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Complex pci

Ravi S Hira, Larry S Dean
Provisional use of rotational atherectomy (RA) is indicated for procedural success in heavily calcified lesions. In the current study, RA use at three high volume percutaneous coronary intervention (PCI) centers between 2005 and 2013 was 1.4%. MACE rate was 17.8% at median follow-up of 22 months. Peripheral vascular disease (PVD), diabetes mellitus (DM), acute coronary syndrome (ACS), and SYNTAX > 23 were found to be independently associated with MACE. With increasing complexity of disease and SYNTAX score, there is usually an increase in severity of calcification and need for atherectomy...
October 2016: Catheterization and Cardiovascular Interventions
Vladimir Dedovic, Goran Stankovic
Despite permanent improvement in success rate and technical developments, chronic total occlusion (CTO) remains undertreated by percutaneous coronary intervention (PCI). Dedicated CTO operators from Japan, Europe and USA perform these procedures with success rate beyond 90%, but there is still huge gap between this group of specialists and broader population of PCI operators. Recently proposed CTO scores can be used for patients' selection according to the CTO operators' experience. Patients with low CTO score values may be suitable for less experienced operators at the beginning of the CTO PCI learning curve, while more complex CTOs (higher CTO score values) should be differed to CTO experts...
October 19, 2016: Panminerva Medica
Francesco Pelliccia, Fabiana Rollini, Giuseppe Marazzi, Cesare Greco, Carlo Gaudio, Dominick J Angiolillo, Giuseppe Rosano
The combination of AF and coronary artery disease not only is a common clinical setting, it is also a complex setting to deal with anticoagulation and antiplatelet therapy, and it is associated with significantly higher mortality rates. Unfortunately, there are no sufficient data available to optimally guide clinical practice in such settings. This review focuses specifically on newer oral anticoagulants (NOACs) associated with dual antiplatelet therapy (DAPT) in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI)...
October 3, 2016: International Journal of Cardiology
Romain Didier, Marco A Magalhaes, Edward Koifman, Florent Leven, Philippe Castellant, Jacques Boschat, Yannic Jobic, Sarkis Kiramijyan, Pierre-Philippe Nicol, Martine Gilard
AIMS: The radiation exposure resulting from cardiovascular procedures may increase the risk of cancer, and/or cause skin injury. Whether the novel cardiovascular automated radiation reduction X-ray system (CARS) can help reduce the patient radiation dose in daily clinical practice remains unknown. The aim of this study was to evaluate the reduction in patient radiation dose with the use of CARS in the cardiac catheterisation laboratory (CCL). METHODS AND RESULTS: This study retrospectively analysed 1,403 consecutives patients who underwent a cardiac catheterisation with coronary angiography (CA) and/or a percutaneous coronary intervention (PCI) in the Brest University Hospital over the course of one year...
October 10, 2016: EuroIntervention
Silvia Casarotto, Angela Comanducci, Mario Rosanova, Simone Sarasso, Matteo Fecchio, Martino Napolitani, Andrea Pigorini, Adenauer G Casali, Pietro D Trimarchi, Melanie Boly, Olivia Gosseries, Olivier Bodart, Francesco Curto, Cristina Landi, Maurizio Mariotti, Guya Devalle, Steven Laureys, Giulio Tononi, Marcello Massimini
Objective Validating objective, brain-based indices of consciousness in behaviorally unresponsive patients represents a challenge due to the impossibility of obtaining independent evidence through subjective reports. Here we address this problem by first validating a promising metric of consciousness - the perturbational complexity index (PCI) - in a benchmark population who could confirm the presence or absence of consciousness through subjective reports, and then applying the same index to patients with disorders of consciousness (DOC)...
September 22, 2016: Annals of Neurology
Masatoshi Minamisawa, Takashi Miura, Hirohiko Motoki, Hideki Kobayashi, Masanori Kobayashi, Hiroyuki Nakajima, Hikaru Kimura, Hiroshi Akanuma, Eiichiro Mawatari, Toshio Sato, Shoji Hotta, Yuichi Kamiyoshi, Takuya Maruyama, Noboru Watanabe, Takayuki Eisawa, Shinichi Aso, Shinichiro Uchikawa, Keisuke Senda, Takehiro Morita, Naoto Hashizume, Naoyuki Abe, Soichiro Ebisawa, Atsushi Izawa, Yusuke Miyashita, Jun Koyama, Uichi Ikeda
Although coronary artery disease (CAD) is common in patients with heart failure (HF), little is known about the prognostic significance of coronary lesion complexity in patients with prior HF undergoing percutaneous coronary intervention (PCI). The aim of this study was to investigate whether the coronary Synergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) score could improve risk stratification in HF patients with CAD. Two hundred patients (mean age 73 ± 11 years, left ventricular ejection fraction 49 ± 15 %) with prior HF who underwent PCI were divided into two groups stratified by SYNTAX score (median value 12) and tracked prospectively for 1 year...
