Pub Date : 2024-12-01DOI: 10.1016/j.jscai.2024.102399
Jennifer Rymer MD, MBA, MHS , J. Dawn Abbott MD , Ziad A. Ali MD, DPhil , Mir B. Basir DO , Denise Busman MSN, RN , George D. Dangas MD, PhD , Daniel M. Kolansky MD , Srihari S. Naidu MD , Robert F. Riley MD , Arnold H. Seto MD , Binita Shah MD , Evan Shlofmitz DO , SCAI 2024 Think Tank Coronary Consortium, Connie S. Baumgard MSN, NP , Rafa Cavalcante , Casey Culbertson MD , Crista Gaalswyk , Rob J. Miltner , Jeremy Moretz PharmD , Jeannie Niebuhr , Steve Zizzo
{"title":"Intravascular Coronary Imaging","authors":"Jennifer Rymer MD, MBA, MHS , J. Dawn Abbott MD , Ziad A. Ali MD, DPhil , Mir B. Basir DO , Denise Busman MSN, RN , George D. Dangas MD, PhD , Daniel M. Kolansky MD , Srihari S. Naidu MD , Robert F. Riley MD , Arnold H. Seto MD , Binita Shah MD , Evan Shlofmitz DO , SCAI 2024 Think Tank Coronary Consortium, Connie S. Baumgard MSN, NP , Rafa Cavalcante , Casey Culbertson MD , Crista Gaalswyk , Rob J. Miltner , Jeremy Moretz PharmD , Jeannie Niebuhr , Steve Zizzo","doi":"10.1016/j.jscai.2024.102399","DOIUrl":"10.1016/j.jscai.2024.102399","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"3 12","pages":"Article 102399"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980930","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 : 2024-12-01DOI: 10.1016/j.jscai.2024.102387
Revathy Sampath-Kumar MD, Ori Ben-Yehuda MD, Belal Al Khiami MD, Lawrence Ang MD, Anna Melendez MSN, RN, Ryan Reeves MD, Ehtisham Mahmud MD
Background
A minimum threshold activated clotting time (ACT) to guide heparin dosing during percutaneous coronary intervention (PCI) is associated with lower ischemic complications. However, data are variable regarding the risk of high ACT levels. The aim of this study was to assess the impact of peak procedural ACT on complications and mortality for transfemoral and transradial access PCI.
Methods
The UC San Diego Health National Cardiovascular Data Registry CathPCI Registry was used to obtain data on patients who underwent native vessel PCI from January 2007 to September 2022. Coronary artery bypass graft patients and those who received bivalirudin were excluded. Complications and all-cause mortality at 30 days and 1-year post-PCI were assessed by ACT tertile.
Results
A total of 2473 patients (age 65 ± 12 years; 74% male) undergoing PCI with 53% femoral and 47% radial access were included. The majority (82%) had 1-vessel coronary artery disease with heterogeneous clinical presentations (21.8% ST-elevation myocardial infarction, 25.4% non–ST-elevation myocardial infarction, 4.9% unstable angina, 33.8% stable angina, 3.4% atypical chest pain, 10.7% other indication for PCI). With femoral access, patients in the third tertile (ACT ≥ 275) had significantly higher all-cause mortality at 30 days (5.3% vs 2.7% vs 0.9%; P < .001), 6 months (6.3% vs 4.0% vs 2.0%; P = .007), and 1 year (9.0% vs 6.0% vs 2.7%; P < .001) compared to the second (ACT 228-275) and first tertile (ACT ≤ 228), respectively. A 30-day landmark analysis revealed that there was no difference in all-cause mortality beyond 30 days (3.9% vs 3.4% vs 1.8%; P = .176). There were increased bleeding complications in the highest tertile (12.8% vs 9.8% vs 7.5%; P = .034) and a higher need for blood products (10.4% vs 6.7% vs 5.4%; P = .014). There was no difference in ischemic major adverse cardiovascular events specifically periprocedural myocardial infarction or stroke between tertiles. There was no difference in clinical outcomes by peak ACT for patients who had radial access.
Conclusions
Higher ACT with transfemoral access PCI was associated with increased 30-day mortality, bleeding complications, and need for blood products post-PCI.
