Journal of the Society for Cardiovascular Angiography & Interventions最新文献

Background: The effectiveness of current statin therapy in achieving lipid targets in Indian patients remains uncertain. This observational study aimed to evaluate lipid goal attainment at 1 and 6 months with atorvastatin and rosuvastatin in statin-naïve South Indian patients undergoing percutaneous coronary intervention (PCI).

Methods: This prospective, observational, single-center study included 491 statin-naïve patients who underwent PCI between March 2021 and May 2023. Effects of statins on low-density lipoprotein cholesterol (LDL-C) reduction and lipid goal achievement were assessed at 1 and 6 months. Secondary objectives compared the individual efficacy of atorvastatin vs rosuvastatin, the impact of baseline lipids, statin switching, and the association between lipid goal achievement and major adverse cardiovascular events.

Results: Among 491 patients (mean age, 58.7 years), 437 (89%) presented with acute coronary syndrome. Atorvastatin was prescribed to 327 (66%) and rosuvastatin to 164 (34%). Baseline LDL-C was lower in the rosuvastatin group (122.7 ± 46.2 vs 138.2 ± 48.5 mg/dL; P = .001). At 1 month, 41% achieved American Heart Association/American College of Cardiology lipid goals (47.6% with rosuvastatin vs 37.1% with atorvastatin; P = .041). Atorvastatin to rosuvastatin switching was done in 113 (34.6%) patients. By 6 months, 42.5% achieved goals. Rosuvastatin showed better LDL-C goal attainment (62.8% vs 38.2%; P < .001). Rosuvastatin switching modestly improved outcomes (P ≤ .036).

Conclusions: Only 41.1% and 42.5% of statin-naïve Indian patients undergoing PCI achieved lipid goals on statins at 1 and 6 months, suggesting a need for more intensive lipid-lowering strategies post-PCI. Rosuvastatin was marginally more efficacious than atorvastatin.

Background: Chronic limb-threatening ischemia (CLTI) has a high risk of limb amputation without revascularization. In the Best Surgical Therapy in CLTI (BEST-CLI) trial, endovascular revascularization had a higher risk of major adverse limb events (MALE) or death compared with surgical bypass with a good quality vein. However, endovascular revascularization is still required for patients with poor vein options or high surgical risk. We assessed the factors related to MALE or death among patients with a successful endovascular intervention in the BEST-CLI trial.

Methods: All patients with successful endovascular revascularization in the BEST-CLI trial were followed for a mean of 2.7 years. Baseline patient characteristics, lesion characteristics, and endovascular techniques were compared with the subsequent risk of MALE or death. Multivariable models estimated hazard ratios (HRs) and 95% CIs from Cox proportional hazards models.

Results: Of the 923 patients having endovascular revascularization, 773 (84%) had a successful index procedure. In femoral-popliteal interventions, MALE or death was associated with end-stage renal disease (HR, 1.64; 95% CI, 1.17-2.29), wounds at or above the ankle (HR, 2.13; 95% CI, 1.38-3.29), and longer procedure time (HR, 1.15 per 120 minutes; 95% CI, 1.02-1.30). In below-knee popliteal-tibial interventions, MALE or death was associated with diabetes mellitus (HR, 1.69; 95% CI, 1.18-2.43), end-stage renal disease (HR, 1.80; 95% CI, 1.26-2.57), and longer procedure time (HR, 1.28 per 120 minutes; 95% CI, 1.11-1.47). Interventional technique, including drug-coated technologies, did not relate to MALE or death.

Conclusions: Patient factors were strongly related to MALE or death after successful endovascular revascularization for CLTIs. Endovascular techniques, including drug-coated balloons and stents, were not consistently related to MALE or death in this high-risk population of patients with CLTI, justifying their use when needed for complex disease.

Background: Reducing the number of device exchanges during a left atrial appendage (LAA) closure procedure can minimize the risk of injury, air embolism, and thrombus, and optimize procedural workflow. This study compared zero-exchange transseptal puncture (TSP) workflows facilitated by VersaCross Connect (VCC) that integrate directly into WATCHMAN (WM) therapy sheaths (FXD Curve Access [FXD] and TruSteer), with other TSP devices.

