Catheterization and Cardiovascular Interventions最新文献_第9页

Paclitaxel-Coated Balloon for the Management of In-Stent Coronary Restenosis: An Updated Meta-Analysis and Trial Sequential Analysis 紫杉醇包被球囊治疗支架内冠状动脉再狭窄：一项最新的荟萃分析和试验序列分析。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-01-05 DOI: 10.1002/ccd.31388

Vinícius M. R. Oliveira, Arthur Marot Paiva, Pedro Lucas Alves Alencar, Izadora Caiado Oliveira, João Victor Alves Alencar, Felipe Schmaltz Zalaf, Ricardo Figueiredo Paro Piai, André Maroccolo de Sousa, Humberto Graner Moreira

Background

Drug-coated balloons present a potentially advantageous therapeutic approach for managing coronary in-stent restenosis (ISR). However, the comparative benefits of paclitaxel-coated balloons (PCBs) over uncoated balloons (UCBs) remain unclear.

Aims

We conducted a systematic review and meta-analysis to evaluate and compare the clinical outcomes of patients treated with PCBs and UCBs.

Methods

We systematically searched PubMed, Embase, and Cochrane for studies comparing PCBs and UCBs in managing coronary ISR. We used a random-effects model to pool risk ratios (RRs) and their 95% confidence intervals (CIs). Statistical analyses were conducted using Review Manager 5.4.1. Heterogeneity was assessed using I² statistics. Quality and risk of bias were evaluated using the Cochrane Collaboration's tool.

Results

We included seven randomized controlled trials with 1349 patients, of whom 840 underwent percutaneous coronary intervention with PCB. In our pooled analysis, patients treated with PCB had lower risks of target lesion revascularization (RR 0.31, 95% CI 0.18–0.52; p < 0.01), target vessel revascularization (0.53, 0.42–0.67; p < 0.01), major adverse cardiac events (MACEs) (0.25, 0.16–0.38; p < 0.01), and myocardial infarction (MI) (0.59, 0.37–0.95; p = 0.03). However, there were no significant differences in all-cause mortality (0.79, 0.37–1.70; p = 0.54), cardiac death (0.46, 0.03–8.12; p = 0.60), while tendencies for a significant difference were found for target lesion failure (0.39, 0.13–1.11; p = 0.08), or stent thrombosis (0.21, 0.03–1.35 p = 0.10).

Conclusion

These findings suggest that PCBs are superior to UCBs regarding the occurrence of target lesion revascularization, target vessel revascularization, MACEs, and MI, but they do not differ in all-cause mortality, and cardiac death, while trends to significant differences favoring PCB were found to stent thrombosis and target lesion failure.

背景：药物包被球囊为治疗冠脉支架内再狭窄（ISR）提供了一种潜在的有利治疗方法。然而，紫杉醇包覆气球（PCBs）与未包覆气球（UCBs）的比较效益尚不清楚。目的：我们进行了一项系统回顾和荟萃分析，以评估和比较多氯联苯和ucb治疗患者的临床结果。方法：我们系统地检索PubMed、Embase和Cochrane，以比较多氯联苯和ucb在处理冠状动脉ISR方面的研究。我们使用随机效应模型汇总风险比（rr）及其95%置信区间（ci）。使用Review Manager 5.4.1进行统计分析。采用I2统计量评估异质性。使用Cochrane Collaboration的工具评估偏倚的质量和风险。结果：我们纳入了7项随机对照试验，共1349例患者，其中840例接受了经皮冠状动脉介入治疗。在我们的汇总分析中，接受PCB治疗的患者靶病变血运重建的风险较低(RR 0.31, 95% CI 0.18-0.52；p结论：这些结果提示PCB在靶病变血运重建、靶血管血运重建、mace和心肌梗死的发生率方面优于ucb，但在全因死亡率和心源性死亡方面没有差异，而PCB在支架血栓形成和靶病变失败方面有显著差异的趋势。

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引用次数: 0

Enhanced Efficiency of Sequential Cutting Balloon Angioplasty in Calcified Coronary Artery Disease: The RODIN-CUT Technique 提高顺序切割球囊成形术治疗钙化冠状动脉疾病的效率：RODIN-CUT技术。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-01-05 DOI: 10.1002/ccd.31387

