Pub Date : 2025-10-01DOI: 10.1016/j.jscai.2025.103928
Urooj Fatima MD , Mukta C. Srivastava MD
{"title":"Fasting Guidelines for Invasive Cardiac Procedures: Let Them Eat Cake!","authors":"Urooj Fatima MD , Mukta C. Srivastava MD","doi":"10.1016/j.jscai.2025.103928","DOIUrl":"10.1016/j.jscai.2025.103928","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103928"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340565","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.104058
{"title":"Cover","authors":"","doi":"10.1016/j.jscai.2025.104058","DOIUrl":"10.1016/j.jscai.2025.104058","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 104058"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340562","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103825
Azka Naeem MD , Ilya Giverts MD , Muhammad Hashim Khan MD , Aakash Shetty , Vijay Shetty MD , Benjamin Youdelman MD , Robert Frankel MD , Paul Saunders MD , Habib-Hymie Chera MD
Ventricular septal rupture (VSR) and papillary muscle rupture are lethal complications of acute myocardial infarction. We present the case of a 76-year-old woman presenting with chest pain with electrocardiogram showing ST-segment elevation in the inferior leads. Angiography showed chronic right coronary artery occlusion. A VSR and partially torn papillary muscle was seen on echocardiogram. Percutaneous VSR closure with an Amplatzer device (Abbott) and mitral valve repair with a MitraClip (Abbott) were successfully performed simultaneously, and she was discharged to a skilled nursing facility. Percutaneous intervention seems a promising alternative, even for VSR and papillary muscle rupture in a single setting.
{"title":"Simultaneous Percutaneous Ventricular Septal Closure and Mitral Valve Repair in Postinfarction Mechanical Complications: Case Report","authors":"Azka Naeem MD , Ilya Giverts MD , Muhammad Hashim Khan MD , Aakash Shetty , Vijay Shetty MD , Benjamin Youdelman MD , Robert Frankel MD , Paul Saunders MD , Habib-Hymie Chera MD","doi":"10.1016/j.jscai.2025.103825","DOIUrl":"10.1016/j.jscai.2025.103825","url":null,"abstract":"<div><div>Ventricular septal rupture (VSR) and papillary muscle rupture are lethal complications of acute myocardial infarction. We present the case of a 76-year-old woman presenting with chest pain with electrocardiogram showing ST-segment elevation in the inferior leads. Angiography showed chronic right coronary artery occlusion. A VSR and partially torn papillary muscle was seen on echocardiogram. Percutaneous VSR closure with an Amplatzer device (Abbott) and mitral valve repair with a MitraClip (Abbott) were successfully performed simultaneously, and she was discharged to a skilled nursing facility. Percutaneous intervention seems a promising alternative, even for VSR and papillary muscle rupture in a single setting.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103825"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340492","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103924
Dorian Garin MD , Benjamin Assouline MD , Sophie Degrauwe MD , Juan F. Iglesias MD
A 75-year-old woman presented with severe aortic stenosis and CS (ejection fraction, 10% to 15%; lactate, 4.2 mmol/L; requiring high-dose vasopressors). During index catheterization, upfront Impella CP insertion across the stenotic valve immediately improved hemodynamics (peak-to-peak gradient reduced from 125 to 6 mm Hg). Following stabilization, staged TAVR was performed within 15 hours through the same femoral access. The patient was discharged on day 12 with complete left ventricular recovery (ejection fraction, 65% to 70%) at 6 months. This represents the first reported case of upfront Impella CP insertion during index procedure as bridge-to-TAVR without balloon aortic valvuloplasty, demonstrating feasibility and excellent outcomes in AS-related CS.
{"title":"Upfront Impella CP as Bridge-to-Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis and Cardiogenic Shock: Case Report","authors":"Dorian Garin MD , Benjamin Assouline MD , Sophie Degrauwe MD , Juan F. Iglesias MD","doi":"10.1016/j.jscai.2025.103924","DOIUrl":"10.1016/j.jscai.2025.103924","url":null,"abstract":"<div><div>A 75-year-old woman presented with severe aortic stenosis and CS (ejection fraction, 10% to 15%; lactate, 4.2 mmol/L; requiring high-dose vasopressors). During index catheterization, upfront Impella CP insertion across the stenotic valve immediately improved hemodynamics (peak-to-peak gradient reduced from 125 to 6 mm Hg). Following stabilization, staged TAVR was performed within 15 hours through the same femoral access. The patient was discharged on day 12 with complete left ventricular recovery (ejection fraction, 65% to 70%) at 6 months. This represents the first reported case of upfront Impella CP insertion during index procedure as bridge-to-TAVR without balloon aortic valvuloplasty, demonstrating feasibility and excellent outcomes in AS-related CS.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103924"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340496","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103819
Sebhat Erqou MD, PhD , Michael Kwok MD , Yongdeok Shin MD , Mohammed Motaweih MD , Eric Heinz MD , Aaron Schatz MD , Anna Tomdio MD , Luis A. Guzman MD
Background
Although questioned for more than a decade, fasting prior to invasive cardiac procedures remains the standard of care, due to lack of sufficient randomized data. We sought to synthesize data from existing randomized clinical trials (RCTs) comparing fasting vs nonfasting prior to cardiac procedures.
