Publications by authors named "Alexandru Achim"

18 Publications

  • Page 1 of 1

Impact of Diabetes Mellitus on Early Clinical Outcome and Stent Restenosis after Carotid Artery Stenting.

J Diabetes Res 2022 11;2022:4196195. Epub 2022 Jul 11.

Department of Invasive Cardiology, Medicala 1 Clinic, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.

Background: Diabetes mellitus is closely related to both the severity of carotid disease and its outcome after revascularization. Carotid artery stenting (CAS) has emerged as a viable alternative to surgical endarterectomy but little is known about the impact of diabetes after CAS.

Methods: A consecutive cohort of 1940 patients undergoing CAS in two institutions was divided into two groups, diabetics and nondiabetics, and major cerebrovascular events (MACCEs) were analyzed at 30 days post-CAS and at 1 year follow-up.

Results: There were 730 patients with diabetes, with significantly higher BMI, hypertension, chronic dialysis, and dyslipidemia frequency ( < 0.05). There was no significant difference between the two groups in terms of early and late MACCEs (composite of transient ischemic attack, major stroke, myocardial infarction, and death), with an early rate of 3.5% nondiabetics vs. 5.3%, = 0.08 and 2.4 nondiabetics vs. 2.3% diabetics, = 0.1 at 12 months. Overall stroke/death rate in the asymptomatic patients was 2.4%, and the restenosis rate was higher in the diabetes population (2.3% vs. 1%, = 0.04).

Conclusion: The presence of diabetes was associated with an acceptable increased periprocedural risk for CAS, but no further additional risk emerged during longer term follow-up. Diabetes may precipitate the rate of early in-stent restenosis.
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http://dx.doi.org/10.1155/2022/4196195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9293551PMC
July 2022

In vitro effect of intravascular lithotripsy on the polymer of a drug-eluting stent.

EuroIntervention 2022 07 22;18(4):e333-e334. Epub 2022 Jul 22.

Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland.

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http://dx.doi.org/10.4244/EIJ-D-22-00300DOI Listing
July 2022

Commentary on the enigma of small vessel disease in hypertrophic cardiomyopathy: is invasive assessment of microvascular resistance a novel independent predictor of prognosis?

Cardiovasc Pathol 2022 Jun 26;60:107448. Epub 2022 Jun 26.

Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.

The key pathophysiological features in hypertrophic cardiomyopathy are ventricular hypertrophy, diastolic dysfunction, and abnormalities in the mitral valve apparatus, but coronary microvascular dysfunction and ischemia have also been described. The small vessel disease changes could be reflected in the invasive measurement of the index of microvascular resistance, with prognostic potential.
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http://dx.doi.org/10.1016/j.carpath.2022.107448DOI Listing
June 2022

A case report of left main perforation treated with BeGraft covered stent.

Eur Heart J Case Rep 2022 Jun 6;6(6):ytac230. Epub 2022 Jun 6.

Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland.

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http://dx.doi.org/10.1093/ehjcr/ytac230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9206414PMC
June 2022

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden.

Cardiol Res Pract 2022 31;2022:5108389. Epub 2022 May 31.

Second Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary.

Background: Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds; however, studies examining the relationship between coronary and radial artery calcification are lacking. The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease.

Methods: This is a single-center, retrospective cross-sectional study based on Doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC group) and 99 without (NRC group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (>100 Agatson units), or intracoronary imaging (IVUS, OCT).

Results: A significant correlation was observed between radial calcification and coronary calcification variables (67.3% vs. 32.7%, =0.001). The correlation between risk factors such as age, smoking, chronic kidney disease, and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC group (60% vs. 44%, =0.02). RC, therefore, predicts the extent and severity of coronary artery disease.

Conclusion: RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected.
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http://dx.doi.org/10.1155/2022/5108389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9174008PMC
May 2022

Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization.

Front Cardiovasc Med 2022 9;9:895457. Epub 2022 May 9.

Division of Invasive Cardiology, Internal Medicine Department, University of Szeged, Szeged, Hungary.

Background: Distal radial access (DRA) was recently introduced in the hopes of improving patient comfort by allowing the hand to rest in a more ergonomic position throughout percutaneous coronary interventions (PCI), and potentially to further reduce the rate of complications (mainly radial artery occlusion, [RAO]). Its safety and feasibility in chronic total occlusion (CTO) PCI have not been thoroughly explored, although the role of DRA could be even more valuable in these procedures.

