The Effect of Aggressive Wire Recanalization in Calcified Atheroma and Dilatation (ARCADIA) Technique in Eccentric Calcified Lesion of No-stenting Zone

Purpose: The endovascular approach for eccentric calcified lesions of the no-stenting zone is challenging. This study aimed to investigate the effect of a novel technique for these lesions. Methods: We performed EVT for severe and eccentric calcified lesions using the technique, which is presented previously and named aggressive wire recanalization in calcified atheroma and dilatation (ARCADIA). In brief, a guidewire is passed to the residual lumen firstly. Next, another guidewire is advanced into and cross through the calcified plaque and returned to the distal original lumen with intravascular ultrasound (IVUS) guided. The calcified plaque is dilated by using a scoring-balloon or non-compliant balloon. Results: Consecutive 14 peripheral artery disease patients with isolated and eccentric calcification in a no-stenting zone were treated using ARCADIA technique between January 2018 and March 2020. In IVUS data, lumen cross-section area was significantly increased from 5.2 ± 2.0 mm2 to 18.1 ± 6.9 mm2 (p < 0.01), lumen area was expanded roundly evaluating as symmetry index from 0.45 ± 0.09 to 0.81 ± 0.12 (p < 0.01). There were no distal embolization and perforation after ARCADIA technique. One-year target lesion revascularization occurred in only 2 cases. The primary patency of 1 year was 85.7%. Conclusion: ARCADIA technique is safe and appropriate, and can be 1 option to treat for eccentric calcified lesions of the no-stenting zone as an optimal wire crossing method.

A new approach to bypass wire crossing problem in QCA nano technology

Purpose This study aims to replace current multi-layer and coplanar wire crossing methods in QCA technology to avoid fabrication difficulties caused by them. Design/methodology/approach Quantum-dot cellular automata (QCA) is one of the newly emerging nanoelectronics technology tools that is proposed as a good replacement for complementary metal oxide semiconductor (CMOS) technology. This technology has many challenges, among them being component interconnection and signal routing. This paper will propose a new wire crossing method to enhance layout use in a single layer. The presented method depends on the central cell clock phase to enable two signals to cross over without interference. QCADesigner software is used to simulate a full adder circuit designed with the proposed wire crossing method to be used as a benchmark for further analysis of the presented wire crossing approach. QCAPro software is used for power dissipation analysis of the proposed adder. Findings A new cost function is presented in this paper to draw attention to the fabrication difficulties of the technology when designing QCA circuits. This function is applied to the selected benchmark circuit, and the results show good performance of the proposed method compared to others. The improvement is around 59, 33 and 75% compared to the best reported multi-layer wire crossing, coplanar wire crossing and logical crossing, respectively. The power dissipation analysis shows that the proposed method does not cause any extra power consumption in the circuit. Originality/value In this paper, a new approach is developed to bypass the wire crossing problem in the QCA technique.

Wire Crossing Time Correlate with Left Ventricular End-Diastolic Pressure in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Backgrounds: Mortality and morbidity in acute myocardial infarction depend on the extent of the infarct area. Rapid recovery of coronary artery blood flow with primary percutaneous coronary intervention (pPCI) can limit the extent of infarction and improve left ventricular function. Acute myocardial infarction reduce diastolic function, which in the early stage of diastolic dysfunction, there is an increase in left ventricular end-diastolic pressure (LVEDP). The non-invasive marker of E/e’ ratio is an accurate parameter of increased LVEDP.Methods: This was a cross-sectional study enrolled consecutive patients with ST Segment Elevation Myocardial Infarction (STEMI) who underwent pPCI at Dr. Sardjito Hospital. The wire crossing time was calculated from the onset of chest pain until the guidewire crossed the infarct-related artery during the pPCI procedure. The E/e’ ratio was determined by transthoracic echocardiography which performed within 48 hours after the primary PCI. Correlation between the wire crossing time and the E/e’ ratio was assessed by the Pearson correlation test. The value of p <0.05 was considered statistically significant.Results: A total of 40 patients were enrolled in this study. The mean wire crossing time was 12.73±5.22 hours. The median value of the E/e’ ratio was 8.36 (range: 4.71-22.00). There was a moderate strength and significant correlation between the wire crossing time and the E/e’ ratio (r = 0.572; p <0.001). Patients with E/e’ ratio >15 had significantly longer wire crossing time than in patient with E/e’ ratio ≤15 (20.21±2.5 hours vs. 11.41±4.39 hours; p <0.001; respectively). The wire crossing time was independently associated the E/e’ ratio (r = 0.463; p = 0.003).Conclusion: There was a moderate strength and significant positive correlation between the wire crossing time and increased LVEDP, an earlier marker of diastolic dysfunction, measured by E/e’ ratio using TTE in patients with STEMI underwent pPCI.

