Catheterization and Cardiovascular Interventions最新文献

One of the major issues encountered in patients undergoing evaluation for Transcatheter mitral valve replacement (TMVR) is the risk of Left ventricular outflow tract (LVOT) obstruction. LVOT obstruction is a catastrophic complication of TMVR, the result of displacement of the anterior mitral valve leaflet (AML) toward the interventricular septum. Several strategies to mitigate the risk of LVOT obstruction have been described and include percutaneous laceration of the anterior mitral leaflet (LAMPOON), alcohol septal ablation, trans-atrial leaflet modification (SITRAL) and Balloon Assisted Translocation of Mitral Anterior leaflet to prevent LVOT obstruction (BATMAN). These techniques have certain limitations: procedure complexity for LAMPOON, inconsistent results for alcohol septal ablation, and the need for surgery in SITRAL. While the initial description of BATMAN was through a trans-apical approach, the evolution of a trans-septal approach has improved the utility of this technique. These procedures usually require several steps with multiple wire exchanges, snares, and high energy electrocautery. The complexity of these procedures has hindered their widespread adoption. Herein, we describe a simplified technique called the Single Wire Approach for Traversing Tissue (SWATT) utilized to facilitate a trans-septal BATMAN procedure to traverse the valve leaflets and tissue with minimal exchanges, using the commercially available VERSACROSS transeptal system (Boston Scientific, Natick, MA).

F. Oliveri, M. J. H. van Oort, I. Al Amri, et al., “Intravascular Lithotripsy in Heavily Calcified Chronic Total Occlusion: Procedural and One-Year Clinical Outcomes.” Catheterization and Cardiovascular Interventions 104 (2024): 655–663, https://doi.org/10.1002/ccd.31207.

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Introduction: The super high-pressure NC balloon (OPN NC; SIS Medical AG, Winterthur, Switzerland) is increasingly used in percutaneous coronary intervention (PCI). We performed a systematic review and meta-analysis of its efficacy and safety.

Methods: A systematic review was conducted using PubMed and the Cochrane Library to identify studies using the OPN NC balloon in PCI. Procedural success, major adverse cardiac events (MACE), coronary perforation, and other complications were pooled using weighted means, confidence intervals (CI), and I² statistics for heterogeneity assessment.

Results: Twenty-nine studies (5 prospective including 2 randomized-controlled trials, 12 retrospective, and 12 case reports) were included in the systematic review, of which 11 (3 prospective, 8 retrospective) were included in the meta-analysis. Of the 1015 meta-analysis patients, 50.7% presented with stable angina and 21.6% with an acute coronary syndrome. Mean lesion length was 22.8 ± 13.7 mm, the prevalence of moderate or severe calcification was 93.7%, and 40.4% of lesions were in-stent. Procedural success was 95.1% (95% CI 89.3%-98.8% with significant heterogeneity: I² = 84.9%). The incidence of periprocedural MACE was 1.9% (95% CI 1.1%-2.8%, I² 86.9%), and the incidence of coronary perforation was 0.6% (95% CI 0.3%-1.5%, I² 87.2%).

Conclusions: Use of the OPN NC balloon is associated with high success and acceptable complication rates. The heterogeneity of outcomes underscores the need for additional studies and standardized definitions.

Background: The coronary atrial circulation is the network of vessels that supply blood to the atria, originating from the left circumflex and right coronary arteries. Current descriptions of this arterial system are based on anatomical studies with a limited number of patients, predominantly male. In addition, there is a lack of consensus its angiographic nomenclature.

Aims: This study aimed to evaluate the anatomical variations of coronary atrial branches (CAB) and investigate sex-related differences in their distribution.

Methods: Consecutive patients with ST-elevation myocardial infarction who underwent primary PCI at a tertiary center between 2004 and 2013 were included. Angiographic anatomy of all visible CAB on index coronary angiography was systematically evaluated following a stepwise method, including type of branch; coronary artery of origin; segment of origin, branch course, and atrial dominancy. Specific differences between both sexes were analyzed.

Results: A total of 998 patients (age 61 ± 12, 79% male) were included. The sinus node artery was the dominant CAB in 916 (93%), originating in 37% from distal coronary segments. Different CAB anatomical patterns were identified in both sexes. Compared to females, males presented a higher prevalence of left-sided CAB (left circumflex CAB 459 [58%] vs. 96 [45%], p < 0.001; sigma-shaped CAB 267 [30%] vs. 39 [21%], p = 0.003) and of a left-balanced atrial circulation pattern-defined as the presence of at least two CAB originating from the LCx, with one of them being the dominant CAB-245 (31%) versus 45 (21%), p = 0.005.

Conclusions: This study provides a systematic approach to the angiographic evaluation of CAB. Sex-related phenotypical differences of CAB distribution were found, with males presenting a higher presence of left-sided CAB and a left-balanced atrial circulation pattern.

