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It is well known that atherosclerotic involvement in diabetic patients with critical limb ischemi... more It is well known that atherosclerotic involvement in diabetic patients with critical limb ischemia (CLI) mainly affects below the knee (BTK) arteries.
For this category of fragile patients world over ,the feature of the disease /morbidity involving extended inflammation and tissue loss ,make them reluctant to undergo revascularization . However ,increasing contemporary reports are to date proposing primary angioplasty as a feasible procedure in most diabetic subjects with optimal clinical results .

Papers by Marco Shaker

MOJ Clinical & Medical Case Reports, Jul 10, 2019

A 83 years old woman with past medical history of coronary artery disease, had four stents nine y... more A 83 years old woman with past medical history of coronary artery disease, had four stents nine years ago, colon cancer, finished the chemotherapy course and resection fourteen years ago, iron deficiency anemia, diverticulosis of large intestine, fibromyalgia, osteopenia, presented with an episode of syncope. Patient stated she has been in her usual health when she woke up that morning. Patient took her medications which were amlodipine 10mg daily, Aspirin 81mg daily, HCTZ 25mg Daily, Metoprolol succinate 50 daily, Rosuvastatin 20mg Daily, then was doing her daily activities when she felt weak and nauseated then went to her bed and fell next to it. Syncope was witnessed by daughter who stated that patient lost consciousness for about three minutes, covered in cold sweat, no shaking, no bladder or bowel incontinence were noted. Patient did not remember any of these events. Patient's vitals were within normal limits except the heart rate was 50bpm. Basal metabolic panel and complete blood count were normal. Troponin was negative. EKG (Figure 1) demonstrated HR of 50bpm. Repeated EKG with Sinus bradycardia, HR 60bpm with 1st degree block and new LBBB. (Figure 2) Echocardiography: ejection fraction 60-65%, non significant for any changes.

Cardiovascular Revascularization Medicine, 2020

BACKGROUND Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remai... more BACKGROUND Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains associated with inferior clinical outcomes and an increased risk of restenosis compared with non-diabetics even in the era of drug-eluting stents (DES). The outcomes with drug-coated balloons (DCBs) in diabetic patients have received limited study. METHODS We performed a meta-analysis of all studies published between January 2000 and January 2019 reporting the outcomes with DCB vs. DES after PCI of de-novo coronary lesions in diabetic patients. Outcomes included major adverse cardiovascular events (MACE), target lesion revascularization (TLR), binary restenosis by quantitative coronary angiography (QCA), and late lumen loss (LLL). RESULTS Three studies with 378 patients (440 lesions) were included in the meta-analysis. During 17.3 ± 11.3 months follow-up, DCB were associated with a similar risk of MACE (OR: 0.63, 95% CI [0.36, 1.12], p = 0.11), TLR (OR: 0.51, 95% CI [0.25, 1.06] p = 0.07), binary restenosis (OR: 0.42, 95% CI [0.09, 1.92], p = 0.26), and LLL (mean difference: -0.13 mm, 95% CI [-0.41, 0.14], p = 0.34) compared with DES. CONCLUSION In diabetic patients with de-novo coronary lesions undergoing PCI, DCBs are associated with similar outcomes compared with first-generation DES, with a signal toward potential benefit in lowering target lesion revascularization. Further randomized studies are needed to compare the newer-generation DCBs and DES in this setting.

Cardiovascular and Coronary Artery Imaging, 2022

Journal of the American College of Cardiology, 2018

Percutaneous coronary intervention (PCI) in patients with Diabetes Mellitus (DM) is associated wi... more Percutaneous coronary intervention (PCI) in patients with Diabetes Mellitus (DM) is associated with worse clinical outcomes and increased risk of restenosis compared with non-diabetic patients. The outcomes with drug-coated balloons (DCBs) in diabetic patients have received limited study. We

