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Laurent Juillard - One of the best experts on this subject based on the ideXlab platform.
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Blood pressure decreases after Revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting.
PLOS ONE, 2019Co-Authors: Florence Sens, Gabrielle Normand, Thomas Fournier, Nellie Della-schiava, Stéphane Luong, Caroline C. Pelletier, Philip Robinson, Sandrine Lemoine, Olivier Rouvière, Laurent JuillardAbstract:Background In atherosclerotic renal artery disease, the benefit of Revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital. Objectives To investigate whether this decisional process ensured a clinical benefit to patients assigned to renal Revascularization. Methods Single-centre retrospective cohort study, including patients diagnosed from April 2013 to February 2015 with an atherosclerotic renal artery disease with a peak systolic velocity >180cm/s. For each patient, the decision taken in multidisciplinary meeting (medical treatment or revacularization) was compared to the one guided by international guidelines. Blood pressure values, number of antihypertensive medications, presence of an uncontrolled or resistant hypertension, and glomerular filtration rate at one-year follow-up were compared to baseline values. Safety data were collected. Results Forty-nine patients were included: 26 (53%) were assigned to a medical treatment and 23 (47%) to a renal Revascularization. Therapeutic decision was in accordance with the 2013 American Health Association guidelines and with the 2017 European Society of Cardiology guidelines for 78% and 22% of patients who underwent Revascularization, respectively. Patients assigned to Revascularization presented a significant decrease in systolic blood pressure (-23±34mmHg, p = 0.007), diastolic blood pressure (-12±18mmHg, p = 0.007), number of antihypertensive medications (-1.00±1.03, p = 0.001), and number of uncontrolled or resistant hypertension (p = 0.022 and 0.031) at one-year follow-up. Those parameters were not modified among patients assigned to medical treatment alone. There was no grade 3 adverse event. Conclusion Based on a multidisciplinary selection of Revascularization indications, patients on whom a renal Revascularization was performed exhibited a significant improvement of blood pressure control parameters with no severe adverse events.
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Blood pressure decreases after Revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting
PLoS ONE, 2019Co-Authors: Florence Sens, Gabrielle Normand, Thomas Fournier, Nellie Della-schiava, Stéphane Luong, Philip Robinson, Sandrine Lemoine, Olivier Rouvière, C. Pelletier, Laurent JuillardAbstract:BACKGROUND: In atherosclerotic renal artery disease, the benefit of Revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital. OBJECTIVES: To investigate whether this decisional process ensured a clinical benefit to patients assigned to renal Revascularization. METHODS: Single-centre retrospective cohort study, including patients diagnosed from April 2013 to February 2015 with an atherosclerotic renal artery disease with a peak systolic velocity \textgreater180cm/s. For each patient, the decision taken in multidisciplinary meeting (medical treatment or revacularization) was compared to the one guided by international guidelines. Blood pressure values, number of antihypertensive medications, presence of an uncontrolled or resistant hypertension, and glomerular filtration rate at one-year follow-up were compared to baseline values. Safety data were collected. RESULTS: Forty-nine patients were included: 26 (53%) were assigned to a medical treatment and 23 (47%) to a renal Revascularization. Therapeutic decision was in accordance with the 2013 American Health Association guidelines and with the 2017 European Society of Cardiology guidelines for 78% and 22% of patients who underwent Revascularization, respectively. Patients assigned to Revascularization presented a significant decrease in systolic blood pressure (-23+/-34mmHg, p = 0.007), diastolic blood pressure (-12+/-18mmHg, p = 0.007), number of antihypertensive medications (-1.00+/-1.03, p = 0.001), and number of uncontrolled or resistant hypertension (p = 0.022 and 0.031) at one-year follow-up. Those parameters were not modified among patients assigned to medical treatment alone. There was no grade 3 adverse event. CONCLUSION: Based on a multidisciplinary selection of Revascularization indications, patients on whom a renal Revascularization was performed exhibited a significant improvement of blood pressure control parameters with no severe adverse events.