Methods
We performed a systematic literature search for RCTs comparing fasting vs nonfasting prior to invasive cardiac procedures with moderate sedation. Data were pooled using a random-effects model meta-analysis. We report standardized mean differences (SMDs) or odds ratios (ORs) and 95% CIs.
Results
Overall, 8 RCTs comprising of 3451 participants were included. The average fasting time was 845 minutes in the fasting group and 196 minutes in the nonfasting group. The pooled patient satisfaction score across 6 studies was SMD 0.78 (95% CI, 0.25-1.31) favoring the nonfasting arm. Hypotension (4 studies; OR, 1.6; 95% CI, 1.2-2.3) and hunger (3 studies; OR, 2.7; 95% CI, 1.8-3.7) were significantly higher in the fasting arm. There was a trend toward lower risk of contrast-induced nephropathy (OR, 0.7; 95% CI, 0.4-1.0) in the fasting arm across 4 studies with available data, but it did not reach statistical significance (P = .06). There was no difference in post- vs pre- procedure delta creatinine clearance (SMD, 0.07; 95% CI, −0.17 to 0.31) across 3 studies. There were also no significant differences in nausea/vomiting, hypoglycemia, pneumonia, and mortality.
Conclusions
This synthesis of emergent clinical trial data suggests that nonfasting protocols for cardiac procedures are safe and associated with improved patient satisfaction. This study supports updating fasting guidelines for lower risk invasive cardiac procedures.
{"title":"Re-evaluating Fasting Guidelines for Invasive Cardiac Procedures: A Systematic Review and Meta-analysis of Randomized Clinical Trials","authors":"Sebhat Erqou MD, PhD , Michael Kwok MD , Yongdeok Shin MD , Mohammed Motaweih MD , Eric Heinz MD , Aaron Schatz MD , Anna Tomdio MD , Luis A. Guzman MD","doi":"10.1016/j.jscai.2025.103819","DOIUrl":"10.1016/j.jscai.2025.103819","url":null,"abstract":"<div><h3>Background</h3><div>Although questioned for more than a decade, fasting prior to invasive cardiac procedures remains the standard of care, due to lack of sufficient randomized data. We sought to synthesize data from existing randomized clinical trials (RCTs) comparing fasting vs nonfasting prior to cardiac procedures.</div></div><div><h3>Methods</h3><div>We performed a systematic literature search for RCTs comparing fasting vs nonfasting prior to invasive cardiac procedures with moderate sedation. Data were pooled using a random-effects model meta-analysis. We report standardized mean differences (SMDs) or odds ratios (ORs) and 95% CIs.</div></div><div><h3>Results</h3><div>Overall, 8 RCTs comprising of 3451 participants were included. The average fasting time was 845 minutes in the fasting group and 196 minutes in the nonfasting group. The pooled patient satisfaction score across 6 studies was SMD 0.78 (95% CI, 0.25-1.31) favoring the nonfasting arm. Hypotension (4 studies; OR, 1.6; 95% CI, 1.2-2.3) and hunger (3 studies; OR, 2.7; 95% CI, 1.8-3.7) were significantly higher in the fasting arm. There was a trend toward lower risk of contrast-induced nephropathy (OR, 0.7; 95% CI, 0.4-1.0) in the fasting arm across 4 studies with available data, but it did not reach statistical significance (<em>P</em> = .06). There was no difference in post- vs pre- procedure delta creatinine clearance (SMD, 0.07; 95% CI, −0.17 to 0.31) across 3 studies. There were also no significant differences in nausea/vomiting, hypoglycemia, pneumonia, and mortality.</div></div><div><h3>Conclusions</h3><div>This synthesis of emergent clinical trial data suggests that nonfasting protocols for cardiac procedures are safe and associated with improved patient satisfaction. This study supports updating fasting guidelines for lower risk invasive cardiac procedures.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103819"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340564","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103880
Jeffrey S. Tran MD, Noah Williford MD, Sonakshi Manjunath MD, Rahul Singh MD, Prashanth Thakker MD, Marc Sintek MD, Howard Kurz MD, Alan Zajarias MD, Nathan Frogge MD, Christian McNeely MD, John Lasala MD, Jasvindar Singh MD
Background
Bifurcation stenting of the coronary arteries represents a technical challenge that places patients at risk for poor outcomes. Existing techniques result in multiple stent layers at the neocarina, making for a challenging side branch recross and necessitating multiple kissing balloon inflations. This article presents a novel bifurcation stenting technique that provides full side branch coverage while maintaining carinal geometry, with an easier side branch recross and less technical complexity. Clinical outcomes at 1-year were investigated.