Cardiovascular Revascularization Medicine, 2019

BACKGROUND Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remai... more BACKGROUND Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains associated with inferior clinical outcomes and an increased risk of restenosis compared with non-diabetics even in the era of drug-eluting stents (DES). The outcomes with drug-coated balloons (DCBs) in diabetic patients have received limited study. METHODS We performed a meta-analysis of all studies published between January 2000 and January 2019 reporting the outcomes with DCB vs. DES after PCI of de-novo coronary lesions in diabetic patients. Outcomes included major adverse cardiovascular events (MACE), target lesion revascularization (TLR), binary restenosis by quantitative coronary angiography (QCA), and late lumen loss (LLL). RESULTS Three studies with 378 patients (440 lesions) were included in the meta-analysis. During 17.3 ± 11.3 months follow-up, DCB were associated with a similar risk of MACE (OR: 0.63, 95% CI [0.36, 1.12], p = 0.11), TLR (OR: 0.51, 95% CI [0.25, 1.06] p = 0.07), binary restenosis (OR: 0.42, 95% CI [0.09, 1.92], p = 0.26), and LLL (mean difference: -0.13 mm, 95% CI [-0.41, 0.14], p = 0.34) compared with DES. CONCLUSION In diabetic patients with de-novo coronary lesions undergoing PCI, DCBs are associated with similar outcomes compared with first-generation DES, with a signal toward potential benefit in lowering target lesion revascularization. Further randomized studies are needed to compare the newer-generation DCBs and DES in this setting.

MOJ Clinical & Medical Case Reports, 2019

A 83 years old woman with past medical history of coronary artery disease, had four stents nine y... more A 83 years old woman with past medical history of coronary artery disease, had four stents nine years ago, colon cancer, finished the chemotherapy course and resection fourteen years ago, iron deficiency anemia, diverticulosis of large intestine, fibromyalgia, osteopenia, presented with an episode of syncope. Patient stated she has been in her usual health when she woke up that morning. Patient took her medications which were amlodipine 10mg daily, Aspirin 81mg daily, HCTZ 25mg Daily, Metoprolol succinate 50 daily, Rosuvastatin 20mg Daily, then was doing her daily activities when she felt weak and nauseated then went to her bed and fell next to it. Syncope was witnessed by daughter who stated that patient lost consciousness for about three minutes, covered in cold sweat, no shaking, no bladder or bowel incontinence were noted. Patient did not remember any of these events. Patient's vitals were within normal limits except the heart rate was 50bpm. Basal metabolic panel and complete blood count were normal. Troponin was negative. EKG (Figure 1) demonstrated HR of 50bpm. Repeated EKG with Sinus bradycardia, HR 60bpm with 1st degree block and new LBBB. (Figure 2) Echocardiography: ejection fraction 60-65%, non significant for any changes.

It is well known that atherosclerotic involvement in diabetic patients with critical limb ischemi... more It is well known that atherosclerotic involvement in diabetic patients with critical limb ischemia (CLI) mainly affects below the knee (BTK) arteries.
For this category of fragile patients world over ,the feature of the disease /morbidity involving extended inflammation and tissue loss ,make them reluctant to undergo revascularization . However ,increasing contemporary reports are to date proposing primary angioplasty as a feasible procedure in most diabetic subjects with optimal clinical results .

MOJ Clinical & Medical Case Reports, Jul 10, 2019

A 83 years old woman with past medical history of coronary artery disease, had four stents nine y... more A 83 years old woman with past medical history of coronary artery disease, had four stents nine years ago, colon cancer, finished the chemotherapy course and resection fourteen years ago, iron deficiency anemia, diverticulosis of large intestine, fibromyalgia, osteopenia, presented with an episode of syncope. Patient stated she has been in her usual health when she woke up that morning. Patient took her medications which were amlodipine 10mg daily, Aspirin 81mg daily, HCTZ 25mg Daily, Metoprolol succinate 50 daily, Rosuvastatin 20mg Daily, then was doing her daily activities when she felt weak and nauseated then went to her bed and fell next to it. Syncope was witnessed by daughter who stated that patient lost consciousness for about three minutes, covered in cold sweat, no shaking, no bladder or bowel incontinence were noted. Patient did not remember any of these events. Patient's vitals were within normal limits except the heart rate was 50bpm. Basal metabolic panel and complete blood count were normal. Troponin was negative. EKG (Figure 1) demonstrated HR of 50bpm. Repeated EKG with Sinus bradycardia, HR 60bpm with 1st degree block and new LBBB. (Figure 2) Echocardiography: ejection fraction 60-65%, non significant for any changes.