Transcatheter aortic valve replacement (TAVR) has become a viable treatment option for patients with severe aortic stenosis among all risk subsets. As TAVR use becomes more prevalent and patients live longer with their transcatheter valve, an increasing number of these patients can be expected to present with ACS. Overall, there is a paucity of high-quality data detailing incidence, pathophysiology, and management of ACS in this subset. While most ACS cases post-TAVR are Type II myocardial infarctions (MI), the incidence of Type I MI and ST-elevation myocardial infarction is not negligible. Additionally, ACS in TAVR patients is associated with poor outcomes. While medical management is similar in this cohort to non-TAVR patients, procedural issues pose a unique challenge, especially as related to coronary access in the presence of valve prosthesis. Despite the proven benefit of invasive therapies in the management of ACS in non-TAVR patients, administrative databases suggest a lower utilization of invasive therapies in this cohort, which may highlight a disparity in care and potential for improvement. In this review, we summarize available data regarding the incidence, pathophysiology, and management of ACS in TAVR patients as well as strategies for coronary access post-TAVR.

V. Sharma, A. Arokiadoss, A. Bhardwaj, and S. Shamim, “SAICR-CTO: Single Access Impella-Guided Complete Revascularization in Chronic Total Occlusion—A Novel Approach to High-Risk PCI,” Catheterization and Cardiovascular Interventions 104 (2024): 1540–1543, https://doi.org/10.1002/ccd.31277.

In the “Interventional Technique” section, the statement “This technique was performed by Dr. Shariq Shamim, MD.” has been added.

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Coronary calcification is a major factor leading to stent under-expansion, and subsequent adverse events. This meta-analysis aimed to evaluate the short and long‑term outcomes of rotational atherectomy (RA), followed by modified balloon (cutting or scoring) (MB) versus plain balloon before drug‑eluting stent implantation for calcified coronary lesions. We searched PubMed, Web of Science (WOS), Scopus, and the Cochrane Library Central Register of Controlled Trials (CENTRAL), from inception until 30 January 2024. The risk ratio (RR) with a 95% confidence interval (CI) was used to compare dichotomous outcomes, while continuous outcomes were reported in form of mean difference (MD). Our study included seven studies with 309 patients undergoing RA followed by MB angioplasty, and 414 patients had RA followed by conventional plain balloon angioplasty, before stent implantation. Our analysis revealed no significant difference in-hospital mortality (RR = 0.64, 95% CI [0.18, 2.23], p = 0.49), or long-term mortality (RR = 0.65, 95% CI [0.18, 2.36], p = 0.51). MACE were significantly lower in the cutting balloon group (RR = 0.58, 95% CI [0.37, 0.92], p = 0.02). Angiographic minimum lumen diameter, and change in percent diameter stenosis were significantly higher in the MB group (MD = 0.19, 95% CI [0.08, 0.31], p = < 0.01), and (MD = 3.75, 95% CI [0.76, 6.74], p = 0.01) respectively. No difference was found regarding target lesion revascularization (RR: 0.50, 95% CI [0.24, 1.04], p = 0.06), or target vessel revascularization (RR: 0.71, 95% CI [0.38, 1.33], p = 0.28). RA followed by MB is as safe plain balloon angioplasty before stent implantation in moderate to severely calcified coronary lesions. Moreover, it is associated with significantly better immediate angiographic outcomes, and significantly lower MACE.

Background: Evaluating health status changes following transfemoral carotid artery stenting (TF-CAS) is essential for assessing procedural success, but meaningful clinical changes are unknown. We aimed to determine minimal clinically important differences (MCIDs) and quantify health status improvement or worsening rates after TF-CAS using the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) registry data.

Methods: The SAPPHIRE registry included patients undergoing TF-CAS from 2010 to 2014 for both symptomatic and asymptomatic carotid stenosis. Baseline and 30-day health status were assessed using the SF-36 (2010-2012) for mental and physical component scores (MCS and PCS) and the EQ-5D (2012-2014) for 3 L Index and Visual Analog Scale (VAS) scores. For each score, we calculated the 30-day distribution-based MCID (0.5*standard deviations of baseline health status) by symptom status and the overall cohort (symptom-weighted MCIDs). The changes were then categorized as improved, deteriorated, or unchanged based on these MCIDs.

Results: Health status was assessed using the EQ-5D in 3930 patients and the SF-36 in 3018 patients (27.7% and 30.5% symptomatic, respectively). The MCIDs by symptom status were close, hence weighted MCIDs of 0.09 (Index), 11.00 (VAS), 4.70 (PCS), and 5.40 (MCS) were established. Across all subscales, 21.2%-26.1% of patients improved, 10.5%-16.7% worsened, and 57.2%-66.1% unchanged.

Conclusions: We established thresholds for meaningful health status changes after TF-CAS using common generic instruments. At 30 days after TF-CAS, 70%-80% of patients no change or worsened, while 20%-30% improved. Carotid artery disease-specific instrument would provide better insights into of TF-CAS effects on health status.

Renal denervation is an emerging strategy for the management of uncontrolled hypertension. However, real-world experience is still modest, in particular for the management of complex anatomy, with available data being limited to the selected population of randomized clinical trials. We first describe the feasibility of delivering the renal denervation system to the target site with a child-in-mother technique, using a common coronary guiding extension, in a patient with severe tortuosity and double renal arteries.