背景：在经皮冠状动脉介入治疗（PCI）中，指导肝素剂量的最小阈值激活凝血时间（ACT）与较低的缺血性并发症相关。然而，关于高ACT水平风险的数据是可变的。本研究的目的是评估程序性ACT峰值对经股动脉和经桡动脉PCI手术并发症和死亡率的影响。方法：使用加州大学圣地亚哥分校健康国家心血管数据登记处（CathPCI登记处）获取2007年1月至2022年9月接受原生血管PCI治疗的患者的数据。排除冠状动脉旁路移植术患者和接受比伐鲁定治疗的患者。采用ACT方法评估pci术后30天和1年的并发症和全因死亡率。结果：共2473例患者(年龄65±12岁；74%男性)接受PCI，其中53%为股骨通路，47%为桡骨通路。大多数患者（82%）患有单支冠状动脉疾病，临床表现不均匀（21.8% st段抬高型心肌梗死，25.4%非st段抬高型心肌梗死，4.9%不稳定型心绞痛，33.8%稳定型心绞痛，3.4%不典型胸痛，10.7%其他PCI指征）。对于股骨通路，第三阶段（ACT≥275）的患者在30天的全因死亡率明显更高(5.3% vs 2.7% vs 0.9%；P < 0.001)， 6个月(6.3% vs 4.0% vs 2.0%；P = .007)和1年(9.0% vs 6.0% vs 2.7%；P < 0.001)，分别高于第二分位（ACT 228 ~ 275）和第一分位（ACT≤228）。一项30天的里程碑式分析显示，30天以上的全因死亡率没有差异(3.9% vs 3.4% vs 1.8%；P = .176)。最高不育组出血并发症增加(12.8% vs 9.8% vs 7.5%；P = 0.034)和更高的血液制品需求(10.4% vs 6.7% vs 5.4%；P = .014)。各组间缺血性主要不良心血管事件，特别是围手术期心肌梗死或卒中发生率无差异。桡骨通路患者的临床结果与ACT峰值没有差异。结论：经股通道PCI术中ACT升高与PCI术后30天死亡率、出血并发症和血液制品需求增加相关。
{"title":"Peak Procedural ACT Is Associated With All-Cause Mortality After Femoral Access PCI","authors":"Revathy Sampath-Kumar MD, Ori Ben-Yehuda MD, Belal Al Khiami MD, Lawrence Ang MD, Anna Melendez MSN, RN, Ryan Reeves MD, Ehtisham Mahmud MD","doi":"10.1016/j.jscai.2024.102387","DOIUrl":"10.1016/j.jscai.2024.102387","url":null,"abstract":"<div><h3>Background</h3><div>A minimum threshold activated clotting time (ACT) to guide heparin dosing during percutaneous coronary intervention (PCI) is associated with lower ischemic complications. However, data are variable regarding the risk of high ACT levels. The aim of this study was to assess the impact of peak procedural ACT on complications and mortality for transfemoral and transradial access PCI.</div></div><div><h3>Methods</h3><div>The UC San Diego Health National Cardiovascular Data Registry CathPCI Registry was used to obtain data on patients who underwent native vessel PCI from January 2007 to September 2022. Coronary artery bypass graft patients and those who received bivalirudin were excluded. Complications and all-cause mortality at 30 days and 1-year post-PCI were assessed by ACT tertile.</div></div><div><h3>Results</h3><div>A total of 2473 patients (age 65 ± 12 years; 74% male) undergoing PCI with 53% femoral and 47% radial access were included. The majority (82%) had 1-vessel coronary artery disease with heterogeneous clinical presentations (21.8% ST-elevation myocardial infarction, 25.4% non–ST-elevation myocardial infarction, 4.9% unstable angina, 33.8% stable angina, 3.4% atypical chest pain, 10.7% other indication for PCI). With femoral access, patients in the third tertile (ACT ≥ 275) had significantly higher all-cause mortality at 30 days (5.3% vs 2.7% vs 0.9%; <em>P</em> < .001), 6 months (6.3% vs 4.0% vs 2.0%; <em>P</em> = .007), and 1 year (9.0% vs 6.0% vs 2.7%; <em>P</em> < .001) compared to the second (ACT 228-275) and first tertile (ACT ≤ 228), respectively. A 30-day landmark analysis revealed that there was no difference in all-cause mortality beyond 30 days (3.9% vs 3.4% vs 1.8%; <em>P</em> = .176). There were increased bleeding complications in the highest tertile (12.8% vs 9.8% vs 7.5%; <em>P</em> = .034) and a higher need for blood products (10.4% vs 6.7% vs 5.4%; <em>P</em> = .014). There was no difference in ischemic major adverse cardiovascular events specifically periprocedural myocardial infarction or stroke between tertiles. There was no difference in clinical outcomes by peak ACT for patients who had radial access.