Pub Date : 2025-02-01DOI: 10.1016/j.jscai.2025.102572
Eric Rosenthal MD, FRCP, Matthew I. Jones MBBS
{"title":"Covered Stent Correction of Sinus Venosus Atrial Septal Defects—Continued Technical Modifications Drive the Procedure Forward","authors":"Eric Rosenthal MD, FRCP, Matthew I. Jones MBBS","doi":"10.1016/j.jscai.2025.102572","DOIUrl":"10.1016/j.jscai.2025.102572","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102572"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jscai.2024.102521
Frank F. Ing MD
{"title":"Dr. Charles E. Mullins—January 15, 1932, to November 17, 2024","authors":"Frank F. Ing MD","doi":"10.1016/j.jscai.2024.102521","DOIUrl":"10.1016/j.jscai.2024.102521","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102521"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jscai.2024.102462
Ivan D. Hanson MD , Andres Palomo MD , Adam Tawney MD , Simon R. Dixon MBChB , Dana Bentley MWC , Srihari S. Naidu MD , Mir B. Basir DO , William W. O’Neill MD
Background
The present analysis reports characteristics and outcomes of Society of Cardiovascular Angiography & Interventions (SCAI) stage E shock patients with acute myocardial infarction with cardiogenic shock (AMICS) undergoing percutaneous coronary intervention (PCI) who improved to stage C or D within 24 hours of Impella support (“responders”) vs those patients who remained in stage E (“nonresponders”).
Methods
The SCAI shock stage was assigned prior to initiation of Impella, and a second SCAI shock classification was performed within 24 hours of Impella support. SCAI shock stage was assigned independently by 2 reviewers; in cases where there was a discrepancy, a third reviewer adjudicated the stage assignment. Criteria such as a low pH (≤7.1), the need for multiple vasopressors/mechanical circulatory support devices, or the need for cardiopulmonary resuscitation were used to define stage E shock.
Results
Of the 415 RECOVER III patients, 298 presented in stage E shock; 152 (51.1%) were responders and 145 (48.8%) were nonresponders. Kaplan-Meier 30-day survival estimates were 56.9% and 28.6% in responders and nonresponders, respectively (P < .001). In multivariate analysis, fewer inotropic medications during Impella support (P < .0001), more lesions treated (P = .01), Impella support initiated pre-PCI (P = .03), and baseline white blood cell (P = .048) were all significant predictors for responsiveness to therapy.
Conclusions
Stage E patients who improved to stage C/D within 24 hours of Impella support had significantly better survival than those who remained in stage E. Predictors of responsiveness to therapy were mostly related to shock treatment strategy, and not baseline characteristics. This suggests that whether stage E patients will improve with Impella support is difficult to determine at the time support is initiated, and the SCAI shock stage should be repeated within 24 hours to more accurately determine the prognosis.
{"title":"Acute Myocardial Infarction and Stage E Shock: Insights From the RECOVER III Study","authors":"Ivan D. Hanson MD , Andres Palomo MD , Adam Tawney MD , Simon R. Dixon MBChB , Dana Bentley MWC , Srihari S. Naidu MD , Mir B. Basir DO , William W. O’Neill MD","doi":"10.1016/j.jscai.2024.102462","DOIUrl":"10.1016/j.jscai.2024.102462","url":null,"abstract":"<div><h3>Background</h3><div>The present analysis reports characteristics and outcomes of Society of Cardiovascular Angiography & Interventions (SCAI) stage E shock patients with acute myocardial infarction with cardiogenic shock (AMICS) undergoing percutaneous coronary intervention (PCI) who improved to stage C or D within 24 hours of Impella support (“responders”) vs those patients who remained in stage E (“nonresponders”).</div></div><div><h3>Methods</h3><div>The SCAI shock stage was assigned prior to initiation of Impella, and a second SCAI shock classification was performed within 24 hours of Impella support. SCAI shock stage was assigned independently by 2 reviewers; in cases where there was a discrepancy, a third reviewer adjudicated the stage assignment. Criteria such as a low pH (≤7.1), the need for multiple vasopressors/mechanical circulatory support devices, or the need for cardiopulmonary resuscitation were used to define stage E shock.