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[Management of atherosclerotic renal-artery stenosis in 2016]
Néphrologie et Thérapeutique, 2017Co-Authors: T. Fournier, Olivier Rouvière, F. Sens, A. Millon, Laurent JuillardAbstract:Endovascular Revascularization as treatment of atherosclerotic renal-artery stenosis (aRAS) is controversial since 3 large and multicentric randomised trials (CORAL, ASTRAL, STAR) failed to prove the superiority of percutaneous transluminal renal-artery stenting (PTRAS) over medical treatment only (MT). However, considering the multiple bias of these trials, among which questionable inclusion criterias, these results must be extrapolated in clinical practice with caution. New pathophysiological data have been helping to understand why restoring blood flow does not necessarily lead to kidney function improvement. Today, the diagnostic approach must in one hand confirm the artery stenosis and on the other hand assess its severity and impact on the kidney. Therapeutic options still lie on the American guidelines published in 2006, since no study data can be reasonably used in everyday practice. However, particular sub-groups of patients who could benefit from revascularisation have been identified through recent cohort studies. Further prospective studies are needed in order to confirm the superiority of PTRAS in these populations. Meanwhile, multidisciplinary approach should be promoted, in order to provide the best treatment for each patient.
L. Nolan - One of the best experts on this subject based on the ideXlab platform.
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Short-term response of epiphyseal plate cell populations following selective devascularization and microsurgical Revascularization.
Microsurgery, 1994Co-Authors: C V A Bowen, J. D. Fowler, Peter W Bray, Martin I Boyer, L. NolanAbstract:The distal femoral epiphyseal plates of 21 8-week-old New Zealand white rabbits were totally or partially (nutrient artery only) devascularized, or devascularized and then microsurgically revascularized. Sacrifice was at 24, 48 or 72 hours postoperatively. The heights of the proliferative and hypertrophic zones of the epiphyseal plates operated upon were compared with the contralateral control epiphyseal plates for both the central and the peripheral regions of the epiphyseal plate. Neither extent of devascularization nor Revascularization had a significant effect on the height of the proliferative zone of chondrocytes at any of the follow-up intervals. Selective devascularization of the nutrient artery led to a significant increase in height of the central region of the hypertrophic zone of chondrocytes at 48 and 72 hours. Microsurgical Revascularization did not lead to a significant change in the height of either the central or the peripheral regions of the hypertrophic zone of chondrocytes at any of the follow-up intervals. This study is another ‘building block’ experiment toward vascularized epiphyseal plate transplantation in humans. © 1994 Wiley-Liss, Inc.
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Short-term response of epiphyseal plate cell populations following selective devascularization and microsurgical Revascularization.
Microsurgery, 1994Co-Authors: C V A Bowen, J. D. Fowler, Peter W Bray, Martin I Boyer, L. NolanAbstract:The distal femoral epiphyseal plates of 21 8-week-old New Zealand white rabbits were totally or partially (nutrient artery only) devascularized, or devascularized and then microsurgically revascularized. Sacrifice was at 24, 48 or 72 hours postoperatively. The heights of the proliferative and hypertrophic zones of the epiphyseal plates operated upon were compared with the contralateral control epiphyseal plates for both the central and the peripheral regions of the epiphyseal plate. Neither extent of devascularization nor Revascularization had a significant effect on the height of the proliferative zone of chondrocytes at any of the follow-up intervals. Selective devascularization of the nutrient artery led to a significant increase in height of the central region of the hypertrophic zone of chondrocytes at 48 and 72 hours. Microsurgical Revascularization did not lead to a significant change in the height of either the central or the peripheral regions of the hypertrophic zone of chondrocytes at any of the follow-up intervals. This study is another 'building block' experiment toward vascularized epiphyseal plate transplantation in humans.
C V A Bowen - One of the best experts on this subject based on the ideXlab platform.
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Short-term response of epiphyseal plate cell populations following selective devascularization and microsurgical Revascularization.
