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CARDIOVASCULAR DISEASES (329 journals)                  1 2 | Last

Showing 1 - 200 of 329 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 5)
Acta Cardiologica     Hybrid Journal   (Followers: 2)
Acute Cardiac Care     Hybrid Journal   (Followers: 7)
Adipositas - Ursachen, Folgeerkrankungen, Therapie     Hybrid Journal  
AJP Heart and Circulatory Physiology     Hybrid Journal   (Followers: 12)
Aktuelle Kardiologie     Hybrid Journal   (Followers: 1)
American Heart Journal     Hybrid Journal   (Followers: 58)
American Journal of Cardiology     Hybrid Journal   (Followers: 67)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 17)
American Journal of Hypertension     Hybrid Journal   (Followers: 28)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anatolian Journal of Cardiology     Open Access   (Followers: 6)
Angiología     Full-text available via subscription  
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Angiology     Hybrid Journal   (Followers: 3)
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (Followers: 1)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 12)
AORTA     Open Access  
Archives of Cardiovascular Diseases     Full-text available via subscription   (Followers: 5)
Archives of Cardiovascular Diseases Supplements     Full-text available via subscription   (Followers: 3)
Archives of Cardiovascular Imaging     Open Access   (Followers: 2)
Archivos de cardiología de México     Open Access   (Followers: 1)
Argentine Journal of Cardiology (English edition)     Open Access   (Followers: 2)
Arquivos Brasileiros de Cardiologia     Open Access   (Followers: 1)
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 32)
Artery Research     Hybrid Journal   (Followers: 4)
ARYA Atherosclerosis     Open Access  
ASAIO Journal     Hybrid Journal   (Followers: 3)
ASEAN Heart Journal     Open Access   (Followers: 2)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2)
Aswan Heart Centre Science & Practice Services     Open Access   (Followers: 1)
Atherosclerosis : X     Open Access  
Bangladesh Heart Journal     Open Access   (Followers: 3)
Basic Research in Cardiology     Hybrid Journal   (Followers: 10)
BMC Cardiovascular Disorders     Open Access   (Followers: 22)
Brain Circulation     Open Access   (Followers: 1)
British Journal of Cardiology     Full-text available via subscription   (Followers: 16)
Canadian Journal of Cardiology     Hybrid Journal   (Followers: 18)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiac Electrophysiology Review     Hybrid Journal   (Followers: 2)
Cardiocore     Full-text available via subscription   (Followers: 1)
Cardiogenetics     Open Access   (Followers: 3)
Cardiology     Full-text available via subscription   (Followers: 20)
Cardiology and Angiology: An International Journal     Open Access   (Followers: 1)
Cardiology and Therapy     Open Access   (Followers: 12)
Cardiology Clinics     Full-text available via subscription   (Followers: 14)
Cardiology in Review     Hybrid Journal   (Followers: 8)
Cardiology in the Young     Hybrid Journal   (Followers: 34)
Cardiology Journal     Open Access   (Followers: 6)
Cardiology Plus     Open Access   (Followers: 1)
Cardiology Research     Open Access   (Followers: 15)
Cardiology Research and Practice     Open Access   (Followers: 10)
Cardiopulmonary Physical Therapy Journal     Hybrid Journal   (Followers: 7)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Cardiothoracic Surgeon     Open Access   (Followers: 1)
CardioVasc     Full-text available via subscription   (Followers: 1)
Cardiovascular & Haematological Disorders - Drug Targets     Hybrid Journal   (Followers: 1)
Cardiovascular & Hematological Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 2)
CardioVascular and Interventional Radiology     Hybrid Journal   (Followers: 15)
Cardiovascular and Thoracic Open     Open Access  
Cardiovascular Diabetology     Open Access   (Followers: 10)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 14)
Cardiovascular Endocrinology & Metabolism     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering and Technology     Hybrid Journal   (Followers: 1)
Cardiovascular Intervention and Therapeutics     Hybrid Journal   (Followers: 5)
Cardiovascular Journal     Open Access   (Followers: 6)
Cardiovascular Journal of Africa     Full-text available via subscription   (Followers: 5)
Cardiovascular Journal of South Africa     Full-text available via subscription   (Followers: 1)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Cardiovascular Pathology     Hybrid Journal   (Followers: 4)
Cardiovascular Regenerative Medicine     Open Access  
Cardiovascular Research     Hybrid Journal   (Followers: 15)
Cardiovascular Revascularization Medicine     Hybrid Journal   (Followers: 1)
Cardiovascular System     Open Access  
Cardiovascular Therapeutics     Open Access   (Followers: 1)
Cardiovascular Toxicology     Hybrid Journal   (Followers: 6)
Cardiovascular Ultrasound     Open Access   (Followers: 5)
Case Reports in Cardiology     Open Access   (Followers: 7)
Catheterization and Cardiovascular Interventions     Hybrid Journal   (Followers: 3)
Cerebrovascular Diseases     Full-text available via subscription   (Followers: 3)
Cerebrovascular Diseases Extra     Open Access  
Chest     Full-text available via subscription   (Followers: 100)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 247)
Circulation : Cardiovascular Imaging     Hybrid Journal   (Followers: 15)
Circulation : Cardiovascular Interventions     Hybrid Journal   (Followers: 17)
Circulation : Cardiovascular Quality and Outcomes     Hybrid Journal   (Followers: 11)
Circulation : Genomic and Precision Medicine     Hybrid Journal   (Followers: 15)
Circulation : Heart Failure     Hybrid Journal   (Followers: 26)
Circulation Research     Hybrid Journal   (Followers: 36)
Cirugía Cardiovascular     Open Access  
Clínica e Investigación en Arteriosclerosis     Full-text available via subscription  
Clínica e Investigación en arteriosclerosis (English Edition)     Hybrid Journal  
Clinical and Experimental Hypertension     Hybrid Journal   (Followers: 3)
Clinical Cardiology     Hybrid Journal   (Followers: 11)
Clinical Hypertension     Open Access   (Followers: 5)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6)
