April 2019 Table of Contents

Original Contributions

Coronary Artery Disease

Procedural Impact of a Kissing-Balloon Predilation (Pre-Kissing) Technique in Patients With Complex Bifurcations Undergoing Drug-Eluting Stenting

Francesco Burzotta, MD, PhD*;  Osama Shoeib, MD, PhD*;  Cristina Aurigemma, MD, PhD;  Italo Porto, MD, PhD;   Antonio Maria Leone, MD, PhD;  Giampaolo Niccoli, MD, PhD;  Lorenzo Genuardi, MD;  Carlo Trani, MD;  Filippo Crea, MD   *Joint first authors

This study was designed to help assess the impact of lesion predilation with kissing inflation using under-sized balloons (pre-kissing) on the procedural outcome of percutaneous coronary intervention (PCI) on complex bifurcation lesions (CBLs). Patients who underwent PCI with second-generation drug-eluting stent implantation on a CBL (Medina 1,1,1 or 1,0,1 or 0,1,1) were selected. The PCI procedural details were assessed to evaluate occurrence of “side-branch trouble” (primary procedural endpoint) after main-vessel stenting. Angiographic characteristics, including side-branch TIMI flow during PCI, were also systematically evaluated.

J INVASIVE CARDIOL 2019;31(4):80-88.

Transcatheter Tricuspid Repair

Reverse Cardicac Remodeling After Transcatheter Treatment of Severe Tricuspid Regurgitation Using the Edge-to-Edge MitraClip Technique

Jakob Ledwoch, MD;  Carmen Fellner;  Felix Poch;  Leonhard Schlatterbeck;  Michael Dommasch, MD;  Ralf Dirschinger, MD;  Anja Stundl, MD;  Karl-Ludwig Laugwitz, MD;  Christian Kupatt, MD;  Petra Hoppmann, MD

In recent years, transcatheter treatment techniques for tricuspid regurgitation have rapidly evolved. Cardiac remodeling analysis beyond clinical outcome assessment following transcatheter tricuspid repair is still lacking. The aim of the present series was to analyze cardiac remodeling after tricuspid valve repair using the edge-to-edge Mitra-Clip technique.

J INVASIVE CARDIOL 2019;31(4):89-93.

Coronary Artery Disease

Paclitaxel Drug-Coated Balloon After Bare-Metal Stent Implantation, an Alternative Treatment to Drug-Eluting Stent in High Bleeding Risk Patients (The Panelux Trial)

Jerome Roncalli, MD, PhD;  Matthieu Godin, MD;  Kamel Boughalem, MD;  John Shayne, MD;  Christophe Piot, MD, PhD;  Bruno Huret, MD;  Loic Belle, MD;  Guillaume Cayla, MD, PhD;  Benjamin Faurie, MD;  Max Amor, MD;  Bernard Karsenty, MD;  Florence Leclercq, MD, PhD

Prolonged dual-antiplatelet therapy in high bleeding risk (HBR) patients undergoing percutaneous coronary intervention can be challenging. We assessed the clinical safety of bare-metal stent implantation followed by drug-coated balloon treatment in (HBR) patients for whom drug-eluting stent implantation could be problematic in maintaining low ischemic event rate without increasing hemorrhagic events. This strategy might be an alternative to drug-eluting stent implantation in HBR patients if future randomized trials support this approach.

J INVASIVE CARDIOL 2019;31(4):94-100.

Chronic Total Occlusions

In-Hospital Outcomes of Rotational Atherectomy in High-Risk Patients With Severely Calcified Left Main Coronary Artery Disease: A Single-Center Experience

Ashwat S. Dhillon, MD;  Meena R. Narayanan, MD;  Han Tun, MBBS, MPH;  Antreas Hindoyan, MD;  Ray Matthews, MD; Anilkumar Mehra, MD;  David M. Shavelle, MD;  Leonardo C. Clavijo, MD, PhD

Severe coronary artery calcification is a challenge for percutaneous coronary intervention, particularly in left main coronary artery disease. Rotational atherectomy is a useful tool for modification of calcified plaque prior to intervention. We report our experience with rotational atherectomy for severely calcified left main coronary artery disease in 55 patients.