</div></div><div><h3>Results</h3><div>Of the 415 RECOVER III patients, 298 presented in stage E shock; 152 (51.1%) were responders and 145 (48.8%) were nonresponders. Kaplan-Meier 30-day survival estimates were 56.9% and 28.6% in responders and nonresponders, respectively (<em>P</em> < .001). In multivariate analysis, fewer inotropic medications during Impella support (<em>P</em> < .0001), more lesions treated (<em>P</em> = .01), Impella support initiated pre-PCI (<em>P</em> = .03), and baseline white blood cell (<em>P</em> = .048) were all significant predictors for responsiveness to therapy.</div></div><div><h3>Conclusions</h3><div>Stage E patients who improved to stage C/D within 24 hours of Impella support had significantly better survival than those who remained in stage E. Predictors of responsiveness to therapy were mostly related to shock treatment strategy, and not baseline characteristics. This suggests that whether stage E patients will improve with Impella support is difficult to determine at the time support is initiated, and the SCAI shock stage should be repeated within 24 hours to more accurately determine the prognosis.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102462"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transcatheter correction of sinus venosus defects use balloon-expandable covered stents across the cavoatrial junction to redirect the anomalous right upper pulmonary vein to the left atrium. When the superior vena caval anchor zone is very short, the stent slips caudally, causing residual flows from the right upper pulmonary vein through the cranial end of the stent or embolizes to the right atrium. We report use of a new hybrid stent with an uncovered cranial part deployed by a novel 2-wire strategy that enabled a safe procedure in patients with sinus venosus defects and a short superior vena caval anchor zone.
{"title":"New Covered Stent Design for Correcting Sinus Venosus Defects and a Novel Deployment Technique: A Case Series","authors":"Kothandam Sivakumar MD, DM, Pramod Sagar MD, DM, Thejaswi Puthiyedath MD, DrNB","doi":"10.1016/j.jscai.2024.102501","DOIUrl":"10.1016/j.jscai.2024.102501","url":null,"abstract":"<div><div>Transcatheter correction of sinus venosus defects use balloon-expandable covered stents across the cavoatrial junction to redirect the anomalous right upper pulmonary vein to the left atrium. When the superior vena caval anchor zone is very short, the stent slips caudally, causing residual flows from the right upper pulmonary vein through the cranial end of the stent or embolizes to the right atrium. We report use of a new hybrid stent with an uncovered cranial part deployed by a novel 2-wire strategy that enabled a safe procedure in patients with sinus venosus defects and a short superior vena caval anchor zone.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102501"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jscai.2024.102457
Daniel Bandeira MD , Steven Pfau MD , Daniel Chamié MD, PhD
{"title":"Sailing in Dark Waters: The Challenging Management of Recurrent In-Stent Calcified Nodule Protrusion","authors":"Daniel Bandeira MD , Steven Pfau MD , Daniel Chamié MD, PhD","doi":"10.1016/j.jscai.2024.102457","DOIUrl":"10.1016/j.jscai.2024.102457","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102457"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/S2772-9303(25)00045-6
{"title":"Cover","authors":"","doi":"10.1016/S2772-9303(25)00045-6","DOIUrl":"10.1016/S2772-9303(25)00045-6","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102604"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jscai.2024.102495
Karthik Vedantam MD , Christian A. Torres MD , Sammy Elmariah MD , Pedro Villablanca MD , Mario Goessl MD, PhD , Alan Zajarias MD , Martin B. Leon MD , Nirat Beohar MD
Background
Aortic stenosis is the most frequently acquired native valve disease. Transcatheter aortic valve replacement (TAVR) has emerged as a transformative intervention for patients with severe aortic stenosis. Despite its success, studies have shed light on racial and ethnic disparities in utilization and outcomes of TAVR.
Methods
Using the Transcatheter Valve Therapy Registry between November 2011 through June 2023, we evaluated volume trends of SAPIEN balloon-expandable TAVR performed by race/ethnicity, and its association with in-hospital and 1-year outcomes after the procedure.