Clinical Research in Cardiology     Hybrid Journal   (Followers: 6)
Clinical Research in Cardiology Supplements     Hybrid Journal  
Clinical Trials and Regulatory Science in Cardiology     Open Access   (Followers: 4)
Congenital Heart Disease     Hybrid Journal   (Followers: 6)
Congestive Heart Failure     Hybrid Journal   (Followers: 4)
Cor et Vasa     Full-text available via subscription   (Followers: 1)
Coronary Artery Disease     Hybrid Journal   (Followers: 2)
CorSalud     Open Access  
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 4)
Current Cardiology Reports     Hybrid Journal   (Followers: 7)
Current Cardiology Reviews     Hybrid Journal   (Followers: 4)
Current Cardiovascular Imaging Reports     Hybrid Journal   (Followers: 1)
Current Cardiovascular Risk Reports     Hybrid Journal  
Current Heart Failure Reports     Hybrid Journal   (Followers: 5)
Current Hypertension Reports     Hybrid Journal   (Followers: 6)
Current Hypertension Reviews     Hybrid Journal   (Followers: 6)
Current Opinion in Cardiology     Hybrid Journal   (Followers: 14)
Current Problems in Cardiology     Hybrid Journal   (Followers: 3)
Current Research : Cardiology     Full-text available via subscription   (Followers: 1)
Current Treatment Options in Cardiovascular Medicine     Hybrid Journal   (Followers: 1)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 5)
CVIR Endovascular     Open Access   (Followers: 1)
Der Kardiologe     Hybrid Journal   (Followers: 2)
Echo Research and Practice     Open Access   (Followers: 2)
Echocardiography     Hybrid Journal   (Followers: 4)
Egyptian Heart Journal     Open Access   (Followers: 2)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
ESC Heart Failure     Open Access   (Followers: 4)
European Heart Journal     Hybrid Journal   (Followers: 67)
European Heart Journal - Cardiovascular Imaging     Hybrid Journal   (Followers: 10)
European Heart Journal - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 3)
European Heart Journal - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart Journal : Acute Cardiovascular Care     Hybrid Journal   (Followers: 1)
European Heart Journal : Case Reports     Open Access   (Followers: 1)
European Heart Journal Supplements     Hybrid Journal   (Followers: 8)
European Journal of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9)
European Journal of Cardio-Thoracic Surgery Supplements     Full-text available via subscription   (Followers: 2)
European Journal of Cardiovascular Nursing     Hybrid Journal   (Followers: 5)
European Journal of Heart Failure     Hybrid Journal   (Followers: 14)
European Journal of Preventive Cardiology.     Hybrid Journal   (Followers: 6)
European Stroke Organisation     Hybrid Journal   (Followers: 3)
Experimental & Translational Stroke Medicine     Open Access   (Followers: 8)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 3)
Folia Cardiologica     Open Access  
Forum Zaburzeń Metabolicznych     Hybrid Journal  
Frontiers in Cardiovascular Medicine     Open Access   (Followers: 1)
Future Cardiology     Hybrid Journal   (Followers: 6)
General Thoracic and Cardiovascular Surgery     Hybrid Journal   (Followers: 3)
Global Cardiology Science and Practice     Open Access   (Followers: 5)
Global Heart     Hybrid Journal   (Followers: 3)
Heart     Hybrid Journal   (Followers: 48)
Heart and Mind     Open Access  
Heart and Vessels     Hybrid Journal  
Heart Failure Clinics     Full-text available via subscription   (Followers: 2)
Heart Failure Reviews     Hybrid Journal   (Followers: 3)
Heart India     Open Access   (Followers: 2)
Heart International     Full-text available via subscription  
Heart Rhythm     Hybrid Journal   (Followers: 11)
Heart Views     Open Access   (Followers: 2)
HeartRhythm Case Reports     Open Access  
Hellenic Journal of Cardiology     Open Access   (Followers: 1)
Herz     Hybrid Journal   (Followers: 3)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 2)
Hypertension     Full-text available via subscription   (Followers: 23)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Hypertension Research     Hybrid Journal   (Followers: 5)
Ibrahim Cardiac Medical Journal     Open Access  
IJC Heart & Vessels     Open Access   (Followers: 1)
IJC Heart & Vasculature     Open Access   (Followers: 1)
IJC Metabolic & Endocrine     Open Access   (Followers: 1)
Indian Heart Journal     Open Access   (Followers: 5)
Indian Journal of Cardiovascular Disease in Women WINCARS     Open Access  
Indian Journal of Thoracic and Cardiovascular Surgery     Hybrid Journal  
Indian Pacing and Electrophysiology Journal     Open Access   (Followers: 1)
Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery     Hybrid Journal   (Followers: 1)
Insuficiencia Cardíaca     Open Access  
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7)
International Cardiovascular Forum Journal     Open Access  
International Journal of Angiology     Hybrid Journal   (Followers: 2)
International Journal of Cardiology     Hybrid Journal   (Followers: 18)
International Journal of Cardiovascular and Cerebrovascular Disease     Open Access   (Followers: 2)
International Journal of Cardiovascular Imaging     Hybrid Journal   (Followers: 2)
International Journal of Cardiovascular Research     Hybrid Journal   (Followers: 6)
International Journal of Heart Rhythm     Open Access  
International Journal of Hypertension     Open Access   (Followers: 8)
International Journal of Hyperthermia     Open Access  
International Journal of Stroke     Hybrid Journal   (Followers: 30)
International Journal of the Cardiovascular Academy     Open Access  
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 2)
Interventional Cardiology Review     Full-text available via subscription  
JACC : Basic to Translational Science     Open Access   (Followers: 5)
JACC : Cardiovascular Imaging     Hybrid Journal   (Followers: 18)
JACC : Cardiovascular Interventions     Hybrid Journal   (Followers: 17)
JACC : Heart Failure     Full-text available via subscription   (Followers: 14)
JAMA Cardiology     Hybrid Journal   (Followers: 28)
JMIR Cardio     Open Access  
Jornal Vascular Brasileiro     Open Access  
Journal of Clinical & Experimental Cardiology     Open Access   (Followers: 5)
Journal of Arrhythmia     Open Access  
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal of Cardiac Failure     Hybrid Journal   (Followers: 1)