</div></div><div><h3>Conclusions</h3><div>Higher ACT with transfemoral access PCI was associated with increased 30-day mortality, bleeding complications, and need for blood products post-PCI.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"3 12","pages":"Article 102387"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980932","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 : 2024-12-01DOI: 10.1016/j.jscai.2024.102283
Lucas X. Marinacci MD , Sanjum S. Sethi MD, MPH , Molly L. Paras MD , Abdallah El Sabbagh MD , Eric A. Secemsky MD, MSc , M. Rizwan Sohail MD , Christoph Starck MD , Benjamin Bearnot MD, MPH , Evin Yucel MD , Raymond H.M. Schaerf MD , Yasir Akhtar MD , Ahmad Younes MD, MBA , Marquand Patton DO , Pedro Villablanca MD , Seenu Reddy MD, MBA , Daniel Enter MD , John M. Moriarty MD , William Brent Keeling MD , Stephanie El Hajj Younes MD , Charles Kiell MD , Kenneth Rosenfield MD, MSc
The clinical presentation and epidemiology of infective endocarditis (IE) have evolved over time. While the cornerstones of IE treatment remain antimicrobial therapy and surgery, percutaneous mechanical aspiration (PMA) has emerged as an option for carefully selected patients as a complementary modality, based on retrospective data, case series, and expert experience. In this comprehensive review, we summarize the proceedings from an inaugural summit dedicated to the discussion of PMA in the global management of IE, consisting of experts across multiple disciplines from diverse geographic regions and care environments. After conceptualizing the 3 major roles of PMA as a bridge to decision, destination therapy, and adjunctive therapy, we then review the clinical scenarios in which PMA might be considered by IE subtype. We discuss patient selection, the rationale for intervention, and the most recent evidence for each. Next, we consider PMA for IE in the larger context of our health care system across 3 domains: clinical collaboration, financial considerations, and academic innovation, emphasizing the importance of interdisciplinary teams and cross-organizational partnerships, reimbursement models, and the need for high-quality research. Finally, we outline what we determined to be the most pressing outstanding questions in this space. In doing so, we propose a national consortium to help organize efforts to move this field forward and share our progress in these endeavors to date. PMA for IE has great promise, but significant work remains if we are to fully realize its potential to safely and effectively improve outcomes for modern endocarditis patients.
