Cardiovascular Revascularization Medicine

CRT 2012 welcomed former President Bill Clinton

Ron Waksman — 2012-03-01

For me, as the founder and chairman of the annual Cardiovascular Research Technologies (CRT) meeting for the last 15 years, the highlight of this year's meeting was the keynote address given by the 42nd president of the United States, Mr. Bill Clinton. This year we targeted a high-profile individual who could address the meeting's attendees from his own personal experience and share his perspective on health care reform during an election year. The topic remains a highlight of the political debate, especially when a new cardiovascular innovation faces regulatory and reimbursement challenges.

CTO Club: revisiting the final frontier in PCI

Richard R. Heuser — 2012-03-16

When Andrés Gruéntzig () took the first step to perform balloon angioplasty in 1977 in Zurich, Switzerland, we saw the beginning of a new era. Angioplasty first began as a therapy for single-vessel proximal stenosis, and in the early 1980s, with improvement in equipment and a few brave pioneers, this treatment went to the next level. Geoffrey Hartzler (), one of those early pioneers in angioplasty, advanced the therapy from very isolated patient subsets to the treatment of multivessel coronary disease. He also showed us the way to treat acute myocardial infarction, as well as patients with chronic total occlusions. His work showed that chronic total occlusion in percutaneous coronary intervention (PCI) even with rudimentary equipment could be approached effectively, and his group showed that there appeared to be a difference in outcome in chronic total occlusion (CTO) patients who were successfully or unsuccessfully treated. Dr. Hartzler also came up with the concept to approach CTOs in a retrograde fashion, in this case going across saphenous vein grafts, to advance into the native coronaries. The Japanese picked up the mantle on CTOs and basically made a statement to the world that all patients were fair game to be treated with PCI, and their expertise has transformed CTO therapy into a true specialty of interventional cardiology. Working with our Japanese colleagues and also applying some new technology and skills, a small group of us began the CTO Club in the United States. Greg Braden () and Don Baim () were leaders when we organized the first CTO Club. The original concept with the Club was that we would rotate the meeting to various sites in the United States involving not only our CTO gurus in the United States but also European and Japanese leaders.

Impact of vascular approach (transradial vs. transfemoral) on the efficacy of thrombus aspiration in acute myocardial infarction patients

2012-01-09

Abstract: Background: Manual thrombus aspiration improves the efficacy of percutaneous coronary interventions (PCIs) in ST-elevation acute myocardial infarction (STEMI). The transradial approach (TRA) is an emerging vascular approach for PCI but is associated with specific technical requirements. As data on the combination of thrombus aspiration and TRA are scarce, we sought to assess the feasibility of TRA manual thrombus aspiration in STEMI patients.Methods: All consecutive patients treated with manual thrombectomy for acute STEMI in three Italian hospitals were considered. Patients were divided according to the vascular approach into two groups: TRA and transfemoral (TFA). Two primary end points were defined: thrombectomy feasibility (ability to cross the occlusion with the device) and thrombectomy efficacy (absolute thrombus score reduction after device crossing).Results: From January 2008 to December 2009, 303 patients were included: 151 patients (63±13 years) were treated through TFA, and 152 patients (61±12 years, P=.25) were treated through TRA. There were no significant differences in thrombectomy feasibility (75% in the TRA compared to 74.8% in the TFA group, P=.97) or in thrombectomy efficacy (2.6±.8 for TRA and 2.9±2 for TFA, P=.15). In both groups, there was a significant reduction in thrombus score after manual thrombus aspiration. Angiographically evident distal embolization after device crossing was low and observed in seven cases (5%) either for TFA and TRA (P=.99).Conclusions: The present study suggests that, in the setting of acute STEMI, manual thrombus aspiration through TRA is feasible, and its efficacy is comparable to the TFA.

A prospective multicenter registry of laser therapy for degenerated saphenous vein graft stenosis: the COronary graft Results following Atherectomy with Laser (CORAL) trial

2012-03-09

Abstract: Purpose: The primary aim of this study was to prospectively evaluate the safety and efficacy of Excimer laser atherectomy as a primary treatment strategy in consecutively eligible patients presenting for percutaneous coronary intervention (PCI) of degenerated saphenous vein graft (SVG) lesions using a multicenter registry. Prior single-center experience suggested that laser atherectomy may decrease acute procedural complications during treatment of degenerated SVGs, including lesions not amenable to distal protection devices (DPDs).Methods and materials: The COronary graft Results following Atherectomy with Laser investigators enrolled 98 patients at 18 centers between June 23, 2003, and October 4, 2004, with greater than 50% stenosis of an SVG who presented for PCI due to angina pectoris or objective evidence of myocardial ischemia in a concordant myocardial distribution. Laser atherectomy was planned. Patients were excluded if the operator planned to utilize a DPD. Inclusion and exclusion criteria were aligned to those in the Saphenous vein graft Angioplasty Free of Emboli Randomized (SAFER) trial.Results: The primary end point [30-day major adverse cardiac events (MACE)] occurred in 18/98 (18.4%) patients driven primarily by non-q-wave myocardial infarction. Major procedural complications included no reflow (n=5) and major dissection (n=1). No perforations occurred. Univariate predictors of 30-day MACE included lesion length, vessel angulation, plaque burden, SVG degeneracy score, number of laser pulses used, and larger-sized laser catheters.Conclusions: This study demonstrated that Excimer laser atherectomy of diseased SVGs is feasible with results comparable to the 30-day MACE in the control population from the SAFER trial. Whether the addition of laser to embolic protection devices is of any clinical utility remains to be tested in future studies.

Stenting of the unprotected left main coronary artery in patients with severe aortic stenosis prior to percutaneous valve interventions

2012-02-01

Abstract: Aims: High-risk patients with severe aortic stenosis (AS) who are candidates for transcatheter valve implantation (TAVI) or balloon aortic valvuloplasty (BAV) may additionally require revascularization of the unprotected left main coronary artery (UPLM). We aimed to assess the feasibility and procedural safety of UPLM stenting in such patients.Methods and Results: Ten cases of UPLM stenting prior to BAV or TAVI at three medical centers over a 2-year period were identified. Mean age was 84±4 years, aortic valve area was 0.70±0.12 cm2, left ventricular ejection fraction was 58%±3%, and logistic EuroScore was 32±17. Intraaortic balloon counterpulsation was used in three patients. A single stent was used in seven patients, and two stents were used in three patients. One patient received a bare-metal stent, and the others received drug-eluting stents. No procedural complications occurred, and the patients were hemodynamically stable. Three patients subsequently underwent BAV, and seven underwent TAVI. During 6 months of follow-up, two patients died: one due to AS restenosis 6 months after BAV and one due to vascular complications 18 days after TAVI (34 days after UPLM stenting).Conclusions: Stenting of the UPLM in patients with severe AS prior to percutaneous valve intervention seems feasible and safe. This approach may enable more patients to achieve comprehensive percutaneous therapy for severe coronary and valvular disease.