Results
In the 12-year period, 395,618 patients were identified; 357,729 (90.42%) were White, 18,810 (4.75%) Hispanic, 15,100 (3.82%) Black, and 3979 (1.01%) Asian. There was an overall rising trend in proportional usage of TAVR among Hispanics (from 3.3% in 2011/2012 to 5.2% in 2023, P < .01) and Asian patients (from 1.1% in 2011/2012 to 1.3% in 2023, P < .01). Adjusted 1-year major adverse cardiac events (all-cause mortality, stroke, or rehospitalization) were comparable among Black patients (hazard ratio [HR], 1.00; 95% CI, 0.97-1.03; P = .82) and lower among Asian (HR, 0.91; 95% CI, 0.86-0.97; P < .01) and Hispanic patients (HR, 0.89; 95% CI, 0.86-0.91; P < .01) compared with White patients.
Conclusions
Evidence supports favorable outcomes across different ethnic groups, despite the presence of higher levels of comorbidities and lower TAVR utilization. Modest improvements in TAVR utilization disparities among Asian and Hispanic patients have occurred since its introduction; however, utilization in Black patients remains low despite favorable outcomes. Further efforts are needed to understand the reasons and mitigate disparities in minority patients.
{"title":"Racial Disparities Among Patients Undergoing Balloon-Expandable Transcatheter Aortic Valve Replacement","authors":"Karthik Vedantam MD , Christian A. Torres MD , Sammy Elmariah MD , Pedro Villablanca MD , Mario Goessl MD, PhD , Alan Zajarias MD , Martin B. Leon MD , Nirat Beohar MD","doi":"10.1016/j.jscai.2024.102495","DOIUrl":"10.1016/j.jscai.2024.102495","url":null,"abstract":"<div><h3>Background</h3><div>Aortic stenosis is the most frequently acquired native valve disease. Transcatheter aortic valve replacement (TAVR) has emerged as a transformative intervention for patients with severe aortic stenosis. Despite its success, studies have shed light on racial and ethnic disparities in utilization and outcomes of TAVR.</div></div><div><h3>Methods</h3><div>Using the Transcatheter Valve Therapy Registry between November 2011 through June 2023, we evaluated volume trends of SAPIEN balloon-expandable TAVR performed by race/ethnicity, and its association with in-hospital and 1-year outcomes after the procedure.</div></div><div><h3>Results</h3><div>In the 12-year period, 395,618 patients were identified; 357,729 (90.42%) were White, 18,810 (4.75%) Hispanic, 15,100 (3.82%) Black, and 3979 (1.01%) Asian. There was an overall rising trend in proportional usage of TAVR among Hispanics (from 3.3% in 2011/2012 to 5.2% in 2023, <em>P</em> < .01) and Asian patients (from 1.1% in 2011/2012 to 1.3% in 2023, <em>P</em> < .01). Adjusted 1-year major adverse cardiac events (all-cause mortality, stroke, or rehospitalization) were comparable among Black patients (hazard ratio [HR], 1.00; 95% CI, 0.97-1.03; <em>P</em> = .82) and lower among Asian (HR, 0.91; 95% CI, 0.86-0.97; <em>P</em> < .01) and Hispanic patients (HR, 0.89; 95% CI, 0.86-0.91; <em>P</em> < .01) compared with White patients.</div></div><div><h3>Conclusions</h3><div>Evidence supports favorable outcomes across different ethnic groups, despite the presence of higher levels of comorbidities and lower TAVR utilization. Modest improvements in TAVR utilization disparities among Asian and Hispanic patients have occurred since its introduction; however, utilization in Black patients remains low despite favorable outcomes. Further efforts are needed to understand the reasons and mitigate disparities in minority patients.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102495"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jscai.2024.102496
Sheriff N. Dodoo MD , Benedicta Arhinful MD , Sammudeen Ibrahim MD , Olayiwola Bolaji MD , Afia S. Dodoo PharmD , Tracy Aggrey-Ansong BS , Vedang Bhavsar MD , Ugochukwu Egolum MD , Nima Ghasemzadeh MD , Ronnie Ramadan MD , Zachary H. George MD , Uzoma Ibebuogu MD , Habib Samady MD
Background
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist is the standard antithrombotic therapy after percutaneous coronary intervention (PCI); however, the optimal duration of this treatment remains a topic of ongoing debate. This study aimed to assess the clinical utility of an ultrashort dual antiplatelet therapy (US-DAPT) regimen (≤1 month) compared with standard DAPT (≥6 months) after PCI. In addition, the outcomes of choosing single antiplatelet therapy after US-DAPT, either clopidogrel or ticagrelor, were also analyzed.
