July 2020 Table of Contents


from July • Vol 32, No. 7

Original Contributions

Peripheral Vascular Disease

243      Total IN.PACT All-Subjects One-Year Analysis and Standard vs Broader Implications

Daniel S. Kobe, MD;  Michael R. Jaff, DO;  Thomas Zeller, MD, PhD;  Peter A. Schneider, MD;

Mehdi H. Shishehbor, DO, MPH, PhD


Drug-coated balloons (DCBs) have been shown to be superior to percutaneous transluminal angioplasty (PTA) for symptomatic femoropopliteal disease in randomized clinical trials; however, their clinical effectiveness and safety in more complex disease is less defined. The study sought to conduct a patient-level pooled analysis of all prospective randomized and single-arm studies evaluating the safety and efficacy of IN.PACT Admiral DCB (Medtronic) worldwide and in patients with complex disease. Subjects were treated with either IN.PACT Admiral DCB (n = 1837) or PTA (n = 143). 


Animal Study

249      Safety and Accuracy of a Novel Bioimpedance System for Real-Time Detection and Monitoring of Endovascular Procedure-Related Bleeding in a Porcine Model

Philippe Généreux, MD;  Kenneth Bueche, MS;  Jennifer Vondran, MS;  Alice Chuang, PhD;  Mehdi Razavi, MD


Periprocedural bleeding events during endovascular procedures are frequent and are associated with increased morbidity, mortality, and healthcare costs. The aim of this study was to determine the safety and accuracy of a novel bleed detection system, the Early Bird Bleed Monitoring System (EBBMS; Saranas) for the detection of simulated internal bleeding and the monitoring of bleed progression associated with endovascular procedures.


Access Site Bleeding

255      First-in-Human Study of the Saranas Early Bird Bleed Monitoring System for the Detection of Endovascular Procedure-Related Bleeding Events

Philippe Généreux, MD; Tamim M. Nazif, MD;  Joggy K. George, MD;  Colin M. Barker, MD; 

Charles T. Klodell, MD;  James P. Slater, MD;  Mehdi Razavi, MD;  Ken Bueche, MS;  Manesh R. Patel, MD; Amir Kaki, MD;  Ajay J. Kirtane, MD, SM;  Zaffer A. Syed, MS;  Bart E. Muhs, MD, PhD; Dimitri Karmpaliotis, MD, PhD


Bleeding complications after endovascular procedures are frequent and associated with poor prognosis. Our aim was to evaluate the safety and accuracy of the Early Bird Bleed Monitoring System (EBBMS; Saranas) for the detection of access-site related bleeds in humans undergoing endovascular procedures. 


Transcatheter Aortic Valve Replacement

262      Insights From Modern Imaging and Catheter Wire Measurements in Patients Undergoing Transcatheter Aortic Valve Replacement

Jessica Roback, BS;  Zara Ammar;  Saagar Shah;  Anthony DeFranco, MD;  Arshad Jahangir, MD;  M. Fuad Jan, MBBS, MD;  Suhail Q. Allaqaband, MD;  Tanvir Bajwa, MD;  Khawaja Afzal Ammar, MD


Prior studies have neither described methods for crossing a severely stenotic aortic valve (AV) in light of modern imaging modalities (echocardiography, computed tomography, fluoroscopy) nor characterized a successful crossing. This study aimed to fill that gap. 


Transcatheter Aortic Valve Replacement

269      Urologic Complications in Patients Receiving Indwelling Urinary Catheters During Transcatheter Aortic Valve Replacement

Joshua Lampert, MD;  Matthew T. Finn, MD, MS;  Alex Kantor, BS;  Deniz Akkoc, BS;  Shmuel Chen, MD, PhD; Russel Brandwein, PA-C;  Kathryn Fidlow, BSN;  Ming Liao, MS;  Omar Khalique, MD;  Rebecca T. Hahn, MD; Torsten P. Vahl, MD;  Isaac George, MD;  Ajay Kirtane, MD, SM;  Martin B. Leon, MD;  Susheel K. Kodali, MD; Tamim M. Nazif, MD


The minimalist approach to transcatheter aortic valve replacement (TAVR) focuses on avoiding extraneous invasive measures. Data describing the clinical impact of routine indwelling urinary catheter (IUC) in TAVR patients is limited. We sought to examine outcomes after IUC placement in patients undergoing TAVR. 