J INVASIVE CARDIOL 2019;31(4):101-106. (Epub 2019 January 15).

Radial Access Technique

Safety of Calcium-Channel Blockers During Radial Cardiac Catheterization in Patients With Acute Myocardial Infarction or Systolic Heart Failure

Barbara D. Lawson, MD;  M. Zubair Khan, MBBS;  Richard H. Cooke, MD;   J. Emilio Exaire, MD;  Luis A. Guzman, MD;  Zachary M. Gertz, MD

Adoption of the radial approach for cardiac catheterization has been slow in the United States, possibly because of concern over radial artery vasospasm. Spasmolytic drugs, typically intra-arterial calcium-channel blockers (CCBs), are used to prevent spasm, but their safety is not well established in high-risk populations, such as those with ST-segment elevation myocardial infarction or systolic heart failure, in whom CCB may be contraindicated. The aim of this study was to evaluate the safety of CCBs during radial artery catheterization in two populations with a contraindication to their use.

J INVASIVE CARDIOL 2019;31(4):107-110. (Epub 2018 December 15).

Peripheral Vascular Disease

A Percutaneous Crossing Algorithm for Femoropopliteal and Tibial Artery Chronic Total Occlusions (PCTO Algorithm)

Subhash Banerjee, MD;  Mehdi H. Shishehbor, DO, MPH, PhD;   Jihad A. Mustapha, MD;  Ehrin J. Armstrong, MD, MSc;  Mohammad Ansari, MD;  John H. Rundback, MD;  Bryan Fisher, MD; Constantino S. Peña, MD;  Emmanouil S. Brilakis, MD, PhD;  Arthur C. Lee, MD;  Sahil Parikh, MD

Peripheral artery chronic total occlusions (PCTOs) are frequently encountered during endovascular treatment of peripheral artery disease. Failure to successfully cross PCTOs accounts for the majority of unsuccessful endovascular procedures and associated complications. This review outlines a contemporary ultrasound-based approach to crossing femoropopliteal PCTOs based on a review of prospectively collected case report surveys, published evidence, and expert opinion compiled by the writing group members. 

J INVASIVE CARDIOL 2019;31(4):111-119.

Clinical Images

Prolonged Ultrasound-Assisted Catheter-Directed Low-Dose Thrombolysis for Acute Pulmonary Embolism Unresponsive to Systemic Thrombolysis

Alessandro Beneduce, MD;  Francesco Giannini, MD;  Gianmarco Iannopollo, MD;  Letizia Bertoldi, MD;  Francesco Melillo, MD;  Marta Panzeri, MD;  Roberto Nicoletti, MD;  Francesco De Cobelli, MD;  Francesco Gentile, MD;  Alberto Margonato, MD;  Antonio Colombo, MD;  Azeem Latib, MD

Our experience suggests that ultrasound-assisted thrombolysis with the EkoSonic system could be a valid bail-out strategy in cases of massive pulmonary embolism unresponsive to systemic thrombolysis and provides insight into the role of prolonged administration time in non-high bleeding risk patients with elevated thrombotic burden and initial suboptimal results. In this setting, multimodality imaging could guide patient selection and monitor treatment efficacy to individualize its duration in cases of slow hemodynamic improvement.

J INVASIVE CARDIOL 2019;31(4):E56-E57.

Clinical Images

Dissection Re-entry Technique: How is it Really Looking?

Ioannis Tsiafoutis, MD;  Athanasios Antonakopoulos, MD;  Michael Koutouzis, MD;   Konstantina Katsanou, MD;  Dimitrios Protogeros, MD;  Theodoros Zografos, MD, PhD

Dissection re-entry is a widely used technique in many chronic total occlusion centers. This account of a failed re-entry attempt provides in vivo photographic evidence of how the vessel looked after such an attempt. Operators are advised to keep dissection of subintimal space and hematoma limited and use dedicated materials and techniques for controlled re-entry.

