Journal of Invasive Cardiology最新文献

Objectives: The association of contrast volume to the risk of contrast-related acute kidney injury (CR-AKI) appears to have resulted in a change in daily practice toward using lower contrast volume for all patients. Distal transradial access (dTRA) has advantages in terms of faster haemostasis and lower rates of proximal radial artery occlusion. The present study aimed to describe the authors' experience with the combination of ultra-low contrast (ULC) strategy and dTRA for routine coronary procedures in a real-world and broad population of all-comers patients.

Methods: Of 6852 patients consecutively included into the DISTRACTION registry from February 2019 to July 2024, successful ULC coronary procedures via dTRA were achieved in 4328 (63.2%). Related data were retrospectively assessed.

Results: Most patients were male with acute coronary syndromes, and the mean patient age was 63.6 ± 15 years. Access-site crossover occurred in only 3% of cases. Right dTRA was the most frequently utilized primary access site, and was almost always performed with standard 6-French radial sheaths. ULC strategy was feasible for every scenario, with the overall contrast volume less than or equal to 40 mL for 96.4% of all patients, regardless of coronary bypass surgical grafts presence, percutaneous coronary intervention immediately following coronary angiography, anatomical or clinical complexity, or unavailability of intravascular ultrasound guidance. Neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA were recorded. The rates of CR-AKI were very low (1.1%).

Conclusions: When performed by experienced operators, the minimalist combination of ULC strategy and dTRA for routine coronary procedures, regardless of baseline creatinine clearance, appears to be safe and feasible.

Objectives: The use of intravascular lithotripsy (IVL) in patients with calcified coronary and peripheral arterial disease is now commonplace; however, its use in procedures specific to congenital heart disease is rare, with a very limited published case-based experience to date. The authors report the outcomes of 4 patients with congenital heart disease who underwent IVL-assisted transcatheter procedures in the effort to inform future operators as to the potential benefits and risks of this technology in this patient population.

Methods and results: Four patients underwent IVL-assisted transcatheter procedures including branch pulmonary artery stenting, aortic coarctation stenting, and transcatheter pulmonary valve replacement. All 4 patients underwent successful IVL-assisted implantation of large stents in highly calcified native or surgically implanted biological conduits without significant complications.

Conclusions: The use of IVL-assisted interventions in patients with severe native or surgical calcified vascular conduits is feasible and may be a useful adjunct in conduit stent implantation and dilation. Vascular injury during angioplasty of calcified vessels and conduits remains a concern despite the use of lithotripsy, and covered stent implantation should be considered prior to aggressive dilation in order to reduce the risk of catastrophic rupture.

A 76-year-old man diagnosed with severe pure native aortic regurgitation (PNAR) underwent transcatheter aortic valve replacement (TAVR) due to high surgical risk. The computed tomography angiography showed no calcification and no stenosis of the aortic valve, with an annulus perimeter of 81.1 mm and sinus diameters of 35 to 38 mm.

Quantification of invasive hemodynamics and mitral annular calcification-related mitral stenosis remains underexplored in patients exposed to chest radiation. We sought to explore invasive hemodynamic parameters via transseptal catheterization in patients with and without chest radiation who had a diagnosis of mitral annular calcification-related mitral stenosis. After excluding patients with more than moderate mitral regurgitation, we found that there was no difference in mitral valve area on hemodynamic testing in patients with and without radiation with an elevated baseline transmitral gradient on transthoracic echocardiography in the setting of mitral annular calcification-related mitral stenosis. There was a higher transmitral gradient and left atrial pressure in patients with prior radiation consistent with left atrial noncompliance, suggesting that treatment mitral valve stenosis may not relieve symptoms in this cohort of patients.