Cardiovascular Revascularization Medicine, 2020

BACKGROUND Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remai... more BACKGROUND Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains associated with inferior clinical outcomes and an increased risk of restenosis compared with non-diabetics even in the era of drug-eluting stents (DES). The outcomes with drug-coated balloons (DCBs) in diabetic patients have received limited study. METHODS We performed a meta-analysis of all studies published between January 2000 and January 2019 reporting the outcomes with DCB vs. DES after PCI of de-novo coronary lesions in diabetic patients. Outcomes included major adverse cardiovascular events (MACE), target lesion revascularization (TLR), binary restenosis by quantitative coronary angiography (QCA), and late lumen loss (LLL). RESULTS Three studies with 378 patients (440 lesions) were included in the meta-analysis. During 17.3 ± 11.3 months follow-up, DCB were associated with a similar risk of MACE (OR: 0.63, 95% CI [0.36, 1.12], p = 0.11), TLR (OR: 0.51, 95% CI [0.25, 1.06] p = 0.07), binary restenosis (OR: 0.42, 95% CI [0.09, 1.92], p = 0.26), and LLL (mean difference: -0.13 mm, 95% CI [-0.41, 0.14], p = 0.34) compared with DES. CONCLUSION In diabetic patients with de-novo coronary lesions undergoing PCI, DCBs are associated with similar outcomes compared with first-generation DES, with a signal toward potential benefit in lowering target lesion revascularization. Further randomized studies are needed to compare the newer-generation DCBs and DES in this setting.

Cardiovascular and Coronary Artery Imaging, 2022

Journal of the American College of Cardiology, 2018

Percutaneous coronary intervention (PCI) in patients with Diabetes Mellitus (DM) is associated wi... more Percutaneous coronary intervention (PCI) in patients with Diabetes Mellitus (DM) is associated with worse clinical outcomes and increased risk of restenosis compared with non-diabetic patients. The outcomes with drug-coated balloons (DCBs) in diabetic patients have received limited study. We

Cardiovascular Revascularization Medicine, 2019

BACKGROUND Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remai... more BACKGROUND Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains associated with inferior clinical outcomes and an increased risk of restenosis compared with non-diabetics even in the era of drug-eluting stents (DES). The outcomes with drug-coated balloons (DCBs) in diabetic patients have received limited study. METHODS We performed a meta-analysis of all studies published between January 2000 and January 2019 reporting the outcomes with DCB vs. DES after PCI of de-novo coronary lesions in diabetic patients. Outcomes included major adverse cardiovascular events (MACE), target lesion revascularization (TLR), binary restenosis by quantitative coronary angiography (QCA), and late lumen loss (LLL). RESULTS Three studies with 378 patients (440 lesions) were included in the meta-analysis. During 17.3 ± 11.3 months follow-up, DCB were associated with a similar risk of MACE (OR: 0.63, 95% CI [0.36, 1.12], p = 0.11), TLR (OR: 0.51, 95% CI [0.25, 1.06] p = 0.07), binary restenosis (OR: 0.42, 95% CI [0.09, 1.92], p = 0.26), and LLL (mean difference: -0.13 mm, 95% CI [-0.41, 0.14], p = 0.34) compared with DES. CONCLUSION In diabetic patients with de-novo coronary lesions undergoing PCI, DCBs are associated with similar outcomes compared with first-generation DES, with a signal toward potential benefit in lowering target lesion revascularization. Further randomized studies are needed to compare the newer-generation DCBs and DES in this setting.

MOJ Clinical & Medical Case Reports, 2019

A 83 years old woman with past medical history of coronary artery disease, had four stents nine y... more A 83 years old woman with past medical history of coronary artery disease, had four stents nine years ago, colon cancer, finished the chemotherapy course and resection fourteen years ago, iron deficiency anemia, diverticulosis of large intestine, fibromyalgia, osteopenia, presented with an episode of syncope. Patient stated she has been in her usual health when she woke up that morning. Patient took her medications which were amlodipine 10mg daily, Aspirin 81mg daily, HCTZ 25mg Daily, Metoprolol succinate 50 daily, Rosuvastatin 20mg Daily, then was doing her daily activities when she felt weak and nauseated then went to her bed and fell next to it. Syncope was witnessed by daughter who stated that patient lost consciousness for about three minutes, covered in cold sweat, no shaking, no bladder or bowel incontinence were noted. Patient did not remember any of these events. Patient's vitals were within normal limits except the heart rate was 50bpm. Basal metabolic panel and complete blood count were normal. Troponin was negative. EKG (Figure 1) demonstrated HR of 50bpm. Repeated EKG with Sinus bradycardia, HR 60bpm with 1st degree block and new LBBB. (Figure 2) Echocardiography: ejection fraction 60-65%, non significant for any changes.