Volume 27 - Issue 4 - April, 2015

Hemodynamic Effects of Standard Versus Larger-Capacity Intraaortic Balloon Counterpulsation Pumps

Navin K. Kapur, MD;  Vikram Paruchuri, MD;  Arjun Majithia, MD;  Michele Esposito, MD;  Henry Shih, MD;  Andrew Weintraub, MD;  Michael Kiernan, MD;  Duc Thinh Pham, MD;  David Denofrio, MD;  Carey Kimmelstiel, MD

Several recent trials have examined the clinical utility of intraaortic balloon counterpulsation pumps (IABPs) in cardiogenic shock and acute coronary syndromes. More recently, a larger-capacity 50 cc IABP was introduced into practice. This study explores the hemodynamic effects of the 50 cc IABP in real-world clinical practice. ...

Commentary: Differential Hemodynamic Profile of High-Capacity Intraaortic Balloon Pumps — New Promise for an Antiquated Technology?

Jonathan Grinstein, MD and Sandeep Nathan, MD, MSc

IABPs likely still have a role in the management of high-risk patients with and without cardiogenic shock. The 50 cc balloon appears to offer both an enhanced as well as more consistent hemodynamic response when compared with the 40 cc balloon; whether this will translate into meaningful morbidity and mortality benefits remains to be seen and should whet our appetite for future prospective studies....

First Optical Coherence Tomography Follow-up of Coronary Bifurcation Lesions Treated by Drug-Eluting Balloons

Gregory A. Sgueglia, MD, PhD1;  Nicolas Foin, MSc, PhD2;  Daniel Todaro, MD, PhD3;  Antonino Stipo, MD3; Justin E. Davies, MD, PhD2;  Achille Gaspardone, MD, MPhil1;  Carlo Di Mario, MD, PhD4;  Edoardo Pucci, MD3

Percutaneous bifurcation intervention with provisional bare-metal stent (BMS) implantation followed by drug-eluting balloon (DEB) treatment represents a valuable opportunity in patients not compliant with long-duration dual-antiplatelet therapy. This study uses optical coherence tomography to assess coronary bifurcation lesions treated by BMS and DEB and explores the association between stent geometry and tissue coverage....

Comparison of Fluoro and Cine Coronary Angiography: Balancing Acceptable Outcomes With a Reduction in Radiation Dose

Ayhan Olcay, MD1;  Ekrem Guler, MD1;  Ibrahim Oguz Karaca, MD1;  Mehmet Onur Omaygenc, MD1; Filiz Kizilirmak, MD1;  Erkam Olgun, MD1;  Esra Yenipinar, RN1;  Huseyin Altug Cakmak, MD2;  Dursun Duman, MD

Use of last fluoro hold (LFH) mode in fluoroscopy, which enables the last live image to be saved and displayed, could reduce radiation during percutaneous coronary intervention when compared with cine mode. This is the first study to compare coronary angiography radiation doses and image quality between LFH and conventional cine mode techniques. ...

The Association Between the Extent of Coronary Artery Disease and Major Bleeding Events After Percutaneous Coronary Intervention: From the ACUITY Trial

Mahesh V. Madhavan, MD1,*;  Philippe Généreux, MD1,2,3,*;  Tullio Palmerini, MD4;  Adriano Caixeta, MD, PhD5;  Ke Xu, PhD2;  Thomas C. McAndrew, MS2;  Dominic P. Francese, MPH2;  Ajay J. Kirtane, MD, MS1,2;  Roxana Mehran, MD2,6;  Gregg W. Stone, MD1,2

The relationship between the extent of coronary artery disease (CAD) and bleeding after PCI remains understudied. This study sought to evaluate the relation between the extent of CAD and bleeding risk in patients undergoing PCI for non-ST segment elevation acute coronary syndrome. ...

Clinical Outcomes of Patients With Critical Limb Ischemia who Undergo Routine Coronary Angiography and Subsequent Percutaneous Coronary Intervention

Michael S. Lee, MD1;  Seung-Woon Rha, MD2;  Seung Kyu Han, MD3;  Byoung Geol Choi, MS2;  Se Yeon Choi, MS2;  Yoonjee Park, MD2;  Raghu Akkala, MD2;  Hu Li, MD2;  Sung Il Im, MD2;  Ji Bak Kim, MD2;  Sunki Lee, MD2;  Jin Oh Na, MD2;  Cheol Ung Choi, MD2;  Hong Euy Lim, MD2;  Jin Won Kim, MD2;  Eung Ju Kim, MD2;  Chang Gyu Park, MD2;  Hong Seog Seo, MD2;  Dong Joo Oh, MD2

Critical limb ischemia is associated with a high risk of cardiovascular ischemic events. We assessed the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty. ...

Forearm Arterial Anatomy and Flow Characteristics: A Prospective Observational Study

Samir B. Pancholy, MD1;  Laura A. Heck1;  Tejas Patel, MD2

Morphometric data on Caucasian radial and ulnar arteries are limited, with no data on flow interdependence in the forearm arterial circuit. We evaluated 250 upper extremities in 125 patients, performing ultrasonography to measure and compare radial and ulnar artery lumen diameters. ...

The Clinical Implications of Balloon Rupture During Cardiovascular Interventions

Georgios Christopoulos, MD;  Michael Luna, MD;  Emmanouil S. Brilakis, MD, PhD

Balloon rupture is an infrequent complication of cardiac catheterization that can lead to vessel injury. We report 6 cases that highlight the potential consequences of balloon rupture, including perforation, dissection, balloon entrapment, and distal embolization, and discuss prevention and treatment strategies....

Transcatheter Closure of Five Atrial Septal Communications in the Presence of Severe Pulmonary Arterial Hypertension and Severe Left Ventricular Non-Compliance

Michael P. Flaherty, MD, PhD1; Sameh Sayfo, MD1;  Jon Resar, MD2

We describe a hemodynamic conundrum in a patient with five septal communications in whom the coexistence of unmasked bidirectional physiologic shunting, severe pulmonary arterial hypertension, and worsening left-sided overload dissuaded initial closure. We report our strategy for hemodynamic evaluation and successful closure of all defects....

Rotational Atherectomy in the Era of Cost Containment

Paula Mota, MD1;  Romeu Cação2;  António Leitão Marques, MD3

Interventional cardiologists are frequently asked to reduce procedural costs, and devices that are initially thought to be more expensive can sometimes reduce overall costs. This was the case at our institution with direct Rotawire and rotational atherectomy; our letter discusses the cost savings in two interesting cases....

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