Pub Date : 2024-04-26DOI: 10.1161/CIRCINTERVENTIONS.123.013729
Arash Salavitabar, M. Eisner, Aimee K Armstrong, Brian Boe, Joanne L. Chisolm, J. Cheatham, S. Cheatham, Thomas Forbes, Thomas K Jones, G. Krings, B. Morray, Zachary L. Steinberg, Jyothsna Akam-Venkata, M. Voskuil, D. Berman
BACKGROUND Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction. METHODS This is a retrospective, multicenter study of transverse aortic arch stent implantation. Univariable and multivariable analyses were performed. RESULTS Index catheterization included 187 stent implants in 146 patients. The median age is 14.3 years (interquartile range, 9.3-19), weight is 53 kg (30-69), and follow-up is 53 months (12-120). The most common stent design was open cell (n=90, 48%). Stents overlapped 142 arch vessels (37 carotid arteries) in 118 (81%) cases. Technical and procedural success rates were 100% and 88%, respectively. Lower weight (P=0.018), body surface area (P=0.013), and minimum-to-descending aortic diameter ratio (P<0.001) were associated with higher baseline aortic gradient. The residual gradient was inversely associated with implant and final dilation diameters (P<0.001). The combined incidence of aortic injury and stent-related complications was 14%. There were no reports of abnormal brain scans or stroke. Blood pressure cuff gradient, echocardiographic arch velocity, and hypertension rates improved within 1-year follow-up with increased antihypertensive medication use. Reintervention was reported in 60 (41%) patients at a median of 84 (22-148) months to first reintervention. On multivariable logistic regression, residual aortic gradient >10 mm Hg was associated with increased odds of reintervention at all time points when controlling for each final dilation diameter, weight, and minimum-to-descending aortic diameter ratio. CONCLUSIONS Transverse aortic arch stent implantation has high rates of technical, procedural, and medium-to-long-term clinical success. Aortic gradient >10 mm Hg is associated with increased odds of reintervention at 1-year and most recent follow-ups. Open cell stent design was frequently used for its advantages in conformability, perfusion of arch vessels, low fracture rate, and the ability to perform effective angioplasty of side cells.
{"title":"Percutaneous Balloon-Expandable Stent Implantation to Treat Transverse Aortic Arch Obstruction: Medium- to Long-Term Outcomes of a Retrospective Multicenter Study.","authors":"Arash Salavitabar, M. Eisner, Aimee K Armstrong, Brian Boe, Joanne L. Chisolm, J. Cheatham, S. Cheatham, Thomas Forbes, Thomas K Jones, G. Krings, B. Morray, Zachary L. Steinberg, Jyothsna Akam-Venkata, M. Voskuil, D. Berman","doi":"10.1161/CIRCINTERVENTIONS.123.013729","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.123.013729","url":null,"abstract":"BACKGROUND\u0000Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction.\u0000\u0000\u0000METHODS\u0000This is a retrospective, multicenter study of transverse aortic arch stent implantation. Univariable and multivariable analyses were performed.\u0000\u0000\u0000RESULTS\u0000Index catheterization included 187 stent implants in 146 patients. The median age is 14.3 years (interquartile range, 9.3-19), weight is 53 kg (30-69), and follow-up is 53 months (12-120). The most common stent design was open cell (n=90, 48%). Stents overlapped 142 arch vessels (37 carotid arteries) in 118 (81%) cases. Technical and procedural success rates were 100% and 88%, respectively. Lower weight (P=0.018), body surface area (P=0.013), and minimum-to-descending aortic diameter ratio (P<0.001) were associated with higher baseline aortic