Randomized trial of insulin versus usual care in reducing restenosis after coronary intervention in patients with diabetes. the STent Restenosis And Metabolism (STREAM) study

2012-02-01

Abstract: Background: Diabetes status is an independent marker of restenosis after percutaneous coronary intervention (PCI). Previous studies suggest that metabolic abnormalities associated with diabetes increase stent restenosis by promoting intimal hyperplasia. Preclinical studies have indicated that insulin therapy reduces intimal hyperplasia. The objective of this study was to determine whether insulin-mediated glucose lowering reduces in-stent restenosis in patients with diabetes undergoing PCIs.Methods: We conducted a prospective, randomized, multicenter, open-labeled study with blinded outcomes. Patients were randomized 1:1 to daily bedtime subcutaneous NPH insulin (Novo Nordisk) versus usual therapy with oral hypoglycemic agents. The main outcomes were change in volume of intimal hyperplasia within the stent measured by intravascular ultrasound and late lumen loss by quantitative coronary angiography at 6 months post-PCI.Results: Seventy-eight patients (36 insulin, 42 usual care) were randomized. Eight patients in each group received drug-eluting stents. The insulin group achieved greater reductions in both glycosylated hemoglobin A1c (mean±S.D.) (insulin: 8.0%±1.2% to 6.7%±0.7% vs. control: 7.5%±1.2% to 7.1%±1.0 %, P=.0038) and fasting glucose (insulin: 9.3±3.8 to 5.8±1.7 vs. usual care: 8.4±2.4 to 7.7±2.0 mmol/l, P<.0001). There were no hypoglycemic events. At 6 months, there were no significant differences in either intravascular-ultrasound-determined neointimal volume (insulin: 41.2±38.9 vs. usual care: 48.4±40.2 mm3, P=.33) or late lumen loss by angiography (insulin: 1.29±0.74 mm vs. usual care: 1.02±0.71 mm, P=.17).Conclusions: Addition of a single bedtime dose of insulin in patients with diabetes does not influence in-stent restenosis.

Percutaneous left ventricular support for high-risk PCI and cardiogenic shock: who gets what?

2012-03-09

Abstract: Background: Temporary use of a percutaneous left ventricular assist device (PLVAD) may be beneficial in patients undergoing high-risk percutaneous coronary intervention (PCI) and those with cardiogenic shock (CS).Methods: Seventy-four consecutive patients undergoing high-risk PCI and those with CS receiving intraaortic balloon pump (IABP), TandemHeart (TH), or Impella device (IMP) were enrolled. Patient undergoing high-risk PCI (n=57) and those treated for CS (n=17) were analyzed as separate cohorts. Patients undergoing IABP-assisted PCI were compared to those undergoing PLVAD (TH and IMP)-assisted PCI. The primary end point was in-hospital major adverse cardiovascular events, and the secondary end point was in-hospital vascular complications.Results: For the high-risk PCI cohort (n=57), 22 received PLVAD and 35 received IABP. Patients receiving IABP were younger and less likely to have a prior myocardial infarction (MI) and less likely to be on dialysis compared to those receiving PLVAD support. Patients receiving PLVAD support had a higher baseline Syntax score, had a higher prevalence of unprotected left main disease, underwent treatment of more coronary lesions, received more coronary stents, and more likely received drug-eluting stents compared to those receiving IABP support. The primary and secondary end points were similar between both groups. For the CS cohort (n=17), 4 received PLVAD and 13 received IABP. Patients receiving PLVAD support were more likely to have a prior MI, had a lower ejection fraction, underwent treatment of more coronary lesions, and received more coronary stents compared to those receiving IABP support. The primary and secondary end points were similar between both groups.Conclusions: IABP compared with PLVAD use for high-risk PCI and CS is associated with significantly different baseline patient, clinical, procedural, and angiographic characteristics. In-hospital clinical outcome was similar between both groups in both the high-risk PCI and the CS cohorts. When physicians have access to each of these devices, short-term clinical outcome appears to be similar.

Fluoroscopy use and left anterior descending artery angiography to guide transapical access in patients with prior cardiac surgery

2011-12-19

Abstract: Background: Patients with severe aortic stenosis (AS) and prior cardiac surgery undergoing aortic valve replacement (AVR) are at high risk. Transapical AVR might reduce the risk in patients not suitable for the transfemoral approach. We aimed to describe the fluoroscopy and left anterior descending artery (LAD) angiography guidance technique for transapical AVR access and the initial related procedural results.Methods: Patients with severe AS and prior cardiac surgery undergoing transapical AVR using LAD angiographic-guided apical puncture were analyzed (n=9). Additional guidance was added to the standard technique as follows. Minithoracotomy was performed at the level of the intercostal space in closer relationship to the apex identified by fluoroscopy. LAD angiography was performed at the time that the area of interest was recognized by radiopaque marker to ensure puncture lateral to the LAD. Apical needle puncture was performed under fluoroscopy guidance directed towards the aortic root.Results: The population had a mean age of 83 years and was more frequently male (89%) with a high-risk profile (mean Society of Thoracic Surgeons score of 11%). Two patients received the 23-mm Edwards SAPIEN valve, and seven patients received the 26-mm SAPIEN device. All nine patients underwent successful implantation of transcatheter aortic valves with virtual abolishment of transaortic gradient, without procedural complications.Conclusion: Fluoroscopy and angiography for guidance of the transapical approach facilitate a safe and rapid access to the apex, insuring no risk of damage to the LAD or to large diagonals.

Intravascular ultrasound insights from the Cobalt Chromium Stent With Antiproliferative for Restenosis II (COSTAR II) trial comparing CoStar and Taxus paclitaxel-eluting stents

2012-03-14

Abstract: Background: Dedicated IVUS analyses of the second CObalt chromium STent with Antiproliferative for Restenosis (COSTAR II) trial have not been documented. We aim to compare IVUS findings between CoStar paclitaxel-eluting stent (PES) and Taxus PES in patients enrolled in the COSTAR II trial. We also attempted to examine the possible regional impact of multiple stenting.Methods and materials: Among the 1700 patients enrolled, 238 were assigned to an IVUS cohort including 168 patients treated by provisional multiple stenting. At 9 months, qualitative and quantitative IVUS observations including incomplete stent apposition (ISA) and neointimal proliferation (neointimal obstruction: neointimal volume/stent volume ×100) were compared between CoStar and Taxus PESs.Results: In qualitative analysis, late-acquired ISA was observed in 1 patient treated by Taxus PES. Impaired strut continuity suggestive of stent fracture was observed in 2 out of 33 patients treated by multiple CoStar, and 4 out of 21 patients treated by multiple Taxus (P=.14). No such findings were found in single-stented patients in either stent subset. Quantitative analysis showed greater neointimal obstruction in CoStar (19.7%±13.4%, n=52) than in Taxus (10.7%±9.9%, n=38), whereas no significant difference in neointimal obstruction was found between single and multiple stenting in either CoStar or Taxus PES.Conclusions: The CoStar PES exhibits greater neointimal proliferation compared with Taxus PES at 9 months but with similar qualitative outcomes including late-acquired ISA. IVUS findings suggestive of stent fracture were found only in multiple-stenting cases irrespective of the stent used.