J INVASIVE CARDIOL 2019;31(4):E58-E59.

Clinical Images

The Impact of Plaque Rupture on Mismatch Between Intravascular Ultrasound Minimal Lumen Area and Fractional Flow Reserve Measured in an Angiographically Borderline Left Main With Complex Left Anterior Descending Involvement 

Michał Świerczewski;  Zuzanna Sala;  Michał Gwidon Markiewicz, MD;  Gary S. Mintz, MD;   Łukasz Kalińczuk, MD

Plaque rupture is known to affect the mismatch between anatomy and physiology. In this case, we relied on fractional flow reserve along with the tomographic perspective of intravascular ultrasound.

J INVASIVE CARDIOL 2019;31(4):E60-E61.

Clinical Images

Cocaine-Associated ST-Elevation Myocardial Infarction: Different Pathophysiological Mechanisms

M.T. López-Lluva, MD;  A. Jurado-Román, PhD;  I. Sánchez-Pérez, MD;  J. Abellán-Huerta, PhD; Fernando Lozano Ruiz-Poveda, PhD

There are many underlying mechanisms for cocaine-associated myocardial infarction, and the culprit must be elucidated for appropriate therapeutic management. Optical coherence tomography provides unique insights when angiography alone has limited diagnostic value; it also aids in the decision between conservative management and revascularization strategy and guides coronary interventions.

J INVASIVE CARDIOL 2019;31(4):E62-E63.

Clinical Images

Percutaneous Closure of an Iatrogenic Perimembranous Ventricular Septal Defect After     Mechanical Aortic Valve Replacement Using a Novel Venous-Arteriovenous Loop

Chak-Yu So, MBChB;  Gary Shing-Him Cheung, MBBS;  Yat-Yin Lam, MD

This image illustrates the feasibility of percutaneous closure of perimembranous ventricular septal defect occluder in a patient with mechanical aortic valve replacement utilizing a novel venous-arteriovenous loop, and emphasizes the importance of concomitant fluoroscopic and echocardiographic guidance in structural heart interventions.

J INVASIVE CARDIOL 2019;31(4):E64-E65.

Clinical Images

Right Ventricular Wall Hematoma Following Angioplasty to Right Coronary Artery Occlusion

Mina S.A. Ghobrial, BMedSci, MBChB (Hons), MRCP and Mohaned Egred, BSc (Hons), MBChB, MD

Right ventricle intramural hematoma is a rare complication of right coronary artery PCI. With the increased uptake and prevalence of complex chronic total occlusion interventions, unusual complications will continue to occur; sharing and raising the awareness of these complications is of paramount importance.

J INVASIVE CARDIOL 2019;31(4):E66.

Brief Communications

Counterintuitively Crossing a Critically Stenosed Aortic Valve is a Diastolic Phenomenon

Amer Hawatmeh, MD;  Mohammad Thawabi, MD;  Nasir Asif;  Zain Khakwani, MD;  Nishant Sethi, MD; Yassir Nawaz, MD;  Rajiv Tayal, MD, MPH;  Marc Cohen, MD;  Najam Wasty, MD

There are no data in the literature indicating whether aortic valve crossing typically occurs during systole or diastole. We hypothesize that aortic valve crossing is a diastolic phenomenon and describe our technique for crossing critically stenosed aortic valves.

J INVASIVE CARDIOL 2019;31(4):E67-E68.


Acupuncture-Related Cardiac Complications: A Systematic Review

Waqas Ullah, MD;  Asrar Ahmad, MD;  Maryam Mukhtar, MBBS;  Hafeez Ul Hassan Virk, MD;     Usman Sarwar, MD;  Vincent Figueredo, MD

This literature review examines the burden of cardiac adverse events due to acupuncture; the 30 cases reported include infective endocarditis, cardiac tamponade, pericarditis, and cardiac rupture.

J INVASIVE CARDIOL 2019;31(4):E69-E72.