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Park HM, Kim CL, Kong D, Heo SH, Park HJ. Innovations in Vascular Repair from Mechanical Intervention to Regenerative Therapies. Tissue Eng Regen Med 2025:10.1007/s13770-024-00700-x. [PMID: 39921820 DOI: 10.1007/s13770-024-00700-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 12/19/2024] [Accepted: 12/31/2024] [Indexed: 02/10/2025] Open
Abstract
BACKGROUND Vascular diseases, including atherosclerosis and thrombosis, are leading causes of morbidity and mortality worldwide, often resulting in vessel stenosis that impairs blood flow and leads to severe clinical outcomes. Traditional mechanical interventions, such as balloon angioplasty and bare-metal stents, provided initial solutions but were limited by restenosis and thrombosis. The advent of drug-eluting stents improved short-term outcomes by inhibiting vascular smooth muscle cell proliferation, however, they faced challenges including delayed reendothelialization and late-stage thrombosis. METHODS This review highlights the progression from mechanical to biological interventions in treating vascular stenosis and underscores the need for integrated approaches that combine mechanical precision with regenerative therapies. RESULTS To address long-term complications, bioresorbable stents were developed to provide temporary scaffolding that gradually dissolves, yet they still encounter challenges with mechanical integrity and optimal degradation rates. Consequently, emerging therapies now focus on biological approaches, such as gene therapy, extracellular vesicle treatments, and cell therapies, that aim to promote vascular repair at the cellular level. These strategies offer the potential for true vascular regeneration by enhancing endothelialization, modulating immune responses, and stimulating angiogenesis. CONCLUSION Integrating mechanical precision with regenerative biological therapies offers a promising future for treating vascular stenosis. A comprehensive approach combining these modalities could achieve sustainable vascular health.
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Affiliation(s)
- Hye-Min Park
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea
| | - Chae-Lin Kim
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea
| | - Dasom Kong
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea
| | - Seon-Hee Heo
- Department of Surgery, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
| | - Hyun-Ji Park
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea.
- Advanced College of Bio-Convergence Engineering, Ajou University, Suwon, 16499, Republic of Korea.
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Khawaja M, Britt M, Rizwan A, Abraham J, Nguyen T, Munaf U, Khan MA, Arshad H, Munye M, Newman N, Ielasi A, Eccleshall S, Vassiliou VS, Merinopoulos I, Cortese B, Krittanawong C. Coronary drug-coated balloons: A comprehensive review of clinical applications and controversies. Trends Cardiovasc Med 2025; 35:84-95. [PMID: 39243831 DOI: 10.1016/j.tcm.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
Drug-coated balloons have emerged as a promising therapeutic option in the treatment of cardiovascular disease. This review article provides an overview of the concept of drug-coated balloons and their clinical applications in both de novo and treated coronary artery disease. A summary of key clinical trials and registry studies evaluating drug-coated balloons is presented for reference. Overall, this article aims to provide clinicians and researchers with a comprehensive understanding of the current state of drug-coated balloon technology and its implications in clinical practice.
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Affiliation(s)
- Muzamil Khawaja
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Michael Britt
- Department of Internal Medicine, Emory University, Atlanta, GA 30322, USA
| | - Affan Rizwan
- Department of Internal Medicine, The University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Jocelyn Abraham
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Taylor Nguyen
- Division of Hospital Medicine, Northwestern Memorial Hospital, Chicago, IL 60611, United States
| | - Uzair Munaf
- Department of Internal Medicine, Dow Medical College, 75300 Karachi, Pakistan
| | - Muhammad Asad Khan
- Department of Family Medicine, West Chicago Immediate Care, West Chicago, IL 60185-2847, USA
| | - Hassaan Arshad
- Department of Internal Medicine, Capital Health Regional Medical Centre, Trenton, NJ 08638-4143, USA
| | - Muhamed Munye
- Department of Internal Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Noah Newman
- Department of Internal Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom; Norfolk and Norwich University Hospital NHS Foundation Trust and University of East Anglia, Norwich, England
| | - Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom; Norfolk and Norwich University Hospital NHS Foundation Trust and University of East Anglia, Norwich, England
| | - Bernardo Cortese
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland, Ohio, USA; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy; DCB Academy, Milano, Italy
| | - Chayakrit Krittanawong
- Department of Cardiology, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA.
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Iwańczyk S, Lazar FL, Onea HL, Pesenti N, Wańha W, Woźniak P, Gościniak W, Prof ML, Cortese B. Sirolimus-coated balloon versus drug-eluting stent for complex coronary lesions. A propensity matched comparison. Int J Cardiol 2024; 415:132436. [PMID: 39153511 DOI: 10.1016/j.ijcard.2024.132436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/26/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in complex coronary artery disease (CAD) has been established as the standard of care, but stent-related events are not uncommon. Sirolimus-Coated Balloon (SCB)-based angioplasty is an emerging technology, although it needs to be thoroughly evaluated compared with DES in the complex PCI setting. This study aimed to investigate the safety and efficacy of SCB-based angioplasty compared with new-generation DES in complex PCI. METHODS Net adverse cardiovascular events (NACE: all-cause death, target lesion revascularization, non-fatal myocardial infarction, and major bleedings according to BARC classification), as a primary study endpoint was compared between SCB and new-generation DES for complex coronary lesions. RESULTS Among 1782 patients with complex CAD, 1076 were treated with a sirolimus-coated balloon (EASTBOURNE Registry) and 706 with new-generation DES (COMPLEX Registry). After propensity score matching, a total of 512 patients in both groups were analyzed. NACE occurred more significantly in the DES group during the 1-year follow-up (10.5% vs. 3.9%, p = 0.003), mainly due to a higher risk of bleeding (6.6% vs. 0.4%, p = 0.001). The Cox model adjusted for lesion length showed a significantly lower hazard of NACE (HR: 0.23, CI [0.10, 0.52], p < 0.001) and all-cause mortality (HR: 0.07, CI [0.01, 0.66], p = 0.020) in SCB compared to DES group. CONCLUSIONS SCB angioplasty has an advantage over DES for the treatment of complex CAD regarding NACE, significantly reducing the incidence of major bleeding without increasing ischemic endpoints. SCB may be an alternative to DES in selected patients with complex coronary lesions.
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Affiliation(s)
- Sylwia Iwańczyk
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland; DCB Academy, Milano, Italy
| | - Florin-Leontin Lazar
- Medical Clinic Number 1, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Horea-Laurentiu Onea
- Medical Clinic Number 1, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Italy
| | - Wojciech Wańha
- DCB Academy, Milano, Italy; Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Patrycja Woźniak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Weronika Gościniak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Lesiak Prof
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Bernardo Cortese
- DCB Academy, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy; Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Pagezy A, Marlière S. [Coronary calcified and resistant lesions angioplasty in the outpatient, myth or reality?]. Ann Cardiol Angeiol (Paris) 2024; 73:101806. [PMID: 39305712 DOI: 10.1016/j.ancard.2024.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 10/22/2024]
Abstract
Progress in coronary angioplasty has enabled outpatients treatment with rates of immediate complications below 1%. This shows a clear improvement in patient's comfort and it represents an important medical and economic gain. Considering the demographic evolution of the population, there is an increasing number of calcified coronary lesions which represent, according to the series, up to a quarter of angioplasties. However, their care is more delicate with a greater risk of complications and procedural failure. In fact, with the difficulties of crossing and with the vascular intrusions related to pre-dilation or sub-dilation stent deployment, the complication risk increases by almost 10% in these cases of angioplasties. Similarly, the death rate at 30 days goes from 4.7% in angioplasty in general up to 24.4% in calcified lesions. Several devices for atherectomy and plaque preparation have been developed in order to better overcome the lesions and better prepare the stent installation at the cost of a risk of complications between 2 and 10%. The three most frequent complications are dissection (1.8 to 7%), slow/no-flow (0.1 to 3%) and coronary perforation (0.2 to 4%). Nevertheless, despite this procedural increased risk, ambulatory angioplasty of calcified complex lesions can become a reality subject to 4-6 hours monitoring in a specialized unit with dedicated protocols.
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Wańha W, Iwańczyk S, Januszek R, Wolny R, Tomasiewicz B, Kuliczkowski W, Reczuch K, Pawlus P, Pawłowski TZ, Kuźma Ł, Kubler P, Niezgoda P, Kubica J, Gil RJ, Pawłowski TF, Gąsior M, Jaguszewski M, Wybraniec M, Witkowski A, Kowalewski M, D'Ascenzo F, Greco A, Bartuś S, Lesiak M, Grygier M, Wojakowski W, Cortese B. Long-Term Outcomes Following Sirolimus-Coated Balloon or Drug-Eluting Stents for Treatment of In-Stent Restenosis. Circ Cardiovasc Interv 2024; 17:e014064. [PMID: 39051094 DOI: 10.1161/circinterventions.124.014064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Evidence suggests that drug-coated balloons may benefit in-stent restenosis (ISR) treatment. However, the efficacy of new-generation sirolimus-coated balloon (SCB) compared with the latest generation drug-eluting stents (DESs) has not been studied in this setting. METHODS All patients in the EASTBORNE (The All-Comers Sirolimus-Coated Balloon European Registry) and DEB-DRAGON (DEB vs Thin-DES in DES-ISR: Long Term Outcomes) registries undergoing percutaneous coronary intervention for DES-ISR were included in the study. The primary study end point was target lesion revascularization at 24 months. Secondary end points were major adverse cardiovascular events, all-cause death, myocardial infarction, and target vessel revascularization at 24 months. Our goal was to evaluate the efficacy and safety of SCB versus thin-struts DES in ISR at long-term follow-up. RESULTS A total of 1545 patients with 1679 ISR lesions were included in the pooled analysis, of whom 621 (40.2%) patients with 621 lesions were treated with thin-strut DES and 924 (59.8%) patients with 1045 lesions were treated with SCB. The unmatched cohort showed no differences in the incidence of target lesion revascularization (10.8% versus 11.8%; P=0.568); however, there was a trend toward lower rates of myocardial infarction (7.4% versus 5.0%; P=0.062) and major adverse cardiovascular events (20.8% versus 17.1%; P=0.072) in the SCB group. After propensity score matching (n=335 patients per group), there were no significant differences in the rates of target lesion revascularization (11.6% versus 11.8%; P=0.329), target vessel revascularization (14.0% versus 13.1%; P=0.822), myocardial infarction (7.2% versus 4.5%; P=0.186), all-cause death (5.7% versus 4.2%; P=0.476), and major adverse cardiovascular event (21.5% versus 17.6%; P=0.242) between DES and SCB treatment. CONCLUSIONS In patients with ISR, angioplasty with SCB compared with thin-struts DES is associated with comparable rates of target lesion revascularization, target vessel revascularization, myocardial infarction, all-cause death, and major adverse cardiovascular events at 2 years.