Methods
We queried MEDLINE, Cochrane Central Registry of Controlled Trials, Embase, and ClinicalTrials.gov databases from their commencement to May 2024 for all randomized controlled trials (RCTs) that directly compared US-DAPT (≤1 month) with standard therapy (≥6 months). The primary end point was net adverse clinical events (NACE), defined as a composite of major adverse cardiovascular or cerebrovascular events (MACCE) and clinically relevant bleeding (CRB).
Results
Seven RCTs were included in the analysis, comprising 34,774 patients (US-DAPT, n = 17,383; standard therapy, n = 17,391) who were enrolled with a mean age of 67 ± 10 years and 74.7% male. US-DAPT was associated with a 20% lower risk of NACE (OR, 0.80; 95% CI, 0.68-0.94; P = .006; I2 = 74%) and 47% reduction in CRB (OR, 0.53; 95% CI, 0.37-0.75; P < .001; I2 = 77%) compared with standard therapy at 12 months. Similarly, US-DAPT was associated with statistically significant reduction in all-cause mortality (OR, 0.88; 95% CI, 0.77-0.99; P = .04; I2 = 0%) and TVR (OR, 0.87; 95% CI, 0.78-0.98; P = .02; I2 = 41%) However, no significant difference in MACCE, all-cause mortality, cardiovascular disease–related deaths, MI, stroke, MI, TVR, and ST was observed.
Conclusions
In patients undergoing PCI, US-DAPT was associated with lower NACEs and bleeding risk without increasing the occurrence of ischemic events, including ST and MI, when compared with at least 6 months of DAPT, irrespective of the choice of single antiplatelet therapy, whether clopidogrel or ticagrelor, following DAPT.
{"title":"Ultrashort Versus 1-Year Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention: Meta-analysis of Randomized Controlled Trials","authors":"Sheriff N. Dodoo MD , Benedicta Arhinful MD , Sammudeen Ibrahim MD , Olayiwola Bolaji MD , Afia S. Dodoo PharmD , Tracy Aggrey-Ansong BS , Vedang Bhavsar MD , Ugochukwu Egolum MD , Nima Ghasemzadeh MD , Ronnie Ramadan MD , Zachary H. George MD , Uzoma Ibebuogu MD , Habib Samady MD","doi":"10.1016/j.jscai.2024.102496","DOIUrl":"10.1016/j.jscai.2024.102496","url":null,"abstract":"<div><h3>Background</h3><div>Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist is the standard antithrombotic therapy after percutaneous coronary intervention (PCI); however, the optimal duration of this treatment remains a topic of ongoing debate. This study aimed to assess the clinical utility of an ultrashort dual antiplatelet therapy (US-DAPT) regimen (≤1 month) compared with standard DAPT (≥6 months) after PCI. In addition, the outcomes of choosing single antiplatelet therapy after US-DAPT, either clopidogrel or ticagrelor, were also analyzed.</div></div><div><h3>Methods</h3><div>We queried MEDLINE, Cochrane Central Registry of Controlled Trials, Embase, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> databases from their commencement to May 2024 for all randomized controlled trials (RCTs) that directly compared US-DAPT (≤1 month) with standard therapy (≥6 months). The primary end point was net adverse clinical events (NACE), defined as a composite of major adverse cardiovascular or cerebrovascular events (MACCE) and clinically relevant bleeding (CRB).