Methods: From 2016 to 2021, all patients who underwent CTO PCI in 3 Hungarian centers were included, divided into 2 groups: one receiving proximal radial access (PRA) and another DRA. The primary endpoints were the procedural and clinical success and vascular access-related complications. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and procedural characteristics (volume of contrast, fluoroscopy time, radiation dose, procedure time, hospitalization time).

Results: A total of 337 consecutive patients (mean age 64.6 ± 9.92 years, 72.4% male) were enrolled (PRA = 257, DRA = 80). When compared with DRA, the PRA group had a higher prevalence of smoking (53.8% vs. 25.7%, SMD = 0.643), family history of cardiovascular disease (35.0% vs. 15.2%, SMD = 0.553), and dyslipidemia (95.0% vs. 72.8%, SMD = 0.500). The complexity of the CTOs was slightly higher in the DRA group, with higher degrees of calcification and tortuosity (both SMD >0.250), more bifurcation lesions (45.0% vs. 13.2%, SMD = 0.938), more blunt entries (67.5% vs. 47.1%, SMD = 0.409). Contrast volumes (median 120 ml vs. 146 ml, = 0.045) and dose area product (median 928 mGy×cm vs. 1,300 mGy×cm, < 0.001) were lower in the DRA group. Numerically, local vascular complications were more common in the PRA group, although these did not meet statistical significance (RAO: 2.72% vs. 1.25%, = 0.450; large hematoma: 0.72% vs. 0%, = 1.000). Hospitalization duration was similar (2.5 vs. 3.0 days, = 0.4). The procedural and clinical success rates were comparable through DRA vs. PRA ( = 0.6), moreover, the 12-months rate of MACCE was similar across the 2 groups (9.09% vs. 18.2%, = 0.35).

Conclusion: Using DRA for complex CTO interventions is safe, feasible, lowers radiation dose and makes dual radial access more achievable. At the same time, there was no signal of increased risk of periprocedural or long-term adverse outcomes.
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http://dx.doi.org/10.3389/fcvm.2022.895457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124806PMC
May 2022

Distal radial access: No pain, no gain.

Kardiol Pol 2022 13;80(6):633-634. Epub 2022 May 13.

"Nicolae Stancioiu" Heart Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.

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http://dx.doi.org/10.33963/KP.a2022.0126DOI Listing
July 2022

Surgical Turned-Downed CHIP Cases-Can PCI Save the Day?

Front Cardiovasc Med 2022 7;9:872398. Epub 2022 Apr 7.

Division of Invasive Cardiology, 2nd Department of Internal Medicine, University of Szeged, Szeged, Hungary.

Current guidelines, rarely if at all, address decision-making for revascularization when bypass surgery is not a possibility for high-risk cases. Patients who are surgically turned down are routinely excluded from clinical trials, even though they remain symptomatic. Furthermore, the reasons for surgical ineligibility are often times not captured in standardized risk models. There is no data regarding health status outcomes following PCI procedures in these patients and the ultimate question remains whether the benefits of PCI outweigh its risks in this controversial subpopulation. When CHIP (Complex High risk Indicated Percutaneous coronary interventions) is selected for these very complex individuals, there is no unanimity regarding the goals for interventional revascularization (for instance, the ambition to achieve completeness of revascularization vs. more targeted or selective PCI). The recognition that, worldwide, these patients are becoming increasingly prevalent and increasingly commonplace in the cardiac catheterization labs, along with the momentum for more complex interventional procedures and expanding skillsets, gives us a timely opportunity to better examine the outcomes for these patients and inform clinical decision-making.
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http://dx.doi.org/10.3389/fcvm.2022.872398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021524PMC
April 2022

A case report of COVID-19-associated acute hand ischaemia in a young professional volleyball player.

Eur Heart J Case Rep 2022 Mar 23;6(3):ytac099. Epub 2022 Feb 23.

Invasive Cardiology Division, Internal Medicine Department, Faculty of Medicine, University of Szeged, Semmelweis Str 6, 6726, Szeged, Hungary.