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Affiliation(s)
- Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (W. Wańha, P.P., T.Z.P., W. Wojakowski)
- DCB Academy, Milano, Italy (W. Wańha, S.I., B.C.)
| | - Sylwia Iwańczyk
- DCB Academy, Milano, Italy (W. Wańha, S.I., B.C.)
- Department of Cardiology, Poznań University of Medical Sciences, Poland (S.I., M.L., M. Grygier)
| | - Rafał Januszek
- Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland (R.J., S.B.)
| | - Rafał Wolny
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland (R.W., A.W.)
| | - Brunon Tomasiewicz
- Institute of Heart Diseases, Wrocław University Hospital, Poland (B.T., W.K., K.R., P.K.)
| | - Wiktor Kuliczkowski
- Institute of Heart Diseases, Wrocław University Hospital, Poland (B.T., W.K., K.R., P.K.)
| | - Krzysztof Reczuch
- Institute of Heart Diseases, Wrocław University Hospital, Poland (B.T., W.K., K.R., P.K.)
| | - Paweł Pawlus
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (W. Wańha, P.P., T.Z.P., W. Wojakowski)
| | - Tomasz Z Pawłowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (W. Wańha, P.P., T.Z.P., W. Wojakowski)
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Białystok, Poland (L.K.)
| | - Piotr Kubler
- Institute of Heart Diseases, Wrocław University Hospital, Poland (B.T., W.K., K.R., P.K.)
| | - Piotr Niezgoda
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (P.N., J.K.)
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (P.N., J.K.)
| | - Robert J Gil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland (R.J.G., T.F.P.)
| | - Tomasz F Pawłowski
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland (R.J.G., T.F.P.)
| | - Mariusz Gąsior
- Third Department of Cardiology, Medical University of Silesia, Zabrze, Poland (M. Gąsior)
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdańsk, Poland (M.J.)
| | - Maciej Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Poland (M. Wybraniec)
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland (R.W., A.W.)
| | - Mariusz Kowalewski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland (M.K.)
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Centre Maastricht (CARIM), the Netherlands (M.K.)
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy (M.K.)
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland (M.K.)
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy (F.D.)
| | - Antonio Greco
- A.O.U. Policlinico "G. Rodolico - San Marco," University of Catania, Italy (A.G.)
| | - Stanisław Bartuś
- Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland (R.J., S.B.)
- Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy (B.C.)
| | - Maciej Lesiak
- Department of Cardiology, Poznań University of Medical Sciences, Poland (S.I., M.L., M. Grygier)
| | - Marek Grygier
- Department of Cardiology, Poznań University of Medical Sciences, Poland (S.I., M.L., M. Grygier)
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (W. Wańha, P.P., T.Z.P., W. Wojakowski)
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Shamkhani W, Rashid M, Moledina S, Ludman P, Curzen N, Wijeysundera HC, Grines CL, Mamas MA. Complex High-Risk Percutaneous Coronary Intervention Types, Trends, and Outcomes in Nonsurgical Centres. Can J Cardiol 2024; 40:1237-1246. [PMID: 38215968 DOI: 10.1016/j.cjca.2024.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Limited data are available on complex high-risk percutaneous coronary intervention (CHiP) trends and outcomes in nonsurgical centres (NSCs), particularly in health care systems where most centres are NSCs. METHODS Using data from a national registry, we studied the characteristics and outcomes of CHiP procedures performed for stable angina from 2006 to 2017 according to the presence or absence of on-site surgical cover. Multivariate regression analyses and propensity score matching were used to determine risks for in-hospital death, major bleeding, and major cardiovascular or cerebral events (MACCE). RESULTS Out of 134,730 CHiP procedures, 42,433 (31.5%) were performed in NSCs, increasing from 12.5% in 2006 to 42% in 2017. Compared with surgical centres (SCs), patients who had a CHiP procedure undertaken in NSCs were, on average, 2.4 years older and had a greater prevalence of cardiovascular risks. Common CHiP procedures performed in NSCs included poor left ventricular function (41.6%), chronic renal failure (38.8%), and chronic total occlusion percutaneous coronary intervention (31.1%). NSC-based CHiP is associated with lower odds of mortality (adjusted odds ratio [aOR] 0.7, 95% confidence interval [CI] 0.5-0.8) and major bleeding (aOR 0.7, 95% CI 0.6-0.8). In both groups, MACCE odds were similar (aOR 1.0, 95% CI 0.9-1.1). CONCLUSIONS CHiP numbers have steadily increased in NSCs. NSC patients were older and had a higher prevalence of cardiovascular risks than SC patients. Mortality and major bleeding odds were significantly lower in those cases undertaken in NSCs, although MACCE odds were not different between the groups.
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Affiliation(s)
- Warkaa Shamkhani
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, United Kingdom
| | - Nick Curzen
- University of Southampton, Southampton, United Kingdom; Coronary Research Group, University Hospital Southampton, Southampton, United Kingdom
| | | | - Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
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Bay B, Kiwus LM, Goßling A, Koester L, Blaum C, Schrage B, Clemmensen P, Blankenberg S, Waldeyer C, Seiffert M, Brunner FJ. Procedural and one-year outcomes of robotic-assisted versus manual percutaneous coronary intervention. EUROINTERVENTION 2024; 20:56-65. [PMID: 38165113 PMCID: PMC10756222 DOI: 10.4244/eij-d-23-00375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Robotic-assisted percutaneous coronary intervention (rPCI) has proven to be feasible and safe. Comparative analyses of rPCI versus manual PCI (mPCI) are scarce. AIMS We aimed to investigate procedural aspects and outcomes of rPCI using the second-generation CorPath GRX Vascular Robotic System compared with mPCI in patients with chronic coronary syndrome and non-ST-segment elevation myocardial infarction acute coronary syndrome. METHODS From January to April 2021, 70 patients underwent rPCI at the University Heart & Vascular Center Hamburg-Eppendorf and were recruited into the INTERCATH study. By propensity score matching, a control cohort of 210 patients who underwent mPCI from 2015-2021 was identified. Co-primary endpoints were one-year all-cause mortality and major adverse cardiovascular events (MACE) as a composite of cardiovascular death, unplanned target lesion revascularisation, myocardial infarction, and stroke. RESULTS The median age of the patients (n=280) was 70.7 (25th percentile-75th percentile: 62.0-78.0) years, and 24.6% were female. The Gensini score (28.5 [16.2-48.1] vs 28.0 [15.5-47.0]; p=0.78) was comparable between rPCI versus mPCI. During the PCI procedure, total contrast fluid volume did not differ, whilst longer fluoroscopy times (20.4 min [13.8-27.2] vs 14.4 min [10.4-24.3]; p=0.001) were documented in the rPCI versus mPCI cohort. After 12 months of follow-up, neither all-cause mortality (p=0.22) nor MACE (p=0.25) differed between the groups. CONCLUSIONS rPCI was associated with longer fluoroscopy times compared with mPCI, though without increased use of contrast medium. One-year follow-up revealed no differences in all-cause mortality or MACE, supporting the safety of a robotic-assisted approach.
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Affiliation(s)
- Benjamin Bay
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luisa M Kiwus
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Koester
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Blaum
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Clemmensen
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Waldeyer
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian J Brunner
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Javid R, Wassef N, Wheatcroft SB, Tayebjee MH. Coronary Guidewires in Temporary Cardiac Pacing and Assessment of Myocardial Viability: Current Perspectives and Future Directions. J Clin Med 2023; 12:6976. [PMID: 38002591 PMCID: PMC10672001 DOI: 10.3390/jcm12226976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Intracoronary guidewires used in percutaneous coronary intervention can also be configured to provide temporary ventricular pacing. Trans coronary electrophysiological parameters recorded by employing coronary guidewires may have a potential role in assessing myocardial viability and could provide a means to make an immediate on-table decision about revascularisation. To date, some small studies have demonstrated the safety of this technique in temporary cardiac pacing, but further research is required to refine this approach and establish its clinical utility in myocardial viability assessment. In this review we discuss the potential role of trans coronary electrophysiology in the assessment of myocardial viability.
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Affiliation(s)
- Rabeia Javid
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.J.); (S.B.W.)
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
| | - Nancy Wassef
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
| | - Stephen B. Wheatcroft
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.J.); (S.B.W.)
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
| | - Muzahir H. Tayebjee
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.J.); (S.B.W.)