</div></div><div><h3>Results</h3><div>Seven RCTs were included in the analysis, comprising 34,774 patients (US-DAPT, n = 17,383; standard therapy, n = 17,391) who were enrolled with a mean age of 67 ± 10 years and 74.7% male. US-DAPT was associated with a 20% lower risk of NACE (OR, 0.80; 95% CI, 0.68-0.94; <em>P</em> = .006; <em>I</em><sup>2</sup> = 74%) and 47% reduction in CRB (OR, 0.53; 95% CI, 0.37-0.75; <em>P</em> < .001; <em>I</em><sup>2</sup> = 77%) compared with standard therapy at 12 months. Similarly, US-DAPT was associated with statistically significant reduction in all-cause mortality (OR, 0.88; 95% CI, 0.77-0.99; <em>P</em> = .04; <em>I</em><sup>2</sup> = 0%) and TVR (OR, 0.87; 95% CI, 0.78-0.98; <em>P</em> = .02; <em>I</em><sup>2</sup> = 41%) However, no significant difference in MACCE, all-cause mortality, cardiovascular disease–related deaths, MI, stroke, MI, TVR, and ST was observed.</div></div><div><h3>Conclusions</h3><div>In patients undergoing PCI, US-DAPT was associated with lower NACEs and bleeding risk without increasing the occurrence of ischemic events, including ST and MI, when compared with at least 6 months of DAPT, irrespective of the choice of single antiplatelet therapy, whether clopidogrel or ticagrelor, following DAPT.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102496"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jscai.2024.102492
Helen S. Anwar MD , José M. Montero-Cabezas MD, PhD , Frank Van Der Kley MD, PhD
Transcatheter aortic valve replacement (TAVR) has emerged as a widely approved intervention for managing severe aortic stenosis. As the number of patients undergoing TAVR continues to rise, certain cases present unique challenges, particularly in relation to vascular access. This report highlights a case of successful transfemoral TAVR performed in a patient with an exceptionally tortuous and elongated aortic arch, characterized by significant curvature reminiscent of the treble clef musical symbol.
{"title":"Navigating Treble Clef Aorta: A Challenge for Transfemoral Transcatheter Aortic Valve Replacement—A Case Report","authors":"Helen S. Anwar MD , José M. Montero-Cabezas MD, PhD , Frank Van Der Kley MD, PhD","doi":"10.1016/j.jscai.2024.102492","DOIUrl":"10.1016/j.jscai.2024.102492","url":null,"abstract":"<div><div>Transcatheter aortic valve replacement (TAVR) has emerged as a widely approved intervention for managing severe aortic stenosis. As the number of patients undergoing TAVR continues to rise, certain cases present unique challenges, particularly in relation to vascular access. This report highlights a case of successful transfemoral TAVR performed in a patient with an exceptionally tortuous and elongated aortic arch, characterized by significant curvature reminiscent of the treble clef musical symbol.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102492"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jscai.2024.102516
Pietro Di Santo MD , Omar Abdel-Razek MD, MSc , Graeme Prosperi-Porta MD , Pouya Motazedian MD , Pascal Thériault-Lauzier MD , Saad Alhassani MD , Lee H. Sterling MDCM , Simon Parlow MD , Marie-Eve Mathieu MD , Richard G. Jung MD, PhD , Baylie Morgan BScN , Doug Coyle PhD , Dean A. Fergusson PhD , Kwadwo Kyeremanteng MD , Rebecca Mathew MD , Marino Labinaz MD , Michael Froeschl MD , Rebecca Hibbert MD , Trevor Simard MD, PhD , Jared G. Bird MD , Benjamin Hibbert MD, PhD
Background
Recent technological advancements have expanded access to ultrasound technology. Invasive cardiac procedures come with risks of vascular access complications, necessitating efficient detection methods for dangerous complications such as pseudoaneurysms. Current clinical practice has relied on physical examination, and often requires formal diagnostic imaging to diagnose these complications. The ULTRAsound Assessment of Access SITe COMplications study assessed the diagnostic accuracy of point-of-care ultrasound (POCUS) as an adjunct to physical examination for the detection of pseudoaneurysms following invasive cardiac procedures.
