Catheterization and Cardiovascular Interventions最新文献

Radial artery pseudoaneurysm (PSA) is an uncommon but clinically relevant complication increasingly encountered with the expanding use of radial access in cardiology and critical care. Presentation and management vary widely according to etiology, patient frailty, and arterial wall integrity. We describe two representative cases: an elderly diabetic woman who developed a PSA after complex transradial coronary stenting and was successfully treated with selective coil embolization, and a man with cardiogenic shock and sepsis who developed a PSA following prolonged invasive monitoring and was managed with vascular plug devices. These cases illustrate the heterogeneous mechanisms leading to PSA and emphasize the need for individualized endovascular strategies in complex patients.

Background

Although rotational atherectomy (RA) has been proven to be a useful tool for severely calcified lesions in patients with chronic kidney disease (CKD), there is a paucity of data comparing an elective RA (E-RA) versus a bailout RA (B-RA) strategy.

Aims

To compare the long-term outcomes between E-RA versus B-RA in patients with CKD.

Methods

This prospective, multicentre, randomized study compared E-RA versus B-RA in severely calcified lesions in patients with CKD. Participants were randomized 1:1 and clinically followed. The primary endpoint was major cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR) or stent thrombosis.

Results

124 patients (62 per group) were enrolled and followed up for a median of 4.2 [3.4–5.3] years. Mean age was 77.3 ± 8.3 years; 69.4% were male. There were no baseline differences between groups. There were no differences in MACE (B-RA: 23.3% vs E-RA: 21.3%; log-rank p = 0.97), death (B-RA: 36.7% vs E-RA: 41.0%; log-rank p = 0.53), cardiovascular death (B-RA: 8.3% vs E-RA: 9.8%; log-rank p = 0.71) and MI during long-term follow-up between E-RA and B-RA strategies. There was a non-significant trend toward fewer TVR events (HR: 0.69; 95% CI: 0.19–2.44; p = 0.56) and TLR events (HR: 0.51; 95% CI: 0.13–2.06; p = 0.35) in the E-RA group.

Conclusions

Both E-RA and B-RA showed a high rate of clinical events in the long-term follow-up, consistent with a high-risk population. A non-significant trend toward lower rates of TVR and TLR was observed in E-RA group.

Background

Coronary bifurcation lesions account for 20% of all percutaneous coronary interventions. Acute coronary syndromes involve thrombotic conditions; however, methods for assessing this risk in thrombus-containing bifurcations are unestablished.

Aims

This study aimed to determine whether perfusion balloon dilatation can predict the occurrence of side branch occlusion.

Methods

A total of 38 acute coronary syndrome patients with 65 side branches undergoing percutaneous coronary intervention using a perfusion balloon were enrolled. Based on the side branch flow during perfusion balloon dilatation, the branches were divided into PB-SAFE (perfusion balloon side branch-assisted flow stability, with side branch flow maintained) and not-SAFE (with side branch flow loss) groups.

Results

The PB-SAFE group did not have cases of side branch occlusion, whereas side branch occlusion occurred in 13 (31.7%) branches in the not-SAFE group. Further, this group was identified as a significant predictor of side branch occlusion (p < 0.01). In a lesion-level multivariable analysis with per-patient clustering, not-SAFE remained an independent predictor of side branch occlusion (adjusted OR 20.8, 95% CI 4.08−106, p < 0.01).

Conclusion

The PB-SAFE, our original predictor of side branch occlusion, can predict patients at risk of side branch occlusion during acute coronary syndrome bifurcation lesions.

Background

Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) enhances treatment of complex coronary artery lesions, including left main (LM) disease, by enabling lesion morphology assessment and stent optimization, thereby reducing major adverse cardiac events (MACE).

Aims

The aim of this study was to evaluate the feasibility, safety, and mid-term outcomes of OCT-guided PCI for distal LM bifurcation lesions in the South-Asian population.

Methods

This prospective, multicenter, observational registry included 100 consecutive patients (aged 20–80 years) undergoing OCT-guided PCI for distal LM bifurcation lesions. The primary endpoint was procedural success, defined as residual angiographic stenosis of < 30%, thrombolysis in myocardial infarction (TIMI) 3 flow in all major branches, and adequate stent expansion (≥ 80%) in all vessels. Secondary endpoints included MACE, all-cause mortality, myocardial infarction, stent thrombosis, and target vessel revascularization (TVR) at 12 months.

Results

The primary endpoint was attained in 85% of the patients. At the 12-month follow-up, MACE occurred in 1% of patients, including one (1%) cardiac mortality and one (1%) in-hospital definite stent thrombosis. No TVR or stroke was observed. The mean contrast volume used was 190.6 (71.3) mL, with significantly lower usage in the provisional stented group (174.7 mL) compared to the 2-/3-stented group (p < 0.001). The cumulative impact of OCT guidance was observed in 53% of the included patients (preprocedure: 49%, postprocedure: 13%). An extended follow-up of 18 months showed no additional MACE rates.

Conclusion

OCT-guided PCI was found to be safe for distal LM bifurcation lesions with good procedural success and low rates of MACE and stent thrombosis.

Trial Registration

Clinical Trials Registry of India: CTRI/2021/07/034819.