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complexe coronary intervention

Naotaka Okamoto, Hiroshi Ueda, Takahiro Yoshimura, Surbhi Chamaria, Samit Bhatheja, Yuliya Vengrenyuk, Samaneh Rabiei, Yonandy Barrientos, Vishal Kapur, Nitin Barman, Joseph Sweeny, Usman Baber, Roxana Mehran, Samin K Sharma, Annapoorna S Kini
OBJECTIVES: The aim of the study was to compare the acute outcomes of Absorb bioresorbable vascular scaffolds (BVS) and second-generation drug-eluting stent (DES) implantation in routine clinical practice. There is a paucity of data regarding BVS use in a real-world patient population. METHODS: The study population comprised 40 consecutive patients who underwent percutaneous coronary intervention (PCI) with BVS implantation at a tertiary-care center in New York, New York between July and December of 2016...
April 15, 2018: Journal of Invasive Cardiology
Juan Torrado, Leo Buckley, Ariel Durán, Pedro Trujillo, Stefano Toldo, Juan Valle Raleigh, Antonio Abbate, Giuseppe Biondi-Zoccai, Luis A Guzmán
The field of interventional cardiology has significantly evolved over 40 years by overcoming several challenges. The introduction of first-generation drug-eluting stents significantly reduced the rates of restenosis, but at the expense of an increase of late stent thrombosis. Prolonged antithrombotic therapy reduced rates of stent thrombosis, but at the cost of increased bleeding. Although the advent of second-generation drug-eluting stents subsequently reduced the incidence of late stent thrombosis, its permanent nature prevents full recovery of vascular structure and function with accordant risk of very late stent failure...
April 17, 2018: Journal of the American College of Cardiology
Vincenzo DE Marzo, Domenico D'Amario, Mattia Galli, Rocco Vergallo, Italo Porto
Before the percutaneous spread, the mortality rate of patients with coronary heart disease not suitable for cardiac surgery was markedly high. This limit has been progressively exceeded with the advent of minimally invasive approaches, which, although was initially intended exclusively for low risk patients, was then employed in complex patients often too compromised to undergo cardiac surgery. Given to the rising of high-risk population, due to an increase of patients with multiple chronic conditions linked to the best care offered, we are witnessing an expansion of the high-risk percutaneous coronary interventions (PCI) population...
April 11, 2018: Minerva Cardioangiologica
Karim M Al-Azizi, Amir S Lotfi
BACKGROUND: Patients' intra and post procedural comfort, quick recovery, as well as procedure success, are key elements for choosing the right arterial access site. Radial artery access has been of increasing interest since it was first described. Advanced treatments of coronary lesions, from primary percutaneous interventions during ST elevation myocardial infarction cases to chronic total occlusion cases, have been increasingly done through the radial access. Distal left trans radial artery (dlTRA) is a new technique first described by Kiemineij...
March 26, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Kyle D Buchanan, Rebecca Torguson, Toby Rogers, Linzhi Xu, Jiaxiang Gai, Itsik Ben-Dor, William O Suddath, Lowell F Satler, Ron Waksman
Drug-eluting stents (DES) significantly reduced the incidence of in-stent restenosis (ISR). However, ISR still exists in the contemporary DES era. Previously deemed to be a benign process, ISR leads to complex presentation and intervention. This study aimed to compare the presentation and outcome of DES-ISR versus de novo lesions. We performed a retrospective analysis of 11,666 patients receiving percutaneous coronary intervention from 2003 to 2017 and divided them into 2 groups by de novo stenosis and ISR...
March 13, 2018: American Journal of Cardiology
Bhuvnesh Aggarwal, Wahaj Aman, Omar Jeroudi, Neal S Kleiman
Due to advancing age and increasing comorbidities, the current population has a higher incidence of complex coronary artery disease, often without surgical options for revascularization. In this setting, hemodynamic support devices are an important adjunct in the interventionist's toolbox as they allow for a safer, more effective procedure. The following paper reviews the indications of various available mechanical support devices, highlights their clinical data and technical parameters, and offers a practical approach towards appropriate patient and device selection...