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
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9
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Fukui T, Ogasawara N. Intravascular ultrasound system-guided bail-out stent implantation for iatrogenic aortocoronary dissection: a case report. Eur Heart J Case Rep 2023; 7:ytad332. [PMID: 37547366 PMCID: PMC10401319 DOI: 10.1093/ehjcr/ytad332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
Background Iatrogenic aortocoronary dissection (ACD) is a rare but potentially devastating complication of cardiac catheterization. We describe a case of an iatrogenic ACD following catheter engagement and balloon inflation of the proximal right coronary artery (RCA) during an elective percutaneous coronary intervention (PCI). Case summary An 81-year-old woman presented with an acute inferior wall ST-elevation myocardial infarction. Emergent coronary angiography revealed the three-vessel diseases. Primary PCI for the culprit lesion of the occluded mid-circumflex artery was successfully performed. After 10 days, an elective PCI for the residual RCA lesions was performed. After the balloon inflation of the proximal RCA, iatrogenic ACD was detected. Intravascular ultrasound-guided stent implantation sealing an entry tear prevented further dissection. The post-operative course was uneventful, and the patient was discharged 1 week later. Follow-up cardiac computed tomography revealed a disappearance of the aortocoronary intramural haematoma. Discussion This case emphasizes the importance of prompt detection and intervention for iatrogenic ACD. Heart team discussion is essential to determine whether cardiovascular surgery or percutaneous management should be performed. Bail-out stent implantation sealing an entry tear is frequently used and effective, and an intravascular ultrasound system would help to recognize the morphology of ACD, contributing to the safe procedure.
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Affiliation(s)
- Tomoki Fukui
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka city, Osaka 553-0003, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka city, Osaka 553-0003, Japan
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10
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Ko YG, Choi D, Rha SW, Won JH, Do YS, Lee SW, Menk JS, Kum S. Long-term outcomes after paclitaxel-coated balloon angioplasty of femoropopliteal arteries in Asian patients of the IN.PACT Global Study. Catheter Cardiovasc Interv 2022; 100:1273-1283. [PMID: 36385562 PMCID: PMC10099943 DOI: 10.1002/ccd.30441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The long-term data on the use of drug-coated balloons (DCBs) for femoropopliteal atherosclerotic lesions in the real-world setting are limited, even more so for racially and geographically distinct populations. The present analysis reports the 5-year safety and effectiveness outcomes of a DCB in the Asian subset of the prospective, real-world IN.PACT Global Study. METHODS The IN.PACT Global Study was a prospective, multicenter, international, single-arm study designed to assess the long-term safety and effectiveness of the IN.PACT Admiral DCB in real-world participants with femoropopliteal artery disease. The present analysis included 114 Asian participants (138 lesions) treated in South Korea and Singapore. Assessments through 5 years included freedom from clinically driven target lesion revascularization, the safety endpoint (a composite of freedom from device- and procedure-related mortality through 30 days; and freedom from major target limb amputation and clinically driven target vessel revascularization within 60 months after the index procedure) and major adverse events. RESULTS In this prespecified Asian subset, there was a high incidence of diabetes mellitus (54.4%), hypertension (78.1%), coronary artery disease (43.9%), and concomitant below-the-knee vascular disease of target leg (39.5%). Mean lesion length was 17.4 ± 12.4 cm; 26.8% were in-stent restenosis, and more than half of the lesions were totally occluded (51.4%) and calcified (54.3%). The 5-year Kaplan-Meier estimate of freedom from clinically driven target lesion revascularization was 77.1% (95% confidence interval: 67.0%-84.5%). The safety composite endpoint was 76.0%; the cumulative incidence of all-cause mortality was 19.9%, and no major target limb amputations were reported through 5 years. CONCLUSIONS This subset analysis of Asian participants from the IN.PACT Global Study demonstrated consistent results with the previously reported data of the IN.PACT Admiral DCB. The data confirm the durable clinical effectiveness and safety profile of the DCB through 5 years for femoropopliteal atherosclerotic disease in this real-world population.
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Affiliation(s)
- Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Division of cardiology, Korea University Guro Hospital, Seoul, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Korea
| | - Young-Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Steven Kum
- Department of Surgery, Changi General Hospital, Singapore, Singapore
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11
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Sanchez-Jimenez E, Levi Y, Roguin A. Iatrogenic Aortocoronary Dissection During Right Coronary Artery Procedures: A Systematic Review of the Published Literature. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100443. [PMID: 39132357 PMCID: PMC11308116 DOI: 10.1016/j.jscai.2022.100443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 08/13/2024]
Abstract
Iatrogenic aortocoronary dissection (IACD) occurs mainly during procedures involving the right coronary artery (RCA) and can result in disabilities, the need for urgent complex surgery, and even death. The risk factors for IACD are ill characterized, and the best management strategy is questionable; thus, there is a need to evaluate the characteristics, treatment options, and outcomes of patients with IACD of the RCA. We searched medical databases for publications on IACD of the RCA to present the characteristics of the procedures, management, and outcomes. We report 142 cases of IACD of the RCA, reported between 1973 and 2021. The mean age of the patients was 63.0 years, 81 (57%) were men, 75 (52.8%) presented with stable angina, and 29 (20.4%) had chronic total occlusion of the RCA. The most used catheter shapes were Judkins right (42%) and Amplatz left (25%), and most (56%) catheters were used during percutaneous coronary interventions. Guiding catheters were used in 38% (19/50) of diagnostic procedures when IACD occurred. A catheter size of ≤5F was used in only 3 cases. The catheter size was 6F in 22% of the cases, >6F in 23%, and not reported in 52%. A high-grade dissection (Dunning class III) occurred in 54% (77/142) of the cases. Stenting of the RCA ostium was performed in 88 (62%) of the cases, conservative treatment in 25 (18%), and surgery in 40 (28%) (aortic root repair [5%], coronary artery bypass grafting and aortic root repair [11%], and coronary artery bypass grafting alone [10%]). The mortality rate was 6.5% (5/77) among patients with class III dissection. Each patient should be considered independently. The most frequent intervention was to seal the dissection with a stent in the ostial RCA. However, in select cases published in the literature, a conservative approach was a feasible and successful option.
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Affiliation(s)
| | - Yaniv Levi
- Cardiology Department, Hillel Yaffe Medical Center, Hadera, Israel
- Technion - Israel Institute of Technology, Israel
| | - Ariel Roguin
- Cardiology Department, Hillel Yaffe Medical Center, Hadera, Israel
- Technion - Israel Institute of Technology, Israel
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12
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Brodmann M, Lansink W, Guetl K, Micari A, Menk J, Zeller T. Long-Term Outcomes of the 150 mm Drug-Coated Balloon Cohort from the IN.PACT Global Study. Cardiovasc Intervent Radiol 2022; 45:1276-1287. [PMID: 35864209 PMCID: PMC9458561 DOI: 10.1007/s00270-022-03214-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Data on the long-term safety and effectiveness of drug-coated balloons (DCBs) for the treatment of long femoropopliteal atherosclerotic lesions in the real-world setting are rare. This study reports 3 year and 5 year outcomes of the pre-specified 150 mm balloon sub-cohort of the IN.PACT Global Study. METHODS The IN.PACT Global Study was a prospective, multicentre, international, single-arm study evaluating the performance of the IN.PACT Admiral DCB in real-world patients with femoropopliteal atherosclerotic disease. This pre-specified 150 mm DCB cohort analysis comprised 107 participants (111 lesions) with all target lesions treated with at least one 150 mm DCB. RESULTS Mean lesion length was 20.3 ± 9.2 cm; 18.0% had in-stent restenosis, 58.6% were totally occluded, and 17.1% were severely calcified. Through 60 months, the Kaplan-Meier estimate of freedom from clinically driven target lesion revascularization (CD-TLR) was 72.7% [95% confidence interval (CI):62.4%-80.5%]. The safety composite endpoint (freedom from device/procedure-related death through 30 days; freedom from target limb major amputation and clinically driven target vessel revascularization through 5 years) was 70.5%. The cumulative incidence of major amputation was 1.0% and all-cause mortality was 18.4% through 60 months. Freedom from CD-TLR rates in the provisional stented and non-stented subgroups through 36 months were 64.0% [95% CI: 46.1%-77.3%] and 81.9% [95% CI: 69.7%-89.6%] (log-rank p = 0.074), respectively. CONCLUSIONS The results demonstrate sustained long-term safety of the 150 mm IN.PACT Admiral DCB for long femoropopliteal atherosclerotic lesions in real-world patients. In particular, the results show that DCB angioplasty is an effective revascularization modality in long complex lesions. CLINICALTRIALS gov identifier: NCT01609296. LEVEL OF EVIDENCE Level 3, Cohort Study.
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Affiliation(s)
| | - Wouter Lansink
- Department of Thoracic and Vascular Surgery, Vascular Center ZOL, Genk, Belgium
| | - Katharina Guetl
- Department of Internal Medicine, Medical University, Graz, Austria
| | - Antonio Micari
- Interventional Cardiology, University of Messina Hospital, Messina, Italy
| | | | - Thomas Zeller
- Angiology Department, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
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13
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Caixeta A, Oliveira MDP, Dangas GD. Coronary Artery Dissections, Perforations, and the No‐Reflow Phenomenon. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Cereda AF, Toselli M, Khokhar A, Sticchi A, Gallo F, Ruggiero R, Ponticelli F, Laricchia A, Mangieri A, Sangiorgi G, Colombo A, Giannini F. Iatrogenic aorta-coronary dissection: Case report and systematic review. Catheter Cardiovasc Interv 2021; 97:E900-E910. [PMID: 33201611 DOI: 10.1002/ccd.29367] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/12/2020] [Accepted: 10/26/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES AND BACKGROUND Iatrogenic aorto-coronary dissection (ICD) is one of the most feared complications of interventional cardiology. Although rare, it is characterized by anterograde coronary ischemia and a concomitant aortic dissection, with potentially fatal consequences. METHODS We present an example case of IACD and an accurate case-series review of the literature including 125 published cases. RESULTS There were no significant predisposing factors and the IACD occurred equally in elective and urgent procedures. A significant number of IACDs were associated with CTO procedures. The factors associated with a worse outcome were hemodynamic instability, the presence of anterograde ischemia, and the extent of dissection according to the Dunning classification. Bail-out stenting was the most used strategy and its failure was associated with mortality. CONCLUSION The main features of IACD are anterograde ischemia, retrograde dissection, and hemodynamic instability, each of them should be addressed with no time delay, possibly with bailout stenting, the most employed exit-strategy. According to our proposed algorithm, a shock team approach is required to coordinate the interdisciplinary skills and enabled patients to receive the best treatment.