Left main coronary stenting in a non surgical octogenarian population: a possible approach

2012-03-14

Abstract: Coronary artery bypass grafting is conventionally considered the standard treatment for significant left main coronary artery (LMCA) disease. The management of LMCA disease in octogenarians is however still debated. The aim of this study was to appreciate the safety and effectiveness of percutaneous coronary intervention (PCI) for LMCA disease in octogenarians who were denied for surgical revascularization. The study included 70 consecutive patients ≥80 years of age who had undergone PCI for the treatment of LMCA and who were primary denied by our center's heart team for surgical revascularization. Mean age was 83.4±2.6 years. Mean Euroscore was 21.1±16.7 and mean Syntax score was 28.6±8.7. Overall in-hospital mortality was 11%. Mean follow-up time was 30.5±24.2 months. Overall mortality at the end of follow-up was 28%. Cardiac death was found in 18 patients and 2 patients died from terminal renal insufficiency. One patient (2%) presented with a new STEMI, 7 (11.3%) with a new non-STEMI, 13 (21%) with heart failure, and 2 (3.2%) had minor hemorrhage. There was a percutaneous target vessel revascularization in 6 (10%) patients. During follow-up, the total major adverse cerebral and cardiovascular event (MACCE including death, non-fatal acute myocardial infarction (AMI), target lesion revascularization (TLR), or stroke) was 27.4%. Stent implantation was relatively safely applied for the treatment of LMCA disease in octogenarians who were refused for surgery and who represented a high risk population. Despite a non-negligible rate of MACCE, the clinical long term outcome seems correct for this specific population with heavy basal status.

Acute myocardial infarction in women: is there a sex disparity between door-to-balloon time and clinical outcomes?

Sara D. Collins — 2011-12-12

Coronary artery disease (CAD) has traditionally been thought of as a disease that predominantly affects men. Women, however, are more likely than men to die from a myocardial infarction (MI). Despite increased awareness of heart disease in women and improved outcomes after percutaneous coronary intervention (PCI), women with MI have more mortality and delays to treatment than men. Although all of the reasons behind these differences are not clear, women presenting with MI are a more morbid patient population than their male counterparts. Women consistently demonstrate higher baseline risk, including older age, higher rates of diabetes mellitus (DM), hypertension (HTN) and congestive heart failure (CHF) . This was initially demonstrated in trials conducted in the thrombolytic era, but has persisted in the current era of PCI .

Coronary stenting using the radial approach in two women with situs viscerum inversus and acute myocardial infarction

2010-09-02

Abstract: A situs inversus with dextrocardia (DC) is a rare condition in adults. Usually, patients have structurally normal hearts and normal life expectancy. The incidence of coronary artery disease in this setting is similar to that in the general population.Coronary revascularization may present potential difficulties related to the unusual anatomy. Although the radial artery is a safe and effective site of access for coronary interventions, some anatomical variations may make this procedure more complicated. We describe two cases of patients with situs viscerum inversus and acute myocardial infarction who underwent successful transradial percutaneous coronary intervention (PCI). We will show that coronary angioplasty with stent application via the radial approach in patients with DC is feasible and effective also in emergency and urgent care.

Clinical and silent stroke following aortic valve surgery and transcatheter aortic valve implantation

Camille Hauville, Itsik Ben-Dor, Joseph Lindsay, Augusto D. Pichard, Ron Waksman — 2012-01-09

Abstract: Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to conventional surgery for high-risk patients with aortic stenosis. A recently published randomized clinical trial demonstrated reduction of mortality in high-risk or inoperable patients when compared to medical treatment or balloon aortic valvuloplasty. Despite this evidence of superiority, the rate of TAVI complications is high, and perhaps the most devastating of the nonfatal complications is cerebral injury. This review will compare the incidence of stroke and “silent” cerebral injury after surgical aortic valve replacement and after TAVI and will discuss mechanisms that can lead to cerebral injury during these procedures and subsequently how to prevent this with new protection devices.

Ranolazine for the treatment of refractory angina in a veterans population

2011-08-19

Abstract: Background: Pivotal ranolazine trials did not require optimization of conventional medical therapy including coronary revascularization and antianginal drug therapy prior to ranolazine use. This case series describes the use of ranolazine for the treatment of chronic stable angina refractory to maximal medical treatment in a veterans population.Results: A total of 18 patients with a median age of 66 years were identified. All patients had prior percutaneous coronary intervention and/or coronary artery bypass graft surgery; 83% had three-vessel coronary artery disease, with left main disease present in 39% of patients. Prior to initiating ranolazine, antianginal use consisted of beta blockers (94%), long-acting nitrates (83%) and calcium channel blockers (61%). Median blood pressure (116.2/61.8 mmHg) and pulse (65 beats per min) were controlled. Median preranolazine angina episodes and sublingual nitroglycerin (SLNTG) doses per week were 14 and 10, respectively, with a Canadian Cardiovascular Society (CCS) angina grade of III–IV in 67% of patients. After initiation of ranolazine, median angina episodes per week and SLNTG doses used per week decreased to 0.7 and 0, respectively, with CCS grade of III–IV declining to 17%. Of the 18 subjects enrolled, 44% had complete resolution of angina episodes.Conclusion: The addition of ranolazine to maximally tolerated conventional antianginal drug therapy post coronary revascularization was associated with decreases in angina episodes and SLNTG utilization and improvement in CCS angina grades. Ranolazine may provide an effective treatment option for revascularized patients with refractory angina.

Subclavian stenting in a hostile aortic arch facilitated by a low-profile brachial artery through-and-through access

2011-10-13

Abstract: Subclavian stenting can be extremely difficult in a hostile type II aortic arch (with acute angulation of the subclavian artery origin) or type III aortic arch. This case illustrates use of a low-profile system to gain through-and-through (flossing) access through the brachial artery to facilitate stenting via the femoral approach. This approach can be useful in patients with small brachial arteries where the risk of complication may be high if a standard vascular sheath was placed for stenting via the brachial approach. This technique also avoids the use of a surgical cut down.

