Papers by George Kassimis
Jacc-cardiovascular Interventions, Apr 1, 2011
Medicina, 2021
We present the case of a 70-year-old man with a history of haemophilia B, who presented to our ho... more We present the case of a 70-year-old man with a history of haemophilia B, who presented to our hospital with a non-ST-elevation myocardial infarction. The patient, following consultation by a haemophilia expert, was revascularized with percutaneous coronary intervention (PCI) under adequate clotting factor administration. Patients with haemophilia and acute coronary syndrome, are susceptible to periprocedural bleeding and thrombotic events during PCI, and therefore a balanced management plan should always be implemented by a multidisciplinary team.
The American Journal of Cardiology
Hellenic Journal of Cardiology, 2022
BACKGROUND The impact of adjunctive manual thrombus aspiration (TA) in patients with stent thromb... more BACKGROUND The impact of adjunctive manual thrombus aspiration (TA) in patients with stent thrombosis (ST) treated with percutaneous intervention has not been evaluated in the current era of potent P2Y12 agents and new generation drug eluting stents. We sought to assess the effect of TA using data from a large contemporary registry. METHODS The study population was derived from the Essex ST Investigation Registry (ESTHIR), which contains all consecutive cases of angiographically determined definite ST undergoing interventional treatment in a tertiary cardiac centre between November 2015 and June 2018. Propensity score matching was performed to match patients who underwent TA (TA group) to those who did not (n-TA group). The study endpoints were final TIMI flow and survival free of cardiovascular death (CD) or target-lesion revascularisation (TLR). RESULTS 128 ST patients were included in the present analysis. The mean age was 65±11 years and 84% were male. 90% of the patients presented with STEMI and 85% had very late ST. Seventy-two patients (56%) underwent TA. Following propensity score matching, 30 patients were included in each study group. A higher rate of final TIMI III flow was observed in the TA group (TA vs n-TA group, 100% vs 83%), but this difference did not reach statistical significance (p=0.052). At 1000 days of follow-up, survival free of CD or TLR was not different between the two groups (p=0.8). CONCLUSIONS In a propensity matched population of ST patients undergoing PCI in a contemporary setting, TA was not associated with improved final TIMI flow or long-term cardiovascular outcomes.
Cytokine, 2022
Acute myocardial infarction (AMI) is one of the major causes of morbidity and mortality worldwide... more Acute myocardial infarction (AMI) is one of the major causes of morbidity and mortality worldwide. The inflammation response during and after AMI is common and seems to play a key role in the peri-AMI period, related with ischaemia-reperfusion injury, adverse cardiac remodelling, infarct size and poor prognosis. In this article, we provide an updated and comprehensive overview of the most important cytokines and adipokines involved in the complex pathophysiology mechanisms in AMI, summarizing their prognostic role post-AMI. Data so far support that elevated levels of the major proinflammatory cytokines TNFα, IL-6 and IL-1 and the adipokines adiponectin, visfatin and resistin, are linked to high mortality and morbidity. In contrary, there is evidence that anti-inflammatory cytokines and adipokines as IL-10, omentin-1 and ghrelin can suppress the AMI-induced inflammatory response and are correlated with better prognosis. Mixed data make unclear the role of the novel adipokines leptin and apelin. After all, imbalance of pro-inflammatory and anti-inflammatory cytokines may result in worst AMI prognosis. The incorporation of these inflammation biomarkers in established prognostic models could further improve their prognostic power improving overall the management of AMI patients.
The American Journal of Cardiology, 2022
Journal of Geriatric Cardiology : JGC, 2020
Heavily calcified coronary lesions continue to represent a challenge for percutaneous coronary in... more Heavily calcified coronary lesions continue to represent a challenge for percutaneous coronary intervention (PCI), as they are difficult to dilate, and it is difficult to deliver and implant drug-eluting stents (DES) properly. Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes. Thanks to the introduction of several adjunctive PCI tools, like cutting and scoring balloons, and to the novel intravascular lithotripsy technology, the treatment of such lesions has become increasingly feasible, predictable and safe. However, 360° concentric superficial calcification with inability to cross the calcified lesion with a balloon mandates the use of rotational or orbital atherectomy, which can be safely performed via the transfemoral or transradial approach. In this technical note, we report our initial experience of the “one-man” bailout high-speed rotational atherectomy (HSRA) technique, whereby the operator both adva...