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Affiliation(s)
| | - Marco Toselli
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Arif Khokhar
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Alessandro Sticchi
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Ponticelli
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Giuseppe Sangiorgi
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
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15
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Heinroth KM, Unverzagt S, Mahnkopf D, Horenburg C, Melnyk H, Sedding D, Prondzinsky R. Transcoronary pacing in an animal model : Second coated guidewire versus cutaneous patch as indifferent electrodes. Med Klin Intensivmed Notfmed 2021; 117:227-234. [PMID: 33787979 DOI: 10.1007/s00063-021-00806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transcoronary pacing is a seldom used treatment option for unheralded bradycardias in the setting of percutaneous coronary interventions (PCI). In the present study we compared a coated guidewire inserted proximally into a coronary artery with a cutaneous patch electrode as indifferent electrodes for transcoronary pacing in a porcine model. METHODS Transcoronary pacing was investigated in 7 adult pigs in an animal catheterization laboratory. A standard guidewire insulated by a monorail-balloon was advanced into the periphery of a coronary artery serving as the cathode. As the indifferent anode, a special guidewire with electrical insulated by a polytetrafluoroethylene (PTFE) coating was positioned into the proximal part of the same coronary vessel. Transcoronary pacing parameters (threshold and impedance data and the magnitude of the epicardial electrogram) were compared with unipolar transcoronary pacing using a cutaneous patch electrode. RESULTS Transcoronary pacing was successful against both indifferent electrodes. Pacing thresholds obtained with the coated guidewire technique (1.8 ± 1.3 V) were similar to those obtained by standard unipolar transcoronary pacing with a cutaneous patch electrode (1.8 ± 1.5 V). The impedance with the additional coated guidewire was 419 ± 144 Ω and thereby slightly higher compared to 320 ± 103 Ω obtained by pacing against the patch electrode (p < 0.05). Both settings yielded comparable R‑wave amplitudes (8.0 ± 5.1 mV vs. 7.1 ± 3.6 mV). CONCLUSIONS A second coated guidewire is as effective as a cutaneous patch electrode when added as an indifferent electrode in transcoronary pacing. This transcoronary pacing technique could replace temporary transvenous pacing in emergency situations during PCI, especially when using the radial approach.
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Affiliation(s)
- Konstantin M Heinroth
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany.
| | - Susanne Unverzagt
- Martin-Luther-University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle/Saale, Germany
| | | | - Charlotte Horenburg
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Hannes Melnyk
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Daniel Sedding
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany
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16
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Lo MY, Chen MS, Jen HM, Chen CC, Shen TY. A rare complication of cerebral venous thrombosis during simple percutaneous coronary intervention: A case report. Medicine (Baltimore) 2021; 100:e24008. [PMID: 33530197 PMCID: PMC7850649 DOI: 10.1097/md.0000000000024008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Cerebrovascular accidents (CVAs) after percutaneous coronary intervention (PCI), although rare, are associated with high in-hospital morbidity and mortality rates. Cerebral venous thrombosis (CVT) is an uncommon cause of CVAs compared with arterial disease but is associated with favorable outcomes in most cases. We present a rare case of CVT following a simple PCI procedure with stent implantation, which has not been previously reported in the literature. PATIENT CONCERNS A 78-year-old woman with hypertension, hyperlipidemia, and coronary artery disease received simple PCI with stent implantation. After PCI, she developed a throbbing headache with nausea and vomiting, with her blood pressure increasing to 190/100 mmHg. Drowsiness, disorientation, and neck stiffness were noted. Neurological complication due to the PCI procedure was highly suspected. DIAGNOSIS Noncontrast brain computed tomography was performed along with emergency neurological consultation, and the patient was diagnosed as having acute CVT. INTERVENTIONS The patient was treated with anti-intracranial pressure therapy and anticoagulation therapy through low-molecular-weight heparin and was subsequently treated with warfarin. OUTCOMES After treatment, the patient's symptoms and signs gradually subsided, and her clinical condition improved. She was discharged with full recovery thereafter. LESSONS A case of acute CVT, a rare, and atypical manifestation of venous thromboembolism and CVA, complicated simple PCI with stent implantation. During PCI, identifying patients with a high risk of a CVA is critical, and special care should be taken to prevent this devastating complication.
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Affiliation(s)
- Ming Yuan Lo
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Shiu Chen
- Cardiology Department, Chang Bing Show Chwan Memorial Hospital, Lukang Town, Changhua County, Taiwan
| | - Hsuan-Ming Jen
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chien-Cheng Chen
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Thau-Yun Shen
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
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17
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Vakilian F, Tavallaie A, Alimi H, Poorzand H, Salehi M. Right Atrial Strain in the Assessment of Right Heart Mechanics in Patients with Heart Failure with Reduced Ejection Fraction. J Cardiovasc Imaging 2020; 29:135-143. [PMID: 33605100 PMCID: PMC8099572 DOI: 10.4250/jcvi.2020.0092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/24/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cardiac catheterization is the gold standard for cardiopulmonary hemodynamic assessment, although its widespread use could be restricted due to its invasive nature. The aim of this study is to compare multiple echocardiography parameters, including right atrial (RA) strain, with right heart catheterization (RHC) data in patients with heart failure reduced ejection fraction (HFrEF) in the assessment of right heart hemodynamics. METHODS Patients with HFrEF (defined by left ventricular ejection fraction [LVEF] ≤ 35%) were enrolled prospectively in this study. All patients underwent echocardiography and RHC. RA pressure (RAP), right ventricular end diastolic pressure (RVEDP), systolic pulmonary artery pressure (sPAP) and pulmonary vascular resistance (PVR) were calculated in RHC. Right ventricular (RV) diastolic and systolic function, RAP, RA size, sPAP and PVR were also measured by echocardiography. RESULTS Fifty patients (36 men) aged 13–51 years with LVEF ≤ 35% were enrolled in this study. There was a significant correlation between echocardiography and catheterization data (r > 0.6, p < 0.001). The RV diastolic grading had significant relation with RA volume (p < 0.001) and RA strain (p < 0.001) in echocardiography, and with RVEDP (p = 0.01) and RAP (p < 0.001) in RHC. There were significant relations between the New York Heart Association classification and RV diastolic function grading (p < 0.001), with RA strain (p = 0.019), and size (p = 0.04). CONCLUSIONS RA function, as assessed by strain imaging, correlates with right heart hemodynamics in patients with HFrEF.
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Affiliation(s)
- Farveh Vakilian
- Cardiovascular Department, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Tavallaie
- Cardiovascular Department, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Alimi
- Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoorak Poorzand
- Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Maryam Salehi
- Clinical Research Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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18
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Itoh T, Kimura T, Kudo A, Morino Y, Ikari Y, Yoshioka K, Nakano M, Natsumeda M, Sakuma M, Inami S, Ako J, Nishinari M, Shimohama T, Komatsu T, Ishikawa T, Taguchi I, Sugimura H, Mitarai T, Akashi Y, Suzuki N, Sugi K, Matsumoto K, Kohshoh H, Yoshino H. Clinical and procedure characteristics in patients treated with polytetrafluoroethylene-covered stents after coronary perforation: a CIRC-8U multicenter registry and literature review. Cardiovasc Interv Ther 2020; 36:418-428. [PMID: 33037569 DOI: 10.1007/s12928-020-00716-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
This study aimed at identifying the clinical characteristics and in-hospital outcomes of patients treated with polytetrafluorethylene (PTFE)-covered stents after coronary interventions in a multicenter registry. Subjects with coronary artery perforation were selected from 31,262 consecutive patients who underwent coronary interventions in the hospital registries. Subjects were divided into two groups: those with a PTFE-covered stent implantation and those without a PTFE-covered stent implantation. Clinical characteristics and in-hospital outcomes were compared between the two groups. Data for 82 consecutive coronary perforations (15 PTFE-covered stents and 67 non-PTFE-covered stents) were extracted from each hospital registry. The PTFE-covered stent group had a higher prevalence of perforations due to pre-dilatation before stenting or post-dilatation after stenting (80% vs. 10.4%; p < 0.001), more Ellis classification III perforations (66.6% vs. 28.4%; p = 0.019), longer perforation to hemostasis time (74 min vs. 10 min; p < 0.001), lower hemostatic success rates (73.3% vs. 94.0%; p = 0.015), and higher in-hospital mortality (26.7% vs. 6.0%; p = 0.015) than the non-PTFE-covered stent group. Although the prevalence of intravascular ultrasound (IVUS) usage was high during coronary interventions (86.7%), IVUS was performed in less than half the cases just before coronary perforations (47%) in the PTFE-covered stent group. Patients requiring PTFE-covered stents are more likely to be observed after balloon dilatation before or after stenting and have a poor prognosis. Careful coronary intervention is needed when IVUS image acquisition is not achieved in addition to proper evaluation of IVUS. Furthermore, if coronary artery perforation occurs, it is important to determine the need for a prompt PTFE-covered stent.