Claudiu Ungureanu, Gregor Leibundgut, Mihai Cocoi, Gabriele Gasparini, Giuseppe Colletti, Alexandre Avran, Enrico Poletti, Alice Moroni, Antonio Mangieri, Silviu Dumitrascu, Abdul Mozid, Marouane Boukhris, Alexandru Achim, Carlo Zivelonghi, Elias Bentakhou, Pierfrancesco Agostoni

Background

Heavily calcified coronary artery disease presents significant challenges in percutaneous coronary intervention (PCI), often requiring advanced techniques to achieve optimal outcomes. Cutting balloons (CB) have shown potential for plaque modification; however, their effectiveness is limited without standardized protocols.

Aims

This study introduces the RODIN-CUT technique, a novel approach utilizing sequential CB inflations with real-time intravascular ultrasound (IVUS) guidance. The technique aims to enhance calcified plaque modification, improve stent expansion, and achieve consistent procedural success in heavily calcified coronary lesions.

Methodology

A retrospective analysis of three consecutive patients requiring specialized approaches beyond conventional PCI was included at three centers in Belgium. The RODIN-CUT protocol involved multiple CB inflations at precise lesion segments, followed by immediate IVUS imaging after each inflation to assess plaque modification and guide further therapy. Procedural success was defined as residual stenosis < 30% with TIMI 3 distal flow. The study evaluated the dose-dependent effects of repeated CB inflations on plaque fracture depth and distribution.

Conclusion

The RODIN-CUT technique demonstrated promising outcomes, achieving procedural success in all cases with enhanced stent expansion and minimal complications. The technique's simplicity, cost-effectiveness, and reproducibility make it a viable option for treating heavily calcified coronary lesions. Further large-scale studies are required to validate these findings and establish the RODIN-CUT technique as a standard approach for complex calcified lesions.

背景：严重钙化的冠状动脉疾病对经皮冠状动脉介入治疗（PCI）提出了重大挑战，通常需要先进的技术来达到最佳效果。切割气球（CB）显示出斑块修饰的潜力；然而，如果没有标准化的协议，它们的有效性是有限的。目的：本研究介绍了RODIN-CUT技术，这是一种利用实时血管内超声（IVUS）引导的连续CB充气的新方法。该技术旨在增强钙化斑块修饰，改善支架扩张，并在严重钙化的冠状动脉病变中获得一致的手术成功。方法：回顾性分析了比利时三个中心连续三例需要常规PCI以外的专门方法的患者。RODIN-CUT方案包括在精确的病变部位进行多次CB充气，每次充气后立即进行IVUS成像，以评估斑块的改变并指导进一步的治疗。结论：RODIN-CUT技术显示出良好的效果，所有病例均获得手术成功，支架扩张增强，并发症最小。该技术的简单性、成本效益和可重复性使其成为治疗严重钙化冠状动脉病变的可行选择。需要进一步的大规模研究来验证这些发现，并将RODIN-CUT技术建立为复杂钙化病变的标准方法。

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引用次数: 0

Impact of Sheath Type on Vascular and Bleeding Complications After Transcatheter Aortic Valve Replacement: A Post Hoc Analysis From the MARVEL Registry Study 经导管主动脉瓣置换术后鞘型对血管和出血并发症的影响：MARVEL注册研究的事后分析

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-01-03 DOI: 10.1002/ccd.31396

Emily Pan, Herbert G. Kroon, Pim A. L. Tonino, Giovanni Amoroso, Mika Laine, Evald H. Christiansen, Stefan Toggweiler, Jur Ten Berg, Markus Malmberg, Ton Slagboom, Noriaki Moriyama, Christian J. Terkelsen, Federico Moccetti, Livia Gheorghe, Darra Bigelow, John Webb, David Wood, Nicholas Van Mieghem, Mikko Savontaus

Background

Vascular and bleeding complications remain a concern after transfemoral transcatheter aortic valve replacement (TAVR). The impact of the sheath type on these complications remains unclear.

Methods

The prospective MARVEL registry study analyzed enrolled 500 patients undergoing large-bore transfemoral procedures and arteriotomy closure with the MANTA vascular closure device from 10 hospitals in Europe and Canada. We stratified these patients according to type of sheath used (expandable or conventional). A propensity-matched analysis was performed using VARC-2 major or minor vascular and bleeding complications as the primary endpoint. The secondary endpoint was time to hemostasis.

