January 2020 Table of Contents

Peripheral Vascular Disease 

Outcomes of Transpedal Arterial Access Hemostasis Using a Radial Hemostatic Band

Ebenezer Oni, MD, MPH;  Sean Janzer, MD;  Jon C. George, MD

Despite advancements in endovascular therapy, there have been significant limitations in invasive interventions aimed at revascularization. The transpedal tibial artery retrograde approach has been described as an alternative access for patients with complex disease requiring dual access or failed revascularization via conventional common femoral artery access. In this study, we examined the safety and efficacy of a radial hemostatic band to achieve hemostasis post procedure without compromising the integrity of the accessed tibial artery and found that postprocedure access-vessel hemostasis and patency are reliably and safely achieved using a hemostatic band device.

J INVASIVE CARDIOL 2020;32(1):1-4.

Peripheral Vascular Disease

Approach to Tibiopedal Retrograde Revascularization of Below-The-Knee Peripheral Arterial Diseases With or Without Transradial Guidance Peripheral Angiography

Tak W. Kwan, MD;  Wah Wah Htun, MD;  Samuel Lee, BA;  Ádám Csavajda, MD;  Apurva Patel, MD;  Sooraj Shah, MD; Yili Huang, DO;  Michael Liou;  Béla Merkely, MD, DSc;  Zoltán Ruzsa, MD, PhD

Tibiopedal retrograde revascularization of below-the-knee lesions is an emerging technique in peripheral interventions. We performed an observational cohort study of 194 consecutive adult patients with critical limb ischemia who underwent endovascular intervention for below-the-knee diseases using peripheral angiography and primary tibiopedal access with versus without transradial guidance at two centers. This study demonstrated that the treatment of critical limb ischemia with below-the-knee lesions is feasible and safe, with a high procedural success rate and low access-site complication rate using the tibiopedal access approach regardless of whether or not transradial guidance is utilized. 

J INVASIVE CARDIOL 2020;32(1):6-11.

Transcatheter Aortic Valve Replacement 

Periprocedural Changes in Cognitive Function After Transcatheter and Surgical Aortic Valve Replacement: Results From a Pilot Study Assessing Cognition in Elderly Veterans

Santiago Garcia, MD;  Laura S. Hemmy, PhD;  Rosemary Kelly, MD;  Howard A. Fink, MD, MPH

There is paucity of data comparing periprocedural changes in cognitive function between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). In this pilot observational study, we enrolled patients with severe aortic stenosis scheduled to undergo TAVR or SAVR at the discretion of the heart team in order to detect differences in cognition at baseline or 3 months between the two groups. We observed no significant differences in cognition at baseline or 3 months between SAVR and TAVR groups.

J INVASIVE CARDIOL 2020;32(1):12-17. Epub 2019 November 15.

Peripheral Vascular Disease

The Market Reacts Quickly: Changes in Paclitaxel Vascular Device Purchasing Within the Ascension Healthcare System

Peter P. Monteleone, MD;  Subhash Banerjee, MD;  Priya Kothapalli, MD;  Ariel Dora Stern, PhD;  Daniel Fehder, PhD; Ron Ginor, MD;  Dominic Vollmar;  Edward T. A. Fry, MD;  Mark J. Pirwitz, MD

A meta-analysis of trials in endovascular therapy suggested an increased mortality associated with treatment exposure to paclitaxel. Multiple publications and corrections of prior data were performed, and the United States Food and Drug Administration has issued multiple advisories regarding paclitaxel use. We analyzed how this controversy impacted device purchasing and related utilization patterns in the period immediately following publication of the meta-analysis. 

J INVASIVE CARDIOL 2020;32(1):18-24. Epub 2019 October 15.

