Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, particularly among complex high-risk and indicated patients (CHIP). Revascularization is often beneficial for these patients; however, it requires thorough risk stratification and close multidisciplinary collaboration between cardiologists and cardiac surgeons to optimize outcomes. Personalized treatment plans, including percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), are crucial in this context. In this report, we present a case of a 70-year-old man with left main trunk bifurcation lesions, referred to as a “Four Forks Lesion,” who was successfully revascularized using a PCI strategy, resulting in a favorable prognosis.
{"title":"Percutaneous Coronary Interventional Treatment of Left Main Trifurcation Lesion: A Case Report","authors":"Yi Lu, Xinyi Yan, Qing Qing Wu, Xiaorong Hu","doi":"10.1002/ccd.31381","DOIUrl":"10.1002/ccd.31381","url":null,"abstract":"<div>\u0000 \u0000 <p>Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, particularly among complex high-risk and indicated patients (CHIP). Revascularization is often beneficial for these patients; however, it requires thorough risk stratification and close multidisciplinary collaboration between cardiologists and cardiac surgeons to optimize outcomes. Personalized treatment plans, including percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), are crucial in this context. In this report, we present a case of a 70-year-old man with left main trunk bifurcation lesions, referred to as <i>a</i> “Four Forks Lesion,” who was successfully revascularized using a PCI strategy, resulting in a favorable prognosis.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"720-724"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881351","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}
The ruptured sinus of Valsalva aneurysm (RSOV), a rare but well-recognized clinical entity, is invariably a form of left-to-right shunt due to rupture into right-sided chambers. It causes profound hemodynamic effects, especially when the rupture is acute. Like most other left-to-right shunts, it was only a matter of time before this rare defect also became amenable to transcatheter closure (TCC). Since the first report of TCC of RSOV by Cullen et al. in 1994 using the Rashkind umbrella, in recent times, there has been a spate of case reports, brief communications, and interesting case presentations at interventional meetings using the much more user-friendly and effective devices. We report a case of a 59-year-old female diagnosed with RSOV (noncoronary cusp to right atrium) treated with device closure by using a vascular plug through a retrograde approach without resorting to the usual antegrade technique involving the formation of an arteriovenous loop.
{"title":"Ruptured Sinus of Valsalva Aneurysm: Transcatheter Closure Through Retrograde Approach","authors":"Manjunath Bagur, Prem Alva, Shivakumar N","doi":"10.1002/ccd.31366","DOIUrl":"10.1002/ccd.31366","url":null,"abstract":"<div>\u0000 \u0000 <p>The ruptured sinus of Valsalva aneurysm (RSOV), a rare but well-recognized clinical entity, is invariably a form of left-to-right shunt due to rupture into right-sided chambers. It causes profound hemodynamic effects, especially when the rupture is acute. Like most other left-to-right shunts, it was only a matter of time before this rare defect also became amenable to transcatheter closure (TCC). Since the first report of TCC of RSOV by Cullen et al. in 1994 using the Rashkind umbrella, in recent times, there has been a spate of case reports, brief communications, and interesting case presentations at interventional meetings using the much more user-friendly and effective devices. We report a case of a 59-year-old female diagnosed with RSOV (noncoronary cusp to right atrium) treated with device closure by using a vascular plug through a retrograde approach without resorting to the usual antegrade technique involving the formation of an arteriovenous loop.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"673-676"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881367","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}
The impact of below-the-knee (BK) runoff after drug-coated balloon (DCB) treatment in femoropopliteal (FP) lesions has not been well investigated.
Methods
This retrospective multicenter observational study enrolled 291 consecutive patients with lower extremity artery disease who underwent endovascular therapy with DCBs for FP lesions between January 2018 and December 2021. Patients were classified into four groups based on the BK runoff. Outcome measures included primary patency, freedom from clinically driven target lesion revascularization (CD-TLR) and amputation, and overall survival rates at 24 months. The predictors of restenosis at 24 months were also investigated.
Results
In total, 43, 98, 117, and 33 patients were classified into three, two, one, and no BK runoff groups, respectively. In three, two, one, and no BK runoff groups, the primary patency rates were 72.1%, 67.3%, 61.4%, and 44.1% (p = 0.028); freedom from CD-TLR rates were 87.1%, 78.8%, 71.7%, and 47.1% (p < 0.001); freedom from amputation rates were 95.2%, 97.9%, 92.8%, and 91.5% (p = 0.499); and overall survival rates were 89.4%, 83.2%, 76.6%, and 61.2% (p = 0.007), respectively, at 24 months. Multivariate analysis showed that chronic limb-threatening ischemia, no BK runoff, Lutonix use, and residual stenosis > 30% were independent predictors of primary patency loss at 24 months. The risk score, calculated as the number of predictors, reflected the risk of restenosis.