Results

We identified 196 propensity-matched pairs. Major vascular complications occurred in 3.6% in the expandable sheath group and 4.1% in the conventional sheath group (p = 1.0). Minor vascular complications occurred in 5.6% in the expandable sheath group and 4.6% in the conventional sheath group (p = 0.819). There were no significant differences in bleeding complications between groups. Time to hemostasis after MANTA closure was significantly shorter in the expandable sheath group (30 vs. 60 s, p < 0.001).

Conclusions

A propensity-matched analysis demonstrated no significant differences in vascular complication rates with MANTA arteriotomy closure after removal of large bore expandable or conventional sheaths. Time to hemostasis was significantly shorter in the expandable sheath group.

背景：经股经导管主动脉瓣置换术（TAVR）后血管和出血并发症仍然是一个值得关注的问题。鞘型对这些并发症的影响尚不清楚。方法：前瞻性MARVEL注册研究分析了来自欧洲和加拿大10家医院的500名接受大口径经股手术和使用MANTA血管关闭装置进行动脉切开闭合的患者。我们根据使用的护套类型（可扩展或常规）对这些患者进行分层。以VARC-2主要或次要血管和出血并发症为主要终点进行倾向匹配分析。次要终点是止血时间。结果：我们确定了196对倾向匹配的配对。大血管并发症发生率在扩张鞘组为3.6%，在常规鞘组为4.1% （p = 1.0）。扩张鞘组发生轻微血管并发症的比例为5.6%，常规鞘组为4.6% （p = 0.819）。两组间出血并发症发生率无显著差异。结论：一项倾向匹配分析显示，在切除大孔可扩张鞘和常规鞘后，行MANTA动脉切开术闭合的血管并发症发生率无显著差异。可扩张鞘组止血时间明显缩短。

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引用次数: 0

Flaring of Protruding Coronary Stents Before Transcatheter Aortic Valve Replacement to Minimize Interaction—A Feasibility Study 经导管主动脉瓣置换术前突出的冠状动脉支架放光以减少相互作用的可行性研究。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-01-02 DOI: 10.1002/ccd.31378

Jonathan X. Fang, Pedro Engel Gonzalez, Pedro A. Villablanca, Tiberio M. Frisoli, Louie B. Kamel-Abusalha, James C. Lee, Gennaro Giustino, Dee Dee Wang, William W. O'Neill, Brian P. O'Neill

Background

Protruding coronary artery stents can adversely affect transcatheter aortic valve replacement (TAVR) procedure. Current evidence on the topic is limited.

Aims

We aim to study the clinical feasibility and safety of flaring of protruding coronary artery stents before TAVR to reduce interaction with transcatheter heart valves.

Methods

Twenty consecutive patients with 22 protruding coronary stents were optimized with a dual-diameter balloon before TAVR. Procedural success, stent and valve geometry on angiogram, periprocedural and subsequent clinical outcomes as well as valve hemodynamics on echocardiography were evaluated.

Results

Procedural success was achieved in 100% of coronary procedure and TAVR without any major complication directly related to the flaring of stents. There was no coronary artery obstruction after TAVR or visible stent or valve deformity. All valves had normal hemodynamics immediately post-deployment with none having clinically significant aortic insufficiency. One patient had inpatient mortality unrelated to coronary stent optimization. One valve had hemodynamic valve degeneration on follow-up which was unrelated to coronary stent flaring and the patient was asymptomatic.

Conclusion

Flaring of protruding coronary stents before TAVR is technically feasible and safe and can potentially minimize stent-valve interaction for during of after TAVR.

