June 2020 Table of Contents

Original Contributions

Chronic Total Occlusions

Planned Robotic Chronic Total Occlusion Percutaneous Coronary Intervention: Feasibility Report

Daniel Walters, MD; Mitul Patel, MD; Ryan Reeves, MD; Lawrence Ang, MD; Belal Al Khiami, MD; Ehtisham Mahmud, MD   

Complex robotic percutaneous coronary intervention (PCI) is technically possible and leads to clinically comparable outcomes compared with the manual approach. However, there are limited data on the feasibility of chronic total occlusion revascularization via the robotic PCI approach. Ten consecutive patients undergoing robotic PCI for a coronary chronic total occlusion at a single tertiary academic center were analyzed. The PRECISION, PRECISION GRX, and PROGRESS CTO registries were utilized for data collection with regard to procedural/clinical details and results. 

J INVASIVE CARDIOL 2020;32(6):201-205.

Mitral Valve Disease

Evaluation of Effectiveness and Safety of Transcatheter Mitral Valve Repair Under Moderate Conscious Sedation

Ismail Ates, MD;  Sercan Okutucu, MD;  Gulcan Kose, MD;  Drew Hinson, MD;  Konstantinos Marmagkiolis, MD;  Cezar Iliescu, MD;  Mehmet Cilingiroglu, MD   

Transcatheter mitral valve repair (TMVR) using the MitraClip system (Abbott Vascular) has become a world-wide, well-established therapeutic alternative to symptomatic patients with severe mitral regurgitation and prohibitive surgical risk. Currently, TMVRs are performed under general anesthesia; which increases the overall procedure complexity, time, costs, and possible major complications. Herein, we aimed to present the effectiveness and safety of TMVR under moderate conscious sedation. 

J INVASIVE CARDIOL 2020;32(6):206-210.

Coronary Artery Disease

Novel Prognostic Score for Immediate and Late Success After Percutaneous Mitral Balloon Commissurotomy in Patients With Mitral Stenosis

Luiz Eugenio B. Prota-Filho, MD;  Rafael A. Meneguz-Moreno, MD;  Caio C. V. Queiroz, MD;  Fabricio C. Wohnrath, MD;  
Felipe A.C. Carboni, MD;  Gisele R.C. Silva, MD;  Joselyn I.P. Castro, MD;  Wandemberg S. Silva, MD;  Auristela I.O. Ramos, MD, PhD;  Nisia L. Gomes, MD;  J. Italo Franca, BS, MSc;  Cesar Esteves, MD, PhD;  Sergio L.N. Braga, MD, PhD;  Alexandre Abizaid, MD, PhD;  J. Ribamar Costa Jr, MD, Ph

Percutaneous mitral balloon commissurotomy (PMBC) remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis and suitable anatomy. The Wilkins score, introduced in 1988, remains the most widely used tool to select suitable candidates for PMBC; it is based on only four preprocedure echocardiographic morphological features. The objective of this study was therefore to propose a new score for the prediction of immediate and late success that integrates clinical and hemodynamic parameters. This is a single-center, retrospective analysis of all 1582 patients with severe mitral stenosis who underwent PMBC from August 1987 to July 2010. The composite outcome was cardiovascular death, new PMBC, or mitral valve repair surgery up to 24 years of follow-up. 

J INVASIVE CARDIOL 2020;32(6):211-217.

Radiation Safety

The Impact of Novel X-Ray Systems and X-Ray System Optimization on Patient Radiation Dose Administered During Cardiac Catheterization

Evangelia Vemmou, MD; Ilias Nikolakopoulos, MD; Iosif Xenogiannis, MD; Michael Megaly, MD, MS; Mohamed A. Omer, MD; Larissa Stanberry, PhD; Ross Garberich, MS, MBA; Bavana V. Rangan, BDS, MPH; Kenneth W. Baran, MD; Mario Gössl, MD, PhD; Paul Sorajja, MD; Ivan Chavez, MD; Michael Mooney, MD; Jay Traverse, MD; Yale Wang, MD; Santiago Garcia, MD; Anil Poulose, MD; M. Nicholas Burke, MD; Emmanouil S. Brilakis, MD, PhD   

The effect of x-ray system optimization on patient radiation dose has received limited study. We analyzed patient radiation dose in 1786 cardiac catheterization procedures (diagnostic coronary angiography and/or PCI) performed at a single tertiary-care center before and after x-ray system optimization. 