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Affiliation(s)
- Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan. .,Division of Community Medicine, Department of Medical Education, Iwate Medical University, Yahaba-cho, Shiwa-gun, Japan.
| | - Takumi Kimura
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Akihito Kudo
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Masataka Nakano
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Makoto Natsumeda
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Masashi Sakuma
- Division of Cardiology, Dokkyo Medical University, Mibu, Japan
| | - Shu Inami
- Division of Cardiology, Dokkyo Medical University, Mibu, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Hospital, Sagamihara, Japan
| | - Makoto Nishinari
- Department of Cardiovascular Medicine, Kitasato University Hospital, Sagamihara, Japan
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University Hospital, Sagamihara, Japan
| | - Takaaki Komatsu
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hiroyuki Sugimura
- Division of Cardiology, Dokkyo Medical University Nikko Medical Center, Nikko, Japan
| | - Takanobu Mitarai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nobuaki Suzuki
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiki Sugi
- Division of Cardiology, Saitama Medical University, Moroyama, Japan
| | - Kazuo Matsumoto
- Division of Cardiology, Saitama Medical University, Moroyama, Japan
| | - Hideyasu Kohshoh
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideaki Yoshino
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
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Shaik FA, Slotwiner DJ, Gustafson GM, Dai X. Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature. World J Cardiol 2020; 12:269-284. [PMID: 32774779 PMCID: PMC7383354 DOI: 10.4330/wjc.v12.i6.269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/03/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common during cardiac catheterization, and there are risks of developing serious and potentially life-threatening arrhythmias, such as sustained ventricular tachycardia (VT), ventricular fibrillation (VF) and high-grade conduction disturbances such as complete heart block (CHB), requiring immediate interventions. However, there is lack of systematic overview of these conditions. AIM To systematically review existing literature and gain better understanding of the incidence of cardiac arrhythmias during cardiac catheterization, and their impact on outcomes, as well as potential approaches to minimize this risk. METHODS We applied a combination of terms potentially used in reports describing various cardiac arrhythmias during common cardiac catheterization procedures to systematically search PubMed, EMBASE and Cochrane databases, as well as references of full-length articles. RESULTS During right heart catheterization (RHC), the incidence of atrial arrhythmias (premature atrial complexes, atrial fibrillation and flutter) was low (< 1%); these arrhythmias were usually transient and self-limited. RHC associated with the development of a new RBBB at a rate of 0.1%-0.3% in individuals with normal conduction system but up to 6.3% in individuals with pre-existing left bundle branch block. These patients may require temporary pacing due to transient CHB. Isolated premature ventricular complexes or non-sustained VT are common during RHC (up to 20% of cases). Sustained ventricular arrhythmias (VT and/or VF) requiring either withdrawal of catheter or cardioversion occurred infrequently (1%-1.3%). During left heart catheterizations (LHC), the incidence of ventricular arrhythmias has declined significantly over the last few decades, from 1.1% historically to 0.1% currently. The overall reported rate of VT/VF in diagnostic LHC and coronary angiography is 0.8%. The risk of VT/VF was higher during percutaneous coronary interventions for stable coronary artery disease (1.1%) and even higher for patients with acute myocardial infarctions (4.1%-4.3%). Intravenous adenosine and papaverine bolus for fractional flow reserve measurement, as well as intracoronary imaging using optical coherence tomography have been reported to induce VF. Although uncommon, LHC and coronary angiography were also reported to induce conduction disturbances including CHB. CONCLUSION Cardiac arrhythmias are common and potentially serious complications of cardiac catheterization procedures, and it demands constant vigilance and readiness to intervene during procedures.
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Affiliation(s)
- Fatima A Shaik
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
| | - David J Slotwiner
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
| | - Gregory M Gustafson
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
| | - Xuming Dai
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States.
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20
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Terada N, Kuramochi T, Sugiyama T, Kanaji Y, Hoshino M, Usui E, Yamaguchi M, Hada M, Misawa T, Sumino Y, Hirano H, Nogami K, Ueno H, Wakasa N, Hosokawa M, Murai T, Lee T, Yonetsu T, Kobashi K, Kakuta T. Ventricular Fibrillation During Optical Coherence Tomography/Optical Frequency Domain Imaging - A Large Single-Center Experience. Circ J 2020; 84:178-185. [PMID: 31941850 DOI: 10.1253/circj.cj-19-0736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The risks of ventricular fibrillation (Vfib) associated with frequency-domain optical coherence tomography (OCT)/optical frequency domain imaging (OFDI) remain undetermined. METHODS AND RESULTS We retrospectively studied the occurrence of Vfib during OCT/OFDI for unselected indications. The frequency of Vfib and patient and procedural characteristics were investigated. A total of 4,467 OCT/OFDI pullback examinations were performed in 1,754 patients (median of 2.0 [2.0-3.0] pullbacks for 1.0 [1.0-1.3] vessels). OCT/OFDI was performed during PCI in 899 patients (51.3%). The contrast injection volume per pullback was 14.4 (11.7-17.2) mL with a flow rate of 3.4 (3.2-3.5) mL/s. Vfib occurred in 31 pullbacks (0.69%) in 30 patients (1.7%). No cases of Vfib occurred when using low-molecular-weight dextran. On multivariate analysis, contrast volume was the only independent factor for predicting Vfib (odds ratio, 1.080; 95% confidence interval, 1.008-1.158, P=0.029). The best cutoff value of contrast volume for predicting Vfib was 19.2 mL (area under the curve, 0.713, P<0.001; diagnostic accuracy, 87.1%). CONCLUSIONS The present large, single-center registry study indicated that Vfib during OCT/OFDI was rare for unselected indications. Contrast injection volume used to displace blood should be limited to avoid Vfib.
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Affiliation(s)
- Noriko Terada
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital
| | | | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masao Yamaguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Toru Misawa
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Yohei Sumino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Hidenori Hirano
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Hiroki Ueno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Nobutaka Wakasa
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital
| | | | - Tadashi Murai
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kazuhiko Kobashi
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
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Nestelberger T, Kaiser C, Jeger R. Drug-coated balloons in cardiovascular disease: benefits, challenges, and clinical applications. Expert Opin Drug Deliv 2020; 17:201-211. [PMID: 31918593 DOI: 10.1080/17425247.2020.1714590] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raban Jeger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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22
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Raphael CE, El-Sabbagh A, Corban M, Hajj SE, Prasad A. Emerging therapies in coronary balloon angioplasty, stenting, and bioabsorbable scaffolds. EMERGING TECHNOLOGIES FOR HEART DISEASES 2020:527-557. [DOI: 10.1016/b978-0-12-813704-8.00024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2025]
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23
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The Feasibility and Safety of Same-Day Discharge for All Comers after Elective Percutaneous Coronary Interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:588-591. [PMID: 31767522 DOI: 10.1016/j.carrev.2019.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The safety of same day discharge (SDD) after percutaneous coronary interventions (PCI) has been demonstrated in several studies. However, SDD was only allowed in patients meeting strict criteria. We aimed to evaluate the feasibility and safety of SDD following elective-PCI in all comers. METHODS In 2012, we implemented a strategy of SDD for all elective PCI (no exclusion) but admissions were allowed at the discretion of the treating physician. We assessed the feasibility and safety of this approach in consecutive patients who underwent elective PCI at WVU. RESULTS Out of 3355 patients who underwent PCI between 2012 and 2016, 691 (21%) presented electively. Radial access was utilized in 480 (69.5%). Same day discharge was achieved in 539/691 (78%), and there was no difference between patients who had SDD and those who were admitted with regards to the 30-day major adverse cardiovascular and cerebrovascular events (3.2% vs. 3.5% respectively, P = 0.195). Predictors of SDD failure were procedural complications (OR 12.08, 95%CI 2.20-57.8. P = 0.002), use of Glycoprotein IIB-IIIA inhibitors (OR 3.45, 95%CI 1.067-11.41, P = 0.039), femoral access (OR 2.067, 95%CI 1.25-3.419, p = 0.005), anemia (OR 1.80, 95%CI 1.06-3.04, P = 0.029), home distance ≥60 miles (OR 1.68, 95%CI 1.03-2.72, P = 0.037). CONCLUSION SDD is feasible in the majority of all-comers after elective PCI, and is not associated with increase in adverse events at 30-days. Certain procedural and patient's characteristics predict SDD failure. If validated in prospective studies, these factors can possibly be integrated in a predictive tool to aid in triaging patients, post-elective PCI.
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Transcoronary pacing : Reliability during myocardial ischemia and after implantation of a coronary stent. Med Klin Intensivmed Notfmed 2018; 115:120-124. [PMID: 30302524 DOI: 10.1007/s00063-018-0492-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Transcoronary pacing is a useful therapeutic option for the treatment of unheralded bradycardias in the setting of percutaneous coronary interventions (PCI). OBJECTIVES In the present study, we investigated the influence of stent implantation and transient myocardial ischemia on the feasibility of transcoronary pacing in a porcine model. METHODS 7 adult pigs underwent a percutaneous coronary intervention with implantation of a coronary stent under general anaesthesia in an animal catheterization laboratory. Transcoronary pacing was established by using a standard guidewire isolated with an angioplasty balloon positioned in the periphery of the right coronary artery serving as the cathode. As the indifferent anode, a skin patch electrode at the back of the animal was used. The reliability of transcoronary pacing was assessed by measurement of threshold and impedance data and the magnitude of the epicardial electrogram at baseline, after implantation of a coronary stent and finally during myocardial ischemia. RESULTS Effective transcoronary pacing could be demonstrated in all cases with the standard unipolar transcoronary pacing setup yielding a low pacing threshold at baseline of 1.3 ± 0.8 V with an impedance of 283 ± 67 Ω. Implantation of a coronary stent did not influence the pacing threshold (1.0 ± 0.4 V) and impedance (262 ± 63 Ω). Acute myocardial ischemia lead to a significant but clinically nonrelevant increase of the pacing threshold to 2.0 ± 0.6 V and a drop in pacing impedance (137 ± 39 Ω). CONCLUSIONS Transcoronary pacing in the animal model is not affected by implantation of a coronary stent in the same vessel used for pacing. Despite a significant increase in pacing threshold, the transcoronary pacing approach is reliable in acute myocardial ischemia during a percutaneous coronary intervention.
