound, an inguinal mass, and regional lymphadenopathy. Both cytology of the abnormal lymph nodes and histopathology of the inguinal mass showed granulomatous inflammation. ELISA serology was positive for Pythium insidiosum. The dog developed hypercalcemia secondary to excessive vitamin D production. This conclusion was based on the combination of hyperphosphatemia, suppressed parathyroid hormone, suppressed 25‐hydroxyvitamin D level, and a calcitriol level at the high end of the reference interval. This case report describes the protracted diagnosis of vitamin D‐mediated hypercalcemia in conjunction with cutaneous pythiosis infection. As this was not a known risk in pythiosis cases, delayed diagnosis and treatment of hypercalcemia, along with delayed diagnosis of the pythiosis infection and use of compounded itraconazole, contributed to a poor outcome.
Key Clinical Message Temporary Anchorage Devices‐supported molar intrusion can be an effective non‐surgical alternative for treating Class II anterior open bite in skeletally mature patients, resulting in an improved occlusal relationship and enhanced chin projection through forward autorotation of the mandible. Abstract Temporary Anchorage Devices are titanium alloy miniscrews utilized to provide maximum orthodontic anchorage during the correction of various malocclusions. This case report examined the use of TADs to support posterior intrusion while correcting a patient's Class II anterior open bite malocclusion in support of the patient's request to avoid surgical intervention.
Abstract The arylation of 1,4‐disubstituted triazoles with [CuI(PPh 3 ) 3 ] is reported. The reactions were carried out in relatively concentrated solutions of hot DMF in the presence of air and moisture. These conditions were suitable for a range of substrates, specifically triazoles containing a pyridyl group, which are of interest in diverse applications such as ancillary ligands or bioactive compounds.
Abstract We report on the design of a new well‐defined Pd‐NHC pre‐catalyst [Pd(IMes Me )(cinnamyl)Cl] as effective catalyst in the Miyaura borylation of a series of aryl chlorides. This complex was designed and developed after a screening of different architectures of NHCs, featuring various steric and electronic properties. The synthesis was achieved by the operationally simple method of the weak‐base route, while a complete set of analytical techniques including 1 H NMR, 13 C NMR, and HRMS were employed for the characterization. Moreover, the structure and atom connectivity were unequivocally confirmed by X‐ray diffraction (XRD).
Abstract AgCu bimetallic materials have attracted significant interest as catalysts for selective oxidation reactions. Near‐surface alloys of Ag on Cu have been shown to activate O 2 efficiently at exposed reverse‐segregated isolated Cu atoms within the surface Ag layers. This study focuses on the synthesis of nanoparticle analogs of these alloys and measurement of their performance for ethylene and propylene epoxidation. Supported Cu/SiO 2 catalysts were prepared by strong electrostatic adsorption and partial galvanic replacement of Cu atoms with Ag cations in aqueous media, which led to bimetallic nanoparticles of 3–10 nm average size and 0.25–1.6 Ag:Cu atomic ratios. Galvanic exchange stoichiometry, elemental maps and UV–vis spectroscopy reveal coexistence of Ag and Cu in the nanoparticles. Diffuse reflectance infrared spectra of bound CO indicate the formation of nanoparticles with a Cu core and Ag shell when catalysts with high Ag:Cu ratios are reduced to metallic form. The bimetallic catalysts show improvement over monometallic Ag and Cu and their physical mixtures, exhibiting higher rates, higher initial selectivity than Ag, and resistance to secondary reactions that decrease the selectivity of Cu catalysts at higher alkene conversion. These results demonstrate a simple synthesis method of more selective bimetallic AgCu nanoparticles with core‐shell like structures, which may be of use in a variety of selective oxidation reactions.