Conclusion
No BK runoff was associated with worse midterm primary patency, freedom from CD-TLR, and overall survival rates than at least one BK runoff.
{"title":"Impact of Below-the-Knee Runoff in Patients With Lower Extremity Artery Disease Who Underwent Endovascular Therapy Using Drug-Coated Balloons in Femoropopliteal Lesions","authors":"Takehiro Yamada, Takahiro Tokuda, Naoki Yoshioka, Akio Koyama, Ryusuke Nishikawa, Kiyotaka Shimamura, Takuya Tsuruoka, Hiroki Mitsuoka, Yusuke Sato, Takuma Aoyama","doi":"10.1002/ccd.31375","DOIUrl":"10.1002/ccd.31375","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impact of below-the-knee (BK) runoff after drug-coated balloon (DCB) treatment in femoropopliteal (FP) lesions has not been well investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective multicenter observational study enrolled 291 consecutive patients with lower extremity artery disease who underwent endovascular therapy with DCBs for FP lesions between January 2018 and December 2021. Patients were classified into four groups based on the BK runoff. Outcome measures included primary patency, freedom from clinically driven target lesion revascularization (CD-TLR) and amputation, and overall survival rates at 24 months. The predictors of restenosis at 24 months were also investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 43, 98, 117, and 33 patients were classified into three, two, one, and no BK runoff groups, respectively. In three, two, one, and no BK runoff groups, the primary patency rates were 72.1%, 67.3%, 61.4%, and 44.1% (<i>p</i> = 0.028); freedom from CD-TLR rates were 87.1%, 78.8%, 71.7%, and 47.1% (<i>p</i> < 0.001); freedom from amputation rates were 95.2%, 97.9%, 92.8%, and 91.5% (<i>p</i> = 0.499); and overall survival rates were 89.4%, 83.2%, 76.6%, and 61.2% (<i>p</i> = 0.007), respectively, at 24 months. Multivariate analysis showed that chronic limb-threatening ischemia, no BK runoff, Lutonix use, and residual stenosis > 30% were independent predictors of primary patency loss at 24 months. The risk score, calculated as the number of predictors, reflected the risk of restenosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>No BK runoff was associated with worse midterm primary patency, freedom from CD-TLR, and overall survival rates than at least one BK runoff.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"698-706"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881336","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}
Ben Cohen, Eran Kalmanovich, Leor Perl, Gabi Greenberg, Roy Beigel, Tal Ovdat, Ran Kornowski, Katia Orvin
Background
Although the latest studies failed to prove the benefit of routine intra-aortic balloon pump (IABP) use in patients with acute myocardial infarction (MI) presenting with cardiogenic shock, the benefit of IABP utilization in selected cases in “real world” practice is unknown.
Aims
We sought to follow temporal trends in IABP use in a real-world cohort of acute coronary syndrome (ACS).
Methods
We evaluated IABP utilization and patient outcomes from the Acute Coronary Syndrome in Israel Survey (ACSIS) between the years 2000 and 2021. Temporal trends and outcomes with IABP at two time periods were set: early (before 2012) and late (after 2012).
Results
Out of 18,662 ACS patients, 3.7% received IABP. The rate of IABP use was 4.5% in the early period and decreased to ~2.5% in the late period (p < 0.001). Patients treated with IABP in the early period had more frequently reduced ejection fraction (64.5% vs. 53.2%, p < 0.01) and presented mostly with ST-elevation MI (71.0% vs. 62.4%, p = 0.04). Cardiogenic shock on admission and in-hospital occurred equally in both periods (14.6% vs. 17.1%, p = 0.66; 42.8% vs. 41.9%, p = 0.90, respectively). Thirty-day mortality and MACE were comparable between time periods (28% vs. 30.7%, p = 0.547; 43.6% vs. 44.1%, p = 0.978, respectively) however bleeding complications were significantly higher in the later period (4.8% vs. 11.2%, p = 0.04).
Conclusions
Our real-world ACS data demonstrated a 50% reduction in the utilization of IABP among acute MI patients in the last decade. A comparable poor prognosis with IABP across time periods, suggest sustainable worse outcome in routine albeit selective clinical practice.