{"title":"Percutaneous Mechanical Aspiration for Infective Endocarditis: Proceedings From an Inaugural Multidisciplinary Summit and Comprehensive Review","authors":"Lucas X. Marinacci MD , Sanjum S. Sethi MD, MPH , Molly L. Paras MD , Abdallah El Sabbagh MD , Eric A. Secemsky MD, MSc , M. Rizwan Sohail MD , Christoph Starck MD , Benjamin Bearnot MD, MPH , Evin Yucel MD , Raymond H.M. Schaerf MD , Yasir Akhtar MD , Ahmad Younes MD, MBA , Marquand Patton DO , Pedro Villablanca MD , Seenu Reddy MD, MBA , Daniel Enter MD , John M. Moriarty MD , William Brent Keeling MD , Stephanie El Hajj Younes MD , Charles Kiell MD , Kenneth Rosenfield MD, MSc","doi":"10.1016/j.jscai.2024.102283","DOIUrl":"10.1016/j.jscai.2024.102283","url":null,"abstract":"<div><div>The clinical presentation and epidemiology of infective endocarditis (IE) have evolved over time. While the cornerstones of IE treatment remain antimicrobial therapy and surgery, percutaneous mechanical aspiration (PMA) has emerged as an option for carefully selected patients as a complementary modality, based on retrospective data, case series, and expert experience. In this comprehensive review, we summarize the proceedings from an inaugural summit dedicated to the discussion of PMA in the global management of IE, consisting of experts across multiple disciplines from diverse geographic regions and care environments. After conceptualizing the 3 major roles of PMA as a bridge to decision, destination therapy, and adjunctive therapy, we then review the clinical scenarios in which PMA might be considered by IE subtype. We discuss patient selection, the rationale for intervention, and the most recent evidence for each. Next, we consider PMA for IE in the larger context of our health care system across 3 domains: clinical collaboration, financial considerations, and academic innovation, emphasizing the importance of interdisciplinary teams and cross-organizational partnerships, reimbursement models, and the need for high-quality research. Finally, we outline what we determined to be the most pressing outstanding questions in this space. In doing so, we propose a national consortium to help organize efforts to move this field forward and share our progress in these endeavors to date. PMA for IE has great promise, but significant work remains if we are to fully realize its potential to safely and effectively improve outcomes for modern endocarditis patients.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"3 12","pages":"Article 102283"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980933","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 : 2024-12-01DOI: 10.1016/j.jscai.2024.102397
Michael N. Young MD , Anita W. Asgar MD, MSc , Andrew M. Goldsweig MD, MSc , James B. Hermiller MD , Omar Khalique MD , Steven V. Manoukian MD , Sunil V. Rao MD , Triston B.B.J. Smith MD , Molly Szerlip MD , Chad Kliger MD, MS , SCAI 2024 Think Tank Structural Consortium -, Katie Canpa , Michael Church , Regina Deible , Robert Ferguson , Mounia Haddad , Liz Maguire , Devin Nelson , Jennifer Shetler , Nusrath Sultana
{"title":"Optimizing Health Care Resource Allocation, Workforce “Right-Sizing,” and Stakeholder Collaboration","authors":"Michael N. Young MD , Anita W. Asgar MD, MSc , Andrew M. Goldsweig MD, MSc , James B. Hermiller MD , Omar Khalique MD , Steven V. Manoukian MD , Sunil V. Rao MD , Triston B.B.J. Smith MD , Molly Szerlip MD , Chad Kliger MD, MS , SCAI 2024 Think Tank Structural Consortium -, Katie Canpa , Michael Church , Regina Deible , Robert Ferguson , Mounia Haddad , Liz Maguire , Devin Nelson , Jennifer Shetler , Nusrath Sultana","doi":"10.1016/j.jscai.2024.102397","DOIUrl":"10.1016/j.jscai.2024.102397","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"3 12","pages":"Article 102397"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980931","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 : 2024-12-01DOI: 10.1016/j.jscai.2024.102398
Arash Salavitabar MD , Mamdouh Al-Ahmadi MD , Marvin H. Eng MD , Frank F. Ing MD , Saibal Kar MD , Clifford J. Kavinsky MD, PhD , D. Scott Lim MD , Ada C. Stefanescu Schmidt MD, MSc , Thomas E. Fagan MD , SCAI 2024 Think Tank Congenital Consortium, Dan Gutfinger MD , Katie Jacobsen , Megan Mueller , Jeff Pritchett , Nigel Tinberg , Jason Triche , Dave Williams
