Journal of Invasive Cardiology最新文献

Spontaneous coronary artery dissection (SCAD) is increasingly recognized as a cause of acute myocardial infarction, especially in women and young patients. The majority of SCAD cases can be managed conservatively, but failure to revascularize in the setting of reduced coronary flow, ongoing ischemia, or hemodynamic instability can result in extensive infarction, heart failure, or death. Higher complication rates have historically been reported with percutaneous coronary intervention in SCAD because of iatrogenic dissection, non-luminal wiring, and hematoma propagation. The authors propose an algorithm for managing cases of high-risk SCAD in the cardiac catheterization laboratory where intervention is required to restore coronary flow and limit the infarction. The methods described include options to recanalize the vessel with cutting balloons and strategies for non-luminal wire position.

Objectives: There are limited data on the use of excimer laser coronary atherectomy (ELCA) in conjunction with other calcium modification devices (intravascular lithotripsy [IVL], rotational/orbital atherectomy [RA/OA]). The aim of this analysis was to compare the use of ELCA as a sole device for coronary intervention with ELCA in combination with additional calcium modification devices.

Methods: This was a retrospective analysis of all patients treated with ELCA (either as a sole modification device or in conjunction with another calcium modification device) at a single high-volume center. Data and comparisons between ELCA alone and each of the combination therapies (with IVL, with RA/OA, with both IVL and RA/OA) were presented and compared using statistical methods appropriate to the data type.

Results: This analysis included 98 interventions using ELCA (67 as a sole device, 22 with IVL, 6 with RA/OA, 3 with IVL and RA/OA). ELCA alone or in conjunction with IVL were most utilized for in stent restenosis/underexpansion compared with ELCA in conjunction with RA/OA +/-IVL, which were used more frequently for uncrossable/calcified lesions. The frequency of coronary artery perforation across the entire cohort was 4.1%. Target vessel revascularization frequency was 9.2%, and target vessel myocardial infarction was 3.1% at a median of 1051 days, with no statistically significant differences between the device groups.

Conclusions: ELCA combination therapies have a potential role in certain complex cases and though these are associated with higher risk, they can be safely performed in selected centers using radial access with good medium-term outcomes.

Objectives: The benefits of distal (dTRA) over proximal transradial access (pTRA), mainly faster hemostasis and fewer radial artery occlusion, have been highlighted. Nevertheless, data addressing chronic vs acute coronary syndromes peculiarities are lacking; thus this study aimed to assess those differences.

Methods: The authors conducted a retrospective analysis of 6871 consecutive and all-comers patients from a real-world, large-scale registry of routine coronary angiography and/or percutaneous coronary intervention (PCI) via dTRA.

Results: Mean patient ages were 63.8 ± 15.7, 64.8 ± 15.7, and 62.9 ± 16 years for total, chronic, and acute coronary syndromes groups, respectively. In the chronic coronary syndromes group (n = 2,767, 40.3%) there was predominance of hypertension (83.5% vs 72.9%; P less than .001), diabetes (46.2% vs 37.4%; P less than .001), previous PCI (37.2% vs 20.2%; P less than .001) or coronary bypass surgery (4.9% vs 2.7%; P less than .001), previous ipsilateral pTRA (13.9% vs 8.5%; P less than .001) or dTRA (21.7% vs 8.9%; P less than 0.001) sheath insertion, and ultra-low contrast procedures (66.5% vs 61.2%; P less than .001). In the acute coronary syndromes group, there was predominance of male patients (66.9% vs 63.3%; P = .002), smokers (53.9% vs 45.6%; P less than .001), total amount of PCI (72.3% vs 48.5%; P less than .001), and right dTRA (85.3% vs 70.3%; P less than .001). No major adverse events directly related to dTRA were recorded.

Conclusions: When performed by proficient operators, routine coronary procedures via dTRA appear to be safe and feasible in both chronic and acute coronary syndromes, with similar low rates of access-site crossovers and complications.