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De Marzo V, D'amario D, Galli M, Vergallo R, Porto I. High-risk percutaneous coronary intervention: how to define it today? Minerva Cardioangiol 2018; 66:576-593. [DOI: 10.23736/s0026-4725.18.04679-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Hiraide T, Sawano M, Shiraishi Y, Ueda I, Numasawa Y, Noma S, Negishi K, Ohki T, Yuasa S, Hayashida K, Miyata H, Fukuda K, Kohsaka S. Impact of catheter-induced iatrogenic coronary artery dissection with or without postprocedural flow impairment: A report from a Japanese multicenter percutaneous coronary intervention registry. PLoS One 2018; 13:e0204333. [PMID: 30265698 PMCID: PMC6162084 DOI: 10.1371/journal.pone.0204333] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/05/2018] [Indexed: 12/22/2022] Open
Abstract
Despite the ever-increasing complexity of percutaneous coronary intervention (PCI), the incidence, predictors, and in-hospital outcomes of catheter-induced coronary artery dissection (CICAD) is not well defined. In addition, there are little data on whether persistent coronary flow impairment after CICAD will affect clinical outcomes. We evaluated 17,225 patients from 15 participating hospitals within the Japanese PCI registry from January 2008 to March 2016. Associations between CICAD and in-hospital adverse cardiovascular events were evaluated using multivariate logistic regression. Outcomes of patients with CICAD with or without postprocedural flow impairment (TIMI flow ≤ 2 or 3, respectively) were analyzed. The population was predominantly male (79.4%; mean age, 68.2 ± 11.0 years); 35.6% underwent PCI for complex lesions (eg. chronic total occlusion or a bifurcation lesion.). CICAD occurred in 185 (1.1%), and its incidence gradually decreased (p < 0.001 for trend); postprocedural flow impairment was observed in 43 (23.2%). Female sex, complex PCI, and target lesion in proximal vessel were independent predictors (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.53–3.10; OR, 2.19; 95% CI, 1.58–3.04; and OR, 1.55; 95% CI, 1.06–2.28, respectively). CICAD was associated with an increased risk of in-hospital adverse events (composite of new-onset cardiogenic shock and new-onset heart failure) regardless of postprocedural flow impairment (OR, 10.9; 95% CI, 5.30–22.6 and OR, 2.27; 95% CI, 1.20–4.27, respectively for flow-impaired and flow-recovered CICAD). In conclusion, CICAD occurred in roughly 1% of PCI cases; female sex, complex PCI, and proximal lesion were its independent risk factors. CICAD was associated with adverse in-hospital cardiovascular events regardless of final flow status. Our data implied that the appropriate selection of PCI was necessary for women with complex lesions.
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Affiliation(s)
- Takahiro Hiraide
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Kouji Negishi
- Department of Cardiology, Yokohama Municipal Citizens' Hospital, Kanagawa, Japan
| | - Takahiro Ohki
- Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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27
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Jeger RV, Farah A, Ohlow MA, Mangner N, Möbius-Winkler S, Leibundgut G, Weilenmann D, Wöhrle J, Richter S, Schreiber M, Mahfoud F, Linke A, Stephan FP, Mueller C, Rickenbacher P, Coslovsky M, Gilgen N, Osswald S, Kaiser C, Scheller B. Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial. Lancet 2018; 392:849-856. [PMID: 30170854 DOI: 10.1016/s0140-6736(18)31719-7] [Citation(s) in RCA: 287] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Drug-coated balloons (DCB) are a novel therapeutic strategy for small native coronary artery disease. However, their safety and efficacy is poorly defined in comparison with drug-eluting stents (DES). METHODS BASKET-SMALL 2 was a multicentre, open-label, randomised non-inferiority trial. 758 patients with de-novo lesions (<3 mm in diameter) in coronary vessels and an indication for percutaneous coronary intervention were randomly allocated (1:1) to receive angioplasty with DCB versus implantation of a second-generation DES after successful predilatation via an interactive internet-based response system. Dual antiplatelet therapy was given according to current guidelines. The primary objective was to show non-inferiority of DCB versus DES regarding major adverse cardiac events (MACE; ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation) after 12 months. The non-inferiority margin was an absolute difference of 4% in MACE. This trial is registered with ClinicalTrials.gov, number NCT01574534. FINDINGS Between April 10, 2012, and February 1, 2017, 382 patients were randomly assigned to the DCB group and 376 to DES group. Non-inferiority of DCB versus DES was shown because the 95% CI of the absolute difference in MACE in the per-protocol population was below the predefined margin (-3·83 to 3·93%, p=0·0217). After 12 months, the proportions of MACE were similar in both groups of the full-analysis population (MACE was 7·5% for the DCB group vs 7·3% for the DES group; hazard ratio [HR] 0·97 [95% CI 0·58-1·64], p=0·9180). There were five (1·3%) cardiac-related deaths in the DES group and 12 (3·1%) in the DCB group (full analysis population). Probable or definite stent thrombosis (three [0·8%] in the DCB group vs four [1·1%] in the DES group; HR 0·73 [0·16-3·26]) and major bleeding (four [1·1%] in the DCB group vs nine [2·4%] in the DES group; HR 0·45 [0·14-1·46]) were the most common adverse events. INTERPRETATION In small native coronary artery disease, DCB was non-inferior to DES regarding MACE up to 12 months, with similar event rates for both treatment groups. FUNDING Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Basel Cardiovascular Research Foundation, and B Braun Medical AG.
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Affiliation(s)
- Raban V Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Ahmed Farah
- Knappschaftskrankhenhaus, Klinikum Westfalen, Dortmund, Germany
| | | | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany; Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | | | | | | | | | | | | | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany; Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | | | | | | | - Nicole Gilgen
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- University Hospital Basel, University of Basel, Basel, Switzerland
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Iantorno M, Weintraub WS. Cost-Effectiveness and Economic Burden of PCI. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:561-563. [PMID: 30146118 DOI: 10.1016/j.carrev.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Micaela Iantorno
- Section of Interventional Cardiology, MedStar Heart & Vascular Institute, Georgetown University, Washington, DC
| | - William S Weintraub
- Section of Interventional Cardiology, MedStar Heart & Vascular Institute, Georgetown University, Washington, DC.
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29
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Byrne RA, Stone GW, Ormiston J, Kastrati A. Coronary balloon angioplasty, stents, and scaffolds. Lancet 2017; 390:781-792. [PMID: 28831994 DOI: 10.1016/s0140-6736(17)31927-x] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/24/2017] [Accepted: 06/28/2017] [Indexed: 01/01/2023]
Abstract
Since the first coronary angioplasty on Sept 16, 1977, the field of percutaneous coronary intervention has evolved rapidly. Now marking its 40th anniversary, percutaneous coronary intervention has become one of the most common medical procedures worldwide. Much of this progress has been due to the iteration and improvement of angioplasty technologies. Balloon angioplasty was limited by unpredictable procedural outcomes due to vessel dissection and recoil, and a high rate of restenosis. The introduction of stents resulted in more stable early results and lower rates of restenosis, although early stent thrombosis and neointimal hyperplasia causing vessel renarrowing were key limitations. Drug-eluting stents delivering antiproliferative agents significantly lowered the rates of restenosis, permitting widespread use of percutaneous coronary intervention in more advanced and complex disease. Although fully bioresorbable scaffolds have the potential to further improve long-term outcomes, they have not yet achieved results equivalent to those of conventional metallic drug-eluting stents in the early years after implantation. Progress in catheter technology did not occur in isolation, and the success of percutaneous coronary intervention is also due to important advances in intracoronary imaging, and adjunct pharmacotherapy-each of which is reviewed in other papers in this Series.
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Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislaufforschung (German Centre for Cardiovascular Research), Munich, Germany.
| | - Gregg W Stone
- New York Presbyterian Hospital and Columbia University Medical Center, New York, NY, USA; The Cardiovascular Research Foundation, New York, NY, USA
| | | | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislaufforschung (German Centre for Cardiovascular Research), Munich, Germany
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30
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Schwann TA. The Surgical Treatment of Coronary Artery Occlusive Disease: Modern Treatment Strategies for an Age Old Problem. Surg Clin North Am 2017; 97:835-865. [PMID: 28728719 DOI: 10.1016/j.suc.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coronary artery disease remains a formidable challenge to clinicians. Percutaneous interventions and surgical techniques for myocardial revascularization continue to improve. Concurrently, in light of emerging data, multiple practice guidelines have been published guiding clinicians in their therapeutic decisions. The multidisciplinary Heart Team concept needs to be embraced by all cardiovascular providers to optimize patient outcomes.
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Affiliation(s)
- Thomas A Schwann
- Department of Surgery, University of Toledo College of Medicine & Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA.