gradient. The residual gradient was inversely associated with implant and final dilation diameters (P<0.001). The combined incidence of aortic injury and stent-related complications was 14%. There were no reports of abnormal brain scans or stroke. Blood pressure cuff gradient, echocardiographic arch velocity, and hypertension rates improved within 1-year follow-up with increased antihypertensive medication use. Reintervention was reported in 60 (41%) patients at a median of 84 (22-148) months to first reintervention. On multivariable logistic regression, residual aortic gradient >10 mm Hg was associated with increased odds of reintervention at all time points when controlling for each final dilation diameter, weight, and minimum-to-descending aortic diameter ratio.\u0000\u0000\u0000CONCLUSIONS\u0000Transverse aortic arch stent implantation has high rates of technical, procedural, and medium-to-long-term clinical success. Aortic gradient >10 mm Hg is associated with increased odds of reintervention at 1-year and most recent follow-ups. Open cell stent design was frequently used for its advantages in conformability, perfusion of arch vessels, low fracture rate, and the ability to perform effective angioplasty of side cells.","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":"34 12","pages":"e013729"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.1161/CIRCINTERVENTIONS.123.013191
C. Aurigemma, D. Ding, Shengxian Tu, Chunming Li, Wei Yu, Yingguang Li, Antonio Maria Leone, Enrico Romagnoli, Rocco Vergallo, Alessandro Maino, C. Trani, William Wijns, F. Burzotta
BACKGROUND The FORZA trial (FFR or OCT Guidance to Revascularize Intermediate Coronary Stenosis Using Angioplasty) prospectively compared the use of fractional flow reserve (FFR) or optical coherence tomography (OCT) for treatment decisions and percutaneous coronary intervention (PCI) optimization in patients with angiographically intermediate coronary lesions. Murray law-based quantitative-flow-ratio (μQFR) is a novel noninvasive method for the computation of FFR. In the present study, we evaluated the clinical impact of μQFR, FFR, or OCT guidance in FORZA trial lesions at 3-year follow-up. METHODS μQFR was assessed at baseline and, in the case of a decision to intervene, after (FFR- or OCT-guided) PCI. The baseline μQFR was considered the final μQFR for deferred lesions, and post-PCI μQFR value was taken as final for stented lesions. The primary end point was target vessel failure ([TVF]; cardiac death, target-vessel-related myocardial infarction, and target-vessel-revascularization) at a 3-year follow-up. RESULTS A total of 419 vessels (199 OCT-guided and 220 FFR-guided) were included in the FORZA trial. μQFR was evaluated in 256 deferred lesions and 159 treated lesions (98 OCT-guided PCI and 61 FFR-guided PCI). In treated lesions, post-PCI μQFR was higher in OCT-group compared with FFR-group (median, 0.93 versus 0.91; P=0.023), and the post-PCI μQFR improvement was greater in FFR-group (0.14 versus 0.08; P<0.0001). At 3-year follow-up, OCT- and FFR-guided treatment decisions resulted in comparable TVF rate (6.7% versus 7.9%; P=0.617). Final μQFR was the only predictor of TVF. μQFR ≤0.89 was associated with 3× increase in TVF (11.6% versus 3.7%; P=0.004). PCI was a predictor of higher final μQFR (odds ratio, 0.22 [95% CI, 0.14-0.34]; P<0.001). CONCLUSIONS In vessels with angiographically intermediate coronary lesions, OCT-guided PCI resulted in comparable clinical outcomes as FFR-guided PCI. μQFR estimated at the end of diagnostic or interventional procedure predicted 3-year TVF. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01824030.
