Antonio Mugnolo

University of Rome Tor Vergata, Roma, Latium, Italy

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Publications (5)20.18 Total impact

  • International journal of cardiology 12/2013; · 6.18 Impact Factor
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    ABSTRACT: Background and Objective: Late and very-late stent occlusion remains a serious complication of coronary stenting. Despite their high anti-restenotic efficacy, drug-eluting stents (DES) have been associated to more late-thrombosis as compared to bare-metal stents (BMS). The aim of this study is to analyze the clinical presentation, angiographic and intravascular ultrasound (IVUS) findings in patients with late or very late stent thrombosis and the relationship with the anti-platelet regimen. Methods and Results: Between January 2007 and December 2011, 34 consecutive patients with clinical syndromes compatible with late or very-late stent occlusion were studied with IVUS during emergency catheterization; 25 had DES and 9 had BMS. Thrombotic total occlusion was more common in DES (16=64%) than BMS patients (2=22%; p=0.02) and ST-segment elevation myocardial infarction was the predominant clinical presentation in the former group (60% compared to 22%; p=0.05). The time elapsed between implantation and failure was much longer in DES patients: 33±22 versus 17±14 months for BMS; p=0.05. IVUS analysis showed a higher incidence of incomplete stent apposition (ISA) in the DES group compared to the BMS group (56% versus 11%; p=0.005) and in-stent plaque rupture was the most common finding in the BMS group (78%). In DES group, ISA was found more frequently in patients still under dual anti-platelet therapy (71%). Conclusions: Very late DES failure often causes ST-elevation myocardial infarction; these very late events may not correlate with the interruption of anti-platelet therapy. Severe, late acquired ISA belongs to DES and is frequently observed in patients with very late DES thrombosis. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 04/2013; · 2.51 Impact Factor
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    ABSTRACT: OBJECTIVES: To assess the incidence of silent cerebral embolization when using the transradial approach for diagnostic coronary angiography (DCA). BACKGROUND: Compared to other vascular access sites, the right transradial approach (RTA) could reduce the amount of brain emboli by avoiding mechanical trauma to the aortic wall caused by catheters and wire, whereas it increases manipulation of catheters in the ascending aorta and has a higher risk of direct embolization into the right common carotid artery. A recent study showed an increased incidence of microembolic signals (MES) in RTA compared to femoral. However, left transradial approach (LTA) has never been assessed. METHODS: 40 patients with suspected coronary artery disease were randomized to DCA via RTA (n=20) or LTA (n=20) with contemporaneous bilateral transcranial Doppler monitoring. RESULTS: MES were detected in all patients, with a significantly higher rate in the RTA group (median 61, interquartile range (IQR) 47-105, vs 48, IQR 31-60, p=0.035). MES generated during procedures needing >2 catheters (n=8), are higher than those detected during procedures performed with 2 catheters (n=32, 102, IQR 70-108, vs 48, IQR 33-60, p=0.001). At multivariate analysis increasing number of catheters was the only independent predictor of high incidence of MES (OR 16.4, 95% CI 1.23-219.9, p=0.034, -2LL=26.7). CONCLUSIONS: LTA has a lower risk of brain embolization because of the lower number of catheter exchange maneuvers. Since the degree of brain embolism depends on the magnitude of mechanical manipulation, catheter changes should be minimized to reduce the risk of cerebral embolization.
    International journal of cardiology 10/2012; · 6.18 Impact Factor
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    ABSTRACT: We present a patient with persistent atrial fibrillation (AF) who suffered a cryptogenic transient ischemic attack (TIA) despite full oral anticoagulation therapy. With transesophageal echocardiography (TEE), a patent foramen ovale (PFO) was discovered with a passage of microbubbles during the Valsalva maneuver. Long-term anticoagulation treatment was contraindicated due to the history of a recent gastrointestinal hemorrhage. We performed a transcatheter occlusion of the left atrial appendage (LAA), followed by patent foramen ovale closure during the same procedure. This percutaneous approach could be a good therapeutic strategy in patients with persistent AF and PFO, who have suffered at least one cryptogenic stroke or TIA and have a contraindication to lifelong optimal anticoagulation therapy.
    Journal of Cardiovascular Medicine 10/2011; 13(10):663-4. · 2.66 Impact Factor
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    ABSTRACT: We report a case of myocardial infarction at a young age in a person with a medical history of repeated thrombophlebitis, who was heterozygous for the prothrombin G20210A mutation and homozygous for factor V Leiden mutation. A coronary angiography revealed the presence of a moderate atherosclerotic plaque (60%) in the left anterior descending coronary artery, which gave rise to suspicion of a relationship between prothrombotic gene mutations and atherosclerosis. Genetic screening for inherited thrombophilia, especially in the presence of a strong familiarity or previous venous thrombosis, and the evaluation of atherosclerotic risk factors, may be critical information for primary prevention of arterial thrombosis.
    Journal of Cardiovascular Medicine 10/2009; 11(2):125-6. · 2.66 Impact Factor