        1 2 | Last

Similar Journals
Journal Cover
Cardiovascular Revascularization Medicine
Journal Prestige (SJR): 0.627
Citation Impact (citeScore): 1
Number of Followers: 1  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1553-8389 - ISSN (Online) 1878-0938
Published by Elsevier Homepage  [3161 journals]
  • Use, safety and effectiveness of Subintimal Angioplasty and Re-entry
           Devices for the Treatment of Femoropopliteal Chronic Total Occlusions: a
           Systematic Review of 87 Studies and 4665 Patients
    • Abstract: Publication date: Available online 23 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Damianos G. Kokkinidis, Ioannis Katsaros, Anil Kumar Jonnalagadda, Seth J. Avner, Nikolaos Chaitidis, Christos Bakoyiannis, Amit Kakkar, Eric A. Secemsky, Jay S. Giri, Ehrin J. ArmstrongAbstractBackgroundSubintimal angioplasty (SIA) is often utilized to cross femoropopliteal (FP) artery chronic total occlusions (CTOs). Re-entry devices (RED) can further assist with true lumen re-entry.ObjectiveTo systematically review the literature for studies reporting on the use of SIA, with or without RED.MethodsA systematic review according to the PRISMA guidelines was performed. Quantitative synthesis was applied when possible.Results87 studies and 4665 patients (5161 lesions) were included (63.9% male). 46.7% of patients had critical limb ischemia at the time of the intervention. Two RED types were used (Pioneer and Outback). Sixty-eight studies included lesions treated with SIA without RED, 17 studies included lesions treated with RED only, and two studies included a comparison between the two treatment methods. In total, 3898 (83.6%) patients were treated with SIA without RED and 754 (12.2%) with RED. Procedural success rate ranged from 64.5%–100% (92.5% for SIA without RED, 88.3% for RED cases). The complication rate ranged from 1.6% - 28% among different studies (cumulative rates: SIA: 9.1%, RED 9.3%). Perforations occurred in 1.6% of the total population (n = 46). Primary patency at one year ranged from 22% to 94.1%. Newer studies had a higher patency rate, ranging from 70% to 94.1%.ConclusionSIA with or without RED is a valuable alternative to intraluminal crossing for endovascular treatment of FP CTOs. Procedural success was excellent for both techniques, while the cumulative complication rate was numerically lower in the RED group. Short- and long-term outcomes were acceptable for both techniques.
       
  • Ample evidence for Statins Preloading before PCI on Periprocedural
           Myocardial Infarction Among Stable Angina Pectoris Patients Undergoing
           Percutaneous Coronary Intervention
    • Abstract: Publication date: Available online 23 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Mariam Shariff, U. Ashish Kumar
       
  • Direct Stenting in Patients Treated with Orbital Atherectomy: An ORBIT II
           Subanalysis
    • Abstract: Publication date: Available online 21 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Evan Shlofmitz, Brad J. Martinsen, Ann N. Behrens, Ziad A. Ali, Michael S. Lee, Joseph A. Puma, Richard A. Shlofmitz, Jeffrey W. ChambersAbstractBackgroundDirect stenting offers many potential advantages in appropriately selected lesions. Coronary artery calcification increases the complexity and risk of adverse events associated with percutaneous coronary intervention. This study aimed to examine the feasibility of direct stenting after treatment with orbital atherectomy (OA).MethodsORBIT II was a single-arm trial enrolling 443 subjects with de novo severely calcified coronary lesions treated with OA; direct stenting was utilized in 59.0% of cases. Procedural outcomes and 3-year major adverse cardiac event (MACE) rates were compared in subjects treated with pre-stent balloon dilatation versus direct stenting after OA.ResultsProcedural success (84.2% vs. 93.3%; p= 0.004) was significantly higher in the direct stenting cohort. 3-year MACE occurred less frequently in the direct stenting cohort (29.9% vs. 19.1%; p=0.006), driven by lower rates of myocardial infarction and target lesion revascularization. In a propensity matched analysis, procedural success and 3-year MACE rates were similar in the pre-stent balloon dilatation and direct stenting groups (85.0% vs. 91.8%; p=0.122 and 28.2% vs. 19.6%; p=0.078, respectively).ConclusionsOrbital atherectomy facilitates direct stenting and is associated with high procedural success and favorable 3-year outcomes in carefully selected patients. Randomized studies are needed to assess the optimal strategy after lesion preparation with OA.Summary for Annotated Table of Contents:This post-hoc analysis of the ORBIT II study examined the feasibility of direct stenting after treatment with orbital atherectomy. The results demonstrate that orbital atherectomy facilitates direct stenting and is associated with high procedural success and favorable 3-year outcomes in carefully selected patients. Using lesion preparation with orbital atherectomy and intravascular imaging may obviate the need for pre-stent balloon dilatation prior to stenting in appropriately selected patients with calcified coronary artery disease.
       
  • Advanced hybrid complete revascularization with TECAB and Impella-assisted
           PCI of CTO
    • Abstract: Publication date: Available online 21 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Taishi Hirai, Hiroto Kitahara, Husam H. Balkhy, John E.A. BlairAbstractAn 80-year-old man was referred for multi-vessel coronary artery disease with baseline SYNTAX score of 45 after evaluation for persistent stable angina. He underwent complete hybrid revascularization combining total endoscopic coronary artery bypass utilizing bilateral internal mammary arteries (IMA) with sequential LIMA to left anterior descending artery and diagonal arteries, and RIMA to obtuse marginal after Impella-assisted chronic total occlusion percutaneous coronary intervention of the right coronary artery. This represents a successful case of advanced hybrid coronary revascularization.
       