背景：冠状动脉支架突出会对经导管主动脉瓣置换术（TAVR）产生不利影响。目前关于这个话题的证据是有限的。目的：我们旨在研究TAVR术前突出冠状动脉支架放光的临床可行性和安全性，以减少与经导管心脏瓣膜的相互作用。方法：连续20例22支突出冠状动脉支架患者行TAVR术前双径球囊优化。评估手术成功率、血管造影上支架和瓣膜的几何形状、术中和随后的临床结果以及超声心动图上瓣膜的血流动力学。结果：冠状动脉手术和TAVR 100%成功，无与支架燃烧直接相关的主要并发症。TAVR术后无冠状动脉梗阻，无明显支架或瓣膜畸形。所有瓣膜在部署后立即有正常的血流动力学，没有一个有临床上明显的主动脉不全。1例患者住院死亡率与冠状动脉支架优化无关。随访时一例瓣膜发生血流动力学变性，与冠状动脉支架燃烧无关，患者无症状。结论：在TAVR前将突出的冠状动脉支架放光在技术上是可行和安全的，并且可以潜在地减少TAVR期间和之后支架与瓣膜的相互作用。

{"title":"Flaring of Protruding Coronary Stents Before Transcatheter Aortic Valve Replacement to Minimize Interaction—A Feasibility Study","authors":"Jonathan X. Fang, Pedro Engel Gonzalez, Pedro A. Villablanca, Tiberio M. Frisoli, Louie B. Kamel-Abusalha, James C. Lee, Gennaro Giustino, Dee Dee Wang, William W. O'Neill, Brian P. O'Neill","doi":"10.1002/ccd.31378","DOIUrl":"10.1002/ccd.31378","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Protruding coronary artery stents can adversely affect transcatheter aortic valve replacement (TAVR) procedure. Current evidence on the topic is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aim to study the clinical feasibility and safety of flaring of protruding coronary artery stents before TAVR to reduce interaction with transcatheter heart valves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty consecutive patients with 22 protruding coronary stents were optimized with a dual-diameter balloon before TAVR. Procedural success, stent and valve geometry on angiogram, periprocedural and subsequent clinical outcomes as well as valve hemodynamics on echocardiography were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Procedural success was achieved in 100% of coronary procedure and TAVR without any major complication directly related to the flaring of stents. There was no coronary artery obstruction after TAVR or visible stent or valve deformity. All valves had normal hemodynamics immediately post-deployment with none having clinically significant aortic insufficiency. One patient had inpatient mortality unrelated to coronary stent optimization. One valve had hemodynamic valve degeneration on follow-up which was unrelated to coronary stent flaring and the patient was asymptomatic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Flaring of protruding coronary stents before TAVR is technically feasible and safe and can potentially minimize stent-valve interaction for during of after TAVR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 4","pages":"772-782"},"PeriodicalIF":2.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913785","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}

引用次数: 0

Anatomic vs. Ischemia-Driven Strategies for Percutaneous Coronary Revascularization in Chronic Coronary Syndrome: A Network Meta-Analysis 慢性冠状动脉综合征经皮冠状动脉血管重建术的解剖与缺血驱动策略：网络荟萃分析。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-01-02 DOI: 10.1002/ccd.31331

Federico Giacobbe, Eduardo Valente, Giuseppe Giannino, Hiu Ching Yip, Ovidio De Filippo, Francesco Bruno, Federico Conrotto, Mario Iannaccone, Giuseppe Biondi Zoccai, Mauro Gasparini, Javier Escaned, Gaetano Maria De Ferrari, Fabrizio D'Ascenzo

Introduction

In patients with chronic coronary syndromes (CCS), the benefit of percutaneous coronary intervention (PCI) added to optimal medical therapy (OMT) remains unclear. The indication to PCI may be driven either by angiographic evaluation or ischemia assessment, thus depicting different potential strategies which have not yet been thoroughly compared.

Methods

Randomized controlled trials (RCTs) comparing OMT versus PCI angio-guided or versus PCI non-invasive or invasive ischemia guided were identified and compared via network meta-analysis. Major adverse clinical events (MACE), as defined by each included trial, were the primary endpoint, while cardiovascular (CV) death, myocardial infarction (MI), and unplanned revascularization the secondary ones.

Results

18 studies, encompassing 17,512 patients, were included, with a mean follow-up of 3.5 years. PCI guided by ischemia defined either invasively or not was associated with a reduced risk of MACE compared with OMT alone. Furthermore, PCI guided by non-invasive assessment of ischemia was associated with a reduced risk of MI compared with OMT (hazard ratio [HR]: 0.61 [95% confidence interval: 0.37–0.94). This strategy ranked best also in preventing CV death. Notably, iFR and FFR guided approaches showed the highest probability of performing best for reduction of subsequent revascularizations.