Fibrinolysis is a reasonable alternative for STEMI care during the COVID-19 pandemic

Objective No data are available to develop uniform recommendations for reperfusion therapies in ST-segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to fill the evidence gap regarding STEMI reperfusion strategy during the COVID-19 era. Methods Clinical characteristics and outcomes for 17 patients with STEMI who received fibrinolysis during the COVID-19 pandemic were compared with 20 patients who received primary percutaneous coronary intervention (PPCI), and were further compared with another 41 patients who received PPCI in the pre-COVID-19 period. Results In patients with STEMI, fibrinolysis achieved a comparable in-hospital and 30-day primary composite end point, as compared with those who received PPCI during the COVID-19 pandemic. No major bleeding was detected in either group. Compared patients with STEMI who received PPCI in the pre-COVID-19 period, we found a remarkable extension of chest pain onset-to-first medical contact (FMC) and FMC-to-wire crossing times, significantly increased number and length of stents, and much worse thrombolysis in myocardial infarction flow in patients with STEMI who received PPCI during the COVID-19 pandemic. Conclusion Owing to its considerable efficacy and safety and advantages in conserving medical resources, we recommend fibrinolysis as a reasonable alternative for STEMI care during the COVID-19 pandemic.

The Effect of Door to Wire Crossing and the Incidence of Acute Kidney Injury in ST Segment Elevation Myocardial Infarction Patients Underwent Primary Percutaneous Coronary Intervention at H. Adam Malik Hospital Medan

Background: ST segment elevation myocardial infarction (STEMI) causes hemodynamic changes and an increase in endogenous vasoconstrictor release leads to renal arteriolar vasoconstriction and decreases renal perfusion and may causes acute kidney injury (AKI). Door to wire crossing is a very important prognostic marker in STEMI patients. Aims: To assess the effect of door to wire crossing and the incidence of AKI in STEMI patients with onset <12 hours undergoing primary percutaneous coronary intervention (PCI) at H. Adam Malik General Hospital Medan. Methods: This study is a cohort study conducted from October 2018 to July 2019 with study subjects of STEMI patients with onset <12 hours who underwent primary PCI that met the inclusion and exclusion criteria. Creatinine levels will be checked before and 48-72 hours after the primary PCI as well as the door to wire crossing will be recorded and compared. Result: The incidence of AKI was found around 14% in the group with a door to wire crossing <140 minutes and by 39% in the group with a door to wire crossing> 140 minutes. It was found that the final urea (p = 0.03), creatinine (p = 0.01), CrCl (p = 0.004) and changes in creatinine (p = 0.008) were statistically significant, while the contrast volume was not. In addition, the door to wire cossing >140 minutes (OR: 4.6; p = 0.032), hypertension (OR: 5.96; p = 0.018) and STEMI onset >6 hours (OR: 7.3; p = 0.019) emerged as independent predictors of AKI. Conclusion: STEMI patients with onset <12 hours who underwent primary PCI with the door to wire cossing >140 minutes have 4.6 times likelihood to develop AKI rather than those with door to wire cossing <140 minutes. The incidence of AKI ranges from 14% -39%. The independent predictors of AKI besides door to wire crossing are hypertension and STEMI's onset.