  • Blinding results for transcatheter mitral valve repair
    • Abstract: Publication date: Available online 19 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Jaffar M. Khan, Anees Musallam, Ron Waksman
       
  • Safety of Impella RP
    • Abstract: Publication date: Available online 16 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Nauman Khalid, Toby Rogers, Evan Shlofmitz, Yuefeng Chen, Anees Musallam, Jaffar M. Khan, Micaela Iantorno, Deepakraj Gajanana, Hayder Hashim, Rebecca Torguson, Nelson Bernardo, Ron WaksmanAbstractBackground/Purpose.Right ventricular (RV) mechanical circulatory support remains an important adjunctive therapy for RV failure refractory to medical therapy. Impella RP (Abiomed, Danvers, MA) is approved for providing temporary RV support for patients with acute right heart failure or decompensation following left ventricular assist device implantation, myocardial infarction, heart transplant, or open-heart surgery. Robust data on the most commonly reported complications and failure modes for the Impella RP are lacking. We analyzed the post-marketing surveillance data from the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database to assess these endpoints.Materials/Methods.The MAUDE database was queried for the time period January 1, 2009, through December 31, 2018, for Impella devices by searching for the following event types: “injury”, “malfunction”, “death”, and “other”. The search yielded 436 device reports. Impella RP medical device reports were screened, and 35 reports were included for the final analysis.ResultsIn cases of reported complications, Impella RP was placed most commonly for right ventricular failure (RVF) developing in postcardiotomy patients (20%). The most commonly reported complications included bleeding (42.9%) and vascular complications (22.8%). The modes of failure included damage or fracture of the device elements (34.2%); thrombus, or clot in the system (17.1%); and device detachment (8.6%).ConclusionsFindings from the MAUDE database highlight the failure modes of the Impella RP device that should be addressed in order to improve the device performance and obtain improved clinical outcomes when utilized for RVF.
       
  • Techniques to Optimize the Use of Optical Coherence Tomography: Insights
           From the Manufacturer and User Facility Device Experience (MAUDE) Database
           
    • Abstract: Publication date: Available online 15 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Evan Shlofmitz, Hector M. Garcia-Garcia, Toby Rogers, Nauman Khalid, Yuefeng Chen, Alexandre H. Kajita, Jaffar M. Khan, Micaela Iantorno, Robert A. Gallino, Nelson L. Bernardo, Hayder Hashim, Rebecca Torguson, Ron WaksmanAbstractBackground/PurposeOptical coherence tomography (OCT) is a high-resolution intravascular imaging modality used to assess coronary arteries and as an adjunctive tool for optimization of percutaneous coronary interventions. Overall, the rate of complications and adverse events related to intravascular imaging is low. Limited data exist on the most commonly reported complications and modes of failure related to the use of OCT. Therefore, we analyzed the post-marketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to assess the reported complications and failure modes for OCT and reviewed techniques to optimize device use.Methods/MaterialsThe MAUDE database was queried for all event reports involving coronary OCT devices. Two independent reviewers identified 49 device reports included in the final analysis. Modes of failure and device-related patient complications were assessed.ResultsOf the 49 cases with reported device-related issues, 6.1% involved malfunction prior to insertion of the OCT catheter, and 30.6% of reported events did not result in an associated patient-related adverse event. The most commonly reported adverse events included coronary dissection and difficulty removing the catheter within a previously stented segment. No events of contrast-induced nephropathy were reported.ConclusionsFindings from the MAUDE database highlight the modes of device-related events associated with OCT. Device issues are uncommon, and as a result, users should be aware of optimal techniques to prevent and minimize adverse events related to device use.
       
  • Reflections on percutaneous therapies for secondary mitral regurgitation
    • Abstract: Publication date: Available online 15 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Steven L. Goldberg
       
  • 5-year results of the BIOFLOW-III registry
    • Abstract: Publication date: Available online 15 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Johannes Waltenberger, Johannes Brachmann, Jan van der Heyden, Gert Richardt, Ole Fröbert, Markus Seige, Guy Friedrich, Andrejs Erglis, Mark Winkens, Christian Hegeler-Molkewehrum, Martin Neef, Stefan HoffmannAbstractPurposeWe aimed to assess long-term safety and performance of the Orsiro sirolimus-eluting coronary stent with biodegradable polymer in a large unselected population and in pre-specified subgroups.MethodsBIOFLOW-III is a prospective, multicenter, international, observational registry with follow-up visits scheduled at 6 and 12 months, and at 3 and 5 years. (NCT01553526).Results1356 patients with 1738 lesions were enrolled. Of those, 392 (28.9%) declined to participate in the study extension from 18 months to 5 years, 37 (2.7%) withdrew consent, and 89 (6.6%) were lost to follow-up. At 5-years, Kaplan-Meier estimates of target lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, coronary artery bypass grafting and clinically driven target lesion revascularization was 10.0% [95% confidence interval (CI):8.4;12.0] in the overall population, and 14.0% [95%CI:10.5;18.6], 10.3% [95%CI:7.8;13.5], 1.8% [95%CI:0.3;12.0], and 11.3% [95%CI:8.5;15.1] in the pre-defined risk groups of patients with diabetes mellitus, small vessels ≤2.75 mm, chronic total occlusion, and acute myocardial infarction. Definite stent thrombosis was observed in 0.3% [95%CI:0.1;0.9] of patients.ConclusionThese long-term outcomes provide further evidence on the safety and performance of a sirolimus-eluting biodegradable polymer stent within daily clinical practice. The very low definite stent thrombosis rate affirms biodegradable polymer safety and performance.
       