J INVASIVE CARDIOL 2020;32(6):218-221.

Atrial Fibrillation

Left Atrial Appendage Occlusion in Patients With Thrombus in Left Atrial Appendage​​

Levent Sahiner, MD; Cem Coteli, MD; Ergun Baris Kaya, MD; Ahmet Ates, MD; Gul Sinem Kilic, MD; Hikmet Yorgun, MD; Kudret Aytemir, MD   

Atrial appendage (LAA) occlusion is a therapeutic option for thromboembolic prevention in atrial fibrillation patients who have contraindications to oral anticoagulation or high risk of bleeding. Traditionally, thrombus in the LAA has been considered a contraindication for LAA occlusion. Recently, resistant thrombus formation in patients using oral anticoagulation was suggested as an indication for LAA occlusion. we evaluated the safety and efficacy of LAA occlusion in 12 patients with LAA thrombus. 

J INVASIVE CARDIOL 2020;32(6):222-227

Mitral Valve Disease

Percutaneous Mitral Valve Repair With MitraClip in Inoperable Patients With Severe Mitral Regurgitation Complicated by Cardiogenic Shock

Santiago Garcia, MD; Said Alsidawi, MD; Richard Bae, MD; Joao Cavalcante, MD; Peter Eckman, MD; Mario Gössl, MD, PhD; Robert Steffen, MD; Benjamin Sun, MD; Christian W. Schmidt, MS; Paul Sorajja, MD   

Severe mitral regurgitation (MR) complicated by cardiogenic shock has high operative mortality. Percutaneous leaflet repair with MitraClip (Abbott Vascular) is a less invasive alternative to surgery. The effectiveness and safety of this approach is unknown. We retrospectively analyzed procedural characteristics of shock patients with severe MR treated with MitraClip in a tertiary, high-volume program (Abbott Northwestern Hospital, Minneapolis, Minnesota) during 2010-2019. The primary outcome of the study was 30-day survival free of significant MR (grade £2). One-year mortality was a secondary outcome 

J INVASIVE CARDIOL 2020;32(6):222-227

Coronary Artery Disease

Utility of Radiopaque Bypass Graft Markers During Coronary Angiography Following Coronary Artery Bypass Graft Surgery

Zachary Oman, DO, MBA;  Julien Feghaly, MD;  Lucas Gu, DO;  Ammar Nasir, MD;  Michael Forsberg, MD   

Radiopaque bypass graft markers allow easy visualization of the location of the graft and can minimize contrast use and radiation exposure during follow-up coronary angiography. This retrospective study analyzed coronary artery bypass graft patients who underwent subsequent coronary angiography in the John Cochrane Veterans Affairs Medical Center from January 2009 until September 2017. 

J INVASIVE CARDIOL 2020;32(6):232-234


Transcatheter Aortic Valve Replacement

Interaction Between Balloon-Expandable Valves and Coronary Ostia: Angiographic Analysis and Impact on Coronary Access​​​​

Laurent Faroux, MD, MSc*;  Thomas Couture, MS*;  Camila Guimaraes, MD;  Lucia Junquera, MD;  David del Val, MD;  Guillem Muntané-Carol, MD;  Jerôme Wintzer-Wehekind, MD;  Siamak Mohammadi, MD;  Jean-Michel Paradis, MD;  Robert Delarochellière, MD;  Dimitri Kalavrouziotis, MD;  Eric Dumont, MD;  Sergio Pasian, MD;  Josep Rodés-Cabau, MD         *Joint first authors 

We sought to evaluate the position of balloon-expandable valves in relation to the coronary ostia using an angiographic- and computed-tomography based analysis, and to determine the impact of valve position on coronary angiography/percutaneous coronary intervention feasibility and results. 