Background: Several coronavirus disease-19 (COVID-19)-associated complications are being increasingly reported, including arterial and venous thrombo-embolic events that may lead to amputation of the affected limbs. So far, acute upper limb ischaemia (ULI) has been reported only in critically ill patients.

Case Summary: Herein, we aimed to present a case of a 29-year-old, otherwise healthy male volleyball player, with acute ischaemic signs in the upper extremity who was diagnosed with COVID-19 1 month before the ischaemic event. It has been shown that volleyball players experience repetitive stress that involves their hands and, in particular, their fingers. Repetitive trauma can lead to local vascular abnormalities, such as reduced capillarization and lower resting blood flow that can lead to pain and cold digits, but never acute ULI.

Discussion: To our knowledge, this is the first case of such a hypercoagulable synergistic mechanism that leads to a high thrombus burden. Intra-arterial local thrombolysis and percutaneous transluminal angioplasty failed to succeed, and percutaneous large-bore embolectomy with the Indigo Aspiration System (Penumbra Inc., CA, USA) was deemed necessary.
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http://dx.doi.org/10.1093/ehjcr/ytac099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8941628PMC
March 2022

A case report of recurrent acute myocardial infarction and cardiac arrest due to aortic dissection secondary to IgG4-related aortitis.

Cardiovasc Pathol 2022 Jul-Aug;59:107415. Epub 2022 Feb 7.

University Heart Center Graz, Medical University Graz, Graz, Austria.

Occlusion of the right coronary artery is a relatively rare complication of type A aortic dissection and an example of type 2 myocardial infarction (MI) as well but when it occurs, it may have a fatal result for the patient. Aortic pseudoaneurysms are local type A dissections with a restricted extent in which the majority of the aortic wall has been breached and luminal blood is held in only by a thin rim of the remaining wall, mainly purely the adventitia. They typically occur from iatrogenic trauma by interventional procedures or previous cardiac surgery. We present a case of a 56 years old patient who suffered an acute functional MI due to such pseudoaneurysm formed in the context of an undiagnosed aortitis. The etiology remained unclear until the surgical aortic prosthesis was deemed necessary, finding chronic IgG4 infiltrates in the aortic tissue. To our knowledge, this is the first case of IgG4-related aortitis causing functional MI and cardiogenic shock.
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http://dx.doi.org/10.1016/j.carpath.2022.107415DOI Listing
June 2022

FAME 3 fails to defame coronary artery bypass grafting: what went wrong in the percutaneous coronary intervention arm?

Eur J Cardiothorac Surg 2022 Jun;62(1)

Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland.

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http://dx.doi.org/10.1093/ejcts/ezac036DOI Listing
June 2022

Distal Radial Artery Access for Coronary and Peripheral Procedures: A Multicenter Experience.

J Clin Med 2021 Dec 20;10(24). Epub 2021 Dec 20.

2nd Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, 6720 Szeged, Hungary.

Introduction: Distal radial access (dRA) has recently gained global popularity as an alternative access route for vascular procedures. Among the benefits of dRA are the low risk of entry site bleeding complications, the low rate of radial artery occlusion, and improved patient and operator comfort. The aim of this large multicenter registry was to demonstrate the feasibility and safety of dRA in a wide variety of routine procedures in the catheterization laboratory, ranging from coronary angiography and percutaneous coronary intervention to peripheral procedures.

Methods: The study comprised 1240 patients who underwent coronary angiography, PCI or noncoronary procedures through dRA in two Hungarian centers from January 2019 to April 2021. Baseline patient characteristics, number and duration of arterial punctures, procedural success rate, crossover rate, postoperative compression time, complications, hospitalization duration, and different learning curves were analyzed.

Results: The average patient age was 66.4 years, with 66.8% of patients being male. The majority of patients (74.04%) underwent a coronary procedure, whereas 25.96% were involved in noncoronary interventions. dRA was successfully punctured in 97% of all patients, in all cases with ultrasound guidance. Access site crossover was performed in 2.58% of the patients, mainly via the contralateral dRA. After experiencing 150 cases, the dRA success rate plateaued at >96%. Our dedicated dRA step-by step protocol resulted in high open radial artery (RA) rates: distal and proximal RA pulses were palpable in 99.68% of all patients at hospital discharge. The rate of minor vascular complications was low (1.5%). A threshold of 50 cases was sufficient for already skilled radial operators to establish a reliable procedural method of dRA access.