{"title":"Intra-Aortic Balloon Pump: Overall and Temporal Trends of Comparative Effectiveness in a National Registry","authors":"Ben Cohen, Eran Kalmanovich, Leor Perl, Gabi Greenberg, Roy Beigel, Tal Ovdat, Ran Kornowski, Katia Orvin","doi":"10.1002/ccd.31372","DOIUrl":"10.1002/ccd.31372","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although the latest studies failed to prove the benefit of routine intra-aortic balloon pump (IABP) use in patients with acute myocardial infarction (MI) presenting with cardiogenic shock, the benefit of IABP utilization in selected cases in “real world” practice is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We sought to follow temporal trends in IABP use in a real-world cohort of acute coronary syndrome (ACS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated IABP utilization and patient outcomes from the Acute Coronary Syndrome in Israel Survey (ACSIS) between the years 2000 and 2021. Temporal trends and outcomes with IABP at two time periods were set: early (before 2012) and late (after 2012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 18,662 ACS patients, 3.7% received IABP. The rate of IABP use was 4.5% in the early period and decreased to ~2.5% in the late period (<i>p</i> < 0.001). Patients treated with IABP in the early period had more frequently reduced ejection fraction (64.5% vs. 53.2%, <i>p</i> < 0.01) and presented mostly with ST-elevation MI (71.0% vs. 62.4%, <i>p</i> = 0.04). Cardiogenic shock on admission and in-hospital occurred equally in both periods (14.6% vs. 17.1%, <i>p</i> = 0.66; 42.8% vs. 41.9%, <i>p</i> = 0.90, respectively). Thirty-day mortality and MACE were comparable between time periods (28% vs. 30.7%, <i>p</i> = 0.547; 43.6% vs. 44.1%, <i>p</i> = 0.978, respectively) however bleeding complications were significantly higher in the later period (4.8% vs. 11.2%, <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our real-world ACS data demonstrated a 50% reduction in the utilization of IABP among acute MI patients in the last decade. A comparable poor prognosis with IABP across time periods, suggest sustainable worse outcome in routine albeit selective clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"662-672"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881339","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}
Michael Gao, Alessandro Spirito, Samantha Sartori, Birgit Vogel, Mauro Gitto, Angelo Oliva, Kenneth F. Smith, Joseph Sweeny, Prakash Krishnan, Pedro Moreno, Parasuram Melarcode Krishnamoorthy, Annapoorna Kini, George Dangas, Samin K. Sharma, Roxana Mehran
Background
Whether the high bleeding risk (HBR) criteria of the Academic Research Consortium (ARC) have a consistent predictive ability across different categories of body mass index (BMI) remains unclear.
Methods
Consecutive patients undergoing percutaneous coronary intervention (PCI) between 2012 and 2019 at Mount Sinai Hospital (New York, USA) were stratified into five BMI categories (18.5–24.9 kg/m2 [normoweight], 25–29.9 kg/m2 [overweight], 30–34.9 kg/m2 [Class I obesity], 35–39.9 kg/m2 [Class II obesity], and BMI ≥ 40 kg/m2 [Class III obesity]) and by HBR status. The primary outcome was major bleeding at 1 year after PCI.
Results
Among 16,123 patients, normoweight, overweight, class I, class II, and class III obesity were found in 23.7%, 41%, 24.5%, 9.3%, 4.8% of patients, respectively. Fulfillment of the ARC-HBR criteria ranged between 34.4% and 48.5% across these BMI categories. One-year rates of major bleeding was 6% in normoweight patients (reference), 4.1% in overweight (adj.HR 0.73, 95% CI 0.60–0.88), 3.5% in class I (adj.HR 0.62, 95% CI 0.49–0.77), 4.2% in class II (adj.HR 0.72, 95% CI 0.54–0.96), and 4.9% in class III (adj.HR 0.83, 95% CI 0.58–1.18) obesity. Consistently across the 5 BMI categories, the fulfillment of ARC-HBR criteria was related with > 4% rates of major bleeding at 1-year and with ≥ 2 times risk increase of major bleeding (pint = 0.177).
Conclusions
The presence of the ARC-HBR criteria predicted a significantly increased risk of major bleeding consistently in each BMI category.
