Peripheral Vascular Disease
Clinical Outcomes and Cost Comparisons of Stent and Non-Stent Interventions in Infrainguinal Peripheral Artery Disease: Insights From the Excellence in Peripheral Artery Disease (XLPAD) Registry
Subhash Banerjee, MD; Haekyung Jeon-Slaughter, PhD; Ehrin J. Armstrong, MD, MSc; Christopher Bajzer, MD; Mazen Abu-Fadel, MD; Houman Khalili, MD; Anand Prasad, MD; Bassel Bou Dargham, MD; Preeti Kamath, BDS, MHA; Tayo Addo, MD; Michael Luna, MD; Osvaldo Gigliotti, MD; Mazin Foteh, MD; Ian Cawich, MD; Scott Kinlay, MD; Mujtaba Ali, MD; Bala Ramanan, MD; Khusrow Niazi, MD; Shirling Tsai, MD; Nicolas W. Shammas, MD; Emmanouil S. Brilakis, MD, PhD
The contemporary limb outcomes and costs of stent-based vs non-stent based strategies in endovascular revascularization of femoropopliteal (FP) peripheral artery disease are not well understood. We present data on 2910 FP interventions in 2162 patients from the ongoing United States multicenter Excellence in Peripheral Artery Disease registry between 2006-2016 to compare stent vs non-stent treatment outcomes and associated costs in FP interventions.
Coronary Artery Disease
OCT Analysis of Very Early Strut Coverage of the Synergy Stent in Non-ST Segment Elevation Acute Coronary Syndrome Patients
Marc Laine, MD; Thibaut Dabry, MD; Nicolas Combaret, MD; Pascal Motreff, MD, PhD; Etienne Puymirat, MD, PhD; Franck Paganelli, MD, PhD; Franck Thuny, MD, PhD; Jennifer Cautela, MD; Michael Peyrol, MD; Julien Mancini, MD; Gilles Lemesle, MD, PhD; Laurent Bonello, MD, PhD
Early endothelialization of drug-eluting stents is a major challenge to reduce the risk of stent thrombosis and the duration of dual-antiplatelet therapy in high bleeding-risk patients. Our aim was to evaluate very early strut coverage with optical coherence tomography of the Synergy stent at 1 month in 3839 stent struts from 24 non-ST segment elevation acute coronary syndrome patients.
Transcatheter Aortic Valve Replacement
Immediate Improvement in Left Atrial Function After Transcatheter Aortic Valve Replacement on Doppler Echocardiography
Derek Phan, MD; Armen Chalian, MD; Raj Makkar, MD; Robert J. Siegel, MD; Florian Rader, MD, MSc
More than half of embolic strokes occur >24 hours after transcatheter aortic valve replacement (TAVR) and are therefore not directly procedure related. We aimed to determine immediate changes in left atrial (LA) function after TAVR, which may alter short-term and long-term stroke risk after TAVR. Transesophageal and transthoracic echocardiograms were therefore measured in 85 patients to evaluate LA appendage velocities and Doppler echocardiographic markers of function.
A Cancer Paradox: Machine-Learning Backed Propensity-Score Analysis of Coronary Angiography Findings in Cardio-Oncology
Dinu Valentin Balanescu, MD*; Dominique J Monlezun, MD*; Teodora Donisan, MD; David Boone, MD; Frances Cervoni-Curet, MD; Nicolas Palaskas, MD; Juan Lopez-Mattei, MD; Peter Kim, MD; Cezar Iliescu, MD; Serban Mihai Balanescu, MD *Joint first authors
Cancer has been proposed as a cardiovascular risk factor. We assessed the cardiovascular risk profile and coronary angiography findings of 240 cancer patients and 240 patients without cancer to compare the burden of angiographically detected coronary atherosclerosis.
Transcatheter Aortic Valve Replacement
Comparison Between Traditional and Guide-Catheter Extension Reverse Controlled Antegrade Dissection and Retrograde Tracking: Insights From the PROGRESS-CTO Registry
Iosif Xenogiannis, MD; Dimitri Karmpaliotis, MD; Khaldoon Alaswad, MD; Farouc A. Jaffer, MD, PhD; Robert W. Yeh, MD; Mitul Patel, MD; Ehtisham Mahmud, MD; James W. Choi, MD; M. Nicholas Burke, MD; Anthony H. Doing, MD; Phil Dattilo, MD; Catalin Toma, MD; A.J. Conrad Smith, MD; Barry Uretsky, MD; Oleg Krestyaninov, MD; Dmitrii Khelimskii, MD; Elizabeth Holper, MD; Srinivasa Potluri, MD; R. Michael Wyman, MD; David E. Kandzari, MD; Santiago Garcia, MD; Michalis Koutouzis, MD; Ioannis Tsiafoutis, MD; Wissam Jaber, MD; Habib Samady, MD; Jeffrey W. Moses, MD; Nicholas J. Lembo, MD; Manish Parikh, MD; Ajay J. Kirtane, MD; Ziad A. Ali, MD; Darshan Doshi, MD; Peter Tajti, MD; Bavana V. Rangan, BDS, MPH; Shuaib Abdullah, MD; Subhash Banerjee, MD; Emmanouil S. Brilakis, MD, PhD
The most common re-entry technique during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is reverse controlled antegrade and retrograde tracking (rCART). The use of guide-catheter extensions can facilitate rCART, but has received limited study. We compared the clinical and procedural characteristics and outcomes of traditional rCART vs guide-catheter extension rCART vs cases in which both techniques were used (combined rCART) in patients with successful retrograde CTO crossing in a contemporary, multinational, CTO-PCI registry.
