Radial artery spasm during transradial percutaneous interventions was effectively prevented by the administration of vasodilators. The combination of verapamil 2.5 mg and molsidomine 1 mg provided the strongest relative risk reduction of spasm compared to placebo and should therefore be recommended during percutaneous coronary interventions through the radial approach.

Objectives: The aim of this prospective, multicenter study was to assess the safety, feasibility, acceptance, and cost of ambulatory transradial percutaneous coronary intervention (PCI) under the conditions of everyday practice. Background: Major advances in PCI techniques have considerably reduced the incidence of post‐procedure complications. However, overnight admission still constitutes the standard of care in most interventional cardiology centers. Methods: Eligibility for ambulatory management was assessed in 370 patients with stable angina referred to three high‐volume angioplasty centers. On the basis of pre‐specified clinical and PCI‐linked criteria, 220 patients were selected for ambulatory PCI. Results: The study population included a substantial proportion of patients with complex procedures: 115 (52.3%) patients with multivessel coronary artery disease, 50 (22.7%) patients with multilesion procedures, and 60 (21.5%) bifurcation lesions. After 4‐6 hr observation period, 213 of the 220 patients (96.8%) were cleared for discharge. The remaining seven (3.2%) patients were kept overnight for unstable angina (n = 1), atypical chest discomfort (n = 2), puncture site hematoma (n = 1), or non‐cardiovascular reasons (n = 3). Within 24 hr after discharge, no patients experienced readmission, stent occlusion, recurrent ischemia, or local complications. Furthermore, 99% of patients were satisfied with ambulatory management and 85% reported no anxiety. The average non‐procedural cost was lower for ambulatory PCI than conventional PCI (1,230 ± 98 Euros vs. 2,304 ± 1814 Euros, P < 10−6). Conclusions: Ambulatory PCI in patients with stable coronary artery disease is safe, effective, and well accepted by the patients. It may both significantly reduce costs and optimize hospital resource utilization. © 2012 Wiley Periodicals, Inc.

Compared with the approved dose regimen of clopidogrel (300-mg loading dose [LD], 75-mg maintenance dose [MD]), prasugrel has been demonstrated to reduce ischaemic events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). In ACS, antiplatelet effects of a prasugrel MD regimen have not been previously compared with either a higher clopidogrel MD or after switching from a higher clopidogrel LD. The objective of this study was to evaluate the antiplatelet effect of a prasugrel 10-mg MD versus a clopidogrel 150-mg MD in patients with ACS who had received a clopidogrel 900-mg LD. Patients with non-ST elevation ACS, treated with aspirin and a clopidogrel 900-mg LD, were randomised within 24 hours post-LD to receive a prasugrel 10-mg or clopidogrel 150-mg MD. After 14 days of the initial MD, subjects switched to the alternative treatment for 14 days. The primary endpoint compared maximum platelet aggregation (MPA, 20 microM adenosine diphosphate [ADP]) between prasugrel and clopidogrel MDs for both periods. Responder analyses between treatments were performed using several platelet-function methods. Of 56 randomised subjects, 37 underwent PCI. MPA was 26.2% for prasugrel 10 mg and 39.1% for clopidogrel 150 mg (p<0.001). The prasugrel MD regimen reduced MPA from the post-900-mg LD level (41.2% to 29.1%, p=0.003). Poor response ranged from 0% to 6% for prasugrel 10 mg and 4% to 34% for clopidogrel 150 mg. Thus, in ACS patients a prasugrel 10-mg MD regimen resulted in significantly greater platelet inhibition than clopidogrel at twice its approved MD or a 900-mg LD.

SUMMARY The etiologic and prognostic features which characterize cerebrovascular disease in the later decades of life are not applicable in younger patients. The records of 58 patients who had suffered cerebral infarction between the ages of 15 and 40 were reviewed in order to study these features.Fifty-five percent of the patients were found to have had an identifiable etiology for their cerebral infarction, with nearly half of these suffering from embolic infarction of cardiac origin. In 45% no clear etiology could be established but hypertension was prevalent in those patients between 31 and 40 years of age. Follow up data were obtained on 68% of the hospital survivors; nearly V* of them had completely recovered or had improved.CEREBROVASCULAR DISEASE occurs predominately in the later decades of life. However, the occurrence of stroke in young adults is not an insignificant problem. The annual incidence of stroke in the 35 to 45 age group is estimated at 25 per 100,000.' Aring and Merritt, 2 in an age incidence tabulation of autopsied cases of cerebrovascular lesions, found that 5% of strokes occur in individuals under 40. It has been pointed out that this figure relates to necropsied cases, and that the actual incidence may be greater. 3Two large studies of cerebrovascular disease originating from India 4 and Ceylon 5 estimate that 27.2% and 32% respectively of all strokes occur in adults under 40. These findings may not be applicable to other world populations because of differences in culture, diet, genetics, or other unidentified factors.The etiologic and prognostic features which characterize cerebral infarction among older patients may not be applicable to young adults. Because of the relatively low prevalence of degenerative arterial disease in the young, potentially treatable non-atheromatous conditions may exist in the young adult with stroke.7 Despite careful investigation, among young patients many cases of ischemic cerebrovascular disease emerge in which the etiology is unclear and the role of established risk factors is uncertain. 8 " 12 In order to examine these factors, the records of young adults with cerebral infarction who had been hospitalized at the Medical College of Virginia hospitals were reviewed. MethodsThe Medical College of Virginia Hospital is a large urban teaching center with a population of referral as well as community care patients. The medical records of all inpatients age 15 to 40 with cerebrovascular disease admitted to the Medical College of Virginia Hospitals between August 1, 1970 and July 31, 1975 were reviewed retrospectively.Patients included in the study had suffered cerebral infarction just prior to admission or while in the hospital. Patients with hemorrhagic strokes were not included. If a patient had more than one cerebral infarct during the period of the study, only the first was included. This study was supported in part by the Student Clerkship in stroke sponsored by the American Heart Association.Patient data collected included family history, predisposi...