背景：学术研究联盟（ARC）的高出血风险（HBR）标准是否在不同类别的体重指数（BMI）中具有一致的预测能力尚不清楚。方法：将2012 - 2019年在美国纽约西奈山医院连续接受经皮冠状动脉介入治疗（PCI）的患者分为5类BMI (18.5-24.9 kg/m2[正常体重]、25-29.9 kg/m2[超重]、30-34.9 kg/m2[ⅰ类肥胖]、35-39.9 kg/m2[ⅱ类肥胖]和BMI≥40 kg/m2[ⅲ类肥胖])，并按HBR状态进行分层。主要结局为PCI术后1年大出血。结果：在16123例患者中，体重正常、超重、I级、II级和III级肥胖分别占23.7%、41%、24.5%、9.3%、4.8%。在这些BMI类别中，ARC-HBR标准的完成率在34.4%到48.5%之间。正常体重患者一年大出血发生率为6%（参考），超重患者为4.1% (adj.HR 0.73, 95% CI 0.60-0.88)， I类肥胖患者为3.5% (adj.HR 0.62, 95% CI 0.49-0.77)， II类肥胖患者为4.2% (adj.HR 0.72, 95% CI 0.54-0.96)， III类肥胖患者为4.9% （adj.HR 0.83, 95% CI 0.58-1.18）。在5个BMI类别中，ARC-HBR标准的实现与1年大出血率的40.4%和大出血风险增加≥2倍相关（pint = 0.177）。结论：ARC-HBR标准的存在预测了每个BMI类别中大出血风险的显著增加。
{"title":"Predictive Ability of the Academic Research Consortium High Bleeding Risk Criteria in Patients Undergoing Percutaneous Coronary Intervention According to Body Mass Index","authors":"Michael Gao, Alessandro Spirito, Samantha Sartori, Birgit Vogel, Mauro Gitto, Angelo Oliva, Kenneth F. Smith, Joseph Sweeny, Prakash Krishnan, Pedro Moreno, Parasuram Melarcode Krishnamoorthy, Annapoorna Kini, George Dangas, Samin K. Sharma, Roxana Mehran","doi":"10.1002/ccd.31322","DOIUrl":"10.1002/ccd.31322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Whether the high bleeding risk (HBR) criteria of the Academic Research Consortium (ARC) have a consistent predictive ability across different categories of body mass index (BMI) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients undergoing percutaneous coronary intervention (PCI) between 2012 and 2019 at Mount Sinai Hospital (New York, USA) were stratified into five BMI categories (18.5–24.9 kg/m<sup>2</sup> [normoweight], 25–29.9 kg/m<sup>2</sup> [overweight], 30–34.9 kg/m<sup>2</sup> [Class I obesity], 35–39.9 kg/m<sup>2</sup> [Class II obesity], and BMI ≥ 40 kg/m<sup>2</sup> [Class III obesity]) and by HBR status. The primary outcome was major bleeding at 1 year after PCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 16,123 patients, normoweight, overweight, class I, class II, and class III obesity were found in 23.7%, 41%, 24.5%, 9.3%, 4.8% of patients, respectively. Fulfillment of the ARC-HBR criteria ranged between 34.4% and 48.5% across these BMI categories. One-year rates of major bleeding was 6% in normoweight patients (reference), 4.1% in overweight (adj.HR 0.73, 95% CI 0.60–0.88), 3.5% in class I (adj.HR 0.62, 95% CI 0.49–0.77), 4.2% in class II (adj.HR 0.72, 95% CI 0.54–0.96), and 4.9% in class III (adj.HR 0.83, 95% CI 0.58–1.18) obesity. Consistently across the 5 BMI categories, the fulfillment of ARC-HBR criteria was related with > 4% rates of major bleeding at 1-year and with ≥ 2 times risk increase of major bleeding (<i>p</i><sub>int</sub> = 0.177).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The presence of the ARC-HBR criteria predicted a significantly increased risk of major bleeding consistently in each BMI category.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"681-691"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881362","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}
Simone Fezzi, Aurora Trevisanello, Dario Buccheri, Marco Borgi, Pedro Silva Orrego, Giuseppe Biondi Zoccai, Bernardo Cortese
Background
Drug-coated balloons (DCB) are emerging as an alternative to permanent implants for managing de novo coronary artery disease, particularly in small vessels (SVD). This sub-analysis of the PICCOLETO II study aimed to compare the performance of DCB and DES in terms of Murray's law-based quantitative flow ratio (μFR) changes between baseline, post-percutaneous coronary intervention (PCI), and follow-up.
Methods
Patients with a clinical indication for PCI were assigned to receive either Xience DES or Elutax SV/Emperor DCB. Coronary angiograms were blindly analyzed by an independent Core Laboratory (Consorzio Futuro in Ricerca, University of Ferrara, Italy).
Results
Among 232 patients, 59 were included in this analysis. Pre-PCI μFR was comparable between groups (0.65 ± 0.29 vs. 0.58 ± 0.25; p = 0.20). Post-PCI, the DCB group had a lower acute functional gain compared to DES (+0.21 vs. +0.31; p = 0.064), with lower μFR values (0.86 ± 0.36 vs. 0.89 ± 0.3; p = 0.074). At 6-month follow-up, μFR values were similar between groups (0.84 ± 0.29 vs. 0.84 ± 0.31, p = 0.93), with a comparable late functional loss (−0.02 vs. −0.05; p = 0.93). Angiographic late lumen loss was significantly lower in the DCB group (−0.03 vs. +0.29 mm; p = 0.027).
Conclusions
DCB-based PCI showed a trend toward less favorable immediate post-PCI functional result but a comparable performance at follow-up, suggesting its potential in treating de novo SVD.