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31
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Lipinski MJ, Satler LF. Contrast-induced nephropathy and peripheral intervention: Who's keeping track? Catheter Cardiovasc Interv 2017; 88:274-5. [PMID: 27530192 DOI: 10.1002/ccd.26699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 11/10/2022]
Abstract
The incidence of contrast-induced nephropathy is high at approximately 10% following peripheral angiography and intervention. The same measures taken to protect against contrast-induced nephropathy and acute kidney injury for coronary angiography and intervention should be applied for peripheral angiography and intervention. Greater or mandatory reporting to the Peripheral Vascular Intervention (PVI) Registry of the NCDR may not only better ascertain the true incidence of CIN in general practice, but to also provide benchmarks for institutions to improve patient outcomes.
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Affiliation(s)
- Michael J Lipinski
- Division of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Division of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC
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32
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Paul AD, Avadhani R, Subramanyam K. Anomalous origins and branching patterns in coronary arteries – An angiographic prevalence study. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Heinroth KM, Unverzagt S, Mahnkopf D, Frantz S, Prondzinsky R. The double guidewire approach for transcoronary pacing in a porcine model. Med Klin Intensivmed Notfmed 2016; 112:622-628. [PMID: 27878578 DOI: 10.1007/s00063-016-0235-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transcoronary pacing is used for treatment of unheralded bradycardias in the setting of percutaneous coronary interventions (PCI). OBJECTIVES In the present study we introduced a new concept - the double guidewire approach - for transcoronary pacing in a porcine model. METHODS Transcoronary pacing was applied in 16 adult pigs under general anaesthesia in an animal catheterization laboratory. A special guidewire with electrical insulation by PTFE coating except for the distal part of the guidewire was positioned in the periphery of a coronary artery serving as the cathode. As the indifferent anode, an additional standard floppy tip guidewire was advanced into the proximal part of the same coronary vessel. The efficacy of double guidewire transcoronary pacing was assessed by measurement of threshold and impedance data and the magnitude of the epicardial electrogram compared with unipolar transcoronary pacing using a standard cutaneous patch electrode as indifferent anode. RESULTS Transcoronary pacing was effective in all cases. Pacing thresholds obtained with the double guidewire technique (1.5 ± 0.9 V) were similar to those obtained by standard unipolar transcoronary pacing with a cutaneous patch electrode (1.2 ± 0.7 V) and unipolar transvenous pacing against the same cutaneous patch electrode (1.5 ± 1.0 V). Bipolar transvenous pacing yielded the lowest pacing threshold at 0.8 ± 0.4 V. CONCLUSIONS Transcoronary pacing in the animal model with the novel "double guidewire approach" is a simple and effective pacing technique with comparable pacing thresholds obtained by standard unipolar transcoronary and transvenous pacing.
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Affiliation(s)
- K M Heinroth
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle, Germany.
| | - S Unverzagt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - D Mahnkopf
- IMTR GmbH Rottmersleben, Rottmersleben, Germany
| | - S Frantz
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle, Germany
| | - R Prondzinsky
- Department of Medicine I, Klinikum Merseburg, Merseburg, Germany
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Caixeta A, Ybarra LF, Latib A, Airoldi F, Mehran R, Dangas GD. Coronary Artery Dissections, Perforations, and the No-Reflow Phenomenon. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Adriano Caixeta
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | - Luiz Fernando Ybarra
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | - Azeem Latib
- San Raffaele Scientific Institute; Milan Italy
| | | | - Roxana Mehran
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
| | - George D. Dangas
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
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Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation. Circ Cardiovasc Interv 2016; 9:e003553. [DOI: 10.1161/circinterventions.115.003553] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/25/2016] [Indexed: 01/24/2023]
Abstract
Background—
Intravascular ultrasound detects stent edge dissections after percutaneous coronary intervention that are not seen angiographically. This study investigated the association between stent edge dissections and clinical outcomes.
Methods and Results—
ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a large-scale, prospective, multicenter study of patients undergoing drug-eluting stent implantation. In this prospective substudy, 2062 patients (2433 lesions) were evaluated with intravascular ultrasound to characterize the morphological features and clinical outcomes of stent edge dissection after percutaneous coronary intervention. The prevalence of post–percutaneous coronary intervention stent edge dissection was 6.6% per lesion (161 of 2433). Calcified plaque at the proximal stent edge (relative risk [RR]=1.72;
P
=0.04) and proximal stent edge expansion (RR=1.18;
P
=0.004) were predictors for proximal dissection; attenuated plaque at the distal stent edge (RR=3.52;
P
=0.004), distal reference plaque burden (RR=1.56;
P
<0.0001), and distal edge stent expansion (RR=1.11;
P
=0.02) were predictors for distal dissection. At 1-year follow-up, target lesion revascularization was more common in lesions with versus without dissection (5.2% versus 2.7%;
P
=0.04). Multivariable analysis indicated that residual dissection was associated with target lesion revascularization at 1-year follow-up (RR=2.67;
P
=0.02). Among lesions with dissection, smaller effective lumen area increased the risk of target lesion revascularization at 1-year follow-up (cutoff value of 5.1 mm
2
;
P
=0.05).
Conclusions—
Greater stent expansion and the presence of large, calcified, and/or attenuated plaques were independent predictors of stent edge dissection. Residual stent edge dissection, especially with a smaller effective lumen area, was associated with target lesion revascularization during 1-year follow-up after drug-eluting stent implantation.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00638794.
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36
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Gold RL, Rios JC. Iatrogenic Cardiovascular Disease Secondary to Diagnostic and Therapeutic Procedures. J Intensive Care Med 2016. [DOI: 10.1177/088506668700200107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The number of diagnostic and therapeutic procedures performed in cardiology continues to grow. These pro cedures are generally considered safe or of minimal risk to the patient. However, it is important to remember that significant complications may occur, and in each patient the risk: benefit ratio must be carefully weighed. In this review, the complications documented in the medical literature resulting from the use of cardiologic interventions and procedures are discussed. A thorough knowledge of these complications and their precipitat ing factors can help minimize the risk to the patient.
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Affiliation(s)
- Robert L. Gold
- Division of Cardiovascular Medicine, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01605
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37
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Development and assessment of kerateine nanoparticles for use as a hemostatic agent. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 63:352-8. [DOI: 10.1016/j.msec.2016.03.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/09/2016] [Accepted: 03/01/2016] [Indexed: 12/16/2022]
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38
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Nie SP, Wang X. Identification and Management of Iatrogenic Aortocoronary Dissection. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2016.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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39
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Byrne RA, Joner M. Drug-Coated Balloon Angioplasty for De Novo Stenosis: The Balloon is Back…Reloaded! JACC Cardiovasc Interv 2015; 8:2010-2012. [PMID: 26627991 DOI: 10.1016/j.jcin.2015.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 10/12/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; CVPath Institute, Gaithersburg, Maryland
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40
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Kleiman NS. Is it time to join the cult? Radial access and percutaneous coronary intervention. Circ Cardiovasc Interv 2015; 8:e002745. [PMID: 26056250 DOI: 10.1161/circinterventions.115.002745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neal S Kleiman
- From the Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX; and Weill Cornell Medical College, New York, NY.
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41
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Allahwala UK, Cockburn JA, Shaw E, Figtree GA, Hansen PS, Bhindi R. Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention. EUROINTERVENTION 2015; 10:1154-9. [DOI: 10.4244/eijv10i10a190] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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42
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Zhang SS, Wang W, Zhao CQ, Xie MJ, Li WY, Yang XL, Lv JG. Inhibitory effects of roscovitine on proliferation and migration of vascular smooth muscle cells in vitro. ACTA ACUST UNITED AC 2014; 34:791-795. [PMID: 25480571 DOI: 10.1007/s11596-014-1354-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 10/30/2014] [Indexed: 12/31/2022]
Abstract
Abnormal proliferation and migration of vascular smooth muscle cells (VSMCs) are the major cause of in-stent restenosis (ISR). Intervention proliferation and migration of VSMCs is an important strategy for antirestenotic therapy. Roscovitine, a second-generation cyclin-dependent kinase inhibitor, can inhibit cell cycle of multiple cell types. We studied the effects of roscovitine on cell cycle distribution, proliferation and migration of VSMCs in vitro by flow cytometry, BrdU incorporation and wound healing assay, respectively. Our results showed that roscovitine increased the proportion of G0/G1 phase cells after 12 h (69.57±3.65 vs. 92.50±1.68, P=0.000), 24 h (80.87±2.24 vs. 90.25±0.79, P=0.000) and 48 h (88.08±3.86 vs. 88.87±2.43, P=0.427) as compared with control group. Roscovitine inhibited proliferation and migration of VSMCs in a concentration-dependent way. With the increase of concentration, roscovitine showed increased capacity for growth and migration inhibition. Roscovitine (30 μmol/L) led to an almost complete VSMCs growth and migration arrest. Combined with its low toxicity and selective inhibition to ISR-VSMCs, roscovitine may be a potential drug in the treatment of vascular stenosis diseases and particularly useful in the prevention and treatment of ISR.
