Okasha Tahir, Syed Ibad Ali, Fatima Zehra, Laiba Shamim, Muhammad Umar
{"title":"Safety, efficacy, and optical coherence tomography insights into intravascular lithotripsy for the modification of noneruptive calcified nodules.","authors":"Okasha Tahir, Syed Ibad Ali, Fatima Zehra, Laiba Shamim, Muhammad Umar","doi":"10.1002/ccd.31260","DOIUrl":"https://doi.org/10.1002/ccd.31260","url":null,"abstract":"","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gustavo M. Hirata MD, Athanasios Rempakos MD, A. Walker Boyd MD, Michaella Alexandrou MD, Deniz Mutlu MD, James W. Choi MD, Paul Poommipanit MD, Jaikirshan J. Khatri MD, Laura Young MD, Rhian Davies DO, MS, Sevket Gorgulu MD, Farouc A. Jaffer MD, PhD, Raj Chandwaney MD, Brian Jefferson MD, Basem Elbarouni MD, Lorenzo Azzalini MD, PhD, MSc, Kathleen E. Kearney MD, Khaldoon Alaswad MD, Mir B. Basir DO, Oleg Krestyaninov MD, Dmitrii Khelimskii MD, Nazif Aygul MD, Nidal Abi-Rafeh MD, Ahmed ElGuindy MD, Omer Goktekin MD, Bavana V. Rangan BDS, MPH, Olga C. Mastrodemos BA, Ahmed Al-Ogaili MD, Yader Sandoval MD, M. Nicholas Burke MD, Emmanouil S. Brilakis MD, Jarrod D. Frizzell MD
Background
There is limited information about the frequency and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in anomalous coronary arteries (ACA).
Methods
We examined the clinical and angiographic characteristics and procedural outcomes of CTO PCI in ACA among 14,173 patients who underwent 14,470 CTO PCIs at 46 US and non-US centers between 2012 and 2023.
Results
Of 14,470 CTO PCIs, 36 (0.24%) were CTO PCIs in an ACA. ACA patients had similar baseline characteristics as those without an ACA. The type of ACA in which the CTO lesion was found were as follows: anomalous origin of the right coronary artery (ARCA) (17, 48.5%), anomalous origin of left circumflex coronary artery (9, 25.7%), left anterior descending artery and left circumflex artery with separate origins (4, 11.4%), anomalous origin of the left anterior descending artery (2, 5.7%), dual left anterior descending artery (2, 5.7%) and woven coronary artery 1 (2.8%). The Japan CTO score was similar between both groups (2.17 ± 1.32 vs 2.38 ± 1.26, p = 0.30). The target CTO in ACA patients was more likely to have moderate/severe tortuosity (44% vs 28%, p = 0.035), required more often use of retrograde approach (27% vs 12%, p = 0.028), and was associated with longer procedure (142.5 min vs 112.00 min [74.0, 164.0], p = 0.028) and fluoroscopy (56 min [40, 79 ml] vs 42 min [25, 67], p = 0.014) time and higher contrast volume (260 ml [190, 450] vs 200 ml [150, 300], p = 0.004) but had similar procedural (91.4% vs 85.6%, p = 0.46) and technical (91.4% vs 87.0%, p = 0.59) success. No major adverse cardiac events (MACE) were seen in ACA patients (0% [0] vs 1.9% [281] in non-ACA patients, p = 1.00). Two coronary perforations were reported in ACA CTO PCI (p = 0.7 vs. non-ACA CTO PCI).
Conclusions
CTO PCI of ACA comprise 0.24% of all CTO PCIs performed in the PROGRESS CTO registry and was associated with higher procedural complexity but similar technical and procedural success rates and similar MACE compared with non-ACA CTO PCI.