Peripheral Vascular Disease

276      An Overview of Contrast-Associated Acute Kidney Injury Following Lower-Extremity Percutaneous Peripheral Interventions

Tung H. Nguyen, MD;  Omar Sheikh, MD;  Momhammed Sha’ar, MD;  Shweta Bansal, MD;  Anand Prasad, MD


There is an abundance of literature studying acute kidney injury following percutaneous coronary interventions, with very few studies done in the setting of percutaneous peripheral intervention. This article aims to review what we currently know about contrast-associated acute kidney injury and available prevention strategies, specifically following percutaneous peripheral interventions.


Rapid Communication

E333    Non-Elective Pediatric Cardiac Catheterization during COVID-19 Pandemic: A New York Center Experience

Kristin T. Oshiro, MD;  Mariel E. Turner, MD;  Alejandro J. Torres, MD;  Matthew A. Crystal, MD; 

Julie A. Vincent, MD;  Oliver M. Barry, MD

COVID-19 has led to major changes in hospital systems across the world. In an effort to reduce viral transmission, conserve resources, and in accordance with institutional and state mandates, all elective procedures and surgeries were postponed during the initial outbreak. Guidelines for case selection are limited and management for pediatric catheterization laboratories during this crisis is unprecedented.

Our objective was to report the protocols and case selection of a high-volume pediatric cardiac catheterization laboratory in the epicenter of the novel coronavirus (COVID-19) pandemic. 


Rapid Communication 

E336    Bioprosthetic Valve Fracture for Early Severe Prosthesis Mismatch after SAVR       

Ashleigh Long, MD, PhD and Paul Mahoney, MD


Bioprosthetic valve fracture (BVF), where high pressure balloon inflation is employed to fracture the surgical valve sewing ring to increase the EOA, has been used as an adjunct for valve in valve (TAV in SAV) procedures for degenerated surgical valves to increase EOA, but has not been reported as standalone therapy for early PPM after SAVR. 


Brief Communication

E336    The Original Coronary "Full Metal Jacket": A 30 Year Journey          

John Lawrence, MD;  Michael P. Savage, MD;  Sheldon Goldberg, MD;  David L. Fischman, MD


This report provides a 30-year follow-up on a noteworthy case first described by Fischman et al.in the September/October 1989 publication of The Journal of Invasive Cardiology. The original article provided the first known report of extensive intracoronary stenting, deployed in tandem, now colloquially referred to as a “full metal jacket” (FMJ).  Since this original publication there has been an abundance of data that support this PCI strategy as a safe and effective option to treat coronary disease in a complex and challenging group of patients.  Further investigation is needed to determine exactly which patients are likely to benefit most from this unique PCI strategy and to evaluate long-term outcomes but not necessarily outcomes at 30 years. 


Clinical Images

E340    May-Thurner Syndrome Results in Life-Threatening Condition: Phlegmasia Cerulea Dolens and Rhabdomyolysis   

Wai Kin Chi, MBChB; G.M. Tan, MBChB;  Bryan P. Yan, MBBS, MD


Phlegmasia cerulea dolens is a limb- and life-threatening complication of acute massive proximal deep-vein thrombosis, which causes severe lower-limb venous congestion and ischemia. Venography alone may underestimate the extent of common iliac vein compression in May-Thurner syndrome. Peripheral IVUS is mandatory to better assess common iliac vein compression before and after intervention.



Clinical Images

E342    Post Heart Transplantation Coronary Artery Fistula and Coronary Artery Aneurysm Successfully Managed With the Implantation of Covered Stents   

Felipe H. Valle, MD, PhD;  Bruno Matte, MD, MSc;  Joana Brum, MD;  Nadine Clausell, MD, PhD; Livia A. Goldraich, MD, MSc


Coronary-to-cardiac chamber fistulae and coronary aneurysms are potential complications after heart transplantation, presumably related to the occurrence of myocardium microperforations and direct vascular injury at surveillance endomyocardial biopsies. In the setting of exercise intolerance and large fistulae at major coronary vessels, the possibility of jeopardized myocardial perfusion should be considered. The use of covered stents may provide an effective interventional strategy in this scenario.



