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complexe coronary intervention

Paul N Fiorilli, Saif Anwaruddin
Despite significant advances in treatment of coronary artery disease and improvements in interventional devices and techniques, the subset of obstructive calcified coronary artery disease remains challenging to treat. Percutaneous treatment of these lesions results in increased rates of procedural complications, as well as a higher risk of stent underexpansion and malapposition. This is associated with higher rates of restenosis, target lesion revascularization (TLR), and major adverse cardiac events (MACE)...
December 2016: Current Treatment Options in Cardiovascular Medicine
Sameer Arora, Amol A Bahekar
The management of concomitant obstructive coronary artery disease and severe aortic stenosis in poor surgical candidates is an evolving topic. Although the typical current practice is to perform percutaneous revascularization before transcatheter aortic valve replacement (TAVR), some data have emerged regarding revascularization after performing TAVR. We present the case of a 90-year-old man with multivessel coronary artery disease who was at prohibitive risk for surgical aortic valve replacement. We first performed TAVR with use of hemodynamic support, then Impella-assisted multivessel percutaneous coronary intervention on the patient's unprotected left main coronary artery...
October 2016: Texas Heart Institute Journal
Debabrata Dash
Despite the continuing developments of improved medical devices and increasing operator expertize, coronary chronic total occlusion (CTO) remains as one of the most challenging lesion subsets in interventional cardiology. Percutaneous coronary intervention (PCI) of CTO is a complex procedure carrying the risk of complications that are responsible for significant morbidity and mortality. The complications can be classified as coronary (such as coronary occlusion, perforation, device embolization, or entrapment); cardiac non-coronary (such as periprocedural myocardial infarction); extra cardiac (such as vascular access complications, systemic embolization, contrast-induced nephropathy, and radiation-induced injury)...
September 2016: Indian Heart Journal
Bo Xu, Björn Redfors, Yuejin Yang, Shubin Qiao, Yongjian Wu, Jilin Chen, Haibo Liu, Jue Chen, Liang Xu, Yanyan Zhao, Changdong Guan, Runlin Gao, Philippe Généreux
OBJECTIVES: The aim of this study was to assess the impact of operator experience on prognosis after left main coronary artery (LM) percutaneous coronary intervention (PCI). BACKGROUND: LM PCI can be technically challenging and potentially risky considering the amount of supplied myocardium. METHODS: Consecutive patients who underwent unprotected LM PCI at a single institution were included and compared according to whether the primary operator was an experienced, high-volume LM operator (defined as an operator who performed at least 15 LM PCIs per year for at least 3 consecutive years) or not...
October 24, 2016: JACC. Cardiovascular Interventions
Robert C Welsh, Eric D Peterson
No abstract text is available yet for this article.
October 25, 2016: Journal of the American College of Cardiology
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
Ahmed Farag, Aneesha Chauhan, Sunita Avinash, Chee K Liew, Jonas Eichhöfer, Anoop Chauhan
This case illustrates the complexities of performing a primary percutaneous intervention in a patient with chronic Type A aortic aneurysm and dissection with contraindications for surgical management. We also discuss the significant risk that the patient had to overcome to survive an undiagnosed aortic dissection and an acute ST elevation myocardial infarction.
April 2016: Aorta (Stamford, Conn.)
James Sapontis, Steven P Marso, David J Cohen, William Lombardi, Dimitri Karmpaliotis, Jeffrey Moses, William J Nicholson, Ashish Pershad, R Michael Wyman, Anthony Spaedy, Stephen Cook, Parag Doshi, Robert Federici, Craig R Thompson, Karen Nugent, Kensey Gosch, John A Spertus, J Aaron Grantham
BACKGROUND: Patients with chronic total occlusions of a coronary artery represent a complex, yet common, clinical conundrum among patients with ischemic heart disease. Chronic total occlusion angioplasty is increasingly being used as a treatment for these complex lesions. There is a compelling need to better quantify the safety, efficacy, benefits, and costs of the procedure. METHODS: To address these gaps in knowledge, we designed the Outcomes, Patient Health Status, and Efficiency IN Chronic Total Occlusion Hybrid Procedures (OPEN CTO) study, an investigator-initiated multicenter, single-arm registry including 12 centers with a planned enrollment of 1000 patients...