{"title":"Chronic total occlusion percutaneous coronary intervention of anomalous coronary arteries: insights from the PROGRESS CTO registry","authors":"Gustavo M. Hirata MD, Athanasios Rempakos MD, A. Walker Boyd MD, Michaella Alexandrou MD, Deniz Mutlu MD, James W. Choi MD, Paul Poommipanit MD, Jaikirshan J. Khatri MD, Laura Young MD, Rhian Davies DO, MS, Sevket Gorgulu MD, Farouc A. Jaffer MD, PhD, Raj Chandwaney MD, Brian Jefferson MD, Basem Elbarouni MD, Lorenzo Azzalini MD, PhD, MSc, Kathleen E. Kearney MD, Khaldoon Alaswad MD, Mir B. Basir DO, Oleg Krestyaninov MD, Dmitrii Khelimskii MD, Nazif Aygul MD, Nidal Abi-Rafeh MD, Ahmed ElGuindy MD, Omer Goktekin MD, Bavana V. Rangan BDS, MPH, Olga C. Mastrodemos BA, Ahmed Al-Ogaili MD, Yader Sandoval MD, M. Nicholas Burke MD, Emmanouil S. Brilakis MD, Jarrod D. Frizzell MD","doi":"10.1002/ccd.31248","DOIUrl":"10.1002/ccd.31248","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is limited information about the frequency and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in anomalous coronary arteries (ACA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined the clinical and angiographic characteristics and procedural outcomes of CTO PCI in ACA among 14,173 patients who underwent 14,470 CTO PCIs at 46 US and non-US centers between 2012 and 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 14,470 CTO PCIs, 36 (0.24%) were CTO PCIs in an ACA. ACA patients had similar baseline characteristics as those without an ACA. The type of ACA in which the CTO lesion was found were as follows: anomalous origin of the right coronary artery (ARCA) (17, 48.5%), anomalous origin of left circumflex coronary artery (9, 25.7%), left anterior descending artery and left circumflex artery with separate origins (4, 11.4%), anomalous origin of the left anterior descending artery (2, 5.7%), dual left anterior descending artery (2, 5.7%) and woven coronary artery 1 (2.8%). The Japan CTO score was similar between both groups (2.17 ± 1.32 vs 2.38 ± 1.26, <i>p</i> = 0.30). The target CTO in ACA patients was more likely to have moderate/severe tortuosity (44% vs 28%, <i>p</i> = 0.035), required more often use of retrograde approach (27% vs 12%, <i>p</i> = 0.028), and was associated with longer procedure (142.5 min vs 112.00 min [74.0, 164.0], <i>p</i> = 0.028) and fluoroscopy (56 min [40, 79 ml] vs 42 min [25, 67], <i>p</i> = 0.014) time and higher contrast volume (260 ml [190, 450] vs 200 ml [150, 300], <i>p</i> = 0.004) but had similar procedural (91.4% vs 85.6%, <i>p</i> = 0.46) and technical (91.4% vs 87.0%, <i>p</i> = 0.59) success. No major adverse cardiac events (MACE) were seen in ACA patients (0% [0] vs 1.9% [281] in non-ACA patients, <i>p</i> = 1.00). Two coronary perforations were reported in ACA CTO PCI (<i>p</i> = 0.7 vs. non-ACA CTO PCI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CTO PCI of ACA comprise 0.24% of all CTO PCIs performed in the PROGRESS CTO registry and was associated with higher procedural complexity but similar technical and procedural success rates and similar MACE compared with non-ACA CTO PCI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 6","pages":"1148-1158"},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We conducted a prespecified subanalysis of the POEM trial to assess the association between sex and clinical outcomes following a short 1-month dual-antiplatelet-therapy (DAPT) period after percutaneous coronary intervention (PCI) with bioresorbable polymer everolimus-eluting stent (BP-EES) among patients at high bleeding risk (HBR).
Background
Shortening the DAPT period after PCI is an effective bleeding avoidance strategy with contemporary drug-eluting stents. Whether sex affects the risk of adverse events following PCI is still debated.
Methods
Patients at HBR undergoing PCI with BP-EES were enrolled and treated with 1-month DAPT. If anticoagulation was needed, study participants received an oral anticoagulant (OAC) in addition to a P2Y12 inhibitor for 1 month, followed by OAC only thereafter. The primary endpoint was a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis at 12 months. We report sex-based outcomes of patients included in the POEM study.
Results
We enrolled 129 (29.1%) women and 314 (70.9%) men. Women were older, with lower hemoglobin levels, and worse renal function. Accordingly, they had a trend for a greater number of HBR criteria fulfilled and a higher PARIS bleeding score. However, they were not at a significantly higher risk for the primary endpoint (men vs. women: 5.17% vs. 3.94%; HR 1.30; 95% CI: 0.48-3.54, p = 0.61), or any of the hemorrhagic and ischemic secondary endpoints.
Conclusions
This prespecified subanalysis of the POEM trial suggests that 1-month DAPT following PCI with BP-EES may be a safe and effective therapeutic strategy for women at HBR.