Conclusion: The implementation of distal radial artery access in the everyday routine of a catheterization laboratory for coronary and noncoronary interventions is feasible and safe with an acceptable learning curve.
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http://dx.doi.org/10.3390/jcm10245974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8707635PMC
December 2021

Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation.

EuroIntervention 2022 May;18(1):83-90

The Lambe Institute for Translational Medicine, Smart Sensors Lab and Curam, Saolta University Healthcare Group, Galway, Ireland.

Background: While radial stent deformation has been thoroughly investigated, data on longitudinal deformation are scarce.

Aims: The aim of the study was to describe longitudinal stent deformation associated with the proximal optimisation technique (POT).

Methods: Longitudinal stent deformation was assessed by bench testing and by clinical evaluation. Bench testing was performed in silicone models using 3.00 (n=15) and 3.50 mm (n=14) stent platforms. After deployment, stents were sequentially post-dilated in the proximal main branch up to 5.50 mm, in increments of 0.50 mm, in order to simulate a spectrum of overexpansion. Stent length was redefined by optical coherence tomography (OCT) after each step. Clinical data were collected retrospectively from OCT-guided bifurcation percutaneous coronary intervention cases.

Results: In bench tests, POT has led to significant stent elongation in all cases. The magnitude of elongation was comparable between the 3.00 and the 3.50 mm stent platforms, with 0.86±0.74 mm vs 0.86±0.73 mm, respectively (p=0.71), per 0.5 mm overexpansion. For 3.00 mm stent platforms, maximal elongation was 4.31±1.47 mm after up to 5.5 mm overexpansion. For 3.50 mm platforms, maximal elongation was 2.87±0.94 mm after up to 5.5 mm overexpansion. Thirty-six clinical cases were analysed, of which 22 (61%) were performed in the distal left main. Post-dilation was performed with 0.98±0.36 mm absolute overexpansion, resulting in 2.22±1.35 mm elongation, as compared to nominal stent length.

Conclusions: Overexpansion by POT results in proximal stent elongation. This has to be considered once the stent length is selected and the stent is positioned, especially in the left main stem, where proximal overexpansion is marked and accurate ostial landing is critical.
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http://dx.doi.org/10.4244/EIJ-D-21-00824DOI Listing
May 2022

Distal Radial Secondary Access for Transcatheter Aortic Valve Implantation: The Minimalistic Approach.

Cardiovasc Revasc Med 2022 07 22;40:152-157. Epub 2021 Nov 22.

2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary. Electronic address:

Background: Although not yet recommended by the guidelines, distal radial access, a new site for cardiovascular interventions, has been rapidly acknowledged and adopted by many centers due to its high rate of success, safety and fewer complications. We present our experience using secondary distal radial access during transcatheter aortic valve implantation (TAVI), proposing a new, even more minimal approach.

Methods: As of November 2020, a systematic distal radial approach as secondary access site for TAVI was adopted in our center. Primary endpoints were technical success and major adverse events (MAEs). Secondary endpoints: the access site complication rate, hemodynamic and clinical results of the intervention, procedural related factors, crossover rate to the femoral access site, and hospitalization duration (in days).

Results: From November 2020, 41 patients underwent TAVI using this strategy. Patients had a mean age of 76 ± 11.2 years, 41% were male. Six (14.63%) patients received a balloon-expandable valve and 35 (85.37%) received a self-expandable valve. TAVI was successful in all cases. No complications occurred due to transradial access. Puncture success, defined as completed sheath placement was maximum (N = 41/41,100%) and emergent transfemoral secondary access was not required in any case. Primary transfemoral vascular access site complications occurred in 7 cases (17%) of which 4 (13.63%) were resolved through distal radial access: one occlusion, two flow-limiting stenoses and four perforations of the common femoral artery. There were no additional major vascular complications at 30 days. Overall MACE rate was 2.4%.

Conclusion: The use of the distal radial approach for secondary access in TAVI is safe, feasible and has several advantages over old access sites.
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http://dx.doi.org/10.1016/j.carrev.2021.11.021DOI Listing
July 2022

Clinical application of results of the ISCHEMIA trial.

