AsiaIntervention最新文献

Background: Distal transradial artery (dTRA) access offers benefits to patients and operators.

Aims: We sought to determine the feasibility and safety of the dTRA as a first-line vascular access site and to evaluate predictors of dTRA approach success.

Methods: This retrospective cohort study analysed consecutive patients from three Australian centres who underwent coronary angiography and percutaneous coronary intervention via the dTRA (from November 2019 to December 2023). The primary outcome was procedural success (completion of a case using the dTRA puncture site). Secondary outcomes were access site crossover, procedural safety, arterial patency at follow-up, and predictors of procedural success.

Results: A total of 1,692 patients were included (mean age 70.6±10.5 years, 59% male [n=993], mean body mass index [BMI] 31.0±7.0 kg/m², right dTRA 85%, ultrasound guidance 99%). First pass success was achieved in 92.2% (n=1,560) of patients, and 1.5% had success on the second puncture of the ipsilateral dTRA. Crossover was required in 6.3% (n=107; proximal transradial [n=78; 4.6%], contralateral dTRA [n=22; 1.3%], femoral [n=6; 0.4%], ulnar [n=1; 0.1%]). There were no major vascular complications. Access site bleeding requiring treatment occurred in 0.3% (n=5) of cases. Proximal and distal radial occlusion occurred in 0.1% and 0.4%, respectively. Thirty-day major adverse cardiovascular events occurred in 1.4% (n=24). Radial artery patency was 98% (630/641) at follow-up. Hypertension (odds ratio [OR] 1.73; p=0.029), an experienced operator (attending/consultant and ≥4 years' experience with dTRA; OR 2.80; p<0.001), and a low BMI (OR 1.48 per 10 unit decrease in BMI; p=0.012) were predictors of technical success.

Conclusions: The "distal radial first" approach is feasible and safe for coronary procedures. Factors associated with procedural success include increased operator experience, a low BMI, and hypertension.

Background: The clinical and pathophysiological characteristics of coronary artery disease in very young adults are poorly described.

Aims: Using optical coherence tomography (OCT), we compared culprit lesion morphology in very young adult patients (≤35 years) versus older adult patients (>60 years) with ST-segment elevation myocardial infarction (STEMI).

Methods: Culprit lesion morphology was classified as plaque rupture, plaque erosion, or calcified nodule. Thrombus age was subclassified into acute (intraluminal thrombus with surface irregularity) or subacute (mostly mural thrombus with a smooth surface).

Results: A total of 61 patients who underwent thrombolysis within 24 hours from symptom onset were included, with 38 (59.7%) subjects ≤35 years and 23 (40.3%) subjects >60 years of age. As an underlying mechanism of STEMI thrombosis, plaque erosion was more common in very young patients (52.6% vs 21.7%; p=0.02) while plaque rupture was more common in elderly patients (65.2% vs 36.8%; p=0.03). Acute or subacute thrombus was identified in 68.9% (42/61) of patients, with red thrombus being more frequent in very young patients. In the entire patient cohort, acute thrombus was more frequent in plaque rupture compared with plaque erosion (62.0% vs 28.0%; p=0.01), whereas subacute thrombus was more common in plaque erosion versus plaque rupture (52.0% vs 10.3%; p=0.0008).

Conclusions: OCT showed that plaque erosion and plaque rupture were the most common underlying STEMI mechanisms in very young patients and older patients, respectively, and that subjects with plaque erosion had greater evidence of subacute thrombus.

Background: Patients with acute coronary syndrome (ACS) have a higher risk of requiring target vessel revascularisation after percutaneous coronary intervention (PCI) than patients with stable angina. Neoatherosclerosis is a significant risk factor for very late stent thrombosis, and the presence of neoatherosclerosis is independently associated with major adverse cardiac events.

Aims: In this study, we used optical coherence tomography (OCT) to investigate the impact of ACS on neoatherosclerosis within 1 year after PCI.

Methods: We investigated 102 patients (122 lesions) who had undergone PCI using a second-generation drug-eluting stent (DES) from March 2017 to November 2020 and were followed up with OCT within 1 year. The patients were categorised into the ACS group or non-ACS group according to their clinical findings at the time of target lesion treatment. We used OCT to investigate the presence of neoatherosclerosis.

Results: The ACS group comprised 23 (22.5%) patients. There were no differences in the patients' clinical characteristics between the groups. The total stent length tended to be shorter in the ACS group than in the non-ACS group (24 mm vs 32 mm, respectively; p=0.09), but this difference was not statistically significant. The median duration from PCI was 290 days. Neoatherosclerosis was more frequent in ACS lesions (39% vs 4%; p<0.01), and implantation of a DES in ACS lesions was an independent predictor of neoatherosclerosis occurrence (odds ratio 9.70; p<0.01).

Conclusions: This observational study using OCT indicates that stenting for ACS lesions is associated with early in-stent neoatherosclerosis.