  • Outcomes of patients with atrial fibrillation undergoing percutaneous
           coronary intervention analysis of National Inpatient Sample
    • Abstract: Publication date: Available online 14 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Madhan Shanmugasundaram, Bishnu P. Dhakal, Sangeetha Murugapandian, Mehrtash Hashemzadeh, Timir Paul, Mohammed R. MovahedAbstractBackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia with a prevalence of 15% of patients over 80 years. Coronary artery disease co-exists in 20–30% of patients with atrial fibrillation. The need for triple anticoagulation therapy makes the management of these patients challenging following PCI.MethodsNationwide inpatient sample which is a set of longitudinal hospital inpatient databases was used to evaluate the outcome of patients with AF who underwent PCI. All patients undergoing PCI between 2002 and 2011 were included in the study. Specific ICD-9-CM codes were used to identify the study patients and their outcomes.ResultsThere were 3,226,405 PCIs during the time period of the study of which 472,609 (14.6%) patients had AF. AF patients were older and predominantly male (60%). The number of PCIs had a declining trend from 2002 to 2011. Age adjusted inpatient mortality was significantly higher in PCI AF group compared to the PCI non-AF group (100.82 ± 9.03 vs 54.07 ± 8.96 per 100,000; p 
       
  • Salvage of simultaneous acute coronary closure and retroperitoneal
           bleeding using Veno- arterial extracorporeal membrane oxygenation and
           chronic Total occlusion percutaneous coronary intervention techniques in a
           patient with ST-segment elevation myocardial infarction
    • Abstract: Publication date: Available online 14 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Iosif Xenogiannis, Kasia Hryniewicz, M. Nicholas Burke, Emmanouil S. BrilakisAbstractIatrogenic coronary artery dissection is a feared complication of coronary intervention as it can potentially lead to severe myocardial ischemia, arrhythmias, shock, and death. Bailout-stenting or less often, emergent coronary artery bypass graft surgery may be needed for restoring antegrade flow. We describe a case of inferior ST-segment elevation acute myocardial infarction with preserved antegrade coronary flow. Percutaneous coronary intervention was complicated by acute right coronary artery closure during guide catheter engagement. Attempts for re-entry into the right coronary artery true lumen failed. Attempts to obtain right femoral arterial access resulted in retroperitoneal hematoma. The patient developed refractory ventricular fibrillation and could not be defibrillated. Veno-arterial extracorporeal membrane oxygenation was started using surgical right femoral cutdown for the venous cannula and the left common femoral artery for the arterial cannula. A dissection strategy with a knuckled guidewire was used around previously placed stents followed by successful re-entry into the distal right coronary artery using the Stingray system. The venous cannula was changed to the internal jugular vein and the right common femoral artery and vein were surgically repaired. The patient was decannulated two days later and was eventually discharge from the hospital neurologically intact.
       
  • Determinants of greater peak radiation skin dose in contemporary
           percutaneous coronary interventions
    • Abstract: Publication date: Available online 14 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Hiroko Hasegawa, Kenichi Sakakura, Kohei Hamamoto, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-ichi Momomura, Hideo FujitaAbstractBackgroundSkin radiation injuries, especially radiation ulcers, are serious side effects caused by ionizing radiation during percutaneous coronary interventions (PCI). Because skin radiation injuries are closely associated with the peak skin dose, it is important to minimize the peak skin dose. The aim of the present study was to investigate the determinants of greater peak skin dose in current PCI.MethodsWe included 707 consecutive coronary artery lesions, and divided them into an excess radiation group (n = 26; defined as peak skin dose ≥2 Gray) and a standard radiation group (n = 681; defined as peak skin dose
       
  • Drug-coated balloons in diabetic patients
    • Abstract: Publication date: Available online 13 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Michael Megaly, Abdelrahman Ali, Bishoy Abraham, Charl Khalil, Magdi Zordok, Marco Shaker, Mariam Tawadros, Bassam S. Hennawy, Ayman Elbadawi, Mohamed Omer, Marwan SaadAbstractBackgroundPercutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains associated with inferior clinical outcomes and an increased risk of restenosis compared with non-diabetics even in the era of drug-eluting stents (DES). The outcomes with drug-coated balloons (DCBs) in diabetic patients have received limited study.MethodsWe performed a meta-analysis of all studies published between January 2000 and January 2019 reporting the outcomes with DCB vs. DES after PCI of de-novo coronary lesions in diabetic patients. Outcomes included major adverse cardiovascular events (MACE), target lesion revascularization (TLR), binary restenosis by quantitative coronary angiography (QCA), and late lumen loss (LLL).ResultsThree studies with 378 patients (440 lesions) were included in the meta-analysis. During 17.3 ± 11.3 months follow-up, DCB were associated with a similar risk of MACE (OR: 0.63, 95% CI [0.36, 1.12], p = 0.11), TLR (OR: 0.51, 95% CI [0.25, 1.06] p = 0.07), binary restenosis (OR: 0.42, 95% CI [0.09, 1.92], p = 0.26), and LLL (mean difference: −0.13 mm, 95% CI [−0.41, 0.14], p = 0.34) compared with DES.ConclusionIn diabetic patients with de-novo coronary lesions undergoing PCI, DCBs are associated with similar outcomes compared with first-generation DES, with a signal toward potential benefit in lowering target lesion revascularization. Further randomized studies are needed to compare the newer-generation DCBs and DES in this setting.
       
