Temporary Arterial Stenting: Comparison to Permanent Stenting and Conventional Balloon Injury in a Rabbit Carotid Artery Model

The objective was to assess the arterial wall response to temporary stenting with a removable nitinol stent in comparison with permanent stenting and balloon injury at 28 days in the rabbit carotid artery. Restenosis remains an important limiting factor after the implantation of permanent metallic stents and balloon angioplasty. We have developed a temporary nitinol stent that uses a bolus injection of warmed saline to collapse the stent for percutaneous removal. Vascular changes related to the thermal saline bolus injection required to remove a nitinol implanted stent were assessed in 12 rabbit carotid arteries at 7 and 28 days postinjection. Nitinol stents, inflated to 3.0 mm diameter, were implanted for 3 days (n 5 6) and histology and quantitative histomorphometry examined at 28 days. Results were compared with permanently implanted stents (n 5 5) and balloon injury (n 5 9). Dual bolus injection of 10 ml at 70°C created an acute necrotizing injury and chronic neointimal proliferation, whereas injections of 5 ml at 63°C were minimally injurious. Temporary stenting resulted in the least neointimal proliferation measured by the intima to media ratio (0.22 6 0.10 vs. 1.59 6 0.31 for permanent stenting and; 0.49 6 0.14 for balloon injury; P F 0.001). Temporary stenting maintained a significantly larger lumen than balloon (1.53 6 0.72 mm 2 vs. 0.64 6 0.14 mm 2 ; P F 0.001), which could not be explained by absolute changes in intimal cross sectional area (0.14 6 0.07 mm 2 vs. 0.21 6 0.06 mm 2 respectively; P 5 0.33). Temporary stenting resulted in a relatively larger vessel area within the external elastic lamina than with balloon (2.28 6 1.06 mm 2 vs. 1.30 6 0.18 mm 2 ; P 5 0.007). The thermal stent recovery process can create necrotizing vascular injury and neointimal proliferation at higher temperatures and injectate volumes. Stent removal after 3 days using 63°C saline bolus injection results in less neointimal proliferation than with permanent stents or balloon injury. In comparison to balloon injury, temporary stenting also may have a long-lasting beneficial effect on vessel recoil and remodeling, resulting in larger lumen size after stent removal. Cathet. Cardiovasc. Diagn. 41:85-92, 1997. r 1997 Wiley-Liss, Inc

German colonialism in the courtroom—law, reparation, and the grammars of the Shoah

In the quest to address the lingering consequences of colonialism and slavery, activists and human rights practitioners have increasingly utilized legal channels. This article focuses on the Ovaherero and Nama people's pursuit of reparations from Germany in hearings held in New York between 2017 and 2019. It explores the historical conditions for bringing such a case in the United States, arguing that the 1990s economy-focused Holocaust Restitution Movement is a crucial backdrop. The argument examines the implications of applying this 'thefticide' framework to a colonial genocide, suggesting that it provides both an opening and a foreclosure of reparatory possibility in the context of a colonial history where private property relations were first imposed in order to dispossess

Adverse cutaneous reactions to ticlopidine in patients with coronary stents

A prospective study was carried out to assess the occurrence and character of adverse cutaneous reactions in patients receiving ticlopidine hydrochloride to prevent subacute thrombosis after having undergone placement of coronary stents. During a 1-year period such patients were requested to report any adverse cutaneous reactions, and those with skin reactions were referred for dermatological evaluation. Among the 136 patients who underwent stent placement by one of the authors, 20 were referred for dermatological evaluation. Of these, 16 (11.8%) fit the case definition of ticlopidine-associated cutaneous reactions. In the first 8 consecutive patients ticlopidine was withdrawn (in 2 of these a rechallenge test was later performed); in the next 8 patients ticlopidine was not discontinued before completion of the intended 4-week period of treatment. Patients remained under weekly follow-up and underwent a weekly blood count. Skin biopsies were obtained in 5 patients with different types of eruptions. The skin reactions appeared from 2 to 21 days after commencement of ticlopidine (mean, 10 days), lasting from 2 to 30 days (mean, 5 days). Only 3 patients had other adverse effects: neutropenia in 1 and abdominal pain and nausea in 2. The most common presentations were urticaria, pruritus, and maculopapular eruption. In 3 patients there were previously unreported reactions: fixed drug eruption, erythromelalgia-like eruption, and erythema multiforme–like eruption. Of note was the rapid clearing of the skin eruption in most cases even when the drug was not withdrawn. It was concluded that adverse cutaneous reactions are relatively common in association with ticlopidine treatment but that serious reactions are rare and the disappearance of the signs and symptoms is rapid, suggesting that discontinuation of the drug is not usually imperative. (J Am Acad Dermatol 1999;41:473-6.