October 5, 2016: Heart and Vessels
Takayuki Mori, Kenichi Sakakura, Hiroshi Wada, Yousuke Taniguchi, Kei Yamamoto, Yusuke Adachi, Hiroshi Funayama, Shin-Ichi Momomura, Hideo Fujita
While rotational atherectomy (RA) is used for complex lesions in percutaneous coronary intervention, there are several contraindications such as unprotected left main stenosis or left ventricular dysfunction. We previously reported that the incidence of in-hospital complications was significantly greater in off-label as compared to on-label use RA. However, the mid-term clinical outcomes between off-label and on-label RA have not been investigated. The purpose of this study was to compare the mid-term clinical outcomes between off-label (n = 156) and on-label RA (n = 94)...
October 5, 2016: Heart and Vessels
Aris Karatasakis, Barbara A Danek, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A Jaffer, Robert W Yeh, Mitul P Patel, John N Bahadorani, R Michael Wyman, William L Lombardi, J Aaron Grantham, David E Kandzari, Nicholas J Lembo, Anthony H Doing, Jeffrey W Moses, Ajay J Kirtane, Santiago Garcia, Manish A Parikh, Ziad A Ali, Judit Karacsonyi, Sanjog Kalra, Bavana V Rangan, Pratik Kalsaria, Craig A Thompson, Subhash Banerjee, Emmanouil S Brilakis
OBJECTIVES: We sought to determine the impact of proximal cap ambiguity on procedural techniques and outcomes for coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We examined the clinical and angiographic characteristics and outcomes of 1021 CTO-PCIs performed between 2012 and 2015 at 11 United States centers. RESULTS: Proximal cap ambiguity was present in 31% of target lesions and was associated with increased clinical and angiographic complexity (prior coronary artery bypass graft surgery: 43% vs 33%; P=...
October 2016: Journal of Invasive Cardiology
Zekun Cai, Jianwei Dai, Dan Wu, Jian Qiu, Jun Ma, Guoying Li, Wei Zhu, Hongqiang Lei, Wenhua Huang, Heye Zhang, Lin Xu
The aim of this study is to investigate the value of 3-dimensional global peak longitudinal strain (GPLS) derived from the 3-dimensional speckle-tracking echocardiography (3D-STE) in the diagnosis of the complex non-ST-segment elevation acute coronary syndromes (NSTE-ACS) by comparing GPLS to the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score.A total of 59 inpatients with NSTE-ACS in our hospital between October 2014 and January 2015 were enrolled into our study...
September 2016: Medicine (Baltimore)
Brian B Ghoshhajra, Richard A P Takx, Luke L Stone, Erin E Girard, Emmanouil S Brilakis, William L Lombardi, Robert W Yeh, Farouc A Jaffer
OBJECTIVES: The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with x-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group...
September 23, 2016: European Radiology
Sanjay Verma, Daniel Burkhoff, William W O'Neill
The rate of performing primary percutaneous coronary intervention in patients with complex coronary artery disease is increasing. The use of percutaneous mechanical circulatory support devices provides critical periprocedural hemodynamic support. Mechanical support has increased the safety and efficacy of interventional procedures in this high-risk patient population. Predicting patient response to the selected intervention can be clinically challenging. Here we demonstrate a case where complete hemodynamic collapse during PCI was avoided by mechanical support provided by the Impella device...
September 23, 2016: Catheterization and Cardiovascular Interventions
Aryeh Shalev, Ryo Nakazato, Reza Arsanjani, Rine Nakanishi, Hyung-Bok Park, Yuka Otaki, Victor Y Cheng, Heidi Gransar, Troy M LaBounty, Sean W Hayes, Daniel S Berman, James K Min
RATIONALE AND OBJECTIVES: SYNTAX score is a useful metric determined at the time of invasive coronary angiography (ICA) to assess the complexity of coronary artery disease, and improves prediction of complications at the time of percutaneous complex intervention (PCI). We aimed to determine whether SYNTAX score can be reliably determined from coronary computed tomography angiography (CCTA) and whether a CCTA-derived SYNTAX score can predict complex PCI. MATERIALS AND METHODS: SYNTAX scores were calculated on per-patient, per-vessel, and per-segment basis in 154 consecutive patients who underwent CCTA and ICA...
September 19, 2016: Academic Radiology
Yoriyasu Suzuki, Makoto Muto, Masahisa Yamane, Toshiya Muramatsu, Atsunori Okamura, Yasumi Igarashi, Tsutomu Fujita, Shigeru Nakamura, Akitsugu Oida, Etsuo Tsuchikane
OBJECTIVES: To evaluate factors for predicting retrograde CTO-PCI failure after successful collateral channel crossing. BACKGROUND: Successful guidewire/catheter collateral channel crossing is important for the retrograde approach in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). METHODS: A total of 5984 CTO-PCI procedures performed in 45 centers in Japan from 2009 to 2012 were studied. The retrograde approach was used in 1656 CTO-PCIs (27...