Heart, 2020
Background With an ageing population, the need for treating coronary artery disease in the elderl... more Background With an ageing population, the need for treating coronary artery disease in the elderly using percutaneous coronary intervention (PCI) is on the rise. Technical advances, better peri-procedural pharmacology and greater operator experience have led to improved outcomes after PCI. Octogenarians as a group, however, have been underrepresented in randomised clinical trials for coronary revascularisation. Observational studies therefore provide useful insights into the safety and efficacy of PCI in this patient population in a real-world setting. Aim The aim of this study was to examine the trends in patient characteristics and clinical outcomes after PCI in octogenarians over a 10-year period in a large non-surgical PCI centre and to determine the predictors of mortality in this high risk patient cohort. Methods A total of 782 consecutive octogenarians were identified from a prospectively collected database of all patients undergoing PCI at our centre over a 10-year period be...
Journal of Geriatric Cardiology : JGC, 2019
Octogenarians represent the fastest growing group of patients undergoing percutaneous coronary in... more Octogenarians represent the fastest growing group of patients undergoing percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Comparing coronary lesion characteristics of patients aged < 80 years to those ≥ 80 years undergoing PCI, the octogenarians have a higher prevalence of calcified and ostial lesions, tortuous coronary anatomy, multi-vessel disease and left main stem (LMS) stenosis. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting an even greater benefit following revascularization. Although the very elderly are at an increased cardiovascular mortality risk, the proportion of patients who receive revascularization declines as they age beyond the eighth decade, despite its proven prognostic benefit in this age group. Consequently, the American Heart Association has developed guidelines to highlight the importance of these treatment options in the very ...
Angiology, 2020
We thank Butt et al for their interest in our recently published article on Shockwave intravascul... more We thank Butt et al for their interest in our recently published article on Shockwave intravascular lithotripsy (IVL) for the treatment of severe vascular calcification. Heavily calcified coronary and peripheral artery lesions hamper percutaneous revascularization and impact interventional outcomes by impairing device crossing, impairing stent apposition and expansion, and disrupting drug and polymer release kinetics. Intravascular lithotripsy offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels. This is achieved by low-pressure balloon inflation with the use of localized pulsatile sonic pressure waves. It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus, modifying transmural conduit compliance. In addition to the coronary technology, a growing number of interventionalists are adopting the use of IVL to facilitate percutaneous access in procedures that require large bor...
Cytokine, 2021
Statin therapy comprises an integral part of secondary and to a lesser extent of primary cardiova... more Statin therapy comprises an integral part of secondary and to a lesser extent of primary cardiovascular disease prevention. This is attributed not only to their lipid-lowering properties, but as well to a plethora of pleiotropic actions. Recently, the cytokines secreted by adipose tissue, the so-called adipokines, have been proved to play a critical role in various pathophysiological functions, among which inflammation and atherosclerosis development and vulnerability. The aim of this literature review was to summarize the effects of statins and the underlying mechanisms on the circulating levels of the most common adipokines regulating atherosclerosis process, as a part of their pleiotropic function. Up to now, robust evidence implicates a significant statin-induced reduction of pro-inflammatory adipokines IL-6, TNF-a and visfatin. Weak evidence from limited, small and mostly non-randomized studies suggest increased levels of anti-inflammatory adipokines apelin, vaspin and omentin-1 after statin therapy. In the rest of most known adipokines, statins have shown either controversial (adiponectin, retinol binding protein-4 and fetuin-A) or negligible effects (leptin and resistin) on their circulating levels. Therefore, statins may favourably alter the balance of inflammatory/anti-inflammatory adipokines, implicating a novel atheroprotective mechanism. However, the interplay between statins and adipokines is still not fully elucidated and its potential clinical relevance is warranted.