Methods
We conducted a single-center study that enrolled patients who underwent invasive cardiovascular procedures with suspected access site complications. Cardiology fellows were trained on the use of POCUS by a radiologist with expertise in vascular imaging. The primary outcome focused on the diagnostic odds ratio (DOR) of combined clinical and POCUS assessments compared to Doppler ultrasound or computed tomography.
Results
Among 111 participants, most were female (59.5%), with a mean age of 72.2 years, and with transfemoral access being most prevalent (67.6%). A total of 15 participants were found to have a pseudoaneurysm on formal diagnostic imaging. The combined clinical and POCUS assessments were highly sensitive and demonstrated superior DOR for detecting pseudoaneurysms compared to the physical examination alone (DOR 42.6 [95% CI, 34.6-50.6] vs 15.6 [95% CI, 11.7-19.5]; P < .01).
Conclusions
Point-of-care ultrasound is a highly sensitive tool for detecting pseudoaneurysms following invasive cardiovascular procedures. These findings suggest the potential integration of POCUS into routine practice, which could result in timely complication identification and management, thereby improving patient outcomes and reducing health care costs.
{"title":"Point-of-Care Ultrasound for the Detection of Vascular Access Site Complications—The ULTRASITCOM Study","authors":"Pietro Di Santo MD , Omar Abdel-Razek MD, MSc , Graeme Prosperi-Porta MD , Pouya Motazedian MD , Pascal Thériault-Lauzier MD , Saad Alhassani MD , Lee H. Sterling MDCM , Simon Parlow MD , Marie-Eve Mathieu MD , Richard G. Jung MD, PhD , Baylie Morgan BScN , Doug Coyle PhD , Dean A. Fergusson PhD , Kwadwo Kyeremanteng MD , Rebecca Mathew MD , Marino Labinaz MD , Michael Froeschl MD , Rebecca Hibbert MD , Trevor Simard MD, PhD , Jared G. Bird MD , Benjamin Hibbert MD, PhD","doi":"10.1016/j.jscai.2024.102516","DOIUrl":"10.1016/j.jscai.2024.102516","url":null,"abstract":"<div><h3>Background</h3><div>Recent technological advancements have expanded access to ultrasound technology. Invasive cardiac procedures come with risks of vascular access complications, necessitating efficient detection methods for dangerous complications such as pseudoaneurysms. Current clinical practice has relied on physical examination, and often requires formal diagnostic imaging to diagnose these complications. The ULTRAsound Assessment of Access SITe COMplications study assessed the diagnostic accuracy of point-of-care ultrasound (POCUS) as an adjunct to physical examination for the detection of pseudoaneurysms following invasive cardiac procedures.</div></div><div><h3>Methods</h3><div>We conducted a single-center study that enrolled patients who underwent invasive cardiovascular procedures with suspected access site complications. Cardiology fellows were trained on the use of POCUS by a radiologist with expertise in vascular imaging. The primary outcome focused on the diagnostic odds ratio (DOR) of combined clinical and POCUS assessments compared to Doppler ultrasound or computed tomography.</div></div><div><h3>Results</h3><div>Among 111 participants, most were female (59.5%), with a mean age of 72.2 years, and with transfemoral access being most prevalent (67.6%). A total of 15 participants were found to have a pseudoaneurysm on formal diagnostic imaging. The combined clinical and POCUS assessments were highly sensitive and demonstrated superior DOR for detecting pseudoaneurysms compared to the physical examination alone (DOR 42.6 [95% CI, 34.6-50.6] vs 15.6 [95% CI, 11.7-19.5]; <em>P</em> < .01).</div></div><div><h3>Conclusions</h3><div>Point-of-care ultrasound is a highly sensitive tool for detecting pseudoaneurysms following invasive cardiovascular procedures. These findings suggest the potential integration of POCUS into routine practice, which could result in timely complication identification and management, thereby improving patient outcomes and reducing health care costs.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 2","pages":"Article 102516"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}