October 13, 2016: Coronary Artery Disease
Yohei Sotomi, Rafael Cavalcante, Richard A Shlofmitz, Pannipa Suwannasom, Hiroki Tateishi, Erhan Tenekecioglu, Yaping Zheng, Mohammad Abdelghani, Robbert J de Winter, Joanna J Wykrzykowska, Yoshinobu Onuma, Patrick W Serruys
AIMS: Recently, favourable procedural 30-day and one-year outcomes with the Diamondback 360 Orbital Atherectomy System (OAS) in the treatment of severely calcified lesions have been reported. The purpose of this study was to assess the therapeutic mechanism and efficacy of the OAS with optical coherence tomography (OCT) imaging. METHODS AND RESULTS: This was an observational imaging study in 18 patients with complex calcified coro-nary artery lesions who underwent percutaneous coronary intervention with the OAS...
October 20, 2016: EuroIntervention
Mohamad Lazkani, Divya Ratan Verma, Michael Morris, Ashish Pershad
Preprocedural planning and advanced imaging is vital to achieve a consistent and high level of success for complex coronary chronic total occlusion (CTO) revascularization. Various practice patterns exist around the world when performing coronary artery CTO revascularization. This case report highlights a fusion of global practices in CTO intervention and integration of advanced imaging to achieve successful revascularization.
September 2016: Indian Heart Journal
Sannisha K Dale, Kathleen M Weber, Mardge H Cohen, Leslie R Brody
This study investigated the relationships among abuse, nocturnal levels of cortisol and norepinephrine (NE), and coronary heart disease (CHD) risk as measured by the Framingham risk score among women with human immunodeficiency virus (HIV). Participants (n = 53) from the Chicago Women's Interagency HIV Study (WIHS), a longitudinal prospective cohort study initiated in 1994, were enrolled in this study during 2012. At WIHS baseline and annual follow-up visits, women were asked about recent experiences of abuse...
October 13, 2016: AIDS Care
Erik Skobel, Christian Knackstedt, Alvaro Martinez-Romero, Dario Salvi, Cecilia Vera-Munoz, Andreas Napp, Jean Luprano, Ramon Bover, Sigrid Glöggler, Birna Bjarnason-Wehrens, Nikolaus Marx, Alan Rigby, John Cleland
Low adherence to cardiac rehabilitation (CR) might be improved by remote monitoring systems that can be used to motivate and supervise patients and tailor CR safely and effectively to their needs. The main objective of this study was to evaluate the feasibility of a smartphone-guided training system (GEX) and whether it could improve exercise capacity compared to CR delivered by conventional methods for patients with coronary artery disease (CAD). A prospective, randomized, international, multi-center study comparing CR delivered by conventional means (CG) or by remote monitoring (IG) using a new training steering/feedback tool (GEx System)...
October 11, 2016: Heart and Vessels
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
Daliang Yan, Xiaojuan Liu, Lu Hua, Kunpeng Wu, Xilin Sha, Jianhua Zhao, Chen Yang, Chao Zhang, Jiahai Shi, Xiang Wu
Cardiac allograft vasculopathy (CAV) was the leading cause of late death in heart transplantation recipients. Matrix metalloproteinase-14 (MMP-14), as a member of the MMPs family, has been reported to play a vital role in coronary vascular lesions of allotransplanted hearts. However, concrete mechanism is still unclear. Herein, we showed that the expression of MMP-14 was different between isografts and allografts. Interestingly, we found MMP-14 could interact with CD44 in allografts. Cluster of differentiation 44 (CD44), as a cell adhesion receptor and is involved in cell migration, caused our interest in MMP-14/CD44 complex in allografts...
September 25, 2016: Pathology, Research and Practice
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
Zhaoye Zhou, Qi Jin, Long Yu, Liqun Wu, Bin He
BACKGROUND: Knowledge of atrial electrophysiological properties is crucial for clinical intervention of atrial arrhythmias and the investigation of the underlying mechanism. This study aims to evaluate the feasibility of a novel noninvasive cardiac electrical imaging technique in imaging bi-atrial activation sequences from body surface potential maps (BSPMs). METHODS: The study includes 7 subjects, with 3 atrial flutter patients, and 4 healthy subjects with normal atrial activations...
2016: PloS One
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
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