Left main coronary artery transradial rescue percutaneous coronary intervention for acute myocardial infarction complicated by cardiogenic shock with Impella ventricular mechanical support

Ziad Dahdouh, Vincent Roule, Thérèse Lognoné, Rémi Sabatier, Gilles Grollier — 2011-10-24

Abstract: Mechanical ventricular assist support and especially Impella device that is implanted via femoral access are considered a cornerstone in the therapeutic arsenal of the management of cardiogenic shock. Indeed, the potent antithrombotic agents administered during acute coronary syndromes constitute potential bleeding risk factors. Transradial interventions are nowadays widely used in ST-elevation myocardial infarction patients. However, some operators feel uncomfortable with the transradial approach when facing cardiogenic shock. We report a case of transradial rescue percutaneous intervention for cardiogenic shock in a young man with support of an Impella device via femoral access.

Management of acute left main obstruction after transcatheter aortic valve replacement: the “tunnel technique”

2011-11-17

Abstract: Two cases of acute left main (LM) obstruction complicating transcatheter aortic valve replacement (TAVR) and their management are reported. TAVR with a self-expandable transcatheter aortic prosthesis was performed for treating severe aortic stenosis with small aortic root and severe aortic regurgitation of a degenerated stentless bioprosthesis, respectively. Left main coronary obstruction occurred at a different time from the index procedure. A novel stent-based angioplasty treatment, denominated “the tunnel technique,” was successfully applied in both cases and herein described.

Interventionalists beware: the apical thrombus!

Sinjini Biswas, Andrew E. Ajani — 2011-11-24

Abstract: Recent myocardial infarction is a recognized risk factor for ischemic stroke. Patients who have a stroke in the peri-infarct period are usually in hospital and therefore well placed to access early cerebral reperfusion therapy. However, due to the risk of myocardial rupture, recent myocardial infarction is considered a contraindication to intravenous thrombolysis, which is usually the first-line therapy for the treatment of ischemic stroke. We report a case in which intravenous thrombolysis was safely and effectively used to treat acute ischemic stroke in a patient who had suffered an acute myocardial infarct within the previous 48 h. We also highlight the lack of evidence-based guidelines for the treatment of stroke in this important subgroup of patients.

Excessive axial plaque redistribution during coronary stent implantation confirmed by intravascular ultrasound

2012-01-09

Abstract: We report a case of excessive axial plaque redistribution leading to luminal narrowing at the reference segment confirmed by serial intravascular ultrasound during coronary stent implantation.

Giant saphenous vein graft aneurysm treated with covered stent

Itsik Ben-Dor, Robert Lager, Ron Waksman, Augusto D. Pichard, Robert Gallino — 2011-03-02

Presented is a 76-year-old female with history of coronary artery disease and post-cardiac bypass surgery 20 years ago. She has chronic atrial fibrillation with severe left ventricular dysfunction and implantable cardiac defibrillator. She was referred for diagnostic coronary angiography due to dyspnea on exertion. Coronary angiography demonstrated occluded left anterior descending and circumflex arteries in the mid third; the right coronary artery was occluded in the ostium. The saphenous vein graft (SVG) to the left anterior descending artery is occluded. The SVG to the right coronary artery is patent with a very large aneurysm in the proximal portion (). The 256-slice computed tomography displayed an aneurysm (maximum diameter 5.8×4.5 cm) of the proximal third of the SVG to the right coronary artery (). After engaging the SVG with a 125-cm Judkins Right 6F coronary guide, the aneurysm was crossed with a 0.014-in. Luge coronary guide wire (Boston Scientific). The Judkins Right guide was retrieved and an 8F 90-cm Flexor shuttle sheath (COOK) was advanced to the ostium of the SVG. The coronary guide wire was exchanged over Quick-Cross support catheter (Spectranetics) to a 0.035-in. Supra Core guide wire. A polytetrafluoroethylene self-expandable covered stent 7/50 mm VIABAHN (GORE) was deployed and a balloon 7/40 mm was inflated at high pressure in the proximal and distal end sealing the aneurysm (). The post-procedure course was uneventful and the patient was discharged on dual antiplatelet therapy and warfarin. Coronary artery aneurysms have been defined as localized coronary dilations with diameters at least 1.5 times the diameters of adjacent normal coronary segments.

Ranolazine prevents heart failure with preserved ejection fraction, diastolic dysfunction, and left ventricular hypertrophy in a hypertensive murine model

2012-03-01

Recent in vitro studies on failing human heart muscle has suggested that ranolazine (RAN), a novel antianginal drug known to inhibit late sodium current, may improve diastolic dysfunction (DD) caused by hypertension (HTN)-induced oxidative stress. By improving DD, RAN can improve heart failure with preserved ejection fraction (HFPEF).

PLATINUM Japan SV: platinum chromium everolimus-eluting stent in small vessels

2012-03-01

Small coronary vessel diameter is associated with high restenosis rates and adverse clinical outcomes. The platinum chromium PROMUS Element everolimus-eluting stent (EES, Boston Scientific, Natick, MA, USA) demonstrated low event rates and noninferior clinical outcomes compared to the XIENCE V EES (Abbott, Santa Clara, CA, USA) in arteries ≥2.50 mm. The PLATINUM Japan Small Vessel (SV) study assessed results in small-caliber arteries <2.50 mm in Japan.

Effects of everolimus on in vitro macrophage-derived foam cell viability

Steven Hsu, Eugen Koren, Julie Tai, Yen Chan, Mirna Koscec, Debby Feder — 2012-03-01

Previous studies have described potential antiatherogenic effects of everolimus after systemic and local stent delivery. However, direct effects of everolimus on foam cells (FC) have not been well characterized. We used an in vitro model to explore the effects of everolimus on macrophage-derived FC.

Shorter degradation period in BTI stents after porcine coronary artery implantation

2012-03-01

Bioabsorbable stents (BASs) have the potential advantages of reduction of late stent thrombosis and restoration of vasomotor function after disappearing from the treated coronary sites. Recently, discernible BVS (one BAS) struts were demonstrated by histology at 2 years, and complete degradation was achieved by 3 years. In this study, BTI (one BAS) strut location, degradation, and inflammation were evaluated by histopathology over time.

Intracoronary nitroprusside results in faster, uniform, and uneventful maximal coronary vasodilation during fractional flow reserve measurements

2012-03-01

Fractional flow reserve (FFR) is routinely used for coronary lesion assessment. Maximal coronary vasodilatation can be accomplished by intracoronary (IC) and intravenous (IV) adenosine (the gold standard), IC-nitroprusside (NTP), or IC-papaverin. We compared FFR response to IC-NTP versus IV-adenosine.

Nitroprusside: a reliable drug for fractional flow reserve assessment

2012-03-01

FFR measurement is a growing practice used to evaluate intermediate coronary lesions. Intracoronary (ic) bolus of adenosine or infusion is the preferred method of vasodilation; however, there is little information about another drug that is reliable and safe for this purpose.