J INVASIVE CARDIOL 2020;32(6):235-242


Clinical Outcomes

Differential Longitudinal Outcomes Following Percutaneous Coronary Intervention to the Left Internal Mammary Artery and Other Bypass Grafts of the LAD: Findings From the NCDR​​​​

Keong Keong Yeo, MBBS;  Farnaz Azarbal, MD;  Pearl Zakroysky, MPH;  David Dai, MPH;  Matthew Roe, MD, MHS;  Daniel Wojdyla, MS;  Reginald Low, MD;  Kendrick Shunk, MD, PhD 

Limited studies of percutaneous coronary intervention (PCI) of the left internal mammary artery (LIMA) graft exist. We compared outcomes of different bypass grafts to the left anterior descending (LAD) coronary artery. Participants ≥65 years old in the CathPCI Registry who underwent PCI of a bypass graft to the LAD between 2009 and 2014 were included. 

J INVASIVE CARDIOL 2020;32(6):E143-E150


Team Approach

Characteristics and Outcomes of Patients Who Are Denied From a Percutaneous Edge-to-Edge Mitral Valve Repair After Being Referred to a Transcatheter Mitral Valve Program: Impact of a Dedicated Multidisciplinary Mitral Heart Team Approach​​​​

Anthony Poulin, MD*;  Frédéric Beaupré, MD*;  Caroline Gravel, RN;  Sandra Hadjadj, MSc;  Mathieu Bernier, MD; Jonathan Beaudoin, MD;  Kim O’Connor, MD;  Alfredo Nunes Ferreira-Neto, MD;  Jérôme Wintzer, MD; Eric Dumont, MD;  François Dagenais, MD;  Josep Rodés-Cabau, MD;  Jean-Michel Paradis, MD  *Joint first authors 

Many patients referred for a MitraClip intervention are finally refused for this intervention, and data are very scarce on their outcomes. Our study sought to determine the characteristics and outcomes of patients who are referred to a mitral valve clinic and are finally denied from a percutaneous mitral edge-to-edge repair. 

J INVASIVE CARDIOL 2020;32(6):E151-E157


Peripheral Vascular Disease

The Efficacy of Percutaneous Transluminal Angioplasty on the Limb Salvage and Recovery of Symptoms in Patients With Buerger’s Disease With Critical Limb Ischemia​​​​

Orhan Rodoplu, MD;  Cenk Eray Yildiz, MD;  Didem Melis Oztas, MD;  Cenk Conkbayir, MD;  Orcun Unal, MD;  Mustafa Ozer Ulukan, MD;  Mert Meric, MD;  Murat Ugurlucan, MD;  Ahmet Kirbas, MD 

Buerger’s disease, or thromboangiitis obliterans, is associated with limb-threatening chronic arterial lesions. In this study, we sought to investigate the efficacy of the percutaneous transluminal angioplasty method for the treatment of critical limb ischemia (CLI) in patients with Buerger’s disease in our modest cohort. Patients diagnosed with CLI secondary to Buerger’s disease who underwent percutaneous transluminal angioplasty between May 2014 and June 2017 were retrospectively investigated. Patient demographics, presentations, procedural details, responses to percutaneous treatment, complications, limb salvage, wound healing, reinterventions, and early follow-up data were recorded. 

J INVASIVE CARDIOL 2020;32(6):E158-E167




E168       Endovascular Treatment of a Migrated Superior Vena Cava Stent in the Right Atrium   

Rajesh Vijayvergiya, MD;  Kewal Kanabar, MD;  Sanjeev Kaushal, MD;  Anupam Lal, MD;  Sabari Krishnan, MD


A 42-year-old female with end-stage chronic kidney disease, who was on maintenance hemodialysis for the last 3 years, presented with facial and upper-limb swelling of 2-month duration. A computed tomography (CT) scan confirmed significant stenosis of the superior vena cava (SVC). Following discussion in a multidisciplinary meeting, it was proposed to perform a repeat endovascular intervention to relieve the SVC obstruction and manage the migrated stent. 