{"title":"One-month DAPT after biodegradable-polymer everolimus-eluting stent implantation in women at high-bleeding risk: Insights from the POEM trial","authors":"Matteo Maurina MD, Carlo Andrea Pivato MD, Vijay Kunadian MD, Luca Testa MD, PhD, Carlo Briguori MD, PhD, Andrea Pacchioni MD, Alessia Chiara Latini MD, Nicola Cesani MD, Raffale Piccolo MD, PhD, Carmine Musto MD, PhD, Gennaro Sardella MD, Ciro Indolfi MD, Damiano Regazzoli MD, Valeria Paradies MD, Giulio Stefanini MD, PhD, MSc","doi":"10.1002/ccd.31255","DOIUrl":"10.1002/ccd.31255","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We conducted a prespecified subanalysis of the POEM trial to assess the association between sex and clinical outcomes following a short 1-month dual-antiplatelet-therapy (DAPT) period after percutaneous coronary intervention (PCI) with bioresorbable polymer everolimus-eluting stent (BP-EES) among patients at high bleeding risk (HBR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Shortening the DAPT period after PCI is an effective bleeding avoidance strategy with contemporary drug-eluting stents. Whether sex affects the risk of adverse events following PCI is still debated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients at HBR undergoing PCI with BP-EES were enrolled and treated with 1-month DAPT. If anticoagulation was needed, study participants received an oral anticoagulant (OAC) in addition to a P2Y<sub>12</sub> inhibitor for 1 month, followed by OAC only thereafter. The primary endpoint was a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis at 12 months. We report sex-based outcomes of patients included in the POEM study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 129 (29.1%) women and 314 (70.9%) men. Women were older, with lower hemoglobin levels, and worse renal function. Accordingly, they had a trend for a greater number of HBR criteria fulfilled and a higher PARIS bleeding score. However, they were not at a significantly higher risk for the primary endpoint (men vs. women: 5.17% vs. 3.94%; HR 1.30; 95% CI: 0.48-3.54, <i>p</i> = 0.61), or any of the hemorrhagic and ischemic secondary endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This prespecified subanalysis of the POEM trial suggests that 1-month DAPT following PCI with BP-EES may be a safe and effective therapeutic strategy for women at HBR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 6","pages":"1129-1138"},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>Sirolimus-coated balloon (SCB), a relatively novel technology appears attractive due to the drug properties (safety and efficacy) and sirolimus remains the drug of choice in stents. However, there is limited data long-term data on SCB. In this study, we have explored the clinical outcomes following the use of SCB in de-novo lesions from a real-world practice.</p> </section> <section> <h3> Aims</h3> <p>To report long-term clinical outcomes following the use of Siroliumus coated balloon in de novo lesions.</p> </section> <section> <h3> Methods and Results</h3> <p>We analyzed all patients treated with an SCB in de novo lesions between 2016 and 2023 at four high-volume centers in UK and Italy. The outcomes measured included cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularization (TLR) and major adverse cardiac events (MACE).</p> <p>During the study period, 771 patients had SCB in de novo lesions. Diabetes mellitus was noted in 36% of patients (<i>n</i> = 280), of which 14% (<i>n</i> = 108) were insulin dependent. Fifteen percent (<i>n</i> = 117) had chronic kidney disease, Fifty-two percent (<i>n</i> = 398) of cases were in the setting acute coronary syndrome (ACS) and of which 51 cases (7%) were ST-segment elevation myocardial infarction. Small vessels (<3.0 mm) accounted for 78% (<i>n</i> = 601) of cases and 76% (<i>n</i> = 584) were long lesions (<span></span><math> <semantics> <mrow> <mrow> <mo>≥</mo> </mrow> </mrow> <annotation> <math altimg="urn:x-wiley:15221946:media:ccd31244:ccd31244-math-0001" wiley:location="equation/ccd31244-math-0001.png" display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mrow><mo>unicode{x02265}</mo></mrow></mrow></math></annotation> </semantics></math>20 mm). The mean diameter of SCB was 2.6 ± 0.4 mm and the mean length was 25 ± 10.39 mm. Bailout stenting following SCB was required in 9% lesions (<i>n</i> = 67).</p> <p>During the median follow-up 640 days, total death occurred in 39 (5%) patients and of which, cardiac death occurred in 10 patients (1.3%). TVMI occurred in 20 patients (2.6%). TLR and TVR were 5.6% and 5.8% respectively. The overall MACE rate was 8%. We had no documented case of acute vessel closure.</p> </section> <section> <h3> Conclusions</h3> <p>The results from this long-term follow-up in a real-world
{"title":"Use of sirolimus-coated balloon in de novo coronary lesions; long-term clinical outcomes from a multi-center real-world population","authors":"Sandeep Basavarajaiah MD, FESC, Vinoda Sharma MD, MRCP, Alessandro Sticchi MD, Gianluca Caiazzo MD, PhD, Filiberto Fausto Mottola MD, Bhagya Harindi Loku Waduge MBBS, Sampath Athukorala MD, MRCP, Mazaya Fawazy MD, MRCP, Luca Testa MD, Antonio Colombo MD","doi":"10.1002/ccd.31244","DOIUrl":"10.1002/ccd.31244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sirolimus-coated balloon (SCB), a relatively novel technology appears attractive due to the drug properties (safety and efficacy) and sirolimus remains the drug of choice in stents. However, there is limited data long-term data on SCB. In this study, we have explored the clinical outcomes following the use of SCB in de-novo lesions from a real-world practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To report long-term clinical outcomes following the use of Siroliumus coated balloon in de novo lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We analyzed all patients treated with an SCB in de novo lesions between 2016 and 2023 at four high-volume centers in UK and Italy. The outcomes measured included cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularization (TLR) and major adverse cardiac events (MACE).