Endothelial progenitor cells and development of collateral formation in patients with chronic total coronary artery occlusion and transplantation of EPCs in an experimental model

Doaa M. Gharib — 2012-03-01

In this study, we investigated whether or not the number and function of endothelial progenitor cells (EPCs) were associated with the development of collateral formation in patients with single-vessel coronary artery disease of chronic total occlusion (CTO). We aimed also to examine the ability of EPCs to decrease the size of myocardial infarction, and test formation of neovascularization in an experimental model (dogs) with acute myocardial infarctions (AMI).

Acute and chronic effects of percutaneous renal sympathetic denervation on renal hemodynamics and plasma norepinephrine levels using a novel radiofrequency ablation

Vasilios Papademetriou, Constantine Tsioufis, Parks Eulone, Cary Hata — 2012-03-01

The effect of percutaneous renal sympathetic denervation (RSD) on renal autoregulation, renal hemodynamics, and plasma catecholamines has not been adequately explored. In this study, we investigated the effect of RSD acutely and 1 month postablation in a swine model.

Balloon aortic valvuloplasty for severe aortic stenosis as a bridge to transcatheter/surgical aortic valve replacement

2012-03-01

The introduction of transcatheter aortic valve implantation (TAVI) has led to a revival of balloon aortic valvuloplasty (BAV) as treatment of patients with severe aortic stenosis.

On-treatment platelet reactivity before coronary artery bypass surgery is associated with in-hospital major bleeding

2012-03-01

Patients often undergo coronary-artery bypass graft (CABG) within 5–7 days of thienopyridine therapy. Evidence supporting the use of on-treatment platelet reactivity testing before CABG is very limited. We hypothesized that low on-treatment platelet reactivity before CABG would be associated with higher in-hospital major bleeding (IHMB).

Postoperative prosthesis insufficiency affects mortality in patients undergoing TAVI

2012-03-01

TAVI is by now a valid therapeutic option in elderly patients (pts) with severe symptomatic aortic stenosis considered at high risk or with contraindication to aortic valve replacement (AVR). The impact of postprocedural leaks on mortality is still debated.

Denuded iliac endothelium with long-term high-cholesterol-diet-induced vascular dysfunction and accelerated atherosclerosis as well as neointimal formations after BMS implantation

2012-03-01

High-cholesterol diet induces atherosclerotic lesions which can be accelerated by denudation of endothelium (EC). EC denudation of iliac artery (IA) has not been well studied in the hyperlipemic rabbit. In this study, endothelial function and development atherosclerosis were investigated in nonstented (NSIA) and/or stented iliac artery (SIA).

Mitral regurgitation improves after TAVI

2012-03-01

Although it is known that mitral regurgitation improves after surgical aortic valve replacement (AVR) for aortic stenosis, nowadays, few and contradictory information are available about changes in mitral regurgitation (MR) severity after transcatheter aortic valve implantation (TAVI).

Women are at higher risk for failed percutaneous coronary intervention in ST-elevation myocardial infarction

2012-03-01

Failed percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (MI) is associated with adverse outcome. With recent improvements in PCI techniques, it is unclear what are the incidence and predictors for failed primary PCI. The objective of this study was to determine the outcome and predictors of patients who failed primary PCI after MI.

Microvascular coronary flow comparison in acute myocardial infarction angioplasty treated with a mesh-covered stent versus bare metal stent

2012-03-01

Distal embolization of thrombus/platelet aggregates decreases coronary and myocardial reperfusion during primary percutaneous coronary intervention (PCI) and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI).

Fluoroscopy use and left anterior descending artery angiography to guide transapical access in patients with prior cardiac surgery

2012-03-01

Patients with severe aortic stenosis (AS) and prior cardiac surgery undergoing aortic valve replacement (AVR) are at high risk. We aimed to describe the fluoroscopy and left anterior descending (LAD) artery angiography guidance technique for transapical AVR access and the related procedural results.

Efficacy of emergency room approach versus emergency medical services approach for STEMI activation strategy: optimizing hospital resource utilization while maintaining door-to-balloon time and mortality

Venkateswarlu Chintagumpala, Tony Saraon, Hal Chadow, Ricardo Castillo — 2012-03-01

Many strategies exist, and each has been implemented with the goal of decreasing the time between arrival at the hospital and intracoronary balloon inflation, the door-to-balloon time (D2B). Improving D2B time strategies can result in increasing false-positive STEMI recognition and increasing resource utilization. It is estimated that about US$ 5000 are spent every time the cardiac catheterization laboratory (cath lab) team is activated and later cancelled. We evaluated two strategies—emergency medical services (EMS) activation (prehospital activation) and emergency physician (ER) activation (in-hospital activation)—to compare outcomes.

Gradual decline in the age-adjusted in-hospital mortality rate from STEMI-related cardiogenic shock irrespective of gender, with persistent higher mortality rate in women

Mohammad Reza Movahed, Mehrnoosh Hashemzadeh, Mehrtash Hashemzadeh — 2012-03-01

Recent improvements in the care of critically ill patients should lead to better outcome. The goal of this study was to evaluate the age-adjusted mortality rate from STEMI-related cardiogenic shock in the United States over the last 10 years using a large database based on gender.

Clopidogrel low response and correlation between the different tests: light transmission aggregometry, VerifyNow P2Y12, and VASP

2012-03-01

Clopidogrel low response correlates with poor prognosis after percutaneous coronary intervention (PCI). Many biological tests are currently available to test the clopidogrel response. However, the presence of any correlation between the different tests is today poorly reported.

Angioscopic differences in neointimal coverage between zotarolimus- and everolimus-eluting stents

Koshi Matsuo, Yasunori Ueda, Yasuhiro Akazawa — 2012-03-01

Drug-eluting stents (DES) have demonstrated reduction of late loss (LL) and low target lesion revascularization (TLR) rates through an inhibitory effect on neointimal hyperplasia but might have a risk of late or very late stent thrombosis due to incomplete neointimal cover rate (NIC). Zotarolimus-eluting stent (ZES) and everolimus-eluting stent (EES) are next-negation DES that show higher LL than first-generation DES. However, differences in neointimal coverage between ZES and EES have been unclear.

Intracoronary administration of abciximab via an intracoronary perfusion catheter in patients with a thrombotic coronary occlusion—a single center experience

2012-03-01

At concentrations superior to those achieved with the standard intravenous dose for coronary procedures, abciximab has an active dethrombotic effect by displacing platelet-bound fibrinogen. This analysis investigates whether administration of abciximab by local intracoronary infusion through the ClearWay (CX) RX perfusion catheter improves coronary blood flow (TIMI flow) by reducing thrombus burden.

Combined treatment of thrombotic coronary occlusions by thrombectomy and by intracoronary administration of abciximab via an intracoronary perfusion catheter—which treatment first?