Transcatheter Aortic Valve Replacement 

Impact of Severity of Chronic Kidney Disease on Management and Outcomes Following Transcatheter Aortic Valve Replacement With Newer-Generation Transcatheter Valves

Ely Gracia, MD;  Ting-Yu Wang, BS;  Susan Callahan, NP;  Thomas Bilfinger, MD;  Henry Tannous, MD;  Robert Pyo, MD;  Smadar Kort, MD;  Hal Skopicki, MD, PhD;  Jonathan Weinstein, DO;  Neal Patel, MD;  Daniel Montellese, MD; Giridhar Korlipara, MD;  Shamim Khan, MD;  Joanna Chikwe, MD;  Puja B. Parikh, MD, MPH

The association between chronic kidney disease and outcomes following TAVR in the setting of newer-generation transcatheter heart valves is not well known. Accordingly, we sought to assess the impact of chronic kidney disease severity on outcomes in adults undergoing TAVR with newer-generation transcatheter heart valves. The study population included 298 consecutive patients who underwent TAVR with a newer-generation valve (Sapien 3, CoreValve Evolut R, or Evolut Pro) from December 2015 to June 2018 at an academic tertiary medical center. In this prospective study, moderate and severe chronic kidney disease was associated with a nearly 2-fold and 3-fold higher risk of 30-day readmission, respectively.

J INVASIVE CARDIOL 2020;32(1):25-29. Epub 2019 December 15.

Coronary Artery Disease / Aortic Valve Disease

Systematic Review and Meta-Analysis of Interventional Emergency Treatment of Decompensated Severe Aortic Stenosis

Bernhard Wernly, MD;  Peter Jirak, MD;  Michael Lichtenauer, MD, PhD; Verena Veulemans, MD;  Tobias Zeus, MD;  Kerstin Piayda, MD;  Uta C. Hoppe, MD;  Alexander Lauten, MD;  Christian Frerker, MD;  Christian Jung, MD, PhD

Patients in cardiogenic shock due to decompensated aortic stenosis evidence poor prognosis. Both emergency TAVR and emergency balloon aortic valvuloplasty have been reported in cardiogenic shock patients. We aimed to summarize and compare available studies on emergent balloon aortic valvuloplasty and TAVR in patients suffering from cardiogenic shock due to decompensated aortic stenosis with regard to safety and efficacy. Study-level data were pooled and analyzed for 311 patients in 8 studies, and outcomes were compared between the two strategies.

J INVASIVE CARDIOL 2020;32(1):30-36. Epub 2019 October 15.

Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Replacement Influence on Coronary Hemodynamics: A Quantitative Meta-Analysis and Proposed Decision-Making Algorithm

Rafail A. Kotronias, MBChB, MSc;  Roberto Scarsini, MD;  Skanda Rajasundaram, BA;  Giovanni Luigi De Maria, MD, PhD;  Jonathan L. Ciofani, MD;  Flavio Ribichini, MD;  Rajesh K. Kharbanda, MD, PhD; Adrian P. Banning, MBBS, MD

As TAVR expands to younger and lower-risk severe aortic stenosis patients, appropriate coronary artery disease treatment is key to reducing long-term adverse cardiovascular outcomes. Recently, studies have been exploring the role of coronary-physiology guided revascularization strategies. Our aim was to investigate whether TAVR influences coronary physiology measurements using quantitative meta-analytic methods. Five studies evaluating 250 coronary vessels in 169 severe aortic stenosis patients were quantitatively evaluated for coronary physiology indices before and after TAVR. 

J INVASIVE CARDIOL 2020;32(1):37-40. Epub 2019 November 15.

Original contribution / Coronary Artery Disease 

The MitraClip Procedure in Patients With Moderate Resting but Severe Exercise-Induced Mitral Regurgitation

Jonathan Curio;  Wajahat Tarar;  Haitham Saleh Ali Al-Hindwan;  Richard Neumann;  Christian Berger, MD; Marc-Oscar Hoting, MD;  Mario Kasner, MD;  Ulf Landmesser, MD;  Markus Reinthaler, MD

Optimal timing for percutaneous mitral regurgitation (MR) treatment using MitraClip remains unclear. We evaluated the outcomes after MitraClip in 55 patients with moderate resting MR, progressing to severe exercise-induced MR and compared them to 166 patients with severe resting MR. All-cause deaths and heart failure hospitalizations were assessed as the combined primary endpoint.