背景：药物包被球囊（DCB）正在成为治疗新发冠状动脉疾病，特别是小血管（SVD）的永久性植入物的替代方案。这项PICCOLETO II研究的亚分析旨在比较DCB和DES在基线、经皮冠状动脉介入治疗（PCI）后和随访期间基于默里定律的定量血流比（μFR）变化方面的表现。方法：有PCI临床指征的患者被分配接受Xience DES或Elutax SV/Emperor DCB。冠状动脉造影由独立的核心实验室（意大利费拉拉大学Ricerca的Consorzio Futuro）进行盲目分析。结果：232例患者中，59例纳入分析。两组间pci术前μFR具有可比性(0.65±0.29 vs 0.58±0.25；p = 0.20)。pci后，与DES相比，DCB组的急性功能增益较低(+0.21 vs +0.31；p = 0.064),较低的μFR值(0.86±0.36和0.89±0.3;p = 0.074)。随访6个月时，两组间μFR值相似（0.84±0.29 vs 0.84±0.31,p = 0.93），晚期功能丧失相似(-0.02 vs -0.05；p = 0.93)。血管造影晚期管腔损失在DCB组显著降低(-0.03 vs +0.29 mm；p = 0.027)。结论：基于dcb的PCI显示出PCI术后即时功能结果较差的趋势，但在随访中表现相当，表明其治疗新发SVD的潜力。
{"title":"Physiological Performance of Drug-Coated Balloons in Small Coronary Arteries PICCOLETO II μFR","authors":"Simone Fezzi, Aurora Trevisanello, Dario Buccheri, Marco Borgi, Pedro Silva Orrego, Giuseppe Biondi Zoccai, Bernardo Cortese","doi":"10.1002/ccd.31376","DOIUrl":"10.1002/ccd.31376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Drug-coated balloons (DCB) are emerging as an alternative to permanent implants for managing de novo coronary artery disease, particularly in small vessels (SVD). This sub-analysis of the PICCOLETO II study aimed to compare the performance of DCB and DES in terms of Murray's law-based quantitative flow ratio (μFR) changes between baseline, post-percutaneous coronary intervention (PCI), and follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with a clinical indication for PCI were assigned to receive either Xience DES or Elutax SV/Emperor DCB. Coronary angiograms were blindly analyzed by an independent Core Laboratory (Consorzio Futuro in Ricerca, University of Ferrara, Italy).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 232 patients, 59 were included in this analysis. Pre-PCI μFR was comparable between groups (0.65 ± 0.29 vs. 0.58 ± 0.25; <i>p</i> = 0.20). Post-PCI, the DCB group had a lower acute functional gain compared to DES (+0.21 vs. +0.31; <i>p</i> = 0.064), with lower μFR values (0.86 ± 0.36 vs. 0.89 ± 0.3; <i>p</i> = 0.074). At 6-month follow-up, μFR values were similar between groups (0.84 ± 0.29 vs. 0.84 ± 0.31, <i>p</i> = 0.93), with a comparable late functional loss (−0.02 vs. −0.05; <i>p</i> = 0.93). Angiographic late lumen loss was significantly lower in the DCB group (−0.03 vs. +0.29 mm; <i>p</i> = 0.027).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DCB-based PCI showed a trend toward less favorable immediate post-PCI functional result but a comparable performance at follow-up, suggesting its potential in treating de novo SVD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"643-649"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881356","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}
Ahmed R. Gonnah, Ahmed K. Awad, Ahmed E. Helmy, Ahmed B. Elsnhory, Omar Shazly, Saad A. Abousalima, Aser Labib, Hussein Saoudy, Ayman K. Awad, David H. Roberts
<div> <section> <h3> Background</h3> <p>In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, the optimal management strategy for non-culprit lesions is a subject of ongoing debate. There has been an increasing use of physiology-guidance to assess the extent of occlusion in non-culprit lesions, and hence the need for stenting. Fractional flow reserve (FFR) is commonly used as a technique. This analysis compares FFR versus conservative management in the management of non-culprit lesions in STEMI patients with multivessel disease.</p> </section> <section> <h3> Methods</h3> <p>A comprehensive literature search was conducted on databases from inception to May 25, 2024. We conducted a random-effects meta-analysis using RevMan version 5.3.0, employing the Der-Simonian and Laird method to combine the data.</p> </section> <section> <h3> Results</h3> <p>The analysis of five RCTs including 3759 patients revealed a significantly lower incidence of major adverse cardiovascular events (composite of all-cause mortality, non-fatal myocardial infarction and the need for repeat revascularization [PCI or CABG]) in the FFR group compared to the conservative management group (RR = 0.65, 95% CI: 0.44−0.96, <i>p</i> = 0.03). The revascularization rates were significantly lower in the FFR group (RR = 0.53, 95% CI: 0.43−0.66, <i>p</i> < 0.00001). Additionally, unplanned hospitalization leading to urgent repeat revascularization and any cause hospitalization were significantly lower in the FFR group (RR = 0.72, 95% CI: 0.56−0.94, <i>p</i> = 0.01), and (RR = 0.62, 95% CI: 0.46−0.84, <i>p</i> = 0.002), respectively. The FFR group had a higher risk of definite stent thrombosis (RR = 2.26, 95% CI: 1.10−4.64, <i>p</i> = 0.03). No significant differences were observed between the two groups in mortality, hospitalization for heart failure, or myocardial infarction. Similarly, bleeding rates, cerebrovascular accidents (CVAs), and contrast-induced nephropathy (CIN) were comparable between both groups.