Cardiomyopathy associated with Ceutzfeld–Jakob disease: a diagnosis of exclusion: a case report

Abstract Background Creutzfeldt–Jakob disease (CJD), the most common prion disease in humans, is primarily known for its adverse neurological impact and inevitable mortality. Data regarding myocardial involvement in CJD are scarce. Case summary A 54-year-old female patient, presented with progressive effort dyspnoea, was diagnosed with unexplained non-ischaemic cardiomyopathy. An extensive cardiac work-up including cardiac magnetic resonance imaging (MRI) did not reveal any underlying aetiology. Simultaneously, the patient developed involuntary limb movements and progressive cognitive decline. Thalamic high-signal abnormalities on diffusion-weighted images were apparent on brain MRI. Based on these findings, she was subsequently referred to a neurology department, where she suddenly died the day after her admission. Brain autopsy demonstrated spongiform encephalopathy. A genetic analysis performed to her son revealed a mutation in the PRNP gene; all of these were consistent with CJD. Discussion This case describes the clinical association of CJD and cardiomyopathy and the diagnosis prion-induced cardiomyopathy by exclusion. It is not inconceivable that the coexistence of these two clinical entities may be related to genetic expression and contemporaneously deposition of infectious prions in myocardial muscle and brain tissue. Awareness of this possible association could be of important public-safety concern, and merits further collaborative cardiac-neurological work-up to elucidate this phenotype among patients with unexplained cardiomyopathy with neurological symptoms that resemble CJD. </jats:sec

Stent implantation of saphenous vein graft aorto-ostial lesions in patients with unstable ischemic syndromes: Immediate angiographic results and long-term clinical outcome

Objectives.This study examined the immediate angiographic and long-term clinical results of stenting saphenous vein graft aorto-ostial stenosis at a single center.Background.Data on the feasibility, safety and short- and long-term clinical results of stent implantation in aorto-ostial lesions in patients with unstable angina are limited.Methods.Palmaz or Palmaz-Schatz stents were deployed in 29 patients (mean [±SD] age 70 ± 10 years) with complex (B2 or C) vein graft aorto-ostial lesion morphology. All patients had angina at rest; 23 (79%) had a previous myocardial infarction; and 13 (45%) had two previous bypass operations (mean graft age 9 ± 5 years). Mean left ventricular ejection fraction was 42 ± 13%.Results.Thirty-two stents were deployed in 25 new and 4 restenotic aorto-ostial lesions. Ten additional stents were implanted in five patients for eight lesions other than at ostial locations. Stent implantation was successful in all patients. There was no death, Q wave myocardial infarction, bypass surgery or stent thrombosis in the first 30 days. Stenting improved minimal lumen diameter from 0.7 ± 0.5 mm (95% confidence interval [CI] 0.5 to 0.8) to 3.3 ± 0.5 mm (CI 3.2 to 3.5) and percent diameter stenosis from 80 ± 13% (CI 75% to 85%) to 1 ± 12% (CI −3% to 6%) (p < 0.001 for both variables). Immediate loss from recoil was 0.2 ± 0.2 mm (CI 0.2 to 0.3), corresponding to a percent recoil of 7 ± 5% (CI 5% to 9%). Clinical follow-up in all patients at a mean of 11 ± 8 months revealed that 27 patients (94%) were free of death or myocardial infarction. Bypass surgery and balloon angioplasty were required in one (3%) and two (6%) patients, respectively. In 21 (88%) of the remaining 24 patients, symptoms were lessened by two or more symptom classes.Conclusions.Palmaz or Palmaz-Schatz stent implantation for saphenous vein graft aorto-ostial stenosis has a high likelihood of immediate success and is associated with a large immediate gain in lumen diameter. Thirty-day and long-term adverse event rates are low. These data suggest that stenting saphenous vein graft aorto-ostial lesions is an acceptable therapeutic option in selected elderly patients with unstable angina and large-diameter vessels