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Severe coronary artery calcification is associated with suboptimal stent expansion, higher complication rates and worse clinical outcomes after percutaneous coronary intervention. Several devices and techniques have been developed to facilitate the treatment of calcified coronary lesions. This manuscript outlines best practices and tips on the use of the super high pressure OPN noncompliant balloon (OPN; Swiss Interventional Systems [SIS] Medical AG, Winterthur, Switzerland).

Aims The aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA2DS2-VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared. Methods LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6 months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24 months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during follow-up was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2 years (annual event rates, 290 patients/year) were less frequent than expected from CHADS2 (2.4% vs 9.6%), CHA2DS2-VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores (p<0.001, p=0.003, p=0.047, respectively). Conclusions LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.

Entre las realizaciones del arquitecto barroco Pedro de la Torre para la ciudad de Toledo es posible identificar un retablo hasta ahora inédito, datado en 1653 y en el que colabora el ensamblador toledano Juan García de San Pedro, localizado hoy en la parroquia de Nambroca (Toledo), en el que se aprecian las innovaciones estructurales y ornamentales propias del lenguaje desarrollado por el artista. Among the works of the baroque architect Pedro de la Torre for the city of Toledo is possible to identify an up to now unpublished altarpiece in which collaborates the toledan assembler Juan García de San Pedro. Dated in 1653 and at present located in the parish of Nambroca (Toledo), in which we can appreciate the typical structural and ornamental innovations of the language developed by the artist.

We aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures. Scores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared. Mean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, p<0.001), similar to J-CTO and slightly inferior to CL score (- 0.011, p = 0.004). Regarding net reclassification improvement, CASTLE reclassified better than PROGRESS (overall continuous net reclassification improvement 0.379, p<0.001) in roughly 20% of cases. Procedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.

En relación con el conocido arquitecto madrileño de la segunda mitad del s. XVII Rodrigo Carrasco Gallego (+ 1690), podemos ampliar la biografía del artista, documentando el periodo de su carrera que se podría denominar toledano, entre 1660 y 1674 aproximadamente. Nacido hacia 1640 en Consuegra (Toledo), villa natal del arquitecto y pintor José Jiménez Donoso, Rodrigo Carrasco se encuentra en esos años avecindado en Toledo, donde, formado dentro del círculo del maestro mayor Bartolomé Sombigo, ejerce su oficio de maestro de cantería, principalmente como marmolista, en obras repartidas entre la ciudad del Tajo y otras localidades del entorno. About of the celebrated architect madilenian belonging to the second half of the 17th century Rodrigo Carrasco Gallego (f1690), is possible amplify his biography, documentting the period of his career than colud cali toledan, between 1660 and 1674 approximatiy. Borned towards 1640 at Consuegra (Toledo), home town of the architect and páinter José Jiménez Donoso, Rodrigo Carrasco was living at those years at Toledo, where, formed inside the circle of the major master Bartolomé Sombigo, he exerts as master of stonework, mainly cutting of a marbie, at works dispensed amog the City of the Tajo and localities of the environment.

With this work is to put the time in which the toledan altarpiece of mediated of the XVIIth century adopts the typological features and formal of the baroque altarpiece of Madrid, a change than customs the architect Juan Gómez Lobo constituting a well-defined art of which is exponent the altarpiece of Ntra. Sra. de la Esperanza in the church of San Lucas, an example the baroque standardization of the altarpiece in Toledo in the sixties. Con este trabajo se trata de situar el momento en el que el retablo toledano de mediados del siglo XVII adopta las características tipológicas y formales del retablo barroco madrileño, cambio que personaliza el arquitecto Juan Gómez Lobo constituyendo un arte bien definido del que es exponente el retablo de Ntra. Sra. de la Esperanza de la iglesia de San Lucas, ejemplo de la normalización barroca del retablo en Toledo en la década de los sesenta.

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Como obra inédita dentro del catálogo de realizaciones del arquitecto y ensamblador de retablos Pedro de la Torre (1596-1677), uno de los principales artistas conformadores del arte barroco en el Madrid del siglo XVII, se ha de datar en 1672 el desaparecido retablo mayor de la iglesia parroquial de S. Pedro de Vallecas (Madrid), conocido hoy por fotografía, en el que intervienen otros artistas relevantes que aquí se documentan. As an unknown work belonging to the catalogue of performances of the architect and joiner of «retablos» Pedro de la Torre (1596-1677), one of the main creators of the baroque art at the Madrid of the XVIIth century, it’s possible to date in 1672 the missing main altarpiece of the S. Pedro’s church of Vallecas (Madrid), just known by photograph nowadays, where other important artists worked and are documented here.