  • Comparison of transradial and transfemoral approaches for coronary
           angiography and percutaneous intervention in patients with coronary bypass
           grafts
    • Abstract: Publication date: Available online 12 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Hisham Hirzallah, Ahmed Amro, Damir Kusmic, Zachary Curtis, Emilia C. Leigh, Yazan Numan, Julia Parsons, Mohammad Amro, Sutoidem Akpanudo, Rameez Sayyed, Mehiar ElhamdaniAbstractObjectiveWe sought to compare the transradial and transfemoral approaches for coronary angiography and percutaneous intervention in patients with coronary artery bypass grafts in terms of volume of radiographic contrast administered during cardiac catheterization, fluoroscopy time, and total procedure time.BackgroundThe transradial access has been increasingly used as an alternative to transfemoral. Several studies demonstrated that such access is associated with lower rates of vascular and bleeding complications. Although coronary artery bypass graft patients comprise a significant portion of the coronary artery disease population, this subpopulation was often excluded or underrepresented in transradial access studies.MethodsSingle center, retrospective cohort study. In the study period, all patients who had previously undergone coronary artery bypass graft surgery and had received cardiac catheterization at our institution were included in the study population.ResultsA total of 2153 patients were included in the study. From these, 1937 were performed by femoral artery and 216 by transradial approach. Compared to the transfemoral approach, transradial access was associated with lower contrast use (136.3 ± 74.4 ml vs. 122.8 ± 59.1 ml, p = 0.035) and longer fluoroscopy time (13.9 ± 25.6 min vs. 15.9 ± 14.3 min, p 
       
  • Dual versus triple antithrombotic therapy in patients undergoing
           percutaneous coronary intervention-meta-analysis and meta-regression
    • Abstract: Publication date: Available online 5 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Nayan Agarwal, Ahmed N. Mahmoud, Mohammad Khalid Mojadidi, Harsh Golwala, Islam Y. ElgendyAbstractBackgroundAnti-thrombotic regimen in patients on long term anticoagulation requiring coronary intervention remains a clinical challenge.MethodsWe performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of triple therapy (dual antiplatelet therapy and anticoagulant) with dual therapy (P2Y12 inhibitor and anticoagulant) in patients on long-term anticoagulants after percutaneous coronary intervention (PCI). Major bleeding was the primary outcome.ResultsThree observational studies and 3 randomized controlled trials with a total of 6654 patients met our selection criteria. At a mean follow up of 12.5 months major bleeding was lower in dual therapy cohort compared to triple therapy (2.2% vs 5.2%, RR 0.60, 95% CI 0.44–0.81, P = 0.001). No difference was observed between the two groups for major adverse cardiac events (11.8% vs 13.0%, RR 1.03, CI 0.79–1.34, P = 0.85), all-cause mortality (3.9% vs 5.6%, RR 0.94, CI 0.65–1.36, P = 0.76), myocardial infarction (3.7% vs 3.9%, RR 1.12, CI 0.83–1.50, P = 0.47), target vessel revascularization (6.8% vs 7.1%, RR 1.12, CI 0.72–1.74, P = 0.60), thromboembolic events (1.3% vs 1.6%, RR 0.95, CI 0.55–1.64, P = 0.85) and stent thrombosis (1.3% vs 1.4%, RR1.36, CI 0.84–2.21, P = 0.21).ConclusionFor patients undergoing PCI and requiring long term anticoagulation, a strategy of P2Y12 inhibitor plus anticoagulant confers a benefit of less major bleeding with no difference in major adverse cardiac events, mortality, myocardial infarction, target vessel revascularization, stent thrombosis or thromboembolism compared with triple therapy.
       
  • Comparison of coronary artery bypass grafting and drug-eluting stents in
           patients with left main coronary artery disease and chronic kidney
           disease: A systematic review and meta-analysis
    • Abstract: Publication date: Available online 3 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Mahmoud Barbarawi, Yazan Zayed, Kewan Hamid, Babikir Kheiri, Owais Barbarawi, Saira Sundus, Laith Rashdan, Ahmad Alabdouh, Adam Chahine, Ghassan Bachuwa, Moahmmad Luay AlkotobAbstractBackgroundTreatment of left main coronary artery disease (LMCAD) in patients with chronic kidney disease (CKD) with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. Therefore, we performed a meta-analysis to evaluate the optimal choice of therapy when treating LMCAD in patients with CKD.MethodWe performed an electronic database search of Pubmed, Embase, and Cochrane Library for all studies that compared PCI with CABG when treating LMCAD in the setting of CKD. Major adverse cardiac and cerebrovascular events (MACCE) were the primary outcome. Secondary outcomes included myocardial infarction (MI), cerebrovascular events, all-cause mortality, and repeat revascularization.ResultsOur analysis included 5 studies (2 randomized controlled trial and 3 retrospective) representing a total of 1212 patients. Mean follow up was 3.4 ± 1.3 years. Our study demonstrated a significant reduction in MACCE for patients treated with CABG compared with PCI (odd ratio [OR] 0.72; 95% confidence interval [CI] 0.55–0.95, P = 0.02, I2 = 0%). We also found a significant reduction in both MI (OR 0.55; 95% CI 0.34–0.87; P = 0.01; I2 = 0%) and repeat revascularization (OR 0.22; 95% CI 0.10–0.51; P 
       
  • Sex differences in treatment and prognosis of acute coronary syndrome with
           interventional management
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Virginia Ruiz-Pizarro, Carlos Ferrera, Juan Carlos Gómez-Polo, Julián Palacios-Rubio, Carmen Rico-García Amado, Antonio Fernández-Ortiz, Ana Viana-TejedorAbstractObjectiveFemale sex has been associated with differences in diagnostic and management of acute coronary syndrome (ACS). Our aim was to analyze sex differences in ACS with interventional management in a tertiary care hospital.MethodsPatients with ACS admitted to a Spanish tertiary care referral center were included prospectively and consecutively. All patients included in the study underwent a coronary angiography.ResultsFrom the total cohort of 1214 patients, 290 (24%) were women. Women were older (71 ± 12.8 vs 64 ± 13.4 years, p 
       