</p>\u0000 \u0000 <p>During the study period, 771 patients had SCB in de novo lesions. Diabetes mellitus was noted in 36% of patients (<i>n</i> = 280), of which 14% (<i>n</i> = 108) were insulin dependent. Fifteen percent (<i>n</i> = 117) had chronic kidney disease, Fifty-two percent (<i>n</i> = 398) of cases were in the setting acute coronary syndrome (ACS) and of which 51 cases (7%) were ST-segment elevation myocardial infarction. Small vessels (<3.0 mm) accounted for 78% (<i>n</i> = 601) of cases and 76% (<i>n</i> = 584) were long lesions (<span></span><math>\u0000 <semantics>\u0000 <mrow>\u0000 \u0000 <mrow>\u0000 <mo>≥</mo>\u0000 </mrow>\u0000 </mrow>\u0000 <annotation> <math altimg=\"urn:x-wiley:15221946:media:ccd31244:ccd31244-math-0001\" wiley:location=\"equation/ccd31244-math-0001.png\" display=\"inline\" xmlns=\"http://www.w3.org/1998/Math/MathML\"><mrow><mrow><mo>unicode{x02265}</mo></mrow></mrow></math></annotation>\u0000 </semantics></math>20 mm). The mean diameter of SCB was 2.6 ± 0.4 mm and the mean length was 25 ± 10.39 mm. Bailout stenting following SCB was required in 9% lesions (<i>n</i> = 67).</p>\u0000 \u0000 <p>During the median follow-up 640 days, total death occurred in 39 (5%) patients and of which, cardiac death occurred in 10 patients (1.3%). TVMI occurred in 20 patients (2.6%). TLR and TVR were 5.6% and 5.8% respectively. The overall MACE rate was 8%. We had no documented case of acute vessel closure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results from this long-term follow-up in a real-world","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 6","pages":"1159-1167"},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jasleen Tiwana MD, Kathleen E. Kearney MD, William L. Lombardi MD, Lorenzo Azzalini MD, PhD, MSc
Dry tamponade is a rare complication of percutaneous coronary intervention. It encompasses a heterogenous pathophysiology and is used to describe hemodynamic compromise secondary to a coronary artery perforation, without free-flowing fluid in the pericardium. Tamponade physiology can result from compressive epicardial, intramyocardial, subepicardial hematomas, or dissecting intramyocardial hematomas. The diagnosis of dry tamponade requires hemodynamic derangement in the context of a compressive hematoma as demonstrated by imaging. Although echocardiography can often help identify dry tamponade, additional studies including right heart catheterization, computed tomography, or cardiac magnetic resonance imaging can inform the exact mechanism and help guide management. This article describes a case of dry tamponade, reviews the existing literature on the topic, and offers expert recommendations on diagnosis and management.
{"title":"Challenges in the diagnosis and management of dry tamponade","authors":"Jasleen Tiwana MD, Kathleen E. Kearney MD, William L. Lombardi MD, Lorenzo Azzalini MD, PhD, MSc","doi":"10.1002/ccd.31241","DOIUrl":"10.1002/ccd.31241","url":null,"abstract":"<p>Dry tamponade is a rare complication of percutaneous coronary intervention. It encompasses a heterogenous pathophysiology and is used to describe hemodynamic compromise secondary to a coronary artery perforation, without free-flowing fluid in the pericardium. Tamponade physiology can result from compressive epicardial, intramyocardial, subepicardial hematomas, or dissecting intramyocardial hematomas. The diagnosis of dry tamponade requires hemodynamic derangement in the context of a compressive hematoma as demonstrated by imaging. Although echocardiography can often help identify dry tamponade, additional studies including right heart catheterization, computed tomography, or cardiac magnetic resonance imaging can inform the exact mechanism and help guide management. This article describes a case of dry tamponade, reviews the existing literature on the topic, and offers expert recommendations on diagnosis and management.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 6","pages":"1228-1240"},"PeriodicalIF":2.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Zuin, Claudio Chiastra, Umberto Morbiducci, Diego Gallo, Claudio Bilato, Gianluca Rigatelli
Over the last decade, several in vivo and computational investigations have significantly advanced our understanding of the pathophysiology of coronary bifurcations, contributing to the enhancement of their percutaneous revascularization. The carina of the coronary bifurcations plays a substantial role in generating their main hemodynamic features, including distinctive flow patterns with secondary flows and specific shear stress patterns. These factors play a pivotal role in determining the susceptibility, development, and progression of atherosclerosis. The underlying pathophysiological mechanisms of atherosclerosis in coronary bifurcations are complex and multifactorial. Understanding these mechanisms is fundamental to comprehending lesions at the bifurcation level and informing future treatment strategies. This review aims to present the currently available data regarding the pathophysiological and prognostic role of the carina in coronary bifurcations, offering an interpretation of these findings from the perspective of interventional cardiologists, providing valuable insights for their clinical practice.
