Catheterization and Cardiovascular Interventions最新文献

Objective: The aim of this study was to investigate the effect of control imaging after intravenous (IV) tirofiban infusion on the clinical outcome of patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Methods: Patients who underwent PCI between June 2020 and October 2023 at our tertiary referral hospital and received tirofiban infusion were analyzed. Primary composite endpoint was the combination of cardiovascular death, myocardial infarction, cerebrovascular accident, or unplanned revascularization during follow-up.

Results: A total of 217 patients (22.6% female, mean age: 58 ± 13 years) with ACS who received IV tirofiban therapy after PCI were compared in three groups: Patients without additional procedure (n = 131), patients undergoing control coronary angiography after index PCI (n = 43), and patients undergoing additional PCI after index PCI (n = 43). The most common reason for clinical intervention was STEMI (65.9%). After approximately 1 year of follow-up, primary composite endpoint of cardiac death, myocardial infarction, cerebrovascular accident, or unplanned revascularization was similar in all groups (30 [22.9%] vs. 15 [35%] vs. 12 [28%], p = 0.290).

Conclusion: Repeat coronary angiography and additional PCI after tirofiban infusion in patients undergoing index PCI were associated with similar cardiovascular outcomes at 1-year follow-up compared with no repeat coronary angiography.

Background: Managing aorto-ostial coronary lesions during percutaneous coronary interventions (PCI) presents significant challenges due to complex anatomy, catheter instability, and risks of stent misplacement.

Aims: The OSTIAL pivotal study aimed to assess the feasibility and precision of the floating balloon technique for optimizing stent placement in aorto-ostial lesions (AOL), with post-procedural coronary computed tomography angiography (CCTA) used to evaluate stent positioning.

Methods: This prospective, dual-center observational study included 12 patients undergoing PCI for AOL using the floating balloon technique. The technique stabilizes the guiding catheter by positioning a balloon in the aorta, thereby defining the aorto-ostial landing zone (AOLZ) for precise stent placement. Post-procedural CCTA were systematically performed to assess the positioning of the stent. The primary outcome was technical success including optimal stent placement within the AOLZ and proximal anatomy-dependent geographic miss.

Results: The primary outcome was achieved in 83% of cases, with 66% showing complete AOLZ coverage and 17% classified as a proximal anatomy-dependent geographic miss. Proximal procedure-dependent geographic miss occurred in only 17% of cases, with limited stent protrusion into the aorta (2.3 and 2.9 mm).

Conclusions: The floating balloon technique demonstrated feasibility and precision in optimizing stent placement in AOL, as assessed by CCTA. It offers a promising, cost-effective, and practical alternative to other techniques. Larger studies are required to confirm its efficacy and long-term benefits.

Saphenous venous grafts (SVGs) are prone to progressive degeneration, leading to complex calcified lesions, which present a therapeutic challenge during percutaneous coronary interventions (PCI). Calcium modification techniques such as cutting balloons, intravascular lithotripsy (IVL), and rotational atherectomy have been employed in native coronary arteries; however, the use of rotational atherectomy in SVGs is controversial. This case report presents a novel approach where calcium modification techniques were successfully used to treat calcified stenosis in 30 years old SVG. The case demonstrates safe and effective use of rotational atherectomy in an SVG, possibly making it the first documented application of this technique in such a context. The report explores the rationale, procedural details, and potential risks of this approach, supported by a review of the existing literature.

Severe calcified lesions in the coronary arteries often pose significant challenges for successful percutaneous coronary interventions. In this case, a 78-year-old woman presented with severe calcific disease in the right coronary artery and underwent two sequential interventions. The initial procedure involved rotational atherectomy but failed to fully cross the lesion. The procedure was complicated by an ostial dissection that was treated by stent. Subsequently, orbital atherectomy was employed, successfully crossing the lesion through a newly deployed ostial stent. Additionally, upfront intracoronary adenosine was administered to prevent no-reflow, achieving optimal procedural outcomes. This case highlights the utility of orbital atherectomy as a rescue technique after failed rotational atherectomy and the effectiveness of proactive pharmacological intervention for no-reflow prevention. To our knowledge there were no case reports addressing successful orbital atherectomy following failed rotational atherectomy.

Background: Long-term outcomes of percutaneous coronary intervention (PCI) for left circumflex artery (LCX) ostial lesions remain suboptimal. While a stent-less strategy using directional coronary atherectomy (DCA) and drug-eluting balloon (DEB) may offer a potential solution, no studies have reported on its long-term outcomes.

Aims: This study aims to evaluate the long-term outcomes of a stent-less PCI strategy using DCA and DEB for LCX ostial lesions.