{"title":"Transcatheter Atrioventricular Valve Repair and Replacement Technologies in Pediatric and Adult Congenital Heart Disease: A Paradigm for Improving Access","authors":"Arash Salavitabar MD , Mamdouh Al-Ahmadi MD , Marvin H. Eng MD , Frank F. Ing MD , Saibal Kar MD , Clifford J. Kavinsky MD, PhD , D. Scott Lim MD , Ada C. Stefanescu Schmidt MD, MSc , Thomas E. Fagan MD , SCAI 2024 Think Tank Congenital Consortium, Dan Gutfinger MD , Katie Jacobsen , Megan Mueller , Jeff Pritchett , Nigel Tinberg , Jason Triche , Dave Williams","doi":"10.1016/j.jscai.2024.102398","DOIUrl":"10.1016/j.jscai.2024.102398","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"3 12","pages":"Article 102398"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980478","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 : 2024-12-01DOI: 10.1016/S2772-9303(24)02175-6
{"title":"Cover","authors":"","doi":"10.1016/S2772-9303(24)02175-6","DOIUrl":"10.1016/S2772-9303(24)02175-6","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"3 12","pages":"Article 102486"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143148991","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 : 2024-11-01DOI: 10.1016/j.jscai.2024.102288
Raymond M. Yau MD , Robyn Mitchell ACNP , Aasim Afzal MD , Timothy J. George MD , Syed Siddiqullah MD , Aditya S. Bharadwaj MBBS , Alexander G. Truesdell MD , Carolyn Rosner MSN, NP-C, MBA , Mir B. Basir DO , Ruth Fisher MBA , Allison Dupont MD , Carlos Leon Alviar MD , Haval Chweich MD , Navin K. Kapur MD , Rajan A.G. Patel MD , Scott Silvestry MD , Sandeep M. Patel MD , Jacob Abraham MD
Background
Multidisciplinary cardiogenic shock (CS) programs have been associated with improved outcomes, yet practical guidance for developing a CS program is lacking.
Methods
A survey on CS program development and operational best practices was administered to 12 institutions in diverse sociogeographic regions and practice settings. Common steps in program development were identified.
Results
Key steps for program development were identified: measuring baseline outcomes; identifying subspecialty champions; gaining leadership and team buy-in; developing institution-specific CS protocols; educating staff and referring providers; consulting with external experts; and developing quality assessment and process improvement.
Conclusions
An assessment of 12 US CS programs highlights a blueprint for establishing and maintaining a successful, multidisciplinary shock program.
{"title":"Blueprint for Building and Sustaining a Cardiogenic Shock Program: Qualitative Survey of 12 US Programs","authors":"Raymond M. Yau MD , Robyn Mitchell ACNP , Aasim Afzal MD , Timothy J. George MD , Syed Siddiqullah MD , Aditya S. Bharadwaj MBBS , Alexander G. Truesdell MD , Carolyn Rosner MSN, NP-C, MBA , Mir B. Basir DO , Ruth Fisher MBA , Allison Dupont MD , Carlos Leon Alviar MD , Haval Chweich MD , Navin K. Kapur MD , Rajan A.G. Patel MD , Scott Silvestry MD , Sandeep M. Patel MD , Jacob Abraham MD","doi":"10.1016/j.jscai.2024.102288","DOIUrl":"10.1016/j.jscai.2024.102288","url":null,"abstract":"<div><h3>Background</h3><div>Multidisciplinary cardiogenic shock (CS) programs have been associated with improved outcomes, yet practical guidance for developing a CS program is lacking.</div></div><div><h3>Methods</h3><div>A survey on CS program development and operational best practices was administered to 12 institutions in diverse sociogeographic regions and practice settings. Common steps in program development were identified.</div></div><div><h3>Results</h3><div>Key steps for program development were identified: measuring baseline outcomes; identifying subspecialty champions; gaining leadership and team buy-in; developing institution-specific CS protocols; educating staff and referring providers; consulting with external experts; and developing quality assessment and process improvement.</div></div><div><h3>Conclusions</h3><div>An assessment of 12 US CS programs highlights a blueprint for establishing and maintaining a successful, multidisciplinary shock program.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"3 11","pages":"Article 102288"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704224","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}
Intravascular ultrasound–determined plaque protrusion (PP) during carotid artery stenting (CAS) using conventional stents is reported in 7.6% to 12% of cases and is associated with periprocedural cerebral embolism. The Casper/Roadsaver stent (CRS) is a dual-layer micromesh stent designed to reduce the risk of PP, with a mesh cell diameter 4-fold smaller size than that of conventional stents. This study investigated the incidence of PP with CRS CAS.