Clinical Images

E343    “Avulsion Injury” of the Artery by a Suture-Mediated Closure System During Transcatheter Aortic Valve Implantation   

Toshiki Kaihara, MD, PhD;  Takumi Higuma, MD, PhD;  Shingo Kuwata, MD, PhD;  Masashi Koga, MD;  Mika Watanabe, MD;  Kazuaki Okuyama, MD;  Ryo Kamijima, MD, PhD;  Masaki Izumo, MD, PhD;  Yuki Ishibashi, MD, PhD;  Yasuhiro Tanabe, MD, PhD;  Yoshihiro J. Akashi, MD, PhD; 


There have been no reports about such “avulsion injury” of the femoral artery with a suture-mediated closure system during TAVI. Our pathological analysis of the specimen revealed that it consisted of mainly intima of the blood vessels. Although there was no calcification at the puncture site, calcification was present around the site. This calcification might have cracked and injured the intima, resulting in the complication. We should consider the cut-down method in cases with calcification restricted to the region surrounding the puncture site when we perform TAVI in patients with severe aortic stenosis.



Clinical Images

E347    Optical Coherence Tomography Imaging in Acute Myocardial Infarction: Calcified Nodule as a Culprit Lesion   

Rajesh Vijayvergiya, MD;  Basant Kumar, MD;  Saroj Sahoo, MD;  Sudhanshu Budhakoty, MD;  

Ganesh Kasinadhuni, MD


The acute coronary syndrome is usually due to plaque rupture or erosion. A calcified nodule is an infrequent pathological substrate in such patients. The index case had calcified nodules with added thrombosis as the cause of acute myocardial infarction. It also demonstrated the technical challenges of intervening an eccentric, severely calcified, balloon-uncrossable coronary lesion.



Clinical Images

E348    TAVR in a 65-Year-Old Man With a Bicuspid Aortic Valve With Extremely Large Annulus and Severe Left Ventricular Dysfunction   

Puja B. Parikh, MD;  Michelle W. Bloom, MD;  Robert Pyo, MD;  Neal Patel, MD;  Bharathi Scott, MD;  Kathleen Stergiopoulos, MD, PhD;  Henry Tannous, MD


This case illustrates that transfemoral TAVR is safe and feasible in patients with bicuspid aortic stenosis with extremely large annulus and concomitant severe LV dysfunction. Considerations for THV type and size, anesthesia, hemodynamic support, and open surgical back-up must be taken into account as part of procedural planning.



Clinical Images

E349    Complex Plug-Prosthesis Interaction During Percutaneuous Closure of Mitral Paravalvular Leak: The Butterfly Effect   

Francesco Melillo, MD;  Daniele Cocco, MD;  Stefano Stella, MD;  Giacomo Ingallina, MD;  

Luigi Pannone, MD;  Barbara Bellini, MD;  Vittorio Romano, RT;  Luca Ferri, MD;  Matteo Montorfano, MD;  Eustachio Agricola, MD


The percutaneous closure is a less invasive alternative to surgical PVL closure. However, it is a technically demanding procedure that requires both careful preprocedural planning and intraprocedural guidance. 3D-TEE fluoroscopic-fusion imaging is extremely helpful for intraprocedural monitoring. The knowledge of possible complications is warranted for achieving an optimal result. Recent series showed similar 1-year outcome compared with surgery, but few data are available about intraprocedural issues, especially those related to plug-prosthesis interference. In only 1 patient, late infective endocarditis with device embolization and new leaflet interference was reported. Here, we clearly show how interaction between imaging experts and interventionists allowed us to overcome the challenge of plug-prosthesis interaction in a complex procedure.


Clinical Images

E400    Distal Radial Access for Percutaneous Endovascular Repair of a Radial Artery Pseudoaneurysm   

Ioannis Tsiafoutis, MD;  Theodoros Zografos, MD;  Michael Koutouzis, MD;  Apostolos Katsivas, MD


Percutaneous pseudoaneurysm repair through the ipsilateral ulnar artery is an alternative to surgical repair; however, distal radial access, as described in this case, may offer increased safety.


Letters to the editor

E405    The ISCHEMIA Algorithm or the FAME-2 Algorithm To Detect Ischemia? 

J. Alberto San Roman, MD, PhD, Hospital Clinico Universitario de Valladolid, Valladolid, Valladolid Spain. Email: asanroman@secardiologia.es

Authors’ Reply

Suraj Dahal, MD and Matthew J. Budoff, MD


E460    Adversity as a Catalyst for Change

Mayank Dalakoti​​, MBBS, MRCP; ​Koo Chieh Yang​​, MBBS, MRCP; ​Saurabh Rastogi​, MD, FACC; Pipin Kojodjojo, MD, PhD