Cytokine, 2021
Background: Omentin-1 and vaspin are novel adipokines, and their association with atherosclerosis... more Background: Omentin-1 and vaspin are novel adipokines, and their association with atherosclerosis is still under investigation. The present study aimed to assess the relationship of those adipokines with preclinical, nonsignificant carotid atherosclerosis and the impact of statin therapy on their levels, suggesting a link between adiposity and atherosclerosis. Methods: Eighty-four statin-free subjects with non-significant, preclinical carotid atherosclerosis and elevated LDL-cholesterol levels (>130 mg/dl) were recruited to receive atorvastatin (from 10 to 80 mg per day) (atorvastatin group-AG group). Forty-six age-and gender-matched healthy individuals, without any chronic disease served as controls (control group-CG). Clinical parameters, metabolic profile, serum omentin-1, vaspin concentrations and ultrasound measurements of carotid thickening were obtained at the beginning and after 12 months. Results: At baseline, AG showed lower omentin-1 and vaspin serum levels than CG (p ≤ 0.001). Along the entire study population at baseline, omentin-1 levels were independently related to LDL-cholesterol, while vaspin levels were independently associated with hsCRP and the presence of carotid atherosclerosis (p < 0.05). Within AG, 12months atorvastatin treatment significantly increased omentin-1 (from 202.79 ± 91.41 ng/ml to 262.56 ± 101 ng/ml, p < 0.001) and vaspin concentrations (from 1.29 ± 0.51 ng/ml to 1.70 ± 0.5 ng/ml, p = 0.002). In standard multiple regression analysis, the presence of carotid atherosclerosis related to baseline vaspin levels (β = − 0.232, p < 0.001), while the atorvastatin-induced increase of vaspin was independently associated with hsCRP reduction (β = − 0.198, p = 0.045). Conclusion: Low omentin-1 and vaspin serum levels associated with preclinical, non-significant carotid atherosclerosis. Notably, atorvastatin administration significantly increased both adipokines, but the underlying mechanisms and the clinical impact of those changes requires further investigation.
Cardiovascular Revascularization Medicine, 2020
Background: Intravascular lithotripsy (IVL) (Shockwave Medical, Inc., Fremont, California, USA) i... more Background: Intravascular lithotripsy (IVL) (Shockwave Medical, Inc., Fremont, California, USA) is a novel technology used to modify heavily calcified atherosclerotic plaque in vessels to help facilitate percutaneous coronary intervention and has been shown to be effective in treating critical lesions within the lower limbs. In addition, studies are currently underway evaluating IVL's feasibility in de novo calcified stenotic coronary arteries before stenting. The use and associated complications of IVL in other vascular territories are underreported. We report our institution's initial experience using IVL for the treatment of complex, heavily calcified lesions within the aortic arch vessels. Methods and results: We treated five patients with IVL of the aortic arch vessels, including the carotid (2), subclavian (2), and innominate arteries. Four of the five patients underwent successful IVL treatment and intervention without complications. One patient (carotid intervention) developed acute right eye blindness post-procedure, thought to be due to an embolic plaque, which was successfully treated with tissue plasminogen activator and intravenous heparin. Conclusion: IVL offers promising technology to facilitate the treatment of complex lesions in the vessels of the aortic arch. We do not promote the use of IVL but promote prospective clinical trials to assess the safety and efficacy of this technology in this vascular territory.
Clinical Thyroidology, 2019
CardioVascular and Interventional Radiology, 2013
The use of aspirin is considered the ''gold standard'' for the decrease of major adverse cardiova... more The use of aspirin is considered the ''gold standard'' for the decrease of major adverse cardiovascular events in patients with atherosclerosis, including peripheral arterial disease (PAD), whereas a dual-antiplatelet regimen with aspirin and clopidogrel is usually indicated for such patients after angioplasty and stent deployment. However, a substantial number of subsequent adverse events still occur, even in patients who receive double-antiplatelet therapy. The ''high on-treatment platelet reactivity'' (HTPR) phenomenon has been lately recognized and plays a major role in the management of patients with PAD. Greater and more rapid inhibition of platelet aggregation has become the goal for new antiplatelet agents with the expectation of further improving outcomes for percutaneous intervention for PAD. The purpose of this review article is to highlight current evidence regarding the prevalence, aetiology, and clinical implications of HTPR in PAD as well as to discuss the possibilities of novel alternative antiplatelet regiments.
Oxford Textbook of Interventional Cardiology, 2018
Coronary artery disease (CAD) is virtually ubiquitous in adults with diabetes mellitus (DM) and i... more Coronary artery disease (CAD) is virtually ubiquitous in adults with diabetes mellitus (DM) and it confers a substantially worse prognosis than for non-diabetic patients. There are more than 150 million adults worldwide estimated to have DM, at least half of whom will die from cardiovascular causes. Maturity-onset or type 2 DM accounts for up to 95% of all cases of diabetes and its prevalence has increased by 40% in industrialized countries and almost tripled in developing countries. It has been estimated that the global prevalence of DM among adults will be 7.7% (439 million individuals) in 2025. In the USA, the costs related to DM have been estimated at $174 billion in 2007—$116 billion for direct and $58 billion for indirect medical costs such as disability and work loss—while they are expected to rise to $192 billion by 2020.
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Papers by George Kassimis