Conclusion

In patients with CCS, ischemia-guided PCI, either by invasive or non-invasive assessment, resulted in a reduced risk of MACE compared with OMT alone. The use of invasive or non-invasive tests influenced the benefit of ischemia-driven PCI: non-invasive tests significantly reduced risk of MI compared with OMT, while iFR or FFR showed the highest probability of reducing the need of subsequent revascularization.

在慢性冠脉综合征（CCS）患者中，经皮冠状动脉介入治疗（PCI）加入最佳药物治疗（OMT）的益处尚不清楚。PCI的适应症可能由血管造影评估或缺血评估驱动，因此描绘了尚未完全比较的不同潜在策略。方法：通过网络荟萃分析确定并比较OMT与PCI血管引导或PCI无创或有创缺血引导的随机对照试验（rct）。每个纳入的试验定义的主要临床不良事件（MACE）是主要终点，而心血管（CV）死亡、心肌梗死（MI）和计划外血运重建术是次要终点。结果：纳入18项研究，共17512例患者，平均随访时间为3.5年。与单纯的OMT相比，有创性或无创性缺血指导下的PCI与MACE风险降低相关。此外，与OMT相比，在无创缺血评估指导下PCI与心肌梗死风险降低相关（风险比[HR]: 0.61[95%可信区间：0.37-0.94]）。这种策略在预防心血管疾病死亡方面也名列前茅。值得注意的是，iFR和FFR引导入路在减少后续血运重建方面表现最佳的可能性最高。结论：在CCS患者中，缺血引导下的PCI，无论是通过侵入性评估还是非侵入性评估，与单独的OMT相比，导致MACE的风险降低。使用侵入性或非侵入性试验影响缺血驱动的PCI的益处：与OMT相比，非侵入性试验显著降低心肌梗死的风险，而iFR或FFR显示减少后续血运重建需求的可能性最高。

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引用次数: 0

Transcatheter Aortic Valve Replacement in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis 经导管主动脉瓣置换术治疗肥厚性心肌病：系统回顾和荟萃分析。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-01-02 DOI: 10.1002/ccd.31367

Ashraf Ahmed, Rasha Kaddoura, Abhinav Aggarwal, Tawanda Zinyandu, Fabricio Webber, Carlos Davila, Stuart Zarich

Background

The co-existence of severe aortic stenosis (AS) and hypertrophic cardiomyopathy (HCM) is not uncommon. Surgical intervention is the gold standard management. Patients with high surgical risk might undergo transcatheter aortic valve replacement (TAVR). However, TAVR outcomes are unclear in this population. We aimed to investigate the impact of HCM on the outcomes of TAVR.

Aim

We aim to investigate the outcomes of TAVR in patients with HCM.

Methods

We systematically searched PubMed, EMBASE, and Scopus for studies that compared outcomes of TAVR procedure between patients with HCM and those without it. Using the random-effects model, the odds ratios (OR) with 95% confidence interval (CI) were reported.

Results

We screened 102 articles and identified three observational cohort studies. Compared to patients who underwent TAVR without underlying HCM, TAVR for AS co-existed with HCM was associated with higher rates of mortality (OR 5.79; 95% CI: 3.38; 9.91, p < 0.0001), cardiogenic shock (OR 4.55; 95% CI: 3.40; 6.08, p < 0.0001), aortic dissection (OR 4.95; 95% CI: 3.17; 7.74, p < 0.0001), vascular complications (OR 2.10; 95% CI: 1.27; 3.47, p = 0.004), and renal impairment (OR 1.80; 95% CI: 1.36; 2.40, p < 0.0001). There was no difference between the comparison groups in terms of complete heart block, new permanent pacemaker implantation, or bleeding.

Conclusion

In patients with severe AS and HCM, TAVR was associated with significantly higher occurrence of mortality, cardiogenic shock, aortic dissection, vascular complications, and renal impairment as well as the need for mechanical ventilation than patients who did not have HCM.