Methods
Feasibility of the technique was demonstrated in a wet heart model. A retrospective cohort study was then performed of patients undergoing jailed stent-balloon bifurcation stenting at a single tertiary academic center. The primary end point was a composite of target lesion revascularization (TLR), target lesion myocardial infarction (TLMI), and cardiac death at 1 year postprocedurally.
Results
The primary composite outcome occurred in 13 (7.9%) cases who underwent jailed stent-balloon bifurcation stenting. At 1 year, TLR occurred in 9 (5.4%) cases, TLMI in 3 (1.8%) cases, and cardiac death in 3 (1.8%) cases. In patients with left main bifurcation disease, the primary composite outcome occurred in 6 (9.5%) cases, TLR in 3 (4.8%) cases, TLMI in 2 (3.2%) cases, and cardiac death in 3 (4.8%) cases.
Conclusions
Jailed stent-balloon bifurcation stenting appears to be safe, feasible, and effective. Although not directly comparable, it appears to have similar clinical outcomes to existing bifurcation stenting techniques despite its reduced technical complexity.
{"title":"The Jailed Stent-Balloon Bifurcation Stenting Technique","authors":"Jeffrey S. Tran MD, Noah Williford MD, Sonakshi Manjunath MD, Rahul Singh MD, Prashanth Thakker MD, Marc Sintek MD, Howard Kurz MD, Alan Zajarias MD, Nathan Frogge MD, Christian McNeely MD, John Lasala MD, Jasvindar Singh MD","doi":"10.1016/j.jscai.2025.103880","DOIUrl":"10.1016/j.jscai.2025.103880","url":null,"abstract":"<div><h3>Background</h3><div>Bifurcation stenting of the coronary arteries represents a technical challenge that places patients at risk for poor outcomes. Existing techniques result in multiple stent layers at the neocarina, making for a challenging side branch recross and necessitating multiple kissing balloon inflations. This article presents a novel bifurcation stenting technique that provides full side branch coverage while maintaining carinal geometry, with an easier side branch recross and less technical complexity. Clinical outcomes at 1-year were investigated.</div></div><div><h3>Methods</h3><div>Feasibility of the technique was demonstrated in a wet heart model. A retrospective cohort study was then performed of patients undergoing jailed stent-balloon bifurcation stenting at a single tertiary academic center. The primary end point was a composite of target lesion revascularization (TLR), target lesion myocardial infarction (TLMI), and cardiac death at 1 year postprocedurally.</div></div><div><h3>Results</h3><div>The primary composite outcome occurred in 13 (7.9%) cases who underwent jailed stent-balloon bifurcation stenting. At 1 year, TLR occurred in 9 (5.4%) cases, TLMI in 3 (1.8%) cases, and cardiac death in 3 (1.8%) cases. In patients with left main bifurcation disease, the primary composite outcome occurred in 6 (9.5%) cases, TLR in 3 (4.8%) cases, TLMI in 2 (3.2%) cases, and cardiac death in 3 (4.8%) cases.</div></div><div><h3>Conclusions</h3><div>Jailed stent-balloon bifurcation stenting appears to be safe, feasible, and effective. Although not directly comparable, it appears to have similar clinical outcomes to existing bifurcation stenting techniques despite its reduced technical complexity.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103880"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340577","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103824
Teodora Donisan MD , Conor M. Lane MBBCh, BAO , Christopher J. Francois MD , Guy Reeder MD , Malakh Shrestha MBBS, PhD , Rajiv Gulati MD, PhD , Abhiram Prasad MD
Cabrol Dacron grafts are used to reimplant coronary arteries during aortic root replacement for complex aortic pathologies. Graft complications, particularly chronic total occlusions (CTO), are challenging. We present a 54-year-old man with a right coronary artery Cabrol graft CTO, treated successfully with percutaneous coronary intervention. Preprocedural imaging confirmed graft stump and right coronary artery collateral anatomy. Using advanced CTO techniques, the graft was recanalized, and symptoms improved. This is the first report of a Cabrol graft CTO percutaneous coronary intervention, demonstrating its feasibility and highlighting the importance of adjunctive imaging and need for hybrid antegrade CTO techniques.