January 2018: Methodist DeBakey Cardiovascular Journal
Sanjog Kalra, Hemal Bhatt, Ajay J Kirtane
The treatment of ST-segment elevation myocardial infarction (STEMI) has advanced dramatically over the past 30 years since the introduction of reperfusion therapies, such that mechanical reperfusion with primary percutaneous coronary intervention is now the standard of care. With STEMI, as with other forms of acute coronary syndrome, stent deployment in culprit lesions is the dominant form of reperfusion in the developed world and is supported by contemporary guidelines. However, the precise timing of stenting and the extent to which both culprit and non-culprit lesions should be treated continue to be active areas of study...
January 2018: Methodist DeBakey Cardiovascular Journal
Min Ma, Kai-Yue Diao, Xiao-Jing Liu, Yong He
Anatomic variations, calcified, tortuous, angulated lesions, and lack of support to increase the complexity of transradial intervention (TRI). Guidezilla is a mother-and-child catheter enabling increased support during complex interventions. As there are few published reports of its use, we describe our experience using this device to assist TRI in Chinese patients. The aim of this study was to investigate the efficacy and safety of the Guidezilla guide extension catheter in complex coronary interventions...
April 3, 2018: Scientific Reports
Michael S Lee, Evan Shlofmitz, Alec Goldberg, Richard Shlofmitz
OBJECTIVES: We report the 1-year outcomes of real-world patients with severely calcified coronary arteries who underwent orbital atherectomy. BACKGROUND: Percutaneous coronary intervention of heavily calcified lesions is technically challenging and associated with worse clinical outcomes. Modification of severely calcified coronary lesions with orbital atherectomy facilitates stent delivery and expansion. Although we previously reported the safety of orbital atherectomy at 30 days in all comers with severely calcified coronary lesions, including patients who were excluded from the ORBIT II trial, longer-term follow-up is unknown...
April 2018: Journal of Invasive Cardiology
Itsik Ben-Dor, Toby Rogers, Lowell F Satler, Ron Waksman
Coronary angiography and percutaneous coronary intervention using the radial approach are becoming more frequent. Pronounced guide catheter manipulation in cases with tortuous access routes may lead to severe catheter kinking or knotting. The purpose of this review article is to present several techniques to resolve radial access catheter knots and kinks. First, simple maneuvers such as gentle traction, rotation, and guidewire advancement can often resolve minor kinking; however, complex loops and kinks are often not reversible with these simple maneuvers...
March 30, 2018: Catheterization and Cardiovascular Interventions
Carlo De Innocentiis, Marco Zimarino, Raffaele De Caterina
In multivessel coronary artery disease (MVCAD), myocardial revascularisation can be achieved by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), with complete revascularisation on all diseased coronary segments or with incomplete revascularisation on selectively targeted lesions. Complete revascularisation confers a long-term prognostic benefit, but is associated with a higher rate of periprocedural events compared with incomplete revascularisation. In most patients with MVCAD, the main advantage of CABG over PCI is conferred by the achievement of more extensive revascularisation...
January 2018: Interventional Cardiology
Robert A Byrne, Shmuel Banai, Roisin Colleran, Antonio Colombo
Patients with diabetes have poorer outcomes after percutaneous coronary intervention than patients without diabetes. The Cre8™ EVO drug-eluting stent (DES) has design features that aim to improve clinical outcomes in patients with diabetes. These include Abluminal Reservoir Technology - a proprietary polymer-free drug-release system consisting of reservoirs on the abluminal surface of the stent that control drug release and direct the drug exclusively towards the vessel wall - and the Amphilimus™ drug formulation, which enables enhanced drug-tissue permeation utilising fatty acid transport pathways...
January 2018: Interventional Cardiology
Patrick Marechal, Laurent Davin, Olivier Gach, Christophe Martinez, Mathieu Lempereur, Nicolas Lhoest, Patrizio Lancellotti
Despite an incidence of about 18-52% of the patients undergoing coronary angiography, chronic total occlusions (CTO) are rarely revascularised by percutaneous angioplasty (PCI). Nevertheless, current evidence suggests that successful CTO angioplasty improves symptoms, quality of life and long-term survival. During the last decade, the improvement of specific tools and techniques for these complex procedures, and the increasing experience of operators, have led to the achievement of success and complication rates almost equivalent to non-CTO angioplasty...