{"title":"Carina: A major determinant in the pathophysiology and treatment of coronary bifurcation lesions.","authors":"Marco Zuin, Claudio Chiastra, Umberto Morbiducci, Diego Gallo, Claudio Bilato, Gianluca Rigatelli","doi":"10.1002/ccd.31254","DOIUrl":"https://doi.org/10.1002/ccd.31254","url":null,"abstract":"<p><p>Over the last decade, several in vivo and computational investigations have significantly advanced our understanding of the pathophysiology of coronary bifurcations, contributing to the enhancement of their percutaneous revascularization. The carina of the coronary bifurcations plays a substantial role in generating their main hemodynamic features, including distinctive flow patterns with secondary flows and specific shear stress patterns. These factors play a pivotal role in determining the susceptibility, development, and progression of atherosclerosis. The underlying pathophysiological mechanisms of atherosclerosis in coronary bifurcations are complex and multifactorial. Understanding these mechanisms is fundamental to comprehending lesions at the bifurcation level and informing future treatment strategies. This review aims to present the currently available data regarding the pathophysiological and prognostic role of the carina in coronary bifurcations, offering an interpretation of these findings from the perspective of interventional cardiologists, providing valuable insights for their clinical practice.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transcatheter mitral valve-in-valve implantation is a preferred treatment for degenerating mitral bioprosthetic valves in high-risk surgical patients. A balloon-expandable transcatheter heart valve delivered through a postero-inferior transseptal puncture is deployed within the prosthesis over a guidewire secured in the left ventricle. Patients with aneurysmal left atrium and altered angulation between the planes of atrial septum and mitral prosthesis have unstable position of the guidewire that flips out of the left ventricle into the left atrium when the valve delivery system is advanced. Instead of a transapical access to snare the guidewire and create a railroad in such instances, we report a new technique of transarterial retrograde snaring of the guidewire in the left ventricle for stabilization.
{"title":"A new simple technique for stabilizing the guidewire position within the left ventricle during transcatheter mitral valve-in-valve implantation","authors":"Kothandam Sivakumar MD, DM, Pramod Sagar MD, DM, Puthiyedath Thejaswi MD, DrNB, Sreeja Pavithran MD, FNB","doi":"10.1002/ccd.31256","DOIUrl":"10.1002/ccd.31256","url":null,"abstract":"<p>Transcatheter mitral valve-in-valve implantation is a preferred treatment for degenerating mitral bioprosthetic valves in high-risk surgical patients. A balloon-expandable transcatheter heart valve delivered through a postero-inferior transseptal puncture is deployed within the prosthesis over a guidewire secured in the left ventricle. Patients with aneurysmal left atrium and altered angulation between the planes of atrial septum and mitral prosthesis have unstable position of the guidewire that flips out of the left ventricle into the left atrium when the valve delivery system is advanced. Instead of a transapical access to snare the guidewire and create a railroad in such instances, we report a new technique of transarterial retrograde snaring of the guidewire in the left ventricle for stabilization.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 6","pages":"1316-1321"},"PeriodicalIF":2.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takashi Yanagiuchi MD, Kuniyoshi Fukai MD, Koji Sogabe MD, Yoshihiro Iwasaki MD, Keita Hirano MD, Taku Kato MD, Hirokazu Yokoi MD, Kan Zen MD, Satoaki Matoba MD
Background
Despite the widespread use of drug-coated balloons (DCBs) for femoropopliteal (FP) lesions, there is still no consensus on treatment strategies for DCB restenosis. This study aimed to determine the risk factors for recurrent restenosis after repeat DCB therapy for DCB restenosis in FP lesions.
Methods
This multicenter retrospective study assessed 1176 consecutive limbs in 860 patients who successfully received initial DCB therapy for FP lesions at four cardiovascular centers between May 2018 and December 2022. Among these patients, 118 consecutive limbs of 104 patients treated via repeat DCB for primary DCB restenosis were enrolled.
Results
The Kaplan–Meier estimate of freedom from recurrent restenosis was 74.6% at 1 year. Cox proportional hazard multivariate analysis revealed that recurrent restenosis was independently associated with the time from initial DCB to primary restenosis (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.79–0.92; p < 0.001), history of ≥2 endovascular therapies (EVTs) (HR, 3.11; 95%CI, 1.36–7.12; p = 0.007), and PACSS grade 3 or 4 (HR, 2.76; 95%CI, 1.15–6.63; p = 0.023). Furthermore, receiver operating characteristic curve analysis showed that the cutoff value of the time from initial DCB to primary restenosis to prevent recurrent restenosis was 12.6 months, with an area under the curve of 0.841 (p < 0.001).