2012-03-01

Thrombectomy and intracoronary administration of abciximab via an intracoronary perfusion catheter have been demonstrated to reduce thrombus burden. We analyzed two different treatment strategies: (1) first thrombus-aspiration to reduce thrombus size, then lysis of the rest-thrombus by locally administered abciximab via the ClearWay (CW) RX perfusion catheter versus (2) first pharmacological thrombus-reduction by locally administered abciximab, then, if necessary, thrombus-aspiration of the rest-thrombus.

The true incidence of atrial fibrillation after an atrial flutter ablation with continuous monitoring

Jeffrey Snow, Nikolai A. Snow, Joseph Germano, Sameer P. Parekh — 2012-03-01

The reported incidence of atrial fibrillation (AF) after successful ablation of typical isthmus dependent right atrial flutter (AFl) has been variably reported. Some authors have reported this incidence to be as high as 68% for patients with known AF pre-ablation, to as little as 21.5% of patients with no known AF prior to ablation. Given that monitoring in these follow-up studies was variable and rarely continuous, the true incidence of post-ablation AF may be significantly higher than previously reported. Patients with AFl who also have dual chamber devices (pacemakers or defibrillators); however, are continuously monitored for arrhythmia with near perfect accuracy. Here, we report the true incidence of AF post ablation of typical flutter in an ambulatory private practice setting.

Impact of glycemic control and hypoglycemic agents on the clinical outcome in diabetic patients with percutaneous coronary intervention: from the FU-registry

2012-03-01

It is not yet clear whether glycemic control and hypoglycemic agents used affect the clinical outcome of percutaneous intervention (PCI) in diabetic patients. Among 1809 patients who underwent PCI and received stent placement (FU-registry), we selected 774 DM patients, then divided them into 2 groups: a poor-glycemic-control group, who showed greater than 6.9% HbA1c at the time of PCI (Pre-HbA1c) (“≥6.9 group”, n=357) and a good-glycemic-control group, who showed less than <6.9% at Pre-HbA1c ("<6.9 group", n=417). The patients in the ≥6.9 group were further divided into two groups for further comparisons: a "DM control group" and a "Poor control group". At follow-up (300 days), there was no difference in major adverse cardiac event (MACE) between the <6.9 group and ≥6.9 groups, as well as between the DM control group and Poor control group. In a multivariate analysis, there was no relationship between the incidence of MACE and Pre-HbA1c, Pre- HbA1c ≥6.9% or the HbA1c difference (Pre-HbA1c − HbA1c at follow-up), however, patients treated with insulin (OR:2.23, 95% CI: 1.50–3.30) or thiazolidine (OR:1.9, 95% CI: 1.07–3.41) positively related to MACE, while biguanide (OR:0.17, 95% CI: 0.03–0.59) negatively related to MACE. Insulin treated DM patients with HbA1c <6.5% tended to have increased MACE ().

Outcomes of patients treated with the everolimus- versus the zotarolimus-eluting stents in a consecutive cohort of patients at a tertiary medical center

2012-03-01

In this study we compare the outcomes of the everolimus-eluting stent (EES) versus the zotarolimus-eluting stent (ZES) treated patients at a tertiary medical center and up to one year follow up.

Optimal same-day platelet inhibition in patients receiving drug-eluting stents with or without prior maintenance thienopyridine therapy

2012-03-01

Thienopyridine platelet inhibition (TPI) on the day of drug eluting stent (DES) implantation must be practical and effective. We hypothesized that optimal TPI is achievable in all patients (pts) on maintenance TPI and all receiving initial loading doses for TPI on the day of DES if effectiveness is confirmed using VerifyNow P2Y12 assays and if suboptimal responses (PRU >230) are treated by loading with another agent.

Angiographic factors and multidetector computed tomography analysis: its association in the successful percutaneous coronary treatment of chronic total occlusions

2012-03-01

Percutaneous coronary intervention (PCI) of the chronic total occlusion (CTO) lesions remains a technical challenge due to the lower rate of success compared with the PCI of non-CTO lesions. Identifying the different predictors of failure could lead to a better selection of patients, with a higher rate of PCI success. We design this study to evaluate the multidetector computed tomography (MCT) and its association with prognostic angiographic factors in the successful PCI of a CTO lesion.

Emergent versus elective percutaneous stent implantation in the unprotected left main: long-term outcomes from a single center registry

2012-03-01

Unprotected left main (ULM) coronary disease is considered by contemporary guidelines as a Class I indication for surgery. However, percutaneous coronary intervention (PCI) is often carried out in the ULM in either emergent or in high risk elective procedures. The aim of this study was to evaluate ULM-PCI as a feasible and safe procedure in the emergent setting, and to analyze outcomes in both scenarios.

Safety and one-year revascularization outcomes of Silverhawk atherectomy in treating in-stent restenosis of femoropopliteal arteries: a retrospective review from a single center

2012-03-01

Treatment of in-stent restenosis of the femoropopliteal vessels with balloon angioplasty carries a high rate of recurrence and repeat stenting. Silverhawk atherectomy (SA) has a theoretical advantage of reducing the volume of restenotic tissue and delaying the need for repeat revascularization and stenting. We present a retrospective analysis from our center on the use of SA in treating in-stent restenosis and report on its safety and rates of one-year target lesion revascularization (TLR) and target vessel revascularization (TVR).

Right atrial thrombus in patients with hemodialysis central venous catheters

2012-03-01

Data regarding right atrial thrombus (RAT) in patients with prolonged use of hemodialysis central venous catheters are scarce. We studied the clinical and echocardiographic findings and the management of CVC-RAT.

Safety and feasibility of transradial balloon angioplasty of brachio-axillary hemodialysis access grafts

2012-03-01

Percutaneous balloon angioplasty (PTA) of dysfunctional brachio-axillary hemodialysis grafts (BAHG) is routinely approached by brachial artery or graft puncture; both have limitations and potential complications. We report, a previously unreported, experience of routine transradial approach (TRA) for PTA of BAHG.

Single transradial catheter for right and left coronary diagnosis and intervention

Ali Y. Moustafa, Yan-Kai Hsieh, Cheng-I Cheng, Chiung-Jen Wu — 2012-03-01

There are no data about the utilization of a single transradial guiding catheter for the current routine, transradial, right and left coronary diagnosis, and intervention. We investigated the feasibility and safety of using 6 Fr Ikari left (3.5) guiding catheter for this purpose.

Prognostic significance of reciprocal ST segment depression resolution in patients with acute ST elevation myocardial infarction

2012-03-01

There is conflicting evidence regarding the prognostic significance of resolution of reciprocal ST segment depression (RSTD) in patients with ST elevation myocardial infarction (STEMI).

Impact of initial clinical presentation on clopidogrel low response: is there any intra-individual variability over time?