J INVASIVE CARDIOL 2020;32(1):E1-E8.

Clinical Images

Percutaneous Renal Artery Stenting With Optical Coherence Tomography Imaging in a Young Boy With Recanalized-Thrombus Associated Renal Artery Stenosis

Rajesh Vijayvergiya, MD;  Sudhanshu Budhakoty, MD;  Basant Kumar, MD;  Ganesh Kasinadhuni, MD; Kewal Kanabar, MD

The common cause of renal artery stenosis in young is fibromuscular dysplasia or Takayasu arteritis. Recanalized thrombus, on the other hand, is a rare cause for renal artery stenosis in young patients. OCT imaging confirmed the diagnosis and optimized the renal stenting results.

J INVASIVE CARDIOL 2020;32(1):E9-E10.

Clinical Images

Endovascular Stent-Graft Repair of a Large Renal Artery Pseudoaneurysm With Impending Rupture, Arising From a Solitary Kidney

Rajesh Vijayvergiya, MD;  Basant Kumar, MD;  Sudhanshu Budhakoty, MD;  Ajay Savlania, MS; Anupam Lal, MD

This was an unusual case of a large renal artery pseudoaneurysm with impending rupture, which was successfully treated with an endovascular stent-graft in a solitary kidney.

J INVASIVE CARDIOL 2020;32(1):E11-E12.

Clinical Images

Asymptomatic, Multiple Stent Fractures of a Superficial Femoral Artery

Rajesh Vijayvergiya, MD;  Kewal Kanabar, MD;  Sudhanshu Budhakoty, MD;  Anupam Lal, MD

Certain factors like ostial disease, chronic total occlusion, and long, multiple stents are the main causes of multiple stent fractures, as were present in this case. Such stent fractures are usually associated with significant in-stent restenosis; however, this patient had a patent lumen despite multiple fractures. 

J INVASIVE CARDIOL 2020;32(1):E13.

Clinical Images

Cracking the Plaque With Coronary Lithotripsy: Mechanistic Insights From Optical Coherence Tomography

Alessio La Manna, MD;  Guido D’Agosta, MD;  Giuseppe Venuti, MD;  Corrado Tamburino, MD, PhD

Coronary lithoplasty is a promising technique that can overcome issues regarding the treatment of undilatable, heavily calcified, de novo, and in-stent restenotic lesions, allowing plaque modification and successful stent deployment, as demonstrated by intravascular imaging.

J INVASIVE CARDIOL 2020;32(1):E14.

Clinical Images

Acute Renal Infarction Treated With Local Intra-Arterial Thrombolysis

Ricardo de Souza Alves Ferreira, MD;  José Luis Attab dos Santos, MD;  Clemente Greguolo, MD;  José Fábio Fabris, Jr, MD;  Marcelo D’anzicourt Pinto, MD;  Alan Nasciento Paiva, MD;  Vicente Paulo Resende, Jr, MD;  César Franco de Souza, MD;  Leandro Coumbis Mandaloufas, MD;  Márcio Alves de Urzêda, MD; Renato Sanchez Antonio, MD

A 53-year-old man with stable coronary disease and dyslipidemia was admitted with sudden pain of severe intensity in the left flank. Selective catheterization of the left renal artery, followed by alteplase infusion for 6 hours, resolved the patient’s symptoms.

J INVASIVE CARDIOL 2020;32(1):E15-E16.

Clinical Images

Sealing a Multilobe Left Atrial Appendage With Kissing-Watchman Technique

Jie Zeng, MD*;  Cong Lu, MD*;  Hui Huang    *Joint first authors

A 72-year-old man was admitted because of persistent atrial fibrillation after suffering a stroke 4 months prior. A left atrial appendage was discovered and closed using a kissing-Watchman technique. 

J INVASIVE CARDIOL 2020;32(1):E17.