背景：严重主动脉瓣狭窄（AS）和肥厚型心肌病（HCM）并存的情况并不少见。手术治疗是治疗的金标准。手术风险高的患者可接受经导管主动脉瓣置换术（TAVR）。然而，经导管主动脉瓣置换术在这一人群中的疗效尚不明确。我们旨在研究 HCM 对 TAVR 结果的影响。目的：我们旨在研究 HCM 患者的 TAVR 结果：我们系统地检索了PubMed、EMBASE和Scopus上比较HCM患者和非HCM患者TAVR疗效的研究。结果：我们筛选了102篇文章，发现了3篇观察性文章，其中1篇为研究性文章：我们筛选了 102 篇文章，确定了 3 项观察性队列研究。与接受 TAVR 而无基础 HCM 的患者相比，因强直性脊柱炎合并 HCM 而接受 TAVR 的患者死亡率更高（OR 5.79；95% CI：3.38；9.91，P）：对于患有严重强直性脊柱炎和 HCM 的患者，TAVR 与死亡率、心源性休克、主动脉夹层、血管并发症、肾功能损伤以及机械通气需求相关性明显高于未患 HCM 的患者。

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引用次数: 0

Percutaneous Closure of Sub-Annular Rupture Following Transcatheter Aortic Valve Replacement Complicated by Severe Tricuspid Regurgitation 经导管主动脉瓣置换术并发严重三尖瓣反流后经皮缝合环下破裂。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-01-02 DOI: 10.1002/ccd.31400

Laurent Faroux, Marina Urena-Alcazar, Aurélien Villecourt, Fanny Boyer

Aortic annular rupture is a rare and usually fatal complication of TAVR. We report the case of a sub-annular aortic rupture contained in the right ventricle and percutaneously repaired. The procedure was complicated by new-onset severe tricuspid regurgitation related to tricuspid injury during wire externalization and immediately treated by transcatheter edge-to-edge repair.

主动脉环破裂是TAVR的一种罕见且通常致命的并发症。我们报告的情况下，环状主动脉破裂包含在右心室和经皮修复。由于钢丝外置过程中三尖瓣损伤导致新发严重三尖瓣反流，手术过程变得复杂，并立即通过导管边缘对边缘修复进行治疗。

引用次数: 0

Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction in the United States 美国st段抬高型心肌梗死患者血管内成像与血管造影引导下经皮冠状动脉介入治疗的比较

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2024-12-31 DOI: 10.1002/ccd.31389

Chayakrit Krittanawong, Song Peng Ang, Neil Sagar Maitra, Zhen Wang, Mahboob Alam, Hani Jneid, Samin Sharma

Background

The role of Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is still unclear in patients with STEMI undergoing PCI in the current second-generation DES era.

Aims

This study aimed to evaluate the trends and outcomes of IVUS-guided PCI in patients with STEMI.

Methods

We used the National Inpatient Sample (NIS) database from 2016 to 2021. The primary endpoint of this study is all-cause in-hospital mortality. Secondary endpoints include trends of PCI hospitalizations, trends of mortality, length of stay, and cost of hospitalization.

Results

There were data for 819,645 hospitalizations for STEMI, of which 91.2% (n = 74,7860) utilized angiography-guided PCI, 8.4% (n = 68,985) utilized IVUS-guided PCI and 0.3% (n = 2800) utilized OCT-guided PCI. In-hospital mortality for IVUS-guided PCI was 4.6% (n = 3190) versus 6.0% (n = 44,935) for angiography-guided PCI with an adjusted OR 0.75 (0.68–0.81, p < 0.001). In-hospital mortality for OCT-guided PCI was 3.4% (n = 95) versus 6.0% (n = 44,935) for angiography-guided PCI with an adjusted OR 0.67 (0.43–1.06, p = 0.09).

Conclusions

IVUS/OCT-guidance was increasingly utilized over the years and was associated with a significantly reduced adjusted odds of in-hospital mortality. Large-scale, long-term randomized data are needed to better ascertain where IVUS/OCT may be best utilized for optimization of PCI for STEMI.