Interventional recanalisation of long segment aortic atresia

We report the case of a long-segment aortic atresia as the cause for therapy resistant arterial hypertension in a young adult. Recanalization was achieved interventionally by wire-crossing and stent implantation with subsequent normalization of blood pressure.

A Step Towards Optimisation of 2 to 4 Decoder Using Farooq-Nikesh-Zaid Gate with Coplanar Crossing in Quantum Dot Cellular Automata

The limitations of the existing Complementary Metal Oxide Semiconductor are leading the momentum to various new approaches like Quantum-dot Cellular Automata (QCA). QCA offers low power dissipation, less area and high switching speeds. The Majority Voter is the basic structure that votes out on the majority of the inputs to implement a Boolean Function. The QCA architectures are created by using majority gates with inverters or by using universal gates like AND–OR-Inverter and NAND–NOR-Inverter gate. This paper proposes a quantum-dot cellular automata 2 to 4 decoder using Universal Farooq-Nikesh-Zaid gate, which utilizes the NAND gate logic to implement the functionality. The design offers 33% reduction in the cell count, reduction in the area with Six Clock Phases in simple co planar wire crossing. The proposed design is validated using the QCA Designer tool.

P5521Door-to-balloon time and mortality of a PCI centre: how crucial can 30 minutes be for our STEMI patients?

Introduction STEMI time delays have been presented as an indicator of quality of care. Considering the system delay, the guidelines of European Society of Cardiology (ESC) and American Heart Association (AHA) for the management of STEMI patients (pts) diverge regarding the maximum time from STEMI diagnosis to wire crossing in pts presenting at primary PCI (pPCI) hospitals (≤60min versus ≤90min, respectively). Objective To compare the prognosis between pts presenting at pPCI hospital with maximum time from STEMI diagnosis to wire crossing of ≤60min and patients with times between 61 and 90min. Methods The records of 1679 STEMI pts admitted consecutively in our coronary care unit during six years were analysed retrospectively. Of this pts, 341 (20%) were admitted directly in a PCI centre and 1338 (80%) were rescued by an emergency medical system or presented to a non-PCI centre. Pts that presented at PCI centre were divided into two groups: group 1 – STEMI pts with maximum time from STEMI diagnosis to wire crossing of ≤60min (n=202,69%); group 2 – STEMI pts with times 61–90 min (n=91,31%). Pts with time from STEMI diagnosis to wire crossing >90min were excluded. Primary endpoints were the occurrence of death at 6 months and 1 year; follow-up was completed in 98% of pts. Results Group 2 pts were older (60±14 vs 67±143, p<0.001), with higher proportion of women (14.9% vs 25.3%; p=0.026), hypertension (45.5% vs 61.5%, p=0.035), diabetes (17.1 vs 24.4%, p=0.005) and presented more frequently Killip 4 at admission (2.1% vs 12.5%, p=0.003). Group 1 pts had higher proportion of smokers (62.2% vs 49.4%, p=0.03). Patient delay was statistically higher in group 2 (Mdn (h) 3.8±3.5 vs 5±2, p<0.001), as was the system delay (Mdn (min) 45±9 vs 74±8, p<0.001). In-hospital mortality (3.8% vs 5.1%, p=0.42) wasn't different between groups, but at 1-month (3.8% vs 10.3%, p=0.05), 6-months (4.4% vs 12.8%, p=0.02) and 1-year mortality (5% vs 15.4%, p=0.008) was higher in group 2. In multivariate analysis and after adjusting for different baseline characteristics, pts who complied with the recommended times according to the 2017 ESC guidelines had lower risk mortality at 1 year compared to group 2 [HR 0.42, 95% CI (0.23–0.74), p=0.006]. Conclusion In patients presenting at this PCI centre, complying with the 2017 ESC STEMI guidelines in order to reduce the system delay to ≤60min was crucial, since pts who were reperfused within this recommended time had lower mortality rates.