Coronary Artery Disease
Impella CP Dislodgment, Swap, or Removal: Current Practices
Edo Kaluski, MD; Safi U. Khan, MD; Sudhakar Sattur, MD; Dan Sporn, MD; Maninder Singh, MD
The Impella CP (ICP) catheter offers hemodynamic superiority over the intra-aortic balloon pump. However, device-specific issues are occasionally encountered, especially when long-term mechanical circulatory support is required. We review the literature regarding the potential problems, including ICP dislodgment, ICP mechanical failure, and the need to remove the ICP while maintaining arterial access to either insert a new mechanical circulatory support device or to perform suture-based arteriotomy site closure, and also review the possible solutions to these issues.
Challenging Aorto-Coronary Occlusion: Which Solution?
Giovanni Lorenzoni, MD; Pierluigi Merella, MD; Gavino Casu, MD
Aorto-coronary occlusion is a particularly difficult lesion to treat, especially in an emergent setting. To our knowledge, this is the first description of the use of a microcatheter not to support the guidewire, but to open an aorto-coronary calcific occlusion with anterograde approach in an emergent situation.
Coronary Artery Tenting After Bypass Grafting: A Key Issue During Percutaneous Coronary Intervention of a Chronic Total Occlusion
Alfonso Jurado-Román, MD, PhD; José Ramón Rumoroso, MD; José Abellán-Huerta, MD, PhD; María T. López-Lluva, MD; Ignacio Sánchez-Pérez, MD; Fernando Lozano Ruíz-Poveda, MD, PhD
This image series shows how bypass grafts may tent the vessel to which they are anastomosed, potentially changing the expected course of the native coronary vessel. This fact must be taken into account during CTO-PCI, and this case emphasizes the importance of careful analysis of coronary anatomy with several angiographic projections.
Combined Percutaneous Treatment of Severe Triscuspid Regurgitation and Left Atrial Appendage Closure
Carlos Arellano-Serrano, MD; Vanessa Moñivas, MD, PhD; Rodrigo Estévez-Loureiro, MD, PhD
LAA closure and MitraClip implantation in the tricuspid position in the same procedure is a feasible and safe option in patients with a high surgical risk suffering from severe symptomatic tricuspid regurgitation and bleeding complications under anticoagulant therapy.
Optical Coherence Tomography Evaluation of Coronary Dissection and Intramural Hematoma
Umair Hayat, MBBS; Paul D. Williams, MD; David Austin, MD
Image shows an extensive intramural hematoma causing luminal compression corresponding to the angiographic stenosis. Although intramural hematomas are identifiable on intravascular ultrasound, OCT offers superior characterization and exclusion of alternate diagnoses, such as plaque erosion.
“Single Arm-Double Access” for CTO Intervention
Michael Koutouzis, MD, PhD; Eleftherios Kontopodis, MD; Andreas Tassopoulos, MD; Ioannis Tsiafoutis, MD; Nikolaos Oikonomidis, MD; Efstathios Lazaris, MD
To our knowledge, this is the first reported case of a dual-access approach for CTO intervention using transradial and ipsilateral transulnar access. Although retrograde CTO intervention is a challenging procedure, a single arm-double access approach seems to be a feasible alternative that may be useful in patients with limited access-site availability.
A Novel Approach to Aortoiliac Bifurcation Stenting Using a Single Balloon-Expandable Stent
Mohammed Alomar, MD; Rajiv Tayal, MD, MPH; Michael Amponsah, MD; Marc Cohen, MD; Najam Wasty, MD
Contrary to popular wisdom, predominantly unilateral aortoiliac bifurcation disease can be safely treated with a single stent if the contralateral common iliac ostium is protected with matching balloon inflation. Larger studies on this novel approach with a longer clinical follow-up are needed to validate our results.