Microsurgery, 1994Co-Authors: C V A Bowen, J. D. Fowler, Peter W Bray, Martin I Boyer, L. NolanAbstract:The distal femoral epiphyseal plates of 21 8-week-old New Zealand white rabbits were totally or partially (nutrient artery only) devascularized, or devascularized and then microsurgically revascularized. Sacrifice was at 24, 48 or 72 hours postoperatively. The heights of the proliferative and hypertrophic zones of the epiphyseal plates operated upon were compared with the contralateral control epiphyseal plates for both the central and the peripheral regions of the epiphyseal plate. Neither extent of devascularization nor Revascularization had a significant effect on the height of the proliferative zone of chondrocytes at any of the follow-up intervals. Selective devascularization of the nutrient artery led to a significant increase in height of the central region of the hypertrophic zone of chondrocytes at 48 and 72 hours. Microsurgical Revascularization did not lead to a significant change in the height of either the central or the peripheral regions of the hypertrophic zone of chondrocytes at any of the follow-up intervals. This study is another ‘building block’ experiment toward vascularized epiphyseal plate transplantation in humans. © 1994 Wiley-Liss, Inc.
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Short-term response of epiphyseal plate cell populations following selective devascularization and microsurgical Revascularization.
Microsurgery, 1994Co-Authors: C V A Bowen, J. D. Fowler, Peter W Bray, Martin I Boyer, L. NolanAbstract:The distal femoral epiphyseal plates of 21 8-week-old New Zealand white rabbits were totally or partially (nutrient artery only) devascularized, or devascularized and then microsurgically revascularized. Sacrifice was at 24, 48 or 72 hours postoperatively. The heights of the proliferative and hypertrophic zones of the epiphyseal plates operated upon were compared with the contralateral control epiphyseal plates for both the central and the peripheral regions of the epiphyseal plate. Neither extent of devascularization nor Revascularization had a significant effect on the height of the proliferative zone of chondrocytes at any of the follow-up intervals. Selective devascularization of the nutrient artery led to a significant increase in height of the central region of the hypertrophic zone of chondrocytes at 48 and 72 hours. Microsurgical Revascularization did not lead to a significant change in the height of either the central or the peripheral regions of the hypertrophic zone of chondrocytes at any of the follow-up intervals. This study is another 'building block' experiment toward vascularized epiphyseal plate transplantation in humans.
Patrick W Serruys - One of the best experts on this subject based on the ideXlab platform.
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design and rationale for a randomised comparison of everolimus eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease the excel trial
Eurointervention, 2016Co-Authors: Arie Pieter Kappetein, Patrick W Serruys, Joseph F Sabik, Martin B Leon, David P Taggart, Marie Claude Morice, Bernard J Gersh, Stuart J Pocock, David J Cohen, Lars WallentinAbstract:Aims Coronary artery bypass graft (CABG) surgery is the standard of care for revascularisation of patients with left main coronary artery disease (LMCAD). Recent studies have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may provide comparable outcomes in selected patients with LMCAD without extensive CAD. We therefore designed a trial to investigate whether PCI with XIENCE cobalt-chromium everolimus-eluting stents (CoCr-EES) would result in non-inferior or superior clinical outcomes to CABG in selected patients with LMCAD. Methods and results The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial is a prospective, open-label, multicentre, international study of 1,900 randomised subjects. Patients with significant LMCAD with a SYNTAX score ≤32 and local Heart Team consensus that the subject is appropriate for revascularisation by both PCI and CABG are consented and randomised 1:1 to undergo PCI using CoCr-EES or CABG. All patients undergo follow-up for five years. The primary endpoint is the three-year composite rate of death, stroke or myocardial infarction, assessed at a median follow-up of at least three years (with at least two-year follow-up in all patients), powered for sequential non-inferiority and superiority testing. Conclusions The EXCEL study will define the contemporary roles of CABG and PCI using XIENCE CoCr-EES in patients with LMCAD disease with low and intermediate SYNTAX scores.