背景：在当前第二代DES时代，血管内超声（IVUS）和光学相干断层扫描（OCT）在STEMI患者行PCI中的作用尚不清楚。目的：本研究旨在评估ivus引导下STEMI患者PCI治疗的趋势和结果。方法：我们使用2016年至2021年国家住院患者样本（NIS）数据库。本研究的主要终点是全因住院死亡率。次要终点包括PCI住院趋势、死亡率趋势、住院时间和住院费用。结果：STEMI住院819,645例，其中91.2% （n = 74,7860）采用血管造影引导下PCI， 8.4% （n = 68,985）采用ivus引导下PCI， 0.3% （n = 2800）采用oct引导下PCI。IVUS引导下PCI的住院死亡率为4.6% (n = 3190)，而血管造影引导下PCI的住院死亡率为6.0% (n = 44,935)，调整后OR为0.75 （0.68-0.81,p）。结论：IVUS/ oct指导近年来越来越多地使用，并且与住院死亡率的调整后几率显著降低相关。需要大规模、长期的随机数据来更好地确定IVUS/OCT在STEMI PCI优化中的最佳应用。

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引用次数: 0

Intravascular Lithotripsy: A Promising Treatment for Calcified Lesions in Acute Coronary Syndromes 血管内碎石术：急性冠状动脉综合征钙化病变的一种有希望的治疗方法。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2024-12-31 DOI: 10.1002/ccd.31365

M. Chadi Alraies, Jawad Basit

引用次数: 0

Anatomy of Risk: Decoding the Predictors of Vascular Access Complications in Transcatheter Aortic Valve Replacement 风险解剖：解读经导管主动脉瓣置换术中血管通路并发症的预测因素。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2024-12-30 DOI: 10.1002/ccd.31397

Hunter T. Row, Anyamaria Edwards, Johnathan Beaudrie, Abe Sahmoun, Todd Reil, Thomas Haldis, Cornelius Dyke

Background

Despite advancements in valve implantation devices, vascular access complications (VAC) remain a significant cause of morbidity and mortality for those undergoing transcatheter aortic valve replacement (TAVR). We describe pre-operative imaging analysis of the aortoiliac and femoral arterial beds using the TransAtlantic intersociety consensus (TASC) score, ilio-femoral tortuosity, and procedural characteristics to identify anatomic risk factors predictive of VAC in TAVR.

Methods

Consecutive patients undergoing TAVR from 2012 to 2022 at a single North Dakota hospital were retrospectively reviewed. Pre-operative computed tomography angiography (CTA) was used for vascular analysis of the infrarenal aorta, iliac, and femoral vascular beds. Wilcoxon signed-rank test was used for non-normally distributed or t-test for normally distributed continuous variables and Chi-square or Fisher's exact tests for categorical variables were utilized to examine the association of each variable with vascular complications.

Results

One thousand eighty-nine patients were evaluated with 80 patients identified with VAC. Aortoiliac disease burden of the iliac arteries and posterior wall calcification of the common femoral artery (CFA) were predictive of VAC. Iliofemoral tortuosity and skin to CFA depth were not. Left sided CFA versus right CFA access was associated (p < 0.001). Pretreatment of diseased iliac vessels decreased odds of VAC (OR 0.21, 95% CI, 0.08−0.56).

Conclusion

Our study highlights the importance of preoperative peripheral vascular assessment for TAVR. We identify aortoiliac disease burden, posterior CFA calcification, and left sided common femoral access as risk factors for VAC. A structured approach to the preoperative assessment may optimize planning and enhance outcomes in TAVR.

背景：尽管瓣膜植入装置取得了进步，血管通路并发症（VAC）仍然是经导管主动脉瓣置换术（TAVR）患者发病和死亡的重要原因。我们使用跨大西洋社会共识（TASC）评分、髂股弯曲度和手术特征对主动脉髂和股动脉床进行术前影像学分析，以确定TAVR中预测VAC的解剖危险因素。方法：回顾性分析2012年至2022年在北达科他州一家医院连续接受TAVR的患者。术前应用计算机断层血管造影（CTA）对肾下主动脉、髂、股血管床进行血管分析。对于非正态分布的连续变量使用Wilcoxon符号秩检验，对于正态分布的连续变量使用t检验，对于分类变量使用卡方检验或Fisher精确检验来检验每个变量与血管并发症的相关性。结果：评估了189例患者，其中80例确诊为VAC。髂动脉的髂动脉疾病负担和股总动脉后壁钙化（CFA）是预测VAC的指标。髂股弯曲和皮肤到CFA深度未见变化。结论：我们的研究强调了术前周围血管评估对TAVR的重要性。我们确定主动脉髂疾病负担、CFA后部钙化和左侧股骨总通道是VAC的危险因素。结构化的术前评估方法可以优化TAVR的计划并提高预后。

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引用次数: 0