Methods: Retrospective chart analysis was performed comparing a radiofrequency needle TSP device, requiring multiple exchanges (NRG, n = 30), requiring at least 1 exchange (VersaCross Large Access, n = 49), to a zero-exchange workflow with VCC paired with WM FXD (VCC-FXD, n = 215), or TruSteer Access (TS) (VCC-TS, n = 78) in terms of time to TSP from procedure start and time to initial WM deployment post-TSP in LAA.

Results: One hundred percent TSP success was achieved in all attempts (n = 372). One reported in-hospital death occurred (1/372, 0.27%, reported as not related to TSP). TSP was similar in all groups. Time to initial WM deployment was significantly improved with zero-exchange devices, as was consistency between cases. Subanalysis of the 2 therapy sheaths integrated to VCC performed similarly in time to TSP time, and to initial WM deployment (VCC-FXD = 8.0 ± 4.0 minutes, VCC-TS = 8.1 ± 4.5; P > .999).

Conclusions: Use of VCC, providing a zero-exchange solution for LAA closure, resulted in an improved workflow and consistency of the first deployment of the WM device in LAA. Integration with FXD or TruSteer sheaths resulted in similar improvements overall.

Transseptal puncture (TSP) is a critical step in left atrial appendage closure. This consensus document reviews the evolution of TSP techniques and instrumentation, comparing conventional mechanical methods with radiofrequency-assisted approaches. It highlights the importance of imaging-based preplanning with transoesophageal echocardiography and multislice computed tomography to optimize TSP positioning and procedural outcomes. The inferoposterior fossa ovalis position is generally preferred to achieve coaxial device alignment and enhance safety and efficacy, whereas alternative TSP positions may suit better specific complex anatomies. Procedural guidance under transoesophageal echocardiography and intracardiac echocardiography-guidedosto TSP is illustrated, and a stepwise strategy for challenging cases is outlined. We propose an algorithm for TSP preplanning and intraprocedural guidance, along with expert consensus recommendations developed during the second European Left Atrial Appendage Club meeting.

Recanalization of chronic venous occlusions is sometimes technically challenging. We present a rare case of venous occlusion, due to previous intravenous femoral drug use, with a fibrotic perivenous tissue in the groin, hard to cross. This patient presented with severe venous claudication with an active ulcer. After failure of conventional attempts, we opted for a more aggressive strategy using a modified Chiba needle (Cook Medical)-assisted sharp recanalization technique. We achieved initial technical success in recanalization, but thrombosis eventually recurred because of residual compression on the created extravascular tract. However, the patient showed clinical improvement, and we chose not to attempt another procedure. This case report emphasizes the use of this unconventional crossing technique and provides a detailed, didactic description of the equipment and procedural steps, aiming to illustrate its potential role and limitations in complex venous recanalization.

Background: Bronchial compression (BC) can occur after surgical repair of coarctation of the aorta (CoA); however, its incidence after stent implantation is not well understood. This study investigates the incidence, risk factors, and mechanisms of BC in patients undergoing surgical repair and stent implantation for CoA.

Methods: A retrospective review of patients aged 0-25 years who underwent CoA procedures at Rady Children's Hospital (San Diego, CA) between January 2007 and November 2022 was performed. Patients with computed tomography were included. BC was defined as an affected bronchus measuring <80% of the contralateral bronchus. Patients were divided into 3 groups: (1) group A-stent implantation only; (2) group B-surgical repair only; and (3) group C-surgical repair followed by stent implantation.

Results: Among 205 patients with CoA, 148 met the inclusion criteria. The cohort was 64% male, with a median age at diagnosis of 2 days (IQR 0-54); 18% had single ventricle physiology. Group A included 15 patients (10%), group B had 119 patients (80%), and group C had 14 patients (9%). Surgical patients were younger (median 16 days [IQR, 8-54]) than stent patients [median 1939 days [IQR, 1220-2538]) at the time of the first intervention. BC was observed in 39 (26%) patients. Ten had preprocedural BC; 3 worsened postprocedure. De novo BC incidence was 7% (1/15) in group A, 18% (22/119) in group B, and 43% (6/14) in group C. Three patients required additional BC interventions.

Conclusions: BC incidence in CoA patients is increased and can be exacerbated by procedures. Although most patients with BC did not require intervention, considering preprocedural and postprocedural BC monitoring is recommended for timely diagnosis and management.

