Use of intravascular lithotripsy in non-coronary artery lesions

BACKGROUND Intravascular lithotripsy(IVL)is a novel technique increasingly used for plaque modification and endovascular revascularization in patients with severe calcification and peripheral artery disease.However,much of the available literature on IVL is focused on its use in coronary arteries,with relatively limited data on non-coronary artery use.AIM To analyze the safety and efficacy of current IVL use in non-coronary artery lesions,as reported in case reports and case series.METHODS We searched EMBASE,PubMed,and Reference Citation Analysis databases for case reports and case series on IVL use in peripheral artery disease.We then extracted variables of interest and calculated the mean and proportions of these variables.RESULTS We included 60 patients from 33 case reports/case series.Ninety-eight percent of the cases had IVL usage in only one blood vessel,while four had the IVL used in two vessels(2.0%),resulting in 64 Lesions treated with IVL.The mean age of the patients was 73.7(SD 10.9).IVL was successfully used in severe iliofemoral artery stenosis(51.6%),severe innominate,subclavian,and carotid artery stenosis(26.7%combined),and severe mesenteric vessel stenosis(9.4%).Additionally,IVL was successfully used in severe renal(7.8%)and aortic artery(4.7%)stenosis.There were complications in 12%of the cases,with dissection being the commonest.CONCLUSION IVL has successfully used in plaque modification and endovascular revascularization in severely calcified and challenging lesions in the iliofemoral,carotid,subclavian,aorta,renal,and mesenteric vessels.The most severe but transient complications were with IVL use in the aortic arch and neck arteries.

Telemonitoring in heart failure patients:Systematic review and metaanalysis of randomized controlled trials

BACKGROUND Home telemonitoring has been used as a modality to prevent readmission and improve outcomes for patients with heart failure.However,studies have produced conflicting outcomes over the years.AIM To determine the aggregate effect of telemonitoring on all-cause mortality,heart failure-related mortality,all-cause hospitalization,and heart failure-related hospitalization in heart failure patients.METHODS We conducted a systematic review and meta-analysis of 38 home telemonitoring randomized controlled trials involving 14993 patients.We also conducted a sensitivity analysis to examine the effect of telemonitoring duration,recent heart failure hospitalization,and age on telemonitoring outcomes.RESULTS Our study demonstrated that home telemonitoring in heart failure patients was associated with reduced all-cause[relative risk(RR)=0.83,95% confidence interval(CI):0.75-0.92,P=0.001]and cardiovascular mortality(RR=0.66,95%CI:0.54-0.81,P<0.001).Additionally,telemonitoring decreased the all-cause hospitalization(RR=0.87,95%CI:0.80-0.94,P=0.002)but did not decrease heart failurerelated hospitalization(RR=0.88,95%CI:0.77-1.01,P=0.066).However,prolonged home telemonitoring(12 mo or more)was associated with both decreased all-cause and heart failure hospitalization,unlike shorter duration(6 mo or less)telemonitoring.CONCLUSION Home telemonitoring using digital/broadband/satellite/wireless or blue-tooth transmission of physiological data reduces all-cause and cardiovascular mortality in heart failure patients.In addition,prolonged telemonitoring(≥12 mo)reduces all-cause and heart failure-related hospitalization.The implication for practice is that hospitals considering telemonitoring to reduce heart failure readmission rates may need to plan for prolonged telemonitoring to see the effect they are looking for.