Cardiovascular Intervention and Therapeutics最新文献

The paravalvular leakage (PVL) incidence immediately after transcatheter aortic valve replacement (TAVR) is reportedly lower with ACURATE neo2 than with ACURATE neo. However, the difference in the subsequent PVL improvement between these valves and the improvement mechanism remain unclear. This study aimed to compare the incidence of and changes in the PVL between these valves and investigate the factors associated with PVL improvement. We included 403 patients who underwent TAVR with ACURATE neo2 (n = 134) or ACURATE neo (n = 269). The study endpoint was PVL improvement, defined as a reduction in the PVL grade from mild or higher at discharge to none/trace at 3 months. The PVL incidence of mild grade or higher was significantly lower with ACURATE neo2 than with ACURATE neo at 3 months (15.7% vs. 25.7%; p = 0.0234) but did not differ significantly at discharge (33.3% vs. 27.5%; p = 0.2291). A significant decrease in the PVL was observed only with ACURATE neo2 (p < 0.0001). Multivariate analysis demonstrated that ACURATE neo2 and calcium volume of the aortic leaflets were independent predictors of PVL improvement. The incidence of mild grade or higher PVL was lower with ACURATE neo2 than with ACURATE neo at 3 months due to the subsequent improvement. Patient selection focusing on leaflet calcification is important for preventing PVL because severe calcification impedes PVL improvement.

Slow flow is the most common complication of rotational atherectomy (RA). Compared with long single sessions, short single sessions may reduce the incidence of slow flow just after RA. This study aimed to compare the incidence of slow flow just after RA between short single session and long single session strategies. This multicenter, 1:1 randomized clinical trial was conducted at 3 hospitals in Japan. The short single session strategy was defined as repeating short single sessions (up to 15 s) of RA, whereas the long single session strategy was defined as repeating long single sessions (20-30 s) until the burr crossed the target lesion. The primary outcome was slow flow just after RA, which was defined as [(initial TIMI-frame count before RA) × 1.1 minus (TIMI-frame count just after RA)] less than 0. During the study period, 266 patients were included in the final study population and were randomly assigned to the Short single session group (n = 132) or the long single session group (n = 134). The protocol adherence rate was equally high in both groups (Short single session: 98.5% versus long single session 94.8%, p = 0.172). The incidence of slow flow just after RA was similar between the 2 groups (short single session:14.4% versus long single session: 14.9%, p > 0.999). In conclusion, this randomized trial did not show a benefit of the short single session strategy compared with the long single session strategy in RA with respect to the prevention of slow flow (Unique identifier: UMIN000047231).

Manual aspiration thrombectomy (MAT) is a catheter intervention for cases with a high risk of bleeding. It is a rapid, simple, inexpensive, and single-session intervention for patients with proximal deep vein thrombosis (DVT). We evaluated the long-term outcome of MAT for patients with proximal DVT. All consecutive patients with acute proximal DVT treated at our center from April 2012 to December 2022 were retrospectively screened. Twenty-one patients who underwent MAT were enrolled. We evaluated the incidence and clinical characteristics of post-thrombotic syndrome (PTS) post-MAT in the chronic phase. The venous clot burden extent was assessed using the venographic segment (VS) score during catheter intervention. We evaluated the pre- and post-treatment total VS score. PTS was evaluated by PTS onset at any time between 6 and 24 months. We compared the clinical characteristics of patients with and without PTS (PTS and non-PTS groups, respectively). PTS onset at any time between 6 and 24 months post-MAT was 33%. The PTS group had a significantly higher post-treatment total VS score and lower thrombus aspiration success rate than the non-PTS group. Furthermore, the PTS group had a significantly longer duration from onset to intervention than the non-PTS group. PTS onset post-MAT was 33% in the chronic phase. The PTS group showed a lower thrombus aspiration success rate and longer duration from DVT onset to intervention than the non-PTS group. These findings suggest that earlier and substantial thrombus reduction with MAT may be associated with a lower risk of PTS.

