Journal of Invasive Cardiology最新文献

Objectives: Failure of vascular closure device (VCD) is the most common cause of access-site vascular complications in transfemoral transcatheter aortic valve implantation (TAVI). The authors sought to determine if the systematic use of arteriotomy-site ballooning with concomitant manual compression following the delivery of a plug-based VCD (MANTA, Teleflex) can optimize toggle-plug assembly apposition to the common femoral artery (CFA) wall and improve the final hemostatic efficacy.

Methods: In this prospective, observational, single-center study, 323 consecutive patients undergoing transfemoral TAVI from October 2021 to December 2024 underwent access closure with the MANTA VCD. The primary endpoints were VCD failure rate, predictors of VCD failure, and access-site and access-related major and minor vascular complications, according to the Valve Academic Research Consortium-3 definition.

Results: VCD failure occurred in 12 (3.7%) patients (Failure group). The independent predictors of failure were minimum CFA diameter and patient risk as assessed by the Society of Thoracic Surgeons Predicted Risk of Mortality score. Receiver operating characteristic analysis showed CFA minimum diameter with an area under the curve of 0.77 (0.69-0.86, P less than .001); the best cutoff was 6.30 mm (sensitivity 83%; specificity 59%; positive predictive value 7%; negative predictive value 99%). Access-site vascular complications occurred in 21 (6.5%) patients.

Conclusions: The systematic use of arteriotomy-site ballooning plus concomitant manual compression following MANTA VCD delivery should be considered to improve the final hemostatic efficacy. This device should be avoided when dealing with small (less than 6.3 mm) CFA diameters.

Objectives: The management of patients with calcified de novo lesions remains a major clinical challenge even in the era of drug-eluting stents (DES). Drug-coated balloon (DCB) therapy has emerged as an alternative to DES to treat de novo lesions. Nevertheless, the management of calcified lesions using intravascular lithotripsy (IVL) combined with DCB to treat de novo lesions has not been investigated. The authors report the short-term results of our preliminary experience with this novel approach.

Methods: The authors conducted a multicenter retrospective study of 14 patients who underwent percutaneous coronary intervention for de novo lesions treated with IVL followed by DCB in 3 centers between September 2023 and July 2024.

Results: The mean age of the patients was 69 years, and 71% were male. At 30 days, 1 patient experienced non-cardiac death. No lesion site thrombosis, target lesion revascularization (TLR), or cardiac death occurred at the 30-day follow-up. At the 6-month follow-up, 2 (14.3%) patients experienced TLR.

Conclusions: This real-world data using IVL followed by DCB (in cases of acceptable lesion preparation) in patients with de novo calcified coronary lesions suggest that this strategy is feasible and appears to have an acceptable target lesion failure rate at mid-term follow-up. This proof of concept could be hypothesis-generating for larger studies.

The authors present 2 case examples of the C-PUSH (catheter push) optical coherence tomography (OCT) technique. The C-PUSH technique allows baseline assessment of virgin (unmodified) plaque in severely stenosed vessels where blood clearance is suboptimal and when OCT acquisition is performed in the standard fashion.

Objectives: Additional studies are needed on the follow-up outcomes of 1- vs 2-stent techniques in bifurcation percutaneous coronary interventions (PCI).

Methods: The authors examined the angiographic and procedural characteristics, and outcomes of 1306 bifurcation PCIs (1139 patients) performed at 6 centers between 2014 and 2024 from the PROGRESS-BIFURCATION registry.

Results: Upfront 1-stent PCI (96.2% provisional stenting, 2% mini crush with 1 stent, 1.7% side branch [SB] stent only) was used in 75.5% of lesions; upfront 2-stent PCI was used in 24.5% (48.1% double kissing crush, 16.9% culotte, 35% other). Patients treated with an upfront 2-stent strategy were older (68 ± 12 vs 66 ± 12 years; P = .011) and more likely to have dyslipidemia (82.7% vs 76.0%; P = .019) and a history of heart failure (27.6% vs 20.3%; P = .011). An upfront 2-stent strategy was more common in left main bifurcations and lesions with moderate/severe calcification or larger SB diameter. Upfront 2-stent strategies required longer procedure and fluoroscopy times and higher patient radiation dose but similar contrast volume. Two-stent strategies were associated with higher technical success (98.4% vs 94.4%; P = .003), but similar procedural success (93.5% vs 90.4%; P = .116) and in-hospital major adverse cardiac events (MACE) (5.2% vs 3.9%; P = .355) compared with 1-stent strategies. Follow-up data was available for 783 patients. During a median follow-up of 1095 days, patients treated with an upfront 2-stent strategy had similar incidence of MACE, target vessel revascularization, myocardial infarction, and all-cause mortality (hazard ratio, 0.99; 95% CI, 0.61-1.62; P = .98).

Conclusions: Upfront 1- vs 2-stent bifurcation PCI was associated with similar procedural success and follow-up outcomes during a median follow-up of 3 years.