  • In complex coronary bifurcations, should a dedicated stent be better than
           a dedicated approach'
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Irene Pescetelli, Fabrizio Ricci, Marco Zimarino
       
  • Sirolimus nanoparticles: (Delivering) a new hope in stentless percutaneous
           coronary intervention'
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Joshua P. Loh, Hui Wen Sim
       
  • CD34+ Cell Therapy for No-Option Refractory Disabling Angina: Time for FDA
           Approval'
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Lillian Benck, Timothy D. Henry
       
  • The Modern Landscape of Renal Artery Stenosis and Renovascular
           Hypertension
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Benjamin R. Weber, Robert S. Dieter
       
  • Digital ankle brachial index— a valuable tool for Office evaluation
           of PAD'
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Robert E. Beasley
       
  • LVAD decommissioning: A percutaneous cardiac catheterization lab approach
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Luise Holzhauser, Jonathan R. Rosenberg, Nir Uriel, Atman P. Shah
       
  • Transradial access for rotational atherectomy
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Rahman Shah, Ion S. Jovin
       
  • Orbiting a treatment for some with critical hand ischemia
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Ian C. Gilchrist
       
  • Bioresorbable scaffolds for the treatment of acute coronary syndrome. A
           possible niche indication or not'
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Ruben Y.G. Tijssen, Joanna J. Wykrzykowska
       
  • True double bifurcation lesions: new application of the self-expandable
           Axxess stent and review of literature with dedicated bifurcation devices
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Francesco Borgia, Tullio Niglio, Nicola De Luca, Luigi Di Serafino, Giovanni Esposito, Bruno Trimarco, Plinio CirilloAbstractComplex coronary artery bifurcation lesions occurred in hard clinical scenarios, such as acute coronary syndromes, may represent a challenge for interventional cardiologists, with not-defined general consensus on treatment. Even if provisional stenting is the most common option used to restore rapidly the coronary branches flow, improvements in industrial technologies and design of new dedicated bifurcation devices might open new modalities of treatment in these complex cases. The Axxess stent (Biosensors Europe SA, Morges, Switzerland) is a self-expanding biolimus-eluting conical V-shape stent, specifically designed to treat “easily” coronary artery bifurcation lesions, with reported favorable long-term clinical results in stable patients compared to a provisional technique. We report for the first time the feasibility to use this device in a case of “true double coronary bifurcation lesion” occurred in the context of acute coronary syndrome. Moreover, we reviewed studies with bifurcation dedicated devices and available cases of “true double bifurcation lesions”, underlying advantages/disadvantages of using one device over the others during acute coronary syndrome.
       
  • Treatment of critical hand ischemia via orbital atherectomy and focal
           force balloon angioplasty: A mini-review
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Abdul Bahro, Zsuzsanna Igyarto, Connie Williams, John P. Abraham, Brad J. MartinsenAbstractCalcified lesions in below-the-elbow (BTE) arteries are common in patients with diabetes or end-stage renal disease and can lead to critical hand ischemia (CHI). Treatment of calcified lesions with atherectomy has proved useful in the lower extremities, however, atherectomy in the upper extremities and especially BTE, is not typically considered due to the small vessel size. We review and discuss these studies along with other CHI-related articles and also present a case of a severely calcified ulnar artery lesion treated with orbital atherectomy and plain Chocolate balloon angioplasty.
       
  • Safety and efficacy of radial versus femoral access for rotational
           Atherectomy: A systematic review and meta-analysis
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Abdul Ahad Khan, Hemang B. Panchal, Syed Imran M. Zaidi, Muralidhar R. Papireddy, Debabrata Mukherjee, Mauricio G. Cohen, Subhash Banerjee, Sunil V. Rao, Samir Pancholy, Timir K. PaulAbstractIntroductionOver the recent years, there has been increased interest in the use of transradial (TR) access for percutaneous coronary intervention (PCI), including rotational atherectomy (RA). However, a large proportion of operators seem to be reluctant to use TR access for complex PCI including rotational atherectomy for heavily calcified coronary lesions.MethodsWe searched MEDLINE, ClinicalTrials.gov and the Cochrane Library for studies comparing radial versus femoral access in patients undergoing RA. Studies were included if they reported at least one of the following outcomes in each group separately: major adverse cardiac events (MACE), major bleeding, stent thrombosis, myocardial infarction (MI), hospital length of stay, radiation exposure, procedure time, procedure success and all-cause mortality. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated and a p-value of
       
  • Mitral valve stenosis after transcatheter aortic valve replacement: Case
           report and review of the literature
    • Abstract: Publication date: Available online 1 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Francesco Cannata, Damiano Regazzoli, Giancarlo Barberis, Mauro Chiarito, Pier Pasquale Leone, Vincenzo Lavanco, Giulio G. Stefanini, Giuseppe Ferrante, Paolo Pagnotta, Renato Bragato, Elena Corrada, Lucia Torracca, Gianluigi Condorelli, Bernhard ReimersAbstractMitral stenosis is a rare and potentially severe complication of transcatheter aortic valve replacement (TAVR). Given the anatomic coupling and interdependence of the aortic and mitral valves, it comes by itself that procedures (either surgical or percutaneous) involving the aortic valve imply the risk of altering mitral valve function. Indeed, transcatheter aortic prostheses may impair adequate anterior mitral leaflet (AML) opening, especially when implanted in a “low” position, thus resulting in high transvalvular gradients.Hereby, we report the case of a 71-year-old male with symptomatic severe aortic stenosis and a history of previous surgical mitral valve repair who underwent TAVR with a self-expandable prosthesis. Notwithstanding an acceptable angiographic position, the prosthetic frame was shown to interfere with the AML, as evidenced by augmented transmitral gradients; nonetheless, pulmonary artery pressures remained unchanged, and the patient experienced symptomatic improvement. Therefore, a conservative approach was chosen and the patient was discharged home after medical therapy optimization.Moreover, we provide a review of the available literature regarding the incidence, predictors and possible management of this infrequent complication.
       