Conclusion
Repeat DCB therapy for DCB restenosis might be an acceptable strategy, particularly for restenosis that occurred more than 12.6 months after initial DCB, given the rate of freedom from recurrent restenosis.
{"title":"Predictors of recurrent restenosis after repeat drug-coated balloon therapy for drug-coated balloon restenosis in femoropopliteal lesions: Results of the RECURRENCE study","authors":"Takashi Yanagiuchi MD, Kuniyoshi Fukai MD, Koji Sogabe MD, Yoshihiro Iwasaki MD, Keita Hirano MD, Taku Kato MD, Hirokazu Yokoi MD, Kan Zen MD, Satoaki Matoba MD","doi":"10.1002/ccd.31245","DOIUrl":"10.1002/ccd.31245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the widespread use of drug-coated balloons (DCBs) for femoropopliteal (FP) lesions, there is still no consensus on treatment strategies for DCB restenosis. This study aimed to determine the risk factors for recurrent restenosis after repeat DCB therapy for DCB restenosis in FP lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective study assessed 1176 consecutive limbs in 860 patients who successfully received initial DCB therapy for FP lesions at four cardiovascular centers between May 2018 and December 2022. Among these patients, 118 consecutive limbs of 104 patients treated via repeat DCB for primary DCB restenosis were enrolled.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Kaplan–Meier estimate of freedom from recurrent restenosis was 74.6% at 1 year. Cox proportional hazard multivariate analysis revealed that recurrent restenosis was independently associated with the time from initial DCB to primary restenosis (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.79–0.92; <i>p</i> < 0.001), history of ≥2 endovascular therapies (EVTs) (HR, 3.11; 95%CI, 1.36–7.12; <i>p</i> = 0.007), and PACSS grade 3 or 4 (HR, 2.76; 95%CI, 1.15–6.63; <i>p</i> = 0.023). Furthermore, receiver operating characteristic curve analysis showed that the cutoff value of the time from initial DCB to primary restenosis to prevent recurrent restenosis was 12.6 months, with an area under the curve of 0.841 (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Repeat DCB therapy for DCB restenosis might be an acceptable strategy, particularly for restenosis that occurred more than 12.6 months after initial DCB, given the rate of freedom from recurrent restenosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 6","pages":"1241-1250"},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alberto Vera MD, PhD, Arturo Lanaspa MD, Octavio Jiménez MD, Adela Navarro MD, PhD, María Teresa Basurte MD, Maite Beunza MD, Mercedes Ciriza MD, Nuria Basterra MD, PhD, Rafael Sadaba MD, PhD, Valeriano Ruiz-Quevedo MD, Virginia Álvarez MD
Background
Coronary embolism (CE) is an uncommon cause of non-atherosclerotic acute myocardial infarction (AMI). Although atrial fibrillation (AF) is the main cause of CE, evidence of clinical, biochemical, echocardiographic, angiographic findings and outcomes of AF CE is lacking.
Methods
We retrospectively analyzed 85 consecutive patients with CE that was diagnosed based on criteria encompassing clinical, angiographic and diagnostic imaging findings. We classified patients according to AF CE or non-AF CE.
Results
Forty-five patients presented with AF CE (53%). Patients with AF CE were older (76 ± 12 vs. 63 ± 14 years; p < 0.001) and had more often chronic kidney disease (24% vs. 5%; p = 0.01). AF CE had lower estimated glomerular filtration rate at admission (59 ± 18 vs. 77 ± 16 ml/min/1.73 m2; p < 0.001) and higher brain natriuretic peptide levels (512 ± 417 vs. 210 ± 479 pg/ml; p = 0.02). Coronary arteriography revealed a higher incidence of coronary artery obstruction in the AF CE group (73% vs. 38%; p = 0.001) without differences in interventional management. The AF CE group showed higher left atrial volume index (LAVI) (42 ± 15 vs. 25 ± 12 ml/m2; p < 0.001) and showed lower left atrium ejection fraction (LAEF) (32 ± 17 vs. 49 ± 17%; p = 0.001). In the multivariable analysis AF CE (OR 10 [95% CI 1.04–95; p = 0.046]) and LAEF (OR 0.94 [95% CI 0.88–0.99; p = 0.02]) were associated with worse in-hospital outcomes. Moreover, in the multivariable analysis, prior stroke (OR 12.5 [95% CI 1.1–137; p = 0.04]) and LAVI (OR 1.1 [95% CI 1.03–1.14; p = 0.003]) were independently associated with worse long-term outcomes.
Conclusion
AF CE has specific characteristics compared to non-AF-CE and it is associated with more in-hospital events. Furthermore, atrial cardiopathy is associated with worse in-hospital and long-term outcomes in this setting.