</p> </section> <section> <h3> Conclusion</h3> <p>Our findings support FFR-guided PCI to manage non-culprit lesions in STEMI patients with multivessel disease as it is potentially safe, with comparable rates of bleeding, CVAs and CIN. It also improves clinical outcomes, as well as reduces revascularization and hospitalization rates. The risk of stent thrombosis remains a concern, and hence the decision making for FFR-guided complete revascularization should take into account the complexity/risk of the procedure, as well as the patients' individual co-morbidities and preferences.</p> </section>
背景：在st段抬高型心肌梗死（STEMI）和多支冠状动脉疾病患者中，非罪魁祸首病变的最佳治疗策略是一个持续争论的主题。越来越多的人使用生理学指导来评估非罪魁祸首病变的闭塞程度，因此需要支架植入术。部分流量储备（FFR）是一种常用的技术。该分析比较了FFR与保守治疗在STEMI合并多血管疾病的非罪魁祸首病变治疗中的作用。方法：对数据库进行全面的文献检索，检索时间为建库至2024年5月25日。我们使用RevMan 5.3.0版本进行随机效应meta分析，采用Der-Simonian和Laird方法对数据进行合并。结果：5项随机对照试验（RCTs）共3759例患者的分析显示，与保守治疗组相比，FFR组的主要不良心血管事件（全因死亡率、非致死性心肌梗死和需要重复血运重建术[PCI或CABG]）的发生率显著降低（RR = 0.65, 95% CI: 0.44-0.96, p = 0.03）。结论：我们的研究结果支持FFR引导下的PCI治疗STEMI多血管疾病患者的非罪魁祸首病变，因为它具有潜在的安全性，出血、CVAs和CIN的发生率相当。它还能改善临床结果，降低血运重建术和住院率。支架血栓形成的风险仍然是一个值得关注的问题，因此，ffr引导下的完全血运重建术的决策应考虑手术的复杂性/风险，以及患者的个人合并症和偏好。
{"title":"Comparing FFR-Guided Complete Revascularization and Conservative Management for Non-Culprit Lesions in STEMI Patients With Multivessel Disease: A Systematic Review and Meta-Analysis","authors":"Ahmed R. Gonnah, Ahmed K. Awad, Ahmed E. Helmy, Ahmed B. Elsnhory, Omar Shazly, Saad A. Abousalima, Aser Labib, Hussein Saoudy, Ayman K. Awad, David H. Roberts","doi":"10.1002/ccd.31379","DOIUrl":"10.1002/ccd.31379","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, the optimal management strategy for non-culprit lesions is a subject of ongoing debate. There has been an increasing use of physiology-guidance to assess the extent of occlusion in non-culprit lesions, and hence the need for stenting. Fractional flow reserve (FFR) is commonly used as a technique. This analysis compares FFR versus conservative management in the management of non-culprit lesions in STEMI patients with multivessel disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted on databases from inception to May 25, 2024. We conducted a random-effects meta-analysis using RevMan version 5.3.0, employing the Der-Simonian and Laird method to combine the data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis of five RCTs including 3759 patients revealed a significantly lower incidence of major adverse cardiovascular events (composite of all-cause mortality, non-fatal myocardial infarction and the need for repeat revascularization [PCI or CABG]) in the FFR group compared to the conservative management group (RR = 0.65, 95% CI: 0.44−0.96, <i>p</i> = 0.03). The revascularization rates were significantly lower in the FFR group (RR = 0.53, 95% CI: 0.43−0.66, <i>p</i> < 0.00001). Additionally, unplanned hospitalization leading to urgent repeat revascularization and any cause hospitalization were significantly lower in the FFR group (RR = 0.72, 95% CI: 0.56−0.94, <i>p</i> = 0.01), and (RR = 0.62, 95% CI: 0.46−0.84, <i>p</i> = 0.002), respectively. The FFR group had a higher risk of definite stent thrombosis (RR = 2.26, 95% CI: 1.10−4.64, <i>p</i> = 0.03). No significant differences were observed between the two groups in mortality, hospitalization for heart failure, or myocardial infarction. Similarly, bleeding rates, cerebrovascular accidents (CVAs), and contrast-induced nephropathy (CIN) were comparable between both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings support FFR-guided PCI to manage non-culprit lesions in STEMI patients with multivessel disease as it is potentially safe, with comparable rates of bleeding, CVAs and CIN. It also improves clinical outcomes, as well as reduces revascularization and hospitalization rates. The risk of stent thrombosis remains a concern, and hence the decision making for FFR-guided complete revascularization should take into account the complexity/risk of the procedure, as well as the patients' individual co-morbidities and preferences.</p>\u0000 </section>\u0000 ","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"633-642"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881319","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}