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Affiliation(s)
- Shuang-Shuang Zhang
- Department of Cardiovascular Medicine, Huazhong University of Science and Technology, Wuhan, 430030, China.,Department of Cardiovascular Medicine, The Central Hospital of Wuhan, Wuhan, 430014, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chong-Qiang Zhao
- Department of Cardiovascular Medicine, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Min-Jie Xie
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wen-Yu Li
- Department of Cardiovascular Medicine, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiang-Li Yang
- Department of Cardiovascular Medicine, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jia-Gao Lv
- Department of Cardiovascular Medicine, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Tepe G, Zeller T, Schnorr B, Claussen CD, Beschorner U, Brechtel K, Scheller B, Speck U. High-grade, non-flow-limiting dissections do not negatively impact long-term outcome after paclitaxel-coated balloon angioplasty: an additional analysis from the THUNDER study. J Endovasc Ther 2014; 20:792-800. [PMID: 24325695 DOI: 10.1583/13-4392r.1] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the impact of using paclitaxel-coated balloons (PCB) on outcome after post-angioplasty dissection in femoropopliteal arteries. METHODS The angiograms obtained in the THUNDER study (ClinicalTrials.gov identifier NCT00156624) were analyzed to compare degrees of dissection and angiographic parameters between the control (uncoated balloons, n=43) and treatment (PCBs, n=43) groups before and after the intervention and at 6-month follow-up. Furthermore, target lesion revascularizations (TLR) were documented up to 2 years. RESULTS In each group, 24 (56%) patients had a dissection after the intervention. At the 6-month follow-up, patients with dissection of any grade after treatment with PCBs had significantly less late lumen loss (0.4 mm) than patients with dissection after treatment with uncoated balloons (1.9 mm, p=0.001) and a lower degree of stenosis (20% vs. 51%, respectively; p=0.003). Patients with severe dissection (grades C, D, or E) especially seemed to benefit from the PCBs, with late lumen loss of 0.4 mm vs. 2.4 mm for controls (p=0.05). The binary restenosis rate was also markedly lower in the PCB group (20%) than in the uncoated group (55%, p=0.02). In the 2-year follow-up, TLR was performed in 56% of patients in the control group compared to 10% of patients in the PCB group (p=0.002). CONCLUSION The results of this subgroup analysis suggest that patients with dissection following treatment with a paclitaxel-coated balloon have a very acceptable outcome and stent implantation is not necessary as long as the dissection does not result in acute flow limitation.
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44
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Shivaraju A, Yu C, Kattan MW, Xie H, Shroff AR, Vidovich MI. Temporal trends in percutaneous coronary intervention--associated acute cerebrovascular accident (from the 1998 to 2008 Nationwide Inpatient Sample Database). Am J Cardiol 2014; 114:206-13. [PMID: 24952927 DOI: 10.1016/j.amjcard.2014.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 11/24/2022]
Abstract
Acute cerebrovascular accident (CVA) after percutaneous coronary intervention (PCI) for acute coronary syndrome and coronary artery disease is associated with high rates of morbidity and mortality. Nationwide Inpatient Sample from 1998 to 2008 was used to identify 1,552,602 PCIs performed for acute coronary syndrome and coronary artery disease. We assessed temporal trends in the incidence, predictors, and prognostic impact of CVA in a broad range of patients undergoing PCI. The overall incidence of CVA was 0.56% (95% confidence interval [CI] 0.55 to 0.57). The incidence of CVA remained unchanged over the study period (adjusted p for trend=0.2271). The overall mortality rate in the CVA group was 10.76% (95% CI 10.1 to 11.4). The adjusted odds ratio (OR) of CVA for in-hospital mortality was 7.74 (95% CI 7.00 to 8.57, p<0.0001); this remained high but decreased over the study period (adjusted p for trend<0.0001). Independent predictors of CVA included older age (OR 1.03, 95% CI 1.02 to 1.03, p<0.0001), disorder of lipid metabolism (OR 1.31, 95% CI 1.24 to 1.38, p<0.001), history of tobacco use (OR 1.21, 95% CI 1.10 to 1.34, p=0.0002), coronary atherosclerosis (OR 1.56, 95% CI 1.43 to 1.71, p<0.0001), and intra-aortic balloon pump use (OR 1.39, 95% CI 1.09 to 1.77, p=0.0073). A nomogram for predicting the probability of CVA achieved a concordance index of 0.73 and was well calibrated. In conclusion, the incidence of CVA associated with PCI has remained unchanged from 1998 to 2008 in face of improved equipment, techniques, and adjunctive pharmacology. The risk of CVA-associated in-hospital mortality is high; however, this risk has decreased over the study period.
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45
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Gopalakrishnan L, Ramana LN, Sethuraman S, Krishnan UM. Ellagic acid encapsulated chitosan nanoparticles as anti-hemorrhagic agent. Carbohydr Polym 2014; 111:215-21. [PMID: 25037345 DOI: 10.1016/j.carbpol.2014.03.093] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/26/2014] [Accepted: 03/28/2014] [Indexed: 01/06/2023]
Abstract
Ellagic acid, a naturally occurring polyphenol was encapsulated in chitosan particles prepared by ionotropic gelation and characterized for its physicochemical properties. A maximum encapsulation efficiency of 49% was achieved. The blood clotting time and clot retraction time were calculated for different concentrations of ellagic acid, chitosan and ellagic acid-encapsulated chitosan. A reduction of 34% in the clot time and 16.4% in the retraction time was observed in ellagic acid-encapsulated chitosan when compared with free ellagic acid at concentrations as low as 0.1mg/mL. The physical blend in comparison to free ellagic acid displayed a reduction of 13.8% and 4.6% in the clotting time and retraction time respectively under similar conditions. This suggests that the encapsulation of ellagic acid favors thrombosis due to synergistic action of chitosan and ellagic acid on same molecular targets. This study demonstrates the potential of ellagic acid-chitosan system as an effective anti-hemorrhagic system.
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Affiliation(s)
- Lalitha Gopalakrishnan
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), School of Chemical & Biotechnology, SASTRA University, Thanjavur - 613 401, Tamil Nadu, India
| | - Lakshmi Narashimhan Ramana
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), School of Chemical & Biotechnology, SASTRA University, Thanjavur - 613 401, Tamil Nadu, India
| | - Swaminathan Sethuraman
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), School of Chemical & Biotechnology, SASTRA University, Thanjavur - 613 401, Tamil Nadu, India
| | - Uma Maheswari Krishnan
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), School of Chemical & Biotechnology, SASTRA University, Thanjavur - 613 401, Tamil Nadu, India.
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46
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Estrada JR, Paul JD, Shah AP, Nathan S. Overview of Technical and Cost Considerations in Complex Percutaneous Coronary Intervention. Interv Cardiol 2014; 9:17-22. [PMID: 29588772 PMCID: PMC5808630 DOI: 10.15420/icr.2011.9.1.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/23/2014] [Indexed: 11/04/2022] Open
Abstract
Complex percutaneous coronary intervention (PCI), encompassing an ever-expanding range of challenging lesion sets and patient populations, accounts for a significant proportion of PCI procedures being performed currently. Specific lesion types associated with lower rates of procedural success and higher rates of recurrence or major adverse cardiac events (MACE) include multivessel disease, unprotected left main coronary artery disease, fibrocalcific or undilatable lesions, chronic total occlusions, degenerated saphenous vein graft lesions, thrombotic lesions, and bifurcation disease. Validated tools and technical strategies currently exist to address most procedural scenarios encountered and should be familiar to the complex PCI operator. Anticipated clinical outcomes, projected resource utilization, and cost considerations should all factor into the decisions of when, how, and in whom to intervene.
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Affiliation(s)
- J Raider Estrada
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
| | - Jonathan D Paul
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
| | - Atman P Shah
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
| | - Sandeep Nathan
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
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47
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Barlis P, van Soest G, Serruys PW, Regar E. Intracoronary optical coherence tomography and the evaluation of stents. Expert Rev Med Devices 2014; 6:157-67. [DOI: 10.1586/17434440.6.2.157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Fanelli F, Cannavale A, Gazzetti M, D'Adamo A. Commentary: how do we deal with dissection after angioplasty? J Endovasc Ther 2013; 20:801-4. [PMID: 24325696 DOI: 10.1583/13-4392c.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Stabile E, Ambrosini V, Squarcia R, Salemme L, Popusoi G, Esposito G, Trimarco B, Rubino P. Percutaneous sympathectomy of the renal arteries: the OneShot™ Renal Denervation System is not associated with significant vessel wall injury. EUROINTERVENTION 2013; 9:694-9. [DOI: 10.4244/eijv9i6a113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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50
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Werner N, Bauer T, Hochadel M, Zahn R, Weidinger F, Marco J, Hamm C, Gitt AK, Zeymer U. Incidence and Clinical Impact of Stroke Complicating Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2013; 6:362-9. [DOI: 10.1161/circinterventions.112.000170] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Stroke is a rare but serious complication of percutaneous coronary interventions (PCIs). So far, scant information is available about the incidence and outcome of patients developing stroke after PCI for stable angina or acute coronary syndrome (ACS) in daily clinical practice in Europe today.
Methods and Results—
Between 2005 and 2008, 46 888 patients undergoing PCI were enrolled into the PCI Registry of the Euro Heart Survey Programme (176 centers in 33 European countries) to document patient’s characteristics, PCI details, and hospital complications in different PCI indications. Stroke was observed in 0.4% of the procedures in the total population, in 0.3% of PCIs in elective patients, and in 0.6% in PCIs performed for ACS. The overall in-hospital mortality was 19.2% for patients who developed stroke (elective PCIs, 10.0%; PCI for ACS, 23.2%) compared with 1.3% for those without stroke (elective PCIs, 0.2%; PCI for ACS, 2.3%). In multivariate analysis hemodynamic instability, age ≥75 years, history of stroke, and congestive heart failure were found to be independent predictors for periprocedural stroke in ACS, whereas only PCI of a bypass graft and renal failure could be identified as independent predictors for stroke in elective patients.
Conclusions—
Stroke as complication of PCI occurs rarely (0.4%) in clinical practice in Europe today. However, peri-interventional stroke is still associated with an exceedingly high in-hospital mortality rate. Most predictors for periprocedural stroke are not modifiable and cannot be diminished before PCI. Therefore, treatment of patients with stroke after PCI needs further research.
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Affiliation(s)
- Nicolas Werner
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Timm Bauer
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Matthias Hochadel
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Ralf Zahn
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Franz Weidinger
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Jean Marco
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Christian Hamm
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Anselm K. Gitt
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Uwe Zeymer
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
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