背景：冠状动脉栓塞（CE）是非动脉粥样硬化性急性心肌梗死（AMI）的一个不常见原因。虽然心房颤动（AF）是导致冠状动脉栓塞的主要原因，但目前尚缺乏有关心房颤动性冠状动脉栓塞的临床、生化、超声心动图、血管造影结果和预后的证据：我们回顾性分析了连续 85 例 CE 患者，诊断标准包括临床、血管造影和影像学诊断结果。我们根据房颤 CE 和非房颤 CE 对患者进行了分类：结果：45 名患者患有房颤 CE（53%）。房颤 CE 患者年龄较大（76 ± 12 岁 vs. 63 ± 14 岁；P 2；P 2；P 结论：心房颤动 CE 与非心房颤动 CE 相比具有特殊的特征，与更多的院内事件相关。此外，在这种情况下，心房性心脏病与较差的院内和长期预后有关。
{"title":"Atrial fibrillation versus non-atrial fibrillation coronary embolism","authors":"Alberto Vera MD, PhD, Arturo Lanaspa MD, Octavio Jiménez MD, Adela Navarro MD, PhD, María Teresa Basurte MD, Maite Beunza MD, Mercedes Ciriza MD, Nuria Basterra MD, PhD, Rafael Sadaba MD, PhD, Valeriano Ruiz-Quevedo MD, Virginia Álvarez MD","doi":"10.1002/ccd.31249","DOIUrl":"10.1002/ccd.31249","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary embolism (CE) is an uncommon cause of non-atherosclerotic acute myocardial infarction (AMI). Although atrial fibrillation (AF) is the main cause of CE, evidence of clinical, biochemical, echocardiographic, angiographic findings and outcomes of AF CE is lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 85 consecutive patients with CE that was diagnosed based on criteria encompassing clinical, angiographic and diagnostic imaging findings. We classified patients according to AF CE or non-AF CE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-five patients presented with AF CE (53%). Patients with AF CE were older (76 ± 12 vs. 63 ± 14 years; <i>p</i> < 0.001) and had more often chronic kidney disease (24% vs. 5%; <i>p</i> = 0.01). AF CE had lower estimated glomerular filtration rate at admission (59 ± 18 vs. 77 ± 16 ml/min/1.73 m<sup>2</sup>; <i>p</i> < 0.001) and higher brain natriuretic peptide levels (512 ± 417 vs. 210 ± 479 pg/ml; <i>p</i> = 0.02). Coronary arteriography revealed a higher incidence of coronary artery obstruction in the AF CE group (73% vs. 38%; <i>p</i> = 0.001) without differences in interventional management. The AF CE group showed higher left atrial volume index (LAVI) (42 ± 15 vs. 25 ± 12 ml/m<sup>2</sup>; <i>p</i> < 0.001) and showed lower left atrium ejection fraction (LAEF) (32 ± 17 vs. 49 ± 17%; <i>p</i> = 0.001). In the multivariable analysis AF CE (OR 10 [95% CI 1.04–95; <i>p</i> = 0.046]) and LAEF (OR 0.94 [95% CI 0.88–0.99; <i>p</i> = 0.02]) were associated with worse in-hospital outcomes. Moreover, in the multivariable analysis, prior stroke (OR 12.5 [95% CI 1.1–137; <i>p</i> = 0.04]) and LAVI (OR 1.1 [95% CI 1.03–1.14; <i>p</i> = 0.003]) were independently associated with worse long-term outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AF CE has specific characteristics compared to non-AF-CE and it is associated with more in-hospital events. Furthermore, atrial cardiopathy is associated with worse in-hospital and long-term outcomes in this setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 6","pages":"1196-1203"},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biljana Zafirovska MD, PhD, Aleksandar Jovkovski MD, Ivan Vasilev MD, Hajber Taravari MD, Darko Kitanoski MD, Danica Petkoska MD, Jorgo Kostov MD, PhD, Kalon K. L. Ho MD, Sasko Kedev MD, PhD
<div> <section> <h3> Background</h3> <p>Transradial access (TRA) is now the default access site for PPCI, but technically is a more challenging approach mostly due to anatomic challenges connected to the RA.</p> </section> <section> <h3> Aims</h3> <p>To assess the differences according to sex in radial artery (RA) access site characteristics during primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI).</p> </section> <section> <h3> Material and Methods</h3> <p>All 5092 consecutive STEMI patients from our center in the period from March 2011 until December 2017 were examined. The right proximal radial was the “intention-to-treat” access in all patients. Preprocedural RA angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, need to use another arterial access sites (the primary endpoint for this study), and procedure time were analyzed by sex. Using logistic regression, we selected predictors of radial crossover. Access site bleeding complications and vascular complications were also recorded.