Dual Antiplatelet Therapy Duration Determines Outcome After 2- But Not 1-Stent Strategy in Left Main Bifurcation Percutaneous Coronary Intervention

Objectives

The aim of this study was to investigate clinical outcomes after left main coronary artery (LM) bifurcation percutaneous coronary intervention (PCI) and the impact of the duration of dual antiplatelet therapy (DAPT) according to treatment strategy.

Distal protection of bifurcating vessels: a novel approach.

Distal protection devices protect only a single distal vessel. We describe a novel technique to protect both branches following a thrombus-containing bifurcation lesion. The combination of an occlusive balloon and an arterial filter system provides an attractive solution to the challenging environment of a lesion at high risk for distal embolization supplying more than a single major branch.     

Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomographic Coronary Angiography

ObjectivesThe aim of this study was to define the optimal fluoroscopic viewing angles of both coronary ostia and important coronary bifurcations by using 3-dimensional multislice computed tomographic data.BackgroundOptimal fluoroscopic projections are crucial for coronary imaging and interventions. Historically, coronary fluoroscopic viewing angles were derived empirically from experienced operators.MethodsIn this analysis, 100 consecutive patients who underwent computed tomographic coronary angiography (CTCA) for suspected coronary artery disease were studied. A CTCA-based method is described to define optimal viewing angles of both coronary ostia and important coronary bifurcations to guide percutaneous coronary interventions.ResultsThe average optimal viewing angle for ostial left main stenting was left anterior oblique (LAO) 37°, cranial (CRA) 22° (95% confidence interval [CI]: LAO 33° to 40°, CRA 19° to 25°) and for ostial right coronary stenting was LAO 79°, CRA 41° (95% CI: LAO 74° to 84°, CRA 37° to 45°). Estimated mean optimal viewing angles for bifurcation stenting were as follows: left main: LAO 0°, caudal (CAU) 49° (95% CI: right anterior oblique [RAO] 8° to LAO 8°, CAU 43° to 54°); left anterior descending with first diagonal branch: LAO 11°, CRA 71° (95% CI: RAO 6° to LAO 27°, CRA 66° to 77°); left circumflex bifurcation with first marginal branch: LAO 24°, CAU 33° (95% CI: LAO 15° to 33°, CAU 25° to 41°); and posterior descending artery and posterolateral branch: LAO 44°, CRA 34° (95% CI: LAO 35° to 52°, CRA 27° to 41°).ConclusionsCTCA can suggest optimal fluoroscopic viewing angles of coronary artery ostia and bifurcations. As the frequency of use of diagnostic CTCA increases in the future, it has the potential to provide additional information for planning and guiding percutaneous coronary intervention procedures.     

Percutaneous treatment of a popliteal bifurcation—The value of coronary devices and strategies

In this case report, we describe the use of coronary techniques and devices in the treatment of a complex popliteal artery bifurcation. In particular, we demonstrate that the Venture? wire control catheter is a useful tool not only in coronary lesions but also in wiring angulated peripheral lesions. © 2008 Wiley‐Liss, Inc.     

Optimal control analysis of a tuberculosis model with exogenous re-infection and incomplete treatment

A new mathematical model of tuberculosis (TB) featuring exogenous re-infection and incomplete treatment is presented and analyzed. The model divides total population into susceptible, latently infected, actively infected (uninformed and enlightened), and treatment classes. The model with or without incomplete treatment exhibits backward bifurcation phenomenon, which is caused by the presence of exogenous re-infection. However, further investigation reveals that the absence of incomplete treatment has the potential to reduce the backward bifurcation range significantly. The global dynamics of the TB model without exogenous re-infection is completely determined by the basic reproduction number under certain modifications on parameters. Furthermore, the model is extended to include three time-dependent control functions, such as public awareness campaign, treatment effort, and preventive control against incomplete treatment. The existence of the optimal control for the nonautonomous model is proven and the three controls are characterized using Pontryagin's maximum principle. Numerical simulations are performed to show the significance of singular implementation of each of the controls and combination of the three controls in minimizing the TB burden in the population.