Trends Cardiovasc Med 2021 Nov 2. Epub 2021 Nov 2.

Graz University Heart Center Graz, Medical University Graz, Graz Austria.

More than a decade after the Clinical Outcomes Utilising Revascularization and Aggressive Drug Evaluation (COURAGE) trial, International Study of Comparative Health Effectiveness With Medical And Invasive Approaches (ISCHEMIA) is the second large clinical trial to challenge the concept of revascularization in chronic coronary syndromes whilst addressing some of the shortfalls of its predecessor.
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http://dx.doi.org/10.1016/j.tcm.2021.10.011DOI Listing
November 2021

Revascularization decisions in patients with chronic coronary syndromes: Results of the second International Survey on Interventional Strategy (ISIS-2).

Int J Cardiol 2021 08 7;336:38-44. Epub 2021 May 7.

Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; Cardiovascular Research Center Aalst, OLV-Clinic Aalst, Aalst, Belgium.

Background: In chronic coronary syndromes, guidelines mandate invasive functional guidance of revascularization whenever non-invasive proof of ischemia is missing. ISIS-2 survey aimed to evaluate how the adoption of guideline recommendation on ischemia-guided revascularization has evolved over the last 5-7 years.

Methods: In ISIS-2 participants assessed five complete angiograms, presenting only intermediate stenoses without information on non-invasive pre-testing. Fractional flow reserve was known for each stenosis, but remained undisclosed. Participants could determine stenosis significance either by angiography or by requesting an adjunctive invasive diagnostic method (intravascular imaging or functional tests). Primary endpoint was the rate of requesting adjunctive functional assessment. Secondary endpoints were the rate of concordance between angiography-based decisions and know functional severity. ISIS-2 utilized the same web-based platform as ISIS-1 in 2013. (NCT04001452).

Results: 334 participants performed 2059 lesion evaluations: 1202 (59%) decisions were based solely on angiography without expressed need for further evaluation. These decisions were discordant with known functional significance in 39%, mainly with potential of overtreatment. Participants requested invasive functional assessment in 643 (31%) and intravascular imaging in 214 (10%) cases. Compared to ISIS-1 the rate of purely angiography-based decisions has decreased (59% vs 66%; p < 0.001), while invasive functional tests were more frequently requested (31% vs 25%; p < 0.001).

Conclusions: ISIS-2 suggests an evolving pattern in the intention to integrate invasive coronary physiology into the revascularization decisions. However, the disconnect between recommendations and current thinking is still dominant.
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http://dx.doi.org/10.1016/j.ijcard.2021.05.005DOI Listing
August 2021

Prototype Orthopedic Bone Plates 3D Printed by Laser Melting Deposition.

Materials (Basel) 2019 Mar 19;12(6). Epub 2019 Mar 19.

Center for Advanced Laser Technologies-CETAL, National Institute for Lasers, Plasma and Radiation Physics, 077125 Magurele, Ilfov, Romania.

Laser melting deposition is a 3D printing method usually studied for the manufacturing of machine parts in the industry. However, for the medical sector, although feasible, applications and actual products taking advantage of this technique are only scarcely reported. Therefore, in this study, Ti6Al4V orthopedic implants in the form of plates were 3D printed by laser melting deposition. Tuning of the laser power, scanning speed and powder feed rate was conducted, in order to obtain a continuous deposition after a single laser pass and to diminish unwanted blown powder, stuck in the vicinity of the printed elements. The fabrication of bone plates is presented in detail, putting emphasis on the scanning direction, which had a decisive role in the 3D printing resolution. The printed material was investigated by optical microscopy and was found to be dense, with no visible pores or cracks. The metallographic investigations and X-ray diffraction data exposed an unusual biphasic α+β structure. The energy dispersive X-ray spectroscopy revealed a composition very similar to the one of the starting powder material. The mapping of the surface showed a uniform distribution of elements, with no segregations or areas with deficient elemental distribution. The in vitro tests performed on the 3D printed Ti6Al4V samples in osteoblast-like cell cultures up to 7 days showed that the material deposited by laser melting is cytocompatible.
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http://dx.doi.org/10.3390/ma12060906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471645PMC
March 2019
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