</p> </section> <section> <h3> Results</h3> <p>The STEMI population in this period included 1326 females and 3766 male patients. Females were older (65 ± 11 years) than males (59 ± 11 years, <i>p</i> < 0.0001). Among standard risk factors, hypertension and diabetes mellitus were more common in women and smoking less common. RA anomalies were more frequent in the females (8.8% vs. 6.5%, <i>p</i> < 0.0001), with complex RA loop and tortuous RA twice as frequent in women. Failure of TRA access as the initially chosen site occurred in 4.6% (61) of females versus 2.5% (97) of male STEMI patients (<i>p</i> = 0.0003). The most common subsequent access site was right ulnar access in both groups (57 and 61% respectively). Access site bleeding complications were more common in women 4.4% versus 3.2%, mirrored in hematomas with EASY score III to V. Clinical RA spasm (RAS) was significantly more frequent in females (5.7% vs. 2.2%, <i>p</i> < 0.0001). Multiple regression analysis identified 5 independent predictors for TRA access crossover: previous TRA, anomalous RA, RAS, along with female sex and diabetes.</p> </section> <section> <h3> Conclusion</h3> <p>Female sex is a significant predictor of more complex TRA in STEMI. Understanding sex differences and predictors for TRA crossover will strengthen the use of different procedural modalities that can help in preserving a successful wrist access in female STEMI patients.</p> </section> </di
背景：经桡动脉入路（TRA）是目前经皮冠状动脉介入治疗（PPCI）的默认入路部位，但在技术上是一种更具挑战性的方法，这主要是由于与桡动脉相关的解剖学挑战：研究对象为我中心2011年3月至2017年12月期间连续收治的5092例STEMI患者。所有患者的 "意向治疗 "入路均为右近桡动脉。所有患者均进行了术前 RA 血管造影。我们按性别分析了临床和手术特征、桡动脉解剖变异类型、是否需要使用其他动脉通路（本研究的主要终点）以及手术时间。通过逻辑回归，我们筛选出了桡动脉交叉的预测因素。我们还记录了入路部位出血并发症和血管并发症：这一时期的 STEMI 患者包括 1326 名女性和 3766 名男性。女性年龄（65 ± 11 岁）大于男性（59 ± 11 岁，P 结论：女性性别是 STEMI 的重要预测因素：女性是 STEMI 更复杂 TRA 的重要预测因素。了解性别差异和 TRA 交叉的预测因素将加强对不同手术方式的使用，从而有助于为 STEMI 女性患者保留成功的腕部通路。
{"title":"Sex differences in transradial access failure in ST segment elevation myocardial infarction","authors":"Biljana Zafirovska MD, PhD, Aleksandar Jovkovski MD, Ivan Vasilev MD, Hajber Taravari MD, Darko Kitanoski MD, Danica Petkoska MD, Jorgo Kostov MD, PhD, Kalon K. L. Ho MD, Sasko Kedev MD, PhD","doi":"10.1002/ccd.31247","DOIUrl":"10.1002/ccd.31247","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transradial access (TRA) is now the default access site for PPCI, but technically is a more challenging approach mostly due to anatomic challenges connected to the RA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To assess the differences according to sex in radial artery (RA) access site characteristics during primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>All 5092 consecutive STEMI patients from our center in the period from March 2011 until December 2017 were examined. The right proximal radial was the “intention-to-treat” access in all patients. Preprocedural RA angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, need to use another arterial access sites (the primary endpoint for this study), and procedure time were analyzed by sex. Using logistic regression, we selected predictors of radial crossover. Access site bleeding complications and vascular complications were also recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The STEMI population in this period included 1326 females and 3766 male patients. Females were older (65 ± 11 years) than males (59 ± 11 years, <i>p</i> < 0.0001). Among standard risk factors, hypertension and diabetes mellitus were more common in women and smoking less common. RA anomalies were more frequent in the females (8.8% vs. 6.5%, <i>p</i> < 0.0001), with complex RA loop and tortuous RA twice as frequent in women. Failure of TRA access as the initially chosen site occurred in 4.6% (61) of females versus 2.5% (97) of male STEMI patients (<i>p</i> = 0.0003). The most common subsequent access site was right ulnar access in both groups (57 and 61% respectively). Access site bleeding complications were more common in women 4.4% versus 3.2%, mirrored in hematomas with EASY score III to V. Clinical RA spasm (RAS) was significantly more frequent in females (5.7% vs. 2.2%, <i>p</i> < 0.0001). Multiple regression analysis identified 5 independent predictors for TRA access crossover: previous TRA, anomalous RA, RAS, along with female sex and diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Female sex is a significant predictor of more complex TRA in STEMI. Understanding sex differences and predictors for TRA crossover will strengthen the use of different procedural modalities that can help in preserving a successful wrist access in female STEMI patients.</p>\u0000 </section>\u0000 </di","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 6","pages":"1139-1147"},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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