{"title":"Percutaneous Management of Cabrol Graft Chronic Total Occlusion: Case Report","authors":"Teodora Donisan MD , Conor M. Lane MBBCh, BAO , Christopher J. Francois MD , Guy Reeder MD , Malakh Shrestha MBBS, PhD , Rajiv Gulati MD, PhD , Abhiram Prasad MD","doi":"10.1016/j.jscai.2025.103824","DOIUrl":"10.1016/j.jscai.2025.103824","url":null,"abstract":"<div><div>Cabrol Dacron grafts are used to reimplant coronary arteries during aortic root replacement for complex aortic pathologies. Graft complications, particularly chronic total occlusions (CTO), are challenging. We present a 54-year-old man with a right coronary artery Cabrol graft CTO, treated successfully with percutaneous coronary intervention. Preprocedural imaging confirmed graft stump and right coronary artery collateral anatomy. Using advanced CTO techniques, the graft was recanalized, and symptoms improved. This is the first report of a Cabrol graft CTO percutaneous coronary intervention, demonstrating its feasibility and highlighting the importance of adjunctive imaging and need for hybrid antegrade CTO techniques.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103824"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340578","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103818
Leo Kar Lok Lai MBChB , Hussayn Alrayes DO , Georgi Fram MD , James C. Lee MD , Bryan Zweig MD , Gennaro Giustino MD , Ahmad Jabri MD , Brian P. O’Neill MD , Tiberio M. Frisoli MD , Pedro Engel Gonzalez MD , William W. O’Neill MD , Pedro A. Villablanca MD
{"title":"Retrograde Balloon-Induced Anterior Mitral Leaflet Laceration: The ROBIN Technique","authors":"Leo Kar Lok Lai MBChB , Hussayn Alrayes DO , Georgi Fram MD , James C. Lee MD , Bryan Zweig MD , Gennaro Giustino MD , Ahmad Jabri MD , Brian P. O’Neill MD , Tiberio M. Frisoli MD , Pedro Engel Gonzalez MD , William W. O’Neill MD , Pedro A. Villablanca MD","doi":"10.1016/j.jscai.2025.103818","DOIUrl":"10.1016/j.jscai.2025.103818","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103818"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340684","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103871
Kristina Khaw BSE , Said Ashraf MD , Howard Levite MD , Jeffrey Van Hook DO , Kenneth Khaw MD
Impella CP use in small femoral arteries has increased vascular and ischemic complications. Various techniques have been described to lessen leg ischemia. Our technique uses a small catheter placed below the Impella CP insertion site and runs parallel with it to prevent total occlusion in the femoral artery. This could be a primary technique to try first. If more distal flow to the leg is needed, antegrade access to the superficial femoral artery can be obtained with connection to the adjacent wedge catheter. We describe this use for first time in a patient with cardiogenic shock after myocardial infarction with mitral regurgitation.
{"title":"A Novel Technique to Prevent Femoral Artery Occlusion With Impella CP Sheaths: Case Report","authors":"Kristina Khaw BSE , Said Ashraf MD , Howard Levite MD , Jeffrey Van Hook DO , Kenneth Khaw MD","doi":"10.1016/j.jscai.2025.103871","DOIUrl":"10.1016/j.jscai.2025.103871","url":null,"abstract":"<div><div>Impella CP use in small femoral arteries has increased vascular and ischemic complications. Various techniques have been described to lessen leg ischemia. Our technique uses a small catheter placed below the Impella CP insertion site and runs parallel with it to prevent total occlusion in the femoral artery. This could be a primary technique to try first. If more distal flow to the leg is needed, antegrade access to the superficial femoral artery can be obtained with connection to the adjacent wedge catheter. We describe this use for first time in a patient with cardiogenic shock after myocardial infarction with mitral regurgitation.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103871"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340493","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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