Methods
We prospectively analyzed 89 consecutive arteriosclerotic carotid artery stenoses in 82 patients (64 men; mean age, 76.8 years; 43 symptomatic) who underwent CAS with CRS under intravascular ultrasound. The main end points were the technical success rate, incidences of intraprocedural PP and at 1 week after CAS (delayed PP), incidence of new ipsilateral diffusion-weighted imaging lesion within 48 hours post CAS, and major adverse events (myocardial infarction, stroke, death) within 30 days. Secondary end points were the rate of in-stent restenosis and ipsilateral stroke at 30 days and 12 months.
Results
The technical success rate was 100%. Intraprocedural PP occurred in 2 patients (2.2%). Delayed PP occurred in 3 additional patients (3.4%). Diffusion-weighted imaging positivity was 24.7%. Major adverse events (minor stroke) occurred in 1 patient (1.1%). In-stent restenosis occurred in 5 patients (6.0%) by 12 months. No ipsilateral stroke occurred during the follow-up.
Conclusions
The incidence of intraprocedural PP with CRS CAS was 2.2%, indicating a significant reduction compared to conventional stents. However, at 7 days new PP had occurred in 3.4% of patients, indicating that patients with CRS should be followed up for delayed PP.
{"title":"Intraprocedural and Delayed Plaque Protrusion in Carotid Artery Stenting Using a Dual-Layer Metallic Stent","authors":"Kaoru Myouchin MD , Katsutoshi Takayama MD , Takeshi Wada MD , Yuto Chanoki MD , Hayato Kishida MD , Takahiro Masutani MD , Yumi Ko MD , Yoshitomo Uchiyama MD , Ichiro Nakagawa MD , Toshihiro Tanaka MD","doi":"10.1016/j.jscai.2024.102285","DOIUrl":"10.1016/j.jscai.2024.102285","url":null,"abstract":"<div><h3>Background</h3><div>Intravascular ultrasound–determined plaque protrusion (PP) during carotid artery stenting (CAS) using conventional stents is reported in 7.6% to 12% of cases and is associated with periprocedural cerebral embolism. The Casper/Roadsaver stent (CRS) is a dual-layer micromesh stent designed to reduce the risk of PP, with a mesh cell diameter 4-fold smaller size than that of conventional stents. This study investigated the incidence of PP with CRS CAS.</div></div><div><h3>Methods</h3><div>We prospectively analyzed 89 consecutive arteriosclerotic carotid artery stenoses in 82 patients (64 men; mean age, 76.8 years; 43 symptomatic) who underwent CAS with CRS under intravascular ultrasound. The main end points were the technical success rate, incidences of intraprocedural PP and at 1 week after CAS (delayed PP), incidence of new ipsilateral diffusion-weighted imaging lesion within 48 hours post CAS, and major adverse events (myocardial infarction, stroke, death) within 30 days. Secondary end points were the rate of in-stent restenosis and ipsilateral stroke at 30 days and 12 months.</div></div><div><h3>Results</h3><div>The technical success rate was 100%. Intraprocedural PP occurred in 2 patients (2.2%). Delayed PP occurred in 3 additional patients (3.4%). Diffusion-weighted imaging positivity was 24.7%. Major adverse events (minor stroke) occurred in 1 patient (1.1%). In-stent restenosis occurred in 5 patients (6.0%) by 12 months. No ipsilateral stroke occurred during the follow-up.</div></div><div><h3>Conclusions</h3><div>The incidence of intraprocedural PP with CRS CAS was 2.2%, indicating a significant reduction compared to conventional stents. However, at 7 days new PP had occurred in 3.4% of patients, indicating that patients with CRS should be followed up for delayed PP.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"3 11","pages":"Article 102285"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704230","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 : 2024-11-01DOI: 10.1016/j.jscai.2024.102243
Pamela S. Ropski MD , Graham Peigh MD , James D. Flaherty MD, FSCAI , S. Chris Malaisrie MD , Ranya Sweis MD, FSCAI , Christopher K. Mehta MD , Charles J. Davidson MD, FSCAI , Duc T. Pham MD , Zhiying Meng MS , Abigail S. Baldridge MS , Heather Byrd MS , Laura Jean Davidson MD, MS, FSCAI
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