2012-03-01

Clopidogrel low response correlates with poor prognosis after percutaneous coronary intervention (PCI). It is today clearly demonstrated that there is a large inter-individual variability in clopidogrel response. Some authors also suggest intra-individual variability over time. We assessed the impact of initial clinical presentation on clopidogrel low response.

Evaluation of acute radial artery injury following transradial percutaneous coronary intervention by optical coherence tomography

Vinay Arora, Anupama Shivaraju, Ranya Sweis, Mladen Vidovich, Adhir Shroff — 2012-03-01

Recent evidence has shown a reduced bleeding risk and resultant decreased morbidity and mortality when the transradial approach is utilized over the transfemoral approach for percutaneous coronary intervention (PCI). However, transradial catheterization may introduce acute and/or chronic injury to the radial artery limiting its use for future procedures and as a bypass conduit. Our goal was to utilize optical coherence tomography (OCT) to evaluate the incidence of acute radial artery injury in patients following transradial PCI.

Endovenous laser therapy in the treatment of short saphenous vein disease

Julien Al Shakarchi, Anna Murray, Aneel Banghu, Ajantha Jayatunga, Rajiv Pathak — 2012-03-01

Endovenous laser therapy (EVLT) is an increasingly popular method of treating lower limb varicose veins and is a less invasive alternative to traditional open surgery. There are currently little data regarding the use of EVLT in short saphenous veins (SSV). In this backdrop we analyzed the feasibility of performing EVLT for SSV at our center along with interim follow up results.

Left main stenting using drug-eluting stents: long term outcome in an unselected cohort of patients from a tertiary medical center stratified by Syntax scoring

2012-03-01

The Syntax score has been shown to be a predictor of outcomes in patients with left main (LM) coronary artery disease treated with drug eluting stents (DES). In this study, we evaluate the long term outcome of LM stenting from a single tertiary medical center in an unselected cohort of patients stratified by Syntax scoring.

Association between plasma pentraxin 3 levels and tissue characteristics of coronary plaques using integrated backscatter intravascular ultrasound

Atsushi Iwata, Shin-ichiro Miura, Keijiro Saku — 2012-03-01

Pentraxin 3 (PTX3) is a novel candidate immunoinflammatory marker that has been reported to be associated with cardiometabolic risk factors and to predict adverse outcomes in patients with coronary artery disease (CAD). Therefore, we assessed the associations among plasma levels of PTX3, high-sensitive C-reactive protein (hsCRP), the lipid profile, and coronary plaques assessed by integrated backscatter intravascular ultrasound (IB-IVUS).

TIMI frame count: is it an adequate measure for embolization during stenting in primary PCI?

2012-03-01

TIMI frame count (TFC) is frequently used as an indicator for successful intervention during primary PCI. It is suggested that distal embolization occurs in almost all primary PCIs. The aim of the study was to assess whether the TFC is markedly affected by distal embolization.

Backup support of the mother–child technique: technical considerations for the size of the mother guiding catheter

Satoshi Takeshita, Ayumu Takagi, Shigeru Saito — 2012-03-01

“Mother–child technique” is applicable when the backup support of the guiding catheter is insufficient. We investigated the impact of the size of the mother guiding catheter on the catheter backup support using an in vitro coronary artery tree model.

Clinical factors and Texas Heart PCI risk score correlate with SYNTAX score during patient selection for PCI or CABG

2012-03-01

SYNTAX score is a valuable angiographic score which is based on coronary lesion anatomy; clinical factors are not taken into account during its calculation. The validated Texas Heart PCI score is clinically oriented. In this study we sought to evaluate the correlation of clinical variables and overall Texas Heart PCI score (THI) with the SYNTAX score, which may supplement the score during selection for PCI or CABG.

Apo-A-1 mimetic peptide (FAMP) is a novel candidate of atherosclerotic pet imaging

2012-03-01

Most diagnostic modalities for imaging of atherosclerosis can not provide information on the biology and metabolism of plaque. A number of molecular imaging targets, which were not specific, for atherosclerosis have been identified. We recently developed a novel HDL therapy using apo A-I mimetic peptide (FAMP). HDL therapy was shown to decrease the atherosclerosis plaque burden in a rabbit model. In this study, we explored the potential of FAMP for use in molecular imaging developing plaque lesions in vivo. FAMP was synthesized with 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) and radiolabeled with 68Ga for noninvasive PET in a WHHL-MI rabbit with atherosclerotic lesions. 68Ga-DOTA-FAMP was dramatically taken up by atherosclerotic tissues in blood vessels and aorta in WHHL rabbit, but not in normal rabbit (). Uptake of 68Ga-DOTA-FAMP was confirmed at 6 h after injection when plasma radioactivity almost disappeared. We also tried using another tracer radiolabeled with 64Cu, but this did not work as well as 68Ga-DOTA-FAMP. In conclusion, we have developed PET imaging with a 68Ga-DOTA-FAMP tracer for observing atherosclerotic plaque. Detection of these plaques, which are prone to rupture, could be clinically important for the prevention of cardiac events.

Age affects early mortality in TAVI

2012-03-01

TAVI was developed to treat elderly patients (pts) with symptomatic aortic valve stenosis considered at very high risk or with serious contraindication for aortic valve replacement. The aim of the study is to compare pts above and below 80 years of age according to 30-day VARC mortality.

Level and value of interleukin-18 in patients with acute myocardial infarction undergoing primary coronary angioplasty

Ali Y. Moustafa, Chiung-Jen Wu, Cheng-I Cheng, Cheng-Hs Yang, Hon-Kan Yip — 2012-03-01

The prognostic value of interleukin (IL)-18 in patients with ST-segment elevation acute myocardial infarction (STEMI) is currently unclear. Thus, the purpose of this study was to test whether the circulating IL-18 level can predict prognosis in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

Transradial arterial approach for simultaneous right and left vertebral artery angiographic studies and stenting

Ali Y. Moustafa, Hon-Kan Yip, Cheng-Hs Yang, Chiung-Jen Wu — 2012-03-01

This study investigated whether the transradial artery (TRA) approach using a 6-French (F) Kimny guiding catheter for right vertebral artery (VA) angiographic study and stenting is safe and effective for patients with significant VA stenosis.

Optimizing patient safety during coronary angiography: comparison of a strategy of radial artery access and dual-axis rotational coronary angiography with femoral artery access and standard coronary angiography

2012-03-01

The use of radial artery access for coronary angiographic procedures is increasing in the U.S. in order to reduce risk of access-site related complications. In prior studies, however, it has been associated with increased radiation exposure due to longer procedure times. Novel image acquisition strategies using dual-axis rotational coronary angiography (DARCA) have been shown to reduce radiation exposure and contrast usage. We sought to evaluate patient-based radiation and contrast exposure associated with using a strategy of radial artery access (RA) and DARCA compared to the traditional approach of femoral artery access (FA) and conventional standard coronary angiography (SA), to determine whether the addition of DARCA to RA counteracts the increased radiation exposure of the radial approach.

