Shepherding us into the present: a fond goodbye

EuroIntervention is the official journal of the EAPCI, of which William Wijns is President until September. Over the last two years he has written a regular column for EuroIntervention and has been influential in our development. We asked for his reflections as he comes to the close of his 'official' association with us:

We have come a long way in the last two years and can be proud of how the journal, like the EAPCI, has grown. Initially it was difficult to convince authors to submit articles and publish here, taking advantage of our timely acceptance process. Today EuroIntervention benefits from its maturity and interaction with EuroPCR and the EAPCI. The last few months have seen EuroIntervention indexed in Pubmed/Medline and two excellent supplements, one of which is the EuroPCR Abstract book, published for the first time.

EuroIntervention is unique because of its close association with the EAPCI, but looking at conventional medical publications, I see that EuroIntervention has something more. Besides merely fulfilling its role as a medical journal, the whole seems greater than the parts...you can sense the life and community involvment. There are clinical papers, of course, but also constantly evolving content, with varied new features for a subspecialty publication, including reports on Registries, new and high-tech devices, and sections which pique interest and challenge ideas.

The PDFs that are downloadable free from EuroIntervention's website are another example of commitment to our community. For me, EuroIntervention is not just a journal but a magazine of our profession and, like the EAPCI, it reflects ourselves and our specific and multiple interests.

I thank the Editors for allowing my editorials - sometimes furious, sometimes serene – through which I 'take the pulse' of myself and the profession. Hopefully surgeons will also use this forum for their own ideas.

Our dialogue of diversity, challenge, criticism and consensus characterises our integration as subspecialties within our parent group, the European Society of Cardiology. The ESC's European Heart Journal, meanwhile, seeks to coordinate dissemination of high quality information between all journals published by the Society. EuroIntervention can proudly take its rightful place among them, and I am honoured to have been involved in this process.

Coronary balloon occlusions for diagnostic procedures in normal arteries: an angiographic and clinical follow-up study

Steffen Gloekler1, MD; Pascal Meier2, MD; Tobias Traupe1, MD; Christian Seiler1, MD, FACC, FESC
1. University Hospital Bern, Cardiology, Bern, Switzerland; 2. University of Michigan, Cardiology, Ann Arbor, AL, United States

Aims:

Coronary balloon occlusion (CBO) of an angiographically normal coronary artery segment may be necessary for collateral function assessment and procedures such as optical coherence tomography and angioscopy. Theoretically, this can injure the vessel wall. So far, there are no data on the safety of normal-vessel CBO. The purpose of the present study was to assess the complication rate related to such a procedure.

Methods and results:

426 Normal-vessel CBOs for 60-120 seconds at low inflation pressures of 1-3 atm for collateral function assessment were performed in 316 patients between 1996 and 2008. Primary endpoints were procedural- and long-term complications assessed by angiographies in a part of the cases. Secondary endpoints were major cardiac events (MACE= cardiac death, acute myocardial infarction and unstable angina) during a long-term follow-up period in all patients. Patients were divided in a group with entirely normal- (n=133) and in one with partially normal (n=183) vessels. In 1 of 426 cases (0.2%), acute thrombus formation during guidewire probing occurred. In 150 cases (35%), re-angiography was performed with a mean follow-up of 10 months. During long-term follow-up of >1 year and up to 51/2 years, in one case of each group, new stenoses were detected (1.3%). MACE and elective PCI for stable angina occurred more often in the group with partially normal vessels (5.5% vs 0.8%, p=0.02 and 18% vs 0.8%, p<0.0001).

Conclusions:

CBOs for diagnostic procedures in angiographically normal artery segments hold minimal risk for procedural- and long-term complications over a follow-up period of about 5 years and are important diagnostic tools which can be regarded as safe. Thus, for collateral function measurements, optical coherence tomography and angioscopy, the application of CBOs is justified.

Safe bypass intervention with the combination of embolic protection device and GPIIb/IIIa inhibition

Martin W. Bergmann1, MD; Jochen Krämer2, MD; C. Michael Gross2, MD 1. Dep. of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany; 2. Dep. of Cardiology, Charite Campus Buch, Berlin, Germany

Aims:

Both acute and elective venous bypass intervention is associated with a greater than 10% risc of acute thrombogenic complications. So far no clear strategy has emerged that would reduce this risc. Here we describe the results of a prospective registry evaluating safety and feasibility of combining GPIIb/IIIa inhibition and embolic protection devices.

Methods and results:

A prospective registry of all inpatients in our institution allows for complete follow up of all interventions. In 2004 we implemented a strategy of bypass interventions, where if clinically acceptable patients were pre-treated with eptifibatide for 12 hours prior to elective PCI. Acute interventions were routinely performed after systemic administration of a bolus of abciximab. In addition, bypass interventions were routinely performed with the primary placement of an embolic protection device, namely the Filter Wire device (Boston Scientific). From 2004 to 2007 we performed 228 saphenous vein bypass interventions. From the 35 chronic occluded bypasses, 21 recanalisation procedures were unsuccessful. From the 207 remaining interventions, 85 procedures were performed with drug eluting stents, 118 procedures used bare metal stents and in four cases no stent was placed. In 199 procedures GPIIb/IIIa inhibition had been implemented according to the above mentioned scheme. Filterwire could be positioned in 145 cases. Three acute or subacute thrombotic complications were observed, two of which could be resolved with removal of the device. One thrombotic complications occured within 24 hours of the initial intervention and was succesfully resolved with thrombectomy and the placement of an additional stent. No bypass occlusion was observed.

Conclusions:

The combination of GPIIb/IIIa inhibition and embolic protection devices lowers the complication rate of saphenous vein bypass interventions to levels comparable with native vessel interventions.