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https://doi.org/10.1136/heart.86.3.250

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    iqbal malik

    Editor, JournalScan

    ISCHAEMIC HEART DISEASE

    Bored with PTCA? What about carotid stenting? The more adventurous interventionalist is always on the lookout for a new procedure. TheLancet offers what looks like equivalence at three years for carotid endarterectomy and angioplasty (with a 30% stent rate). However, the combined major stroke/death rate was 10% in both groups at 30 days, higher than 6.5% in the NASCET trial and 7.0% in the ECST trial. In addition, there was no medically treated control group. One could reason that the reason for equivalence (with wide confidence intervals) was that surgery did not produce the benefits expected. The rule has to be that the surgeon has to have a low rate of stroke/death at 30 days to consider surgery a good option over medical treatment, and that angioplasty at present should only be part of a randomised trial.

     1 CAVATAS Investigators. Endovascular versus surgical treatment in patients with carotid stenosis in the carotid and vertebral artery transluminal angioplasty study (CAVATAS): a randomised trial. (2001) Lancet 357:1729–37..

    Thrombolysis is not contraindicated after prolonged CPR: No one doubts the benefits of thrombolysis in myocardial infarction (MI) (or in major pulmonary embolism), but patients with such conditions are prone to cardiac arrest. Standard teaching is that prolonged cardiopulmonary resuscitation (CPR) is a contraindication to thrombolytic treatment because of the risk of bleeding. This prospective study comparing consecutive patients with cardiac arrest (including asystole) showed that there is no specific bleeding risk. Of 40 patients with > 15 minutes of CPR treated with heparin and tissue plasminogen activator (tPA), two had bleeds, and both these were from gastric ulcers > 48 hours after the resuscitation. As a bonus, resuscitation was more likely to …

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    • Journals scanned—American Journal of Medicine; American Journal of Physiology: Heart and Circulatory Physiology; Annals of Thoracic Surgery; Annals of Internal Medicine; Archives of Internal Medicine; BMJ; Chest; European Journal of Cardiothoracic Surgery; Lancet; JAMA; Journal of Clinical Investigation; Journal of Diabetes and its Complications; Journal of Immunology; Journal of Thoracic and Cardiovascular Surgery; Nature Medicine; New England Journal of Medicine; Pharmacoeconomics; Thorax.   Reviewers—C Baker, E Barnes, V Bhatia, R Desilva, M Earley, K Fox, D Gorog, G Jenkins, R Kaprilian, A Kapur, M Khan, P Lambiese, V Markides, M Poullis, P Ramrakha, J Strange, B Wasan, H Walker.