J INVASIVE CARDIOL 2020;32(6):E168-E169




E170       Critical Left Main Coronary Stenosis After Sutureless Aortic Valve Replacement   

Wai Kin Chi, MBChB;  Chak-Yu So, MBChB;  Ka-Lung Chui, MBChB;  Joseph Y.S. Chan, MBBS;  Chi-Yuen Chan, MBChB


Our case illustrates the feasibility of high-risk PCI to salvage LMCA stenosis, possibly caused by coronary injury during direct coronary cardioplegia for a recent triple-valve operation.

J INVASIVE CARDIOL 2020;32(6):E170-E171




Triple-Access Retrograde Chronic Total Occlusion Intervention Through Vein Graft and Epicardial Collaterals   

Ioannis Tsiafoutis, MD;  Catherine Liontou, MD;  Athanasios Antonakopoulos, MD;Konstantina Katsanou, MD;  Michael Koutouzis, MD;  Apostolos Katsivas, MD


Based on the patient’s symptoms and examination, a decision was made to recanalize his totally occluded RCA via retrograde approach through the SVG to the OM. Due to inadequate visualization of the epicardial collaterals and distal RCA via SVG, triple-access was used and injection via left main. In selected CTO cases, triple access may facilitate the retrograde approach, allowing optimal collateral visualization.

J INVASIVE CARDIOL 2020;32(6):E172 




 Technical Considerations for TAVR in the Treatment of Stentless Bioprosthetic Aortic Valve Insufficiency in LVAD Patients   

Jonathan Yap, MBBS, MRCP, MPH;  Benjamin R. Stripe, MD;  Garrett B. Wong, MD;  Thomas W. Smith, MD;  

Jeffrey A. Southard, MD

An 80-year-old man with a history of bicuspid AV complicated by severe AI presented with progressive NYHA class III symptoms and severe bioprosthetic AV insufficiency. Transcatheter aortic valve replacement was planned via transfemoral approach. We encountered several technical challenges and describe them herein. 

J INVASIVE CARDIOL 2020;32(6):E174 




E175       Rotatripsy: A Hybrid “Drill and Disrupt” Approach for Treating Heavily Calcified Coronary Lesions   

Konstantinos Aznaouridis, MD, PhD;  Maria Bonou, MD, PhD;  Constantina Masoura, MD, PhD;  

Chris Kapelios, MD, PhD;  Dimitris Tousoulis, MD, PhD;  John Barbetseas, MD, PhD


In balloon-uncrossable calcified lesions, rotational atherectomy (RA) is the first-line modality to enable operators to advance balloons and stents over the stenosis. If the lesion is undilatable after RA, a hybrid approach with additional intracoronary lithotripsy (rotatripsy) can be an effective approach that further modifies the calcified plaque and enables stent delivery.

J INVASIVE CARDIOL 2020;32(6):E175 




E176       Acute Anterior STEMI in Multivessel Spontaneous Coronary Dissections   

Daniela Trabattoni, MD;  Giulia Santagostino Baldi, MD;  Giovanni Teruzzi, MD;  Edoardo Conte, MD;  

Antonio Bartorelli, MD


Spontaneous coronary artery dissection (SCAD) has a prevalence between 0.2%-4% of all acute coronary syndromes. Multivessel SCAD is unusual. Coronary revascularization remains appropriate for unstable patients or with compromised coronary blood flow. Additionally, IVUS probe advancement and its retrieval could precipitate a dramatic progression of SCAD both distally and proximally to its original site.

J INVASIVE CARDIOL 2020;32(6):E176 




E177       Spontaneous Device Detachment After Its Partial Deployment During Left Atrial Appendage Occlusion: A Nightmare in the Cath Lab

Giuseppe Talanas, MD;  Eleonora Moccia, MD;  Giuseppe D. Sanna, MD, PhD;  Guido Parodi, MD, PhD


To date, this is the first description of a spontaneous unscrewing of an Amplatzer Amulet device from its delivery cable while its lobe was partially deployed within the left atrial appendage. In such cases, the device should be pushed forward to complete the deployment and to rescrew the device to the DC in order to prevent an unavoidable cardiac surgery. 

J INVASIVE CARDIOL 2020;32(6):E177