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the excel and noble trials similarities contrasts and future perspectives for left main revascularisation
Eurointervention, 2015Co-Authors: Carlos M Campos, Gregg W Stone, Evald Hoj Christiansen, Patrick W SerruysAbstract:Unprotected left main coronary artery (ULMCA) stenosis has relatively high prevalence and exposes patients to a high risk for adverse cardiovascular events. The optimal revascularisation strategy (coronary artery bypass surgery [CABG] or percutaneous coronary intervention [PCI]) for patients with complex coronary artery disease is a topic of continuing debate. The introduction of the newer-generation drug-eluting stents (DES) – with documented improvements in both safety and efficacy – has prompted the interventional community to design two new dedicated randomised trials comparing CABG and PCI: the NOBLE (Coronary Artery Bypass Grafting Vs Drug Eluting Stent Percutaneous Coronary Angioplasty in the Treatment of Unprotected Left Main Stenosis) and EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials. The aims of the present review are to describe the similarities and contrasts between these two trials as well to explore their future implications in ULMCA treatment.
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comparison of cost effectiveness of oral rapamycin plus bare metal stents versus first generation of drug eluting stents from the randomized oral rapamycin in argentina orar 3 trial
American Journal of Cardiology, 2014Co-Authors: Alfredo E Rodriguez, Igor F Palacios, Alfredo M Rodriguezgranillo, Juan Mieres, Sonia Tarragona, Carlos Fernandezpereira, Leonardo Solorzano, Ricardo Pauletto, Patrick W Serruys, David AntoniucciAbstract:The aim of this study was to compare 5-year cost-effectiveness and clinical outcomes of patients with oral rapamycin (OR) plus bare-metal stent versus the drug-eluting stent (DES) strategy. During 2006 to 2007, a total of 200 patients were randomized to OR (n = 100) and DES (n = 100). Primary end point was to compare costs of initial procedure and cost-effectiveness of both Revascularization strategies. Safety was evaluated by the composite of death, myocardial infarction, and cerebrovascular accident. Efficacy was assessed by target vessel and target lesion Revascularizations. The 2 groups had similar baseline demographic, clinical, and angiographic characteristics. In the DES group, paclitaxel-, zotarolimus-, and sirolimus-eluting stents were used. Five-year clinical follow-up was accomplished in 99% patients. The DES group had significantly higher procedural (p
Pilar Galan - One of the best experts on this subject based on the ideXlab platform.
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cardiovascular effects of b vitamins and or n 3 fatty acids the su fol om3 trial
International Journal of Cardiology, 2013Co-Authors: Jacques Blacher, Sébastien Czernichow, Francois Paillard, Pierre Ducimetière, Serge Hercberg, Pilar GalanAbstract:Abstract Background Mechanisms involved in coronary stenosis evolution are different than those involved in clinical events. Because of differential vascular effects, N-3 polyunsatured fatty acids (PUFA) and B vitamins could have differential effects on different types of cardiovascular clinical events in high-risk patients. Methods We analyzed the effects of n-3 PUFA and of B vitamins on both coronary Revascularization and on hard coronary events risks in a subgroup of the SU.FOL.OM3 trial, a randomized, double-blind, placebo-controlled secondary prevention trial. Data were analyzed according to the intention-to-treat principle, with the use of Cox proportional-hazards models. Results After a mean follow-up of 4.2±1.0years among the 1,863 participants with coronary heart disease, 163 coronary Revascularizations were performed, and 95 patients experienced a hard coronary event. Neither treatment with n-3 PUFA, nor treatment with B vitamins was associated with any significant effect on the occurrence of hard coronary events. Allocation to n-3 PUFA was not associated with any significant effect on coronary Revascularization. However, treatment with B vitamins was associated with a statistically significant 52% increase in the risk of coronary Revascularization (multivariate HR: 1.52; 95% CI: [1.11–2.10]; p=0.01). Conclusions Neither n-3 PUFA, nor B vitamins reduced the rates of hard coronary events and of coronary Revascularization. Furthermore, B vitamins significantly increased the rate of coronary Revascularization. Consistent with the findings of previous trials, our results do not support the routine use of dietary supplements containing n-3 PUFA and argue against using dietary supplements containing B-vitamins in coronary patients in secondary cardiovascular prevention.