Kawasaki Disease (KD) is a systemic vasculitis that can lead to coronary artery aneurysms (CAA) in up to 10% of treated cases, significantly increasing the risk of thrombosis and acute myocardial infarction (AMI). While thrombolytic therapy is commonly used in adult coronary syndromes, its application in pediatric KD remains poorly studied. We report a 9-month-old infant with KD and giant CAA complicated by a subocclusive thrombus in the left anterior descending artery (LAD). Initial systemic intravenous thrombolysis (IVCT) with alteplase failed to prevent progression to ST-elevation myocardial infarction (STEMI). Intracoronary thrombolysis (ICT) was subsequently performed, achieving partial reperfusion without complications. At 18 months of follow-up, the patient remained asymptomatic with stable left ventricular dysfunction. This single case illustrates the potential feasibility of combining ICT and IVCT in managing coronary thrombosis in pediatric KD. However, as a single observation, these findings cannot be generalized, and the approach requires further investigation. Robust multicenter studies are necessary to establish the safety, efficacy, and optimal use of thrombolytic therapy in pediatric KD patients with coronary thrombosis.
{"title":"Intracoronary Tissue Plasminogen Activator Therapy to Treat Thrombotic Occlusion of a Giant Coronary Aneurysm in Early Kawasaki Disease","authors":"Moras Patrizio, Pilati Mara, Rebonato Micol, Butera Gianfranco","doi":"10.1002/ccd.31382","DOIUrl":"10.1002/ccd.31382","url":null,"abstract":"<div>\u0000 \u0000 <p>Kawasaki Disease (KD) is a systemic vasculitis that can lead to coronary artery aneurysms (CAA) in up to 10% of treated cases, significantly increasing the risk of thrombosis and acute myocardial infarction (AMI). While thrombolytic therapy is commonly used in adult coronary syndromes, its application in pediatric KD remains poorly studied. We report a 9-month-old infant with KD and giant CAA complicated by a subocclusive thrombus in the left anterior descending artery (LAD). Initial systemic intravenous thrombolysis (IVCT) with alteplase failed to prevent progression to ST-elevation myocardial infarction (STEMI). Intracoronary thrombolysis (ICT) was subsequently performed, achieving partial reperfusion without complications. At 18 months of follow-up, the patient remained asymptomatic with stable left ventricular dysfunction. This single case illustrates the potential feasibility of combining ICT and IVCT in managing coronary thrombosis in pediatric KD. However, as a single observation, these findings cannot be generalized, and the approach requires further investigation. Robust multicenter studies are necessary to establish the safety, efficacy, and optimal use of thrombolytic therapy in pediatric KD patients with coronary thrombosis.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"677-680"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881342","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}
Background: Hypoattenuating leaflet thickening (HALT) following transcatheter aortic valve replacement (TAVR) may compromise valve durability, posing a significant barrier to the broader adoption of this technology among younger patients. Self-expanding valves (SEVs) are the most commonly used transcatheter heart valves (THVs) among Chinese patients with aortic stenosis. Understanding the potential mechanisms underlying HALT is, therefore, critical to guide future THV design and development.
Aims: Identify morphological factors associated with HALT Unidentified after SEVs implantation.
Methods: This study included 195 consecutive patients from Fuwai Hospital who underwent TAVR with SEVs. All participants underwent their first postoperative 4D-CT scan within 6 months of the procedure. Key parameters following THV implantation were measured and recorded using 3mensio software. Univariate and multivariable logistic regression models were applied to identify associations between variables and HALT. Discriminatory ability was assessed using receiver operating characteristic (ROC) analysis, followed by bootstrap validation for model robustness.
Results: HALT was observed in 36.4% of patients (71 out of 195 patients). New sinus height (NSH) and leaflet outflow area were identified as independent risk factors for HALT. The areas under the curve (AUC) for NSH and leaflet outflow area were 0.689 (95% CI: 0.612-0.767) and 0.602 (95% CI: 0.521-0.683), respectively, with no significant difference between them (p = 0.082). Bootstrap validation confirmed the robustness of both NSH and leaflet outflow area, showing performance comparable to the initial stepwise model.
Conclusion: NSH and leaflet outflow area were identified as critical post-THV implantation parameters associated with HALT in TAVR patients treated with SEVs. These findings provide valuable insights that could inform the future design and optimization of SEVs.