{"title":"Three-year Clinical Impact of Murray Law-Based Quantitative Flow Ratio and OCT- or FFR-Guidance in Angiographically Intermediate Coronary Lesions.","authors":"C. Aurigemma, D. Ding, Shengxian Tu, Chunming Li, Wei Yu, Yingguang Li, Antonio Maria Leone, Enrico Romagnoli, Rocco Vergallo, Alessandro Maino, C. Trani, William Wijns, F. Burzotta","doi":"10.1161/CIRCINTERVENTIONS.123.013191","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.123.013191","url":null,"abstract":"BACKGROUND\u0000The FORZA trial (FFR or OCT Guidance to Revascularize Intermediate Coronary Stenosis Using Angioplasty) prospectively compared the use of fractional flow reserve (FFR) or optical coherence tomography (OCT) for treatment decisions and percutaneous coronary intervention (PCI) optimization in patients with angiographically intermediate coronary lesions. Murray law-based quantitative-flow-ratio (μQFR) is a novel noninvasive method for the computation of FFR. In the present study, we evaluated the clinical impact of μQFR, FFR, or OCT guidance in FORZA trial lesions at 3-year follow-up.\u0000\u0000\u0000METHODS\u0000μQFR was assessed at baseline and, in the case of a decision to intervene, after (FFR- or OCT-guided) PCI. The baseline μQFR was considered the final μQFR for deferred lesions, and post-PCI μQFR value was taken as final for stented lesions. The primary end point was target vessel failure ([TVF]; cardiac death, target-vessel-related myocardial infarction, and target-vessel-revascularization) at a 3-year follow-up.\u0000\u0000\u0000RESULTS\u0000A total of 419 vessels (199 OCT-guided and 220 FFR-guided) were included in the FORZA trial. μQFR was evaluated in 256 deferred lesions and 159 treated lesions (98 OCT-guided PCI and 61 FFR-guided PCI). In treated lesions, post-PCI μQFR was higher in OCT-group compared with FFR-group (median, 0.93 versus 0.91; P=0.023), and the post-PCI μQFR improvement was greater in FFR-group (0.14 versus 0.08; P<0.0001). At 3-year follow-up, OCT- and FFR-guided treatment decisions resulted in comparable TVF rate (6.7% versus 7.9%; P=0.617). Final μQFR was the only predictor of TVF. μQFR ≤0.89 was associated with 3× increase in TVF (11.6% versus 3.7%; P=0.004). PCI was a predictor of higher final μQFR (odds ratio, 0.22 [95% CI, 0.14-0.34]; P<0.001).\u0000\u0000\u0000CONCLUSIONS\u0000In vessels with angiographically intermediate coronary lesions, OCT-guided PCI resulted in comparable clinical outcomes as FFR-guided PCI. μQFR estimated at the end of diagnostic or interventional procedure predicted 3-year TVF.\u0000\u0000\u0000REGISTRATION\u0000URL: https://www.clinicaltrials.gov; Unique identifier: NCT01824030.","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":"21 13","pages":"e013191"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140657832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.1161/CIRCINTERVENTIONS.124.014128
Hoyle L. Whiteside, Nadia R. Sutton
{"title":"Compunction: The Present Tense of Physiology to Guide Coronary Revascularization in Severe Aortic Stenosis.","authors":"Hoyle L. Whiteside, Nadia R. Sutton","doi":"10.1161/CIRCINTERVENTIONS.124.014128","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014128","url":null,"abstract":"","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":"19 2","pages":"e014128"},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1161/CIRCINTERVENTIONS.124.014076
M. Nobre Menezes, M. Mamas
{"title":"PCI in Cancer Patients: Adding Another Piece to a Complex and Still Very Incomplete Puzzle.","authors":"M. Nobre Menezes, M. Mamas","doi":"10.1161/CIRCINTERVENTIONS.124.014076","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014076","url":null,"abstract":"","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":"257 ","pages":"e014076"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1161/CIRCINTERVENTIONS.124.014078
J. Traverse
{"title":"Use of Pressure-Controlled Intermittent Coronary Sinus Occlusion in STEMI: The Road Not Taken!","authors":"J. Traverse","doi":"10.1161/CIRCINTERVENTIONS.124.014078","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014078","url":null,"abstract":"","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":"47 5","pages":"e014078"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/s0735-1097(24)03166-8
Kenneth L. Harkin, Ethan Loftspring, William Beaty, Amanda Joa, Claudia Serrano-Gomez, Ayman Farid, A. Hausvater, H. Reynolds, N. Smilowitz
{"title":"Visual Estimates of Coronary Slow Flow Are Not Associated with Invasive Wire-Based Diagnoses of Coronary Microvascular Dysfunction.","authors":"Kenneth L. Harkin, Ethan Loftspring, William Beaty, Amanda Joa, Claudia Serrano-Gomez, Ayman Farid, A. Hausvater, H. Reynolds, N. Smilowitz","doi":"10.1016/s0735-1097(24)03166-8","DOIUrl":"https://doi.org/10.1016/s0735-1097(24)03166-8","url":null,"abstract":"","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":"43 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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