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Cardiovascular effects of B-vitamins and/or N-3 fatty acids: The Su.Fol.Om3 trial
International Journal of Cardiology, 2013Co-Authors: Jacques Blacher, Sébastien Czernichow, Francois Paillard, Pierre Ducimetière, Serge Hercberg, Pilar GalanAbstract:Background: Mechanisms involved in coronary stenosis evolution are different than those involved in clinical events. Because of differential vascular effects, N-3 polyunsatured fatty acids (PUFA) and B vitamins could have differential effects on different types of cardiovascular clinical events in high-risk patients. Methods: We analyzed the effects of n-3 PUFA and of B vitamins on both coronary Revascularization and on hard coronary events risks in a subgroup of the SU.FOL.OM3 trial, a randomized, double-blind, placebo-controlled secondary prevention trial. Data were analyzed according to the intention-to-treat principle, with the use of Cox proportional-hazards models. Results: After a mean follow-up of 4.2 +/- 1.0 years among the 1,863 participants with coronary heart disease, 163 coronary Revascularizations were performed, and 95 patients experienced a hard coronary event. Neither treatment with n-3 PUFA, nor treatment with B vitamins was associated with any significant effect on the occurrence of hard coronary events. Allocation to n-3 PUFA was not associated with any significant effect on coronary Revascularization. However, treatment with B vitamins was associated with a statistically significant 52% increase in the risk of coronary Revascularization (multivariate HR: 1.52; 95% CI: [1.11-2.10]; p=0.01). Conclusions: Neither n-3 PUFA, nor B vitamins reduced the rates of hard coronary events and of coronary Revascularization. Furthermore, B vitamins significantly increased the rate of coronary Revascularization. Consistent with the findings of previous trials, our results do not support the routine use of dietary supplements containing n-3 PUFA and argue against using dietary supplements containing B-vitamins in coronary patients in secondary cardiovascular prevention. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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Cardiovascular effects of B-vitamins and/or N-3 fatty acids: the SU.FOL.OM3 trial.
International Journal of Cardiology, 2012Co-Authors: Jacques Blacher, Sébastien Czernichow, Francois Paillard, Pierre Ducimetière, Serge Hercberg, Pilar GalanAbstract:Abstract Background Mechanisms involved in coronary stenosis evolution are different than those involved in clinical events. Because of differential vascular effects, N-3 polyunsatured fatty acids (PUFA) and B vitamins could have differential effects on different types of cardiovascular clinical events in high-risk patients. Methods We analyzed the effects of n-3 PUFA and of B vitamins on both coronary Revascularization and on hard coronary events risks in a subgroup of the SU.FOL.OM3 trial, a randomized, double-blind, placebo-controlled secondary prevention trial. Data were analyzed according to the intention-to-treat principle, with the use of Cox proportional-hazards models. Results After a mean follow-up of 4.2±1.0years among the 1,863 participants with coronary heart disease, 163 coronary Revascularizations were performed, and 95 patients experienced a hard coronary event. Neither treatment with n-3 PUFA, nor treatment with B vitamins was associated with any significant effect on the occurrence of hard coronary events. Allocation to n-3 PUFA was not associated with any significant effect on coronary Revascularization. However, treatment with B vitamins was associated with a statistically significant 52% increase in the risk of coronary Revascularization (multivariate HR: 1.52; 95% CI: [1.11–2.10]; p=0.01). Conclusions Neither n-3 PUFA, nor B vitamins reduced the rates of hard coronary events and of coronary Revascularization. Furthermore, B vitamins significantly increased the rate of coronary Revascularization. Consistent with the findings of previous trials, our results do not support the routine use of dietary supplements containing n-3 PUFA and argue against using dietary supplements containing B-vitamins in coronary patients in secondary cardiovascular prevention.