Background: Guide extension catheters are integral to coronary intervention. First-generation guide catheter extension devices are monorail, blunt-ended tubular structures with limitations. CrossFAST (Vantis Vascular) is a next-generation, microcatheter-led advanced device delivery system intended to allow safe, deep coronary intubation to assist in complex percutaneous coronary intervention.

Methods: The CrossFAST device delivery system was FDA 510(k) cleared in December 2024. We describe this new technology and review 4 of the early clinical cases utilizing CrossFAST to assist in complex percutaneous coronary intervention.

Results: The CrossFAST system was used successfully to assist in-stent delivery in all 4 of these cases: Distal right coronary artery, proximal plus mid left circumflex, mid left anterior descending, and proximal diagonal. The device crossed the target lesion in all cases, allowing seamless stent delivery without complications after conventional attempts, including guide extension catheters, had failed.

Conclusions: The CrossFAST was used successfully in the treatment of these 4 complex, calcific, coronary artery disease cases, to assist in coronary device delivery and placement. Additional data will be needed to further evaluate the safety and efficacy of this technology as compared to conventional approaches to complex coronary artery disease.

Background: With the growing use of radial access in coronary angiography, rare but significant complications such as radial artery pseudoaneurysms are increasingly encountered. This arises when arterial wall disruption leads to a soft tissue hematoma with persistent communication with the arterial lumen. Literature on management remains scarce and consists of a few case reports.

Methods: We conducted a systematic review of cases describing radial artery pseudoaneurysms following coronary angiography from January 1992 to February 2025 using PubMed, Scopus, and Google Scholar. Data extracted included patient demographics, anticoagulant use, clinical presentation, pseudoaneurysm dimensions, timing of symptom onset, and treatment strategies with associated outcomes.

Results: A total of 56 publications comprising 75 patients were analyzed. Mean age was 70.9 years, with predominance in women (58.3%), albeit statistically nonsignificant (P = .157). All patients had access site swelling, and half had pain. Most pseudoaneurysms developed within the first month postprocedure (81.6%). Chronic anticoagulant use was reported in 58.3% of patients, with warfarin being the most common agent. Four primary treatment modalities were reported: compression (n = 24), thrombin injection (n = 9), percutaneous interventions (n = 6), and surgery (n = 36). Compression was the most frequently used but least effective method, with a 58.5% success rate as compared to 100% in the other methods.

Conclusions: Radial artery pseudoaneurysms are rare but potentially serious complications of transradial coronary procedures. Although compression is commonly attempted, invasive treatments offer superior efficacy.

Background: Mitral transcatheter edge-to-edge repair (MTEER) and guideline-directed medical therapy (GDMT) may be used to treat functional mitral regurgitation (FMR) with heart failure (HF). The optimal management of FMR is unclear.

Methods: We performed a contemporary systematic review and meta-analysis comparing MTEER vs GDMT. PubMed, Embase, and Cochrane Central were systematically searched for randomized controlled trials and propensity score matched studies comparing outcomes of MTEER plus GDMT vs GDMT alone in FMR with HF. Odds ratios and risk ratios (RRs) with 95% CI were estimated using random-effects models.

Results: Three randomized controlled trials and 5 propensity score matched studies were identified (n = 2588) comparing MTEER (52.2%) vs GDMT alone (47.8%) for FMR with HF. MTEER was associated with lower risks of 12-month all-cause mortality (RR, 0.74; 95% CI, 0.58-0.95; P = .02), cardiovascular mortality (RR, 0.59; 95% CI, 0.38-0.93; P = .02), and HF hospitalization (RR, 0.64; 95% CI, 0.48-0.86; P < .001) compared with GDMT alone. Additionally, the MTEER group was more likely to achieve New York Heart Association class I/II at 12 months (odds ratio, 2.11; 95% CI, 1.48-2.99; P < .01) than the GDMT group. In contrast, the GDMT group had a significantly lower risk of mitral regurgitation recurrence than the MTEER group (RR, 2.20; 95% CI, 1.79-2.71; P < .01). There was no statistically significant difference in the risk of myocardial infarction or stroke between the groups.

Conclusion: MTEER reduced all-cause cardiovascular mortality and HF hospitalization in patients with FMR and HF compared with GDMT alone. Additionally, MTEER resulted in a significant improvement in functional status in these patients.