September 21, 2016: Catheterization and Cardiovascular Interventions
Krzysztof Milewski, Paweł Gąsior, Stefan Samborski, Piotr P Buszman, Aleksandra Błachut, Adam Wojtaszczyk, Adam Młodziankowski, Artur Mendyk, Marek Król, Wojciech Wojakowski, Paweł E Buszman
INTRODUCTION: Despite the dominance of drug-eluting stents in modern interventional cardiology, there is still a niche for bare metal stents. AIM: The aim of the Polish NexGen registry was to evaluate the safety and efficacy of a new generation cobalt-chromium NexGen stent in a real life patient population. MATERIAL AND METHODS: A prospective multi-center registry was conducted in five clinical sites of American Heart of Poland. Three hundred and eighty-three patients who underwent percutaneous coronary intervention (PCI) with NexGen stent implantation were included...
2016: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
Fadi Al-Rashid, Heike A Hildebrandt, Philipp Kahlert
No abstract text is available yet for this article.
2016: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
Carlo Briguori, Gabriella Visconti, Michael Donahue, Vito Di Palma, Francesca De Micco, Giuseppe Signoriello, Amelia Focaccio
INTRODUCTION: Stent delivery failure may occur especially when treating complex coronary artery stenosis. XLIMUS (CARDIONOVUM GmbH, Bonn, Germany) is a new sirolimus-eluting stent (SES) with the following features: 1) cobalt chromium stent platform, with low (73 μm) strut thickness, (2) biodegradable polymer, and 3) potent antiproliferative drug (Sirolimus). Preliminary data suggest that XLIMUS SES may be ideal for the treatment of complex lesions. METHODS: In this registry, we assessed the deliverability, safety, and efficacy of percutaneous coronary interventions (PCI) using the XLIMUS SES in patients undergoing elective PCI in native coronary vessels for complex de novo lesions, including severe calcification, severe tortuosity, and chronic total occlusion...
September 13, 2016: Journal of Interventional Cardiology
Erin A Woods, Margaret L Ackman, Michelle M Graham, Sheri L Koshman, Rosaleen M Boswell, Arden R Barry
BACKGROUND: Current guidelines recommend triple antithrombotic therapy (TAT), defined as acetylsalicylic acid (ASA), clopidogrel, and warfarin, for patients with nonvalvular atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation. The choice of anticoagulant/antiplatelet therapy in this population is ambiguous and complex, and prescribing patterns are not well documented. OBJECTIVE: To characterize local prescribing patterns for anticoagulant/antiplatelet therapy after percutaneous coronary intervention in patients with nonvalvular atrial fibrillation...
July 2016: Canadian Journal of Hospital Pharmacy
Kunihiro Shimamura, Giulio Guagliumi
Decision making on lesion preparation and stent/scaffold optimization are cornerstones of patient outcome. Intravascular imaging recently emerged as a critical modality to achieve better results of stent/scaffold implantation and superior clinical outcomes compared with coronary angiography alone. Optical coherence tomography (OCT), a light-based intravascular imaging modality with high frame rate in acquisition and very high speed pullback, can interrogate the target vessel in a couple of seconds, and immediately display a pristine longitudinal lumen contour with automatic detection of lesion severity, site and lumen/stent areas...
September 23, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Pil Hyung Lee, Jung-Min Ahn, Mineok Chang, Seunghee Baek, Sung-Han Yoon, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Duk-Woo Park, Seung-Jung Park
Left main coronary artery (LMCA) disease is the highest-risk lesion subset of ischemic heart disease, and has traditionally been an indication for coronary artery bypass grafting (CABG). Recent evidence suggests comparable clinical outcomes between percutaneous coronary intervention (PCI) and CABG for LMCA disease, with similar rates of mortality and serious composite outcomes, a higher rate of stroke with CABG, and a higher rate of repeat revascularization with PCI. These results have been translated to the current guideline recommendation that PCI is a reasonable alternative to CABG in patients with low to intermediate anatomic complexity...
September 13, 2016: Journal of the American College of Cardiology
Sergio García-Blas, Luis Mainar, Juan Sanchis, Julio Núñez
A 64-year-old woman was admitted for non-ST elevation myocardial infarction. The coronary angiogram showed a severe stenosis in the left anterior descending artery (LAD) ostium. A 3.5 mm×18 mm everolimus-eluting stent was directly deployed in the left main and proximal LAD, with significant jailing of the circumflex (Cx) ostium. A 3.25 mm×11 mm everolimus-eluting stent was therefore deployed in the Cx using the T-stenting and small protrusion technique. One year later, the patient was readmitted for non-ST elevation myocardial infarction, and the coronary angiogram showed ostial restenosis of the Cx stent...
October 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
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