Methods: We retrospectively analyzed consecutive patients treated for LCX ostial lesions with DCA to reduce plaque area to < 60%, followed by DEB angioplasty, at Saiseikai Utsunomiya Hospital, Tochigi, Japan, between January 2019 and January 2024. The primary endpoint was clinically driven target lesion revascularization. Secondary endpoints included major adverse cardiac events, defined as a composite of cardiac death, myocardial infarction (MI), and ischemia-driven target vessel revascularization, as well as bleeding complications.

Results: Ten patients were included, five of whom had diabetes mellitus. A total of 80% had concomitant left main trunk (LMT) to left anterior descending artery (LAD) lesions; 60% underwent crossover stenting for LMT-LAD after LCX DCA, while two were treated with DCA and DEB for both LCX and LMT-LAD. All patients underwent follow-up using coronary computed tomography or angiography, with a follow-up period ranging from 8 to 56 months (median: 22 months, IQR: 21.7). TLR occurred in one patient (10%). No cases of cardiac death, MI, or bleeding complications were observed.

Conclusions: DCA followed by DEB demonstrated favorable long-term outcomes for LCX ostial lesions, providing a viable alternative to conventional stent-based PCI strategies.

A 66-year-old man with a baseline electrocardiogram (ECG) showing left bundle branch block developed persistent complete atrioventricular block following stent placement in the proximal left anterior descending artery (LAD), necessitating permanent pacemaker implantation. The complication is believed to have resulted from occlusion of the second septal branch, which likely supplied the right bundle of the His system. During elective interventions targeting the LAD in patients with pre-existing conduction abnormalities, it is crucial to maintain adequate blood flow to the septal perforators.

Background: Left ventricle outflow tract obstruction (LVOTO) is the main limitation of transcatheter mitral valve replacement (TMVR) procedure occurring in 7%-9% of cases and responsible of 25% TMVR screen failures.

Aims: We aim to assess the alcohol septal ablation (ASA) effect on LVOTO risk before TMVR by multistage cardiac computed tomography (CT).

Methods: Patients indicated for TMVR procedure using Sapiens 3 Prosthesis with high LVOTO risk were enrolled in the study. ASA was the first choice technique to reduce this risk based on multiple and staged cardiac CT screening.

Results: Out of 29 consecutive TMVR procedures conducted in our center between March 2021 and April 2023, nine patients presented high LVOTO risk and were enrolled in our study. The main risk factor retained was a reduced predicted NeoLVOT surface 89 mm² [66-135] (< 170 mm²). Most procedures were valve in MAC and all patients underwent at least one ASA. CT control showed a significant increase by 95% in the predicted NeoLVOT surface: 174 mm² [121-240]; p = 0.012 compared to the baseline value. There were no significant paraprosthesis leakage or LVOTO found on TTE according to the MVARC criteria. Cardiac CT showed a larger than predicted final NeoLVOT surface: 215 mm² [175-317]; p = 0.018. One patient died after ASA, and two others during the first year of follow-up. Survivors had significant symptom relief (p = 0.046) and a decreased PASP (38 mmHg [32-47] vs. 54 mmHg [46-62.5]; p = 0.028).

Conclusions: Multistage CT analysis shows that ASA is effective in high LVOTO-risk patients undergoing TMVR.

Background: Congenital heart disease (CHD) patients with pulmonary valve failure may undergo transcatheter pulmonary valve replacement (TPVR). Aspirin is often prescribed as long-term therapy after TPVR to prevent thromboembolic events (TE).

Aims: We aimed to examine the prevalence of aspirin resistance within the CHD TPVR population.

Methods: The VerifyNow point-of-care test quantifies platelet aggregation as Aspirin Reactivity Units (ARU). ARU values greater than 550 suggest aspirin resistance (AR). A retrospective chart review analyzed ARU test results from May 2022 through December 2023 in CHD patients following successful TPVR (n = 48). Lifelong TE history was collected. Association between AR and sex, race, and ethnicity was examined with Fisher's Exact test, and the Wilcoxon rank sum exact test analyzed associations between AR and age.

Results: Three of 45 (6.67%) CHD TPVR aspirin-compliant patients (average age 33.14 years; range 0.74-77.86 years, 47% females) were AR. Interestingly, all AR patients were females, suggesting higher AR prevalence in females (p = 0.094). No significant associations were found between AR and age (p = 0.8), race (p = 0.077), or ethnicity (p = 0.2). No AR patients had a documented history of TE. Five of 42 (11.9%) aspirin sensitive patients had TE while taking aspirin, including two females (not on birth control at time of event) and three males.

Conclusions: AR is prevalent in CHD TPVR patients, but TE occurrence did not correlate with AR. However, AR exclusively in females and TE in aspirin sensitive patients, suggests need for further investigations on the most effective TE prophylaxis in this population.