In patients with connective tissue disease (CTD) and chronic limb-threatening ischemia (CLTI), revascularization is reported to be ineffective, with a poor prognosis and a high rate of lower-limb amputation. However, limited actual data are available. To study the long-term outcomes of endovascular therapy for CLTI patients with CTD, we established a multicenter registry (retrospective cohort study) in Japan. This study looked at major adverse extremity events, amputation-free survival, and all-cause mortality to better understand these rates. We registered 44 consecutive patients. The patients' mean age was 69.6 ± 11.4 years. There were 19 patients (43.2%) with diabetes, but only 4 patients (9.1%) were on dialysis. The average follow-up was 36.1 ± 31.7 months. In 11 patients (25.0%), the target wound healed without requiring lower-limb amputation. Target lesion revascularization occurred in 19 cases (43.2%), while unexpected minor amputations occurred in 11 cases (25.0%), major amputations in 8 cases (18.2%), and death in 15 cases (34.1%). The rates of freedom from major adverse extremity events at 1 and 3 years were 40.3% and 22.3%, respectively. The amputation-free survival rates were 69.3% at 1 year and 58.3% at 3 years. The survival rates were 85.5% at 1 year and 70.3% at 3 years. We conducted a multicenter study to look into the outcomes of CLTI patients with CTD who received endovascular therapy. Given the poor outcomes, more therapeutic advances for CLTI in CTD patients are needed.

Lower extremity peripheral arterial disease is usually a consequence of advanced atherosclerosis, leading to high mortality and morbidity. Although clinical characteristics and outcomes may differ among patients having peripheral disease in different arterial territories, contemporary data are scarce. From January 2019 to December 2022, this multicenter registry study included 712 patients undergoing endovascular treatment (EVT) for either aorto-iliac (AI) or femoropopliteal (FP) lesions. Patient characteristics and outcomes were compared between AI-EVT and FP-EVT groups. Clinical endpoints included major adverse cardiovascular events, major adverse limb events (MALE), and all-cause mortality, stratified by chronic limb-threatening ischemia (CLTI). Of the 712 patients, 217 (30.5%) and 495 (69.5%) underwent AI-EVT or FP-EVT. Patients undergoing AI-EVT were more likely to be men and current smokers, while diabetes was more frequent in the FP-EVT group. The prevalence of CLTI was significantly higher in the FP-EVT group. In the entire study population, the FP-EVT rather than the AI-EVT group had a significantly higher rate of MALE and mortality, but the incidence of major adverse cardiovascular events was similar between the two groups. When focusing only on patients without CLTI, the mortality risk was similar, while the MALE risk was still higher in the FP-EVT group. In conclusion, patients undergoing EVT for AI and FP lesions in contemporary settings were differently characterized by baseline factors. Although the worse clinical outcomes in the FP-EVT group were mainly driven by the higher prevalence of CLTI, the MALE risk was still increased in patients without CLTI.

Outcomes in acute limb ischemia (ALI) depend on early recognition. Rapid evaluation methods in the emergency department (ED) include physical exam, hand-held Doppler (HH), or spectral Doppler (SD) using point-of-care ultrasound (POCUS). This study aims to estimate performance characteristics of HH versus emergency medicine (EM)-performed SD compared to angiography along with clinician confidence when evaluating for ALI. This was a prospective observational pilot study. A convenience sample of patients presenting to an urban, academic ED with concern for ALI who underwent angiography were eligible. The primary aim evaluated diagnostic performance of HH and SD in correctly classifying flow in posterior tibial (PT) and dorsalis pedis (DP) arteries in patients with 100% angiographic occlusion of the proximal vasculature. Binomial exact 95% confidence intervals (CIs) and Fisher's exact tests were used. Twenty-six patients were enrolled. Three cases (11.5% of 26) had normal angiography, five (19.2%) had partial occlusion, and 18 (69.2%) had 100% occlusion. For cases with 100% occlusion, HH always classified PT or DP as abnormal (sensitivity 100, 95% CI 81.5-100%). SD also showed high sensitivity (94.4, 95% CI 72.7-99.9%). Limited utility of specificity calculations was due to low true negatives (n = 3), but these measures were low for HH (66.7, 95% CI 9.4-99.2%) and SD (33.3, 95% CI 0.8-90.6%). There was no association (p = .305) between sonographer confidence and correct diagnostic classification for either HH or SD. In a patient population with suspected ALI, EM-performed HH and SD performed extremely well at identifying abnormal PT or DP flow in patients with complete (100%) angiographic occlusion. These results are useful to power larger trials to determine the role that SD may play in complementing HH evaluation for ALI.

Performing percutaneous coronary intervention (PCI) for heavily calcified coronary lesions remains a significant clinical challenge. In 2023, following the availability of intravascular lithotripsy (IVL), a consensus document was published outlining imaging-guided device selection strategies for the treatment of calcified lesions. Since the publication of that document, the DUAL-PREP study has demonstrated the safety of combining rotational atherectomy (rotablator) with IVL, a strategy previously contraindicated in the original consensus. As a result, a revision of the consensus document became necessary. In the updated consensus, the fundamental principle of imaging-guided treatment planning is retained. However, a key modification is the acknowledgment that IVL may now be considered in cases where post-atherectomy imaging reveals persistent heavy calcification and further atherectomy is deemed either ineffective or potentially harmful to the patient.