March 28, 2018: Expert Review of Cardiovascular Therapy
Gianfranco DE Candia
Percutaneous coronary interventions in patients at high clinical risk with anatomical complexity is one of the most important topics in interventional cardiology. The development of materials and techniques allowed the interventional cardiologist to be able to treat virtually any coronary lesion. The patient's evaluation with clinical and anatomic risk scores allow the physicians to choose the best therapeutic strategy for each individual patient.
March 28, 2018: Minerva Cardioangiologica
Nyal Borges, Samir R Kapadia, Stephen G Ellis
The optimal management of unprotected left main coronary artery (ULMCA) disease is currently a debated topic. Percutaneous coronary intervention (PCI) has seen an increased adoption for the management of ULMCA disease after numerous small-scale randomised trials and cohort studies showed equipoise with coronary artery bypass grafting (CABG) for low complexity lesions. The recently published NOBLE and EXCEL trials are two of the largest international randomised clinical trials comparing PCI and CABG in patients with ULMCA disease...
September 2017: Interventional Cardiology
Kully Sandhu, Robert Butler, James Nolan
Historically, the majority of coronary procedures have been performed via the femoral artery. However, since the inception of the transradial approach, a number of studies have confirmed that this technique is associated with a significant reduction in vascular complications, equivalent procedure times and radiation exposure to femoral procedures, the ability to perform complex coronary interventions, early ambulation and patient preference. Over the last decade, this has led to an exponential rise in the use of the transradial access site, with several potential technical challenges becoming increasingly recognised...
May 2017: Interventional Cardiology
Giovanni Luigi De Maria, Adrian P Banning
Due to its potential prognostic implications and technical complexity, revascularisation of left main coronary artery (LMCA) disease requires careful consideration. Since publication of the results of the SYNTAX study, and more recently the EXCEL and NOBLE trials, there has been particular interest in percutaneous revascularisation of the LMCA. It is becoming clear that percutaneous revascularisation of LMCA disease requires appropriate lesion preparation and carefully optimised stenting in order to offer patients a treatment option as effective as coronary artery bypass grafting...
May 2017: Interventional Cardiology
Ali Tarighatnia, Asghar Mesbahi, Amir Hossein Mohammad Alian, Evin Koleini, Nader Nader
The objective of this study was to evaluate radiation exposure levels in conjunction with operator dose implemented, patient vascular characteristics, and other technical angiographic parameters. In total, 756 radial coronary angioplasties were evaluated in a major metropolitan general hospital in Tabriz, Iran. The classification of coronary lesions was based on the ACC/AHA system. One interventional cardiologist performed all of the procedures using a single angiography unit. The mean kerma-area product and mean cumulative dose for all cases was 5081 μGy m2 and 814...
March 23, 2018: Radiation Protection Dosimetry
Tahgrid Asfar, Tulay Koru-Sengul, Estefania C Ruano-Herreria, Danielle Sierra, David J Lee, Kristopher L Arheart
Introduction: Patients with cancer, cardiovascular disease (CVD), and respiratory disease are susceptible to health consequences related to secondhand smoke (SHS) exposure. The current study examined the prevalence, time-trends and correlates of SHS exposure among these patients compared to individuals without these diseases (control). Methods: Data were obtained from the 2001-2012 National Health and Nutrition Examination Survey. All adults (>20 years old), who were nonsmokers and exposed to SHS (serum cotinine level 0...
March 23, 2018: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
Manabu Ogita, Satoru Suwa, Taketo Sonoda, Shuta Tsuboi, Katsumi Miyauchi, Hiroyuki Daida
Percutaneous coronary intervention (PCI) involving the anomalous coronary artery is challenging with respect to difficulty in achieving stable catheterization. Rotational atherectomy (RA) can facilitate severely calcified lesions to improve stent delivery and stent expansion; however, its utility in tortuous and angulated coronary arteries is limited with difficulty in delivery of the RA burr. The mother-and-child technique is effective for complex PCIs with increased backup force for device delivery in such complicated cases...
2018: Case Reports in Cardiology
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