Characteristics and prognosis of patients treated by hypothermia for an out-of-hospital cardiac arrest related to a ventricular arrhythmia in a cardiac intensive care unit of a French University Hospital

2012-03-01

Recent improvements in the management of out-of-hospital cardiac arrest (OHCA), mainly early resuscitation and therapeutic hypothermia, should allow a better prognosis. This study aims at determining the characteristics and prognosis of patients treated by hypothermia for an OHCA.

Diagnostic performances of new biomarkers for myocardial infarction exclusion for patients without troponin standard elevation in chest pain unit: a prospective study

2012-03-01

Rapid rule out of acute myocardial infarction (AMI) is a major clinical need. Copeptin, as a marker of endogenous stress and highly sensitive troponin assays may be useful in this setting.

Predictive value of baseline C-reactive protein on long term outcomes following primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

2012-03-01

The predictive value of admission C-reactive protein (CRP) for long-term outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) is controversial.

Thrombus aspiration plus Mguard mesh covered stent for treatment of ST-segment elevation myocardial infarction

2012-03-01

Distal embolization is a serious complication in patients (pts) with acute myocardial infarction (MI) undergoing PCI. The Mguard stent (MGS) is a novel mesh-covered stent designed to prevent thrombus embolization. The combined use of thrombus aspiration + MGS has not been evaluated yet. This study was designed to address this question.

Use of Viabahn stent for the treatment of in-stent restenosis in the superficial femoral artery

Farzan Gorgani, Niju Baby Narakathu, Anatoliy Telis, Anvar Babaev — 2012-03-01

In-stent restenosis is a common occurrence in the superficial femoral artery (SFA). There is no universally accepted method to treat in-stent restenosis in the SFA. It is hypothesized that using the Viabahn ePTFE covered stent to treat in-stent restenosis may prevent tissue infiltration and intimal hyperplasia that lead to restenosis.

Late recoil of three different drug-eluting stents measured with intravascular ultrasound at six months post-successful angiographic results

Rodolfo R. Robles, Marco A. Alcantara, Antonio Vargas, Rogelio Robledo — 2012-03-01

An adequate stent expansion is achieved with high pressure stenting which has reduced the rate of restenosis and thrombosis. Stent recoil increases the risk of adverse cardiovascular events. We don't know the late recoil percentage.

The use of a clinical online image transfer system ImageShare can improve triage process and revenue gain from patient referral

2012-03-01

The increasing prevalence of basic interventional cardiology services being offered by hospitals of all sizes led to a decrease in overall referral volumes along with an increase in the complexity of the referred cases. Selection of more complex patients for transfer to high level referral hospitals introduces more challenges and typically requires the coordination and input of physicians from the receiving hospital. Unnecessary transfers may increase patient risk and are associated with tangible costs as well as the opportunity cost of lost revenue from being unable to admit treatable patients because of beds occupied by untreatable ones.

Importance of bifurcation and proximal angle in generation of coronary lesion

Maddury Jyotsna, Kodati Deepthi — 2012-03-01

Linear blood flow through normal coronary artery becomes turbulent flow at branching points exerting shear force on the bifurcation site which in turn predisposes for development of obstructive coronary lesions. We hypothesize that bifurcation angle (BA - angle between the distal main vessel and side branch) and proximal angle (PA- angle between the proximal main vessel and side branch) of branching site are also important in generating more vertices of blood flow. For that we did quantitative coronary angiogram analysis (QCA) with BA, PA measurement of diseased and non-diseased coronary bifurcations in different coronary territories.

Intracoronary glycoprotein IIb/IIIa inhibitor infusion via a perfusion coronary catheter to decrease thrombus burden: Results from the ClearWay Multicenter Registry

2012-03-01

The presence or development of thrombus during percutaneous coronary intervention (PCI) is associated with poor prognosis. This multicenter registry aimed to assess the ClearWay™ (CW) perfusion catheter in reduction of thrombus burden and improvement of the coronary flow during PCI.

Apical motion abnormality in patients undergoing transapical aortic valve replacement is frequent, yet spontaneously reversible

2012-03-01

Trans-apical aortic valve replacement (TA-AVR) is typically performed in aortic stenosis patients with poor peripheral vascular access. While TA-AVR procedural outcome is comparable to trans-femoral, recent reports indicate that TA-AVR patients have significantly higher levels of serum cardiac markers of myocardial injury as compared to trans-femoral patients. We sought to evaluate whether this enzyme leak is associated with regional wall motion abnormality (RWMA) at the apical access site and to assess correlation with outcome.

Safety of early discharge after transradial coronary artery stenting

Ahmad Noeman — 2012-03-01

This study was performed to evaluate the feasibility of same day early discharge after transradial percutaneous coronary intervention. This was a descriptive observational study.

The feasibility of transulnar approach for coronary intervention

Ahmad Noeman — 2012-03-01

These days access for coronary angiography and intervention is increasingly achieved via the radial artery in majority of centers to avoid the vascular complications of femoral access. This study was performed to evaluate the feasibility of transulnar approach for coronary interventions as an alternative to transradial approach.

Comparison of safety and efficacy of EES vs. PES at short- and long-term follow-up in an unrestricted diabetic population

2012-03-01

When compared to PES in the general population, EES has demonstrated superiority in efficacy. However, it is still in controversy whether in the diabetic population this superiority holds.

Frequency of conduction disturbances after transcatheter implantation of an Edwards SAPIEN aortic valve prosthesis

2012-03-01

Disturbances in atrioventricular conduction and further need for permanent pacemaker are common complications after transcatheter aortic valve replacement (TAVR). The objective was to determine the incidence and type of conduction disturbances associated to TAVR using Edwards SAPIEN valves.

Chronic enlargement of distal segment vessel diameter after PCI of chronic total occlusion

Koshi Matsuo, Yasunori Ueda, Yasuhiro Akazawa — 2012-03-01

Although the success rate of chronic total occlusion (CTO) PCI has recently increased, vessel diameter distal to the successfully recanalized CTO lesion is often smaller than expected immediately after recanalization. Therefore, we examined if the distal segment vessel diameter would increase at one year follow-up.

Independent value of a direct stenting strategy over early and late clinical outcomes of patients undergoing elective PCI

2012-03-01

The independent advantages of percutaneous coronary intervention (PCI) with direct stenting (DS) when compared against balloon pre-dilatation (PD) are not entirely clear. Previous studies suggest a decrease in the incidence of periprocedural myocardial injury (PPMI), no-reflow phenomenon, and stent edge restenosis with DS, but baseline patient differences and selection bias could account for these results. This study aimed to compare these two competing strategies during elective PCI and determine outcomes after meticulous adjustment for baseline differences.