{"title":"Morphological Characteristics Following Self-Expanding Transcatheter Heart Valve Implantation and Implications for Hypoattenuating Leaflet Thickening.","authors":"Wence Shi, Guannan Niu, Dejing Feng, Xiangming Hu, Can Wang, Zhenyan Zhao, Hongliang Zhang, Moyang Wang, Yongjian Wu","doi":"10.1002/ccd.31364","DOIUrl":"https://doi.org/10.1002/ccd.31364","url":null,"abstract":"<p><strong>Background: </strong>Hypoattenuating leaflet thickening (HALT) following transcatheter aortic valve replacement (TAVR) may compromise valve durability, posing a significant barrier to the broader adoption of this technology among younger patients. Self-expanding valves (SEVs) are the most commonly used transcatheter heart valves (THVs) among Chinese patients with aortic stenosis. Understanding the potential mechanisms underlying HALT is, therefore, critical to guide future THV design and development.</p><p><strong>Aims: </strong>Identify morphological factors associated with HALT Unidentified after SEVs implantation.</p><p><strong>Methods: </strong>This study included 195 consecutive patients from Fuwai Hospital who underwent TAVR with SEVs. All participants underwent their first postoperative 4D-CT scan within 6 months of the procedure. Key parameters following THV implantation were measured and recorded using 3mensio software. Univariate and multivariable logistic regression models were applied to identify associations between variables and HALT. Discriminatory ability was assessed using receiver operating characteristic (ROC) analysis, followed by bootstrap validation for model robustness.</p><p><strong>Results: </strong>HALT was observed in 36.4% of patients (71 out of 195 patients). New sinus height (NSH) and leaflet outflow area were identified as independent risk factors for HALT. The areas under the curve (AUC) for NSH and leaflet outflow area were 0.689 (95% CI: 0.612-0.767) and 0.602 (95% CI: 0.521-0.683), respectively, with no significant difference between them (p = 0.082). Bootstrap validation confirmed the robustness of both NSH and leaflet outflow area, showing performance comparable to the initial stepwise model.</p><p><strong>Conclusion: </strong>NSH and leaflet outflow area were identified as critical post-THV implantation parameters associated with HALT in TAVR patients treated with SEVs. These findings provide valuable insights that could inform the future design and optimization of SEVs.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881348","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}
Gian Manuel Jiménez-Rodriguez, José Antonio Garcia-Montes, Guering Eid Lidt, Fabio Solis-Jimenez
Aortic coarctation represents up to 7% of congenital heart diseases and is associated with hypertension and coronary artery disease, which continues to be the leading cause of death even after successful surgical repair. However, there is limited knowledge of managing both conditions, especially in the setting of an acute coronary syndrome. We herein present the case of a 53-year-old man with a history of hypertension who initially presented with an ST-elevation myocardial infarction successfully treated with thrombolysis and hemodynamic compromise. During angioplasty, an incidental finding of aortic coarctation was noted. After a thorough evaluation by the heart team, it was determined that percutaneous revascularization with ventricular support was necessary due to the high surgical risk. Aortic coarctation repair was performed first, followed by successful angioplasty with the placement of an Impella CP device through the newly implanted aortic stent. To our knowledge, this is the first reported case of a patient with both STEMI and aortic coarctation treated sequentially and using only a percutaneous approach. It is also the first reported case where a ventricular assist device (VAD) was used to support high-risk PCI in a patient with a repaired aortic coarctation.
{"title":"Immediate Use of Impella CP for High-Risk Percutaneous Coronary Intervention After Repair of Thrombosed Aortic Coarctation","authors":"Gian Manuel Jiménez-Rodriguez, José Antonio Garcia-Montes, Guering Eid Lidt, Fabio Solis-Jimenez","doi":"10.1002/ccd.31371","DOIUrl":"10.1002/ccd.31371","url":null,"abstract":"<div>\u0000 \u0000 <p>Aortic coarctation represents up to 7% of congenital heart diseases and is associated with hypertension and coronary artery disease, which continues to be the leading cause of death even after successful surgical repair. However, there is limited knowledge of managing both conditions, especially in the setting of an acute coronary syndrome. We herein present the case of a 53-year-old man with a history of hypertension who initially presented with an ST-elevation myocardial infarction successfully treated with thrombolysis and hemodynamic compromise. During angioplasty, an incidental finding of aortic coarctation was noted. After a thorough evaluation by the heart team, it was determined that percutaneous revascularization with ventricular support was necessary due to the high surgical risk. Aortic coarctation repair was performed first, followed by successful angioplasty with the placement of an Impella CP device through the newly implanted aortic stent. To our knowledge, this is the first reported case of a patient with both STEMI and aortic coarctation treated sequentially and using only a percutaneous approach. It is also the first reported case where a ventricular assist device (VAD) was used to support high-risk PCI in a patient with a repaired aortic coarctation.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"618-623"},"PeriodicalIF":2.1,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863511","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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