  • Clinical experience with very high-pressure dilatation for resistant
           coronary lesions
    • Abstract: Publication date: Available online 1 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Gioel Gabrio Secco, Achim Buettner, Rosario Parisi, Gianfranco Pistis, Matteo Vercellino, Andrea Audo, Mashayekhi Kambis, Roberto Garbo, Italo Porto, Giuseppe Tarantini, Carlo Di MarioAbstractBackgroundCalcific coronary lesions can be so resistant to prevent symmetric stent dilatation with high risk of ISR/thrombosis. The aim of the current study is to evaluate the safety and efficacy of super high-pressure dilatation (>30-to-45Atm) using a dedicated NC-balloon (OPN, SIS-Medical-AG, Winterthur-Switzerland).MethodsWe retrospectively evaluated 326 consecutive undilatable lesions in which conventional NC-balloons failed to achieve adequate post-dilatation luminal gain. After the failed attempt an OPN-balloon was inflated up to achieve a uniform balloon expansion (maximal dilatation pressure of 45–50 Atm). Lesions were divided into two groups according to the final inflation pressure: Group-I: lesion responsive to 30-40Atm and Group-2:>40 Atm. Angiographic success was defined as residual angiographic stenosis 40ATM (Group II). In 3 patients coronary rupture occurred after balloon inflation and was successfully treated with stent implantation with a final TIMI3-flow. The OPN alone was able to achieve adequate expansion in>90%. 0.9% days MACE were reported.ConclusionThe OPN-dedicated high-pressure balloon provides an effective and safe strategy for treatment of severe resistant coronary lesions.
       
  • Acute catheter-induced subclavian artery thrombosis treated with
           endovascular stent graft placement and rheolytic thrombectomy: A case
           report and review
    • Abstract: Publication date: Available online 1 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Paul H. Tolerico, James E. Harvey, Stewart M. Benton, Milan D. Patel, William J. Nicholson
       
  • Stentablation with rotational atherectomy for the management of
           underexpanded and undilatable coronary stents
    • Abstract: Publication date: Available online 1 March 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Hoyle L. Whiteside, Arun Nagabandi, Deepak KapoorAbstractStentablation with rotational atherectomy for the management of undilatable underexpanded coronary stents is a unique application associated with excellent periprocedural and in-hospital outcomes. Data regarding long-term outcomes remains limited, however the procedure appears to be associated with high prevalence of target lesion revascularization. Given the complexity of such lesions and few available interventional remedies; it is a reasonably safe and widely available approach of which operators should be aware. When stentablation is performed, the principles which guide contemporary rotational atherectomy and percutaneous coronary intervention, including intravascular imaging, should be applied.
       
  • Bioresorbable vascular scaffolds for complex chronic total occlusions
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Kenji Yaginuma, Hiller Moehlis, Matthias Koch, Karlheinz Tischer, Juliane Werner, Gerald S. WernerAbstractPurposeThis analysis of a consecutive series of bioresorbable vascular scaffolds (BVS) implanted for complex chronic total occlusions (CTOs) was done to evaluate the potential of this device to avoid a permanent full metal jacket with drug-eluting stents.PatientsWe analyzed 52 young patients (50.8 ± 8.3 years) for the BVS group, and additionally we followed a subgroup of 17 patients where DES were combined with BVS mainly because severe calcification at the lesion site (hybrid group).ResultsBVS were successfully implanted in 69 of 70 patients. An average of 3.17 BVS were used per lesion in the BVS group, with a CTO length of 28 ± 20 mm, and a reference diameter of 2.92 ± 0.34 mm, 69% were J-CTO ≥ 2. The retrograde approach was used in 38%. The device length was 79 ± 25 mm with 3.65 ± 0.34 mm final balloon diameter. In the hybrid group BVS was used to cover the distal segment beyond the actual occlusion predominantly in LAD lesions. Patients were discharged with dual antiplatelet therapy prescribed for 12 months. At 12 months, no patient had died or experienced an acute myocardial infarction. Angiography or MSCT follow-up available in 67% showed no reocclusion within 12 months. The target revascularization was 7% at 12 months. Two patients experienced a late non-acute reocclusion at 17 and 19 months.ConclusionsThe implantation of BVS for long complex CTOs was feasible with no stent thrombosis despite the high complexity of lesions and multiple BVS implanted. The lack of mechanical strength may lead to the need for focal reintervention, but still the long-term burden of full metal jacketed vessels could be avoided.
       
  • Intramyocardial autologous CD34+ cell therapy for refractory angina: A
           meta-analysis of randomized controlled trials
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Poonam Velagapudi, Mohit Turagam, Dhaval Kolte, Sahil Khera, Omar Hyder, Paul Gordon, Herbert D. Aronow, Jane Leopold, J. Dawn AbbottAbstractBackgroundPrevious studies have demonstrated that intramyocardial human CD34+ cells may relieve symptoms and improve clinical outcomes in chronic refractory angina unresponsive to optimal medical therapy or not amenable to revascularization.MethodsWe performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the impact of human CD34+ cells compared with placebo in chronic refractory angina. Primary efficacy outcomes in our analysis were angina frequency and exercise time. Primary safety outcomes included major adverse cardiovascular events such as myocardial infarction (MI), stroke and death.ResultsThree eligible randomized trials including 269 patients (placebo = 90, CD34+ = 179) were included. Dose of auto-CD34+ cells ranged from 5 × 104 to 5 × 105 cells/kg. Follow-up ranged from 6 to 24 months. In a pooled analysis, administration of CD34+ cells decreased the risk of all-cause mortality [OR 0.24, 95% CI (0.08–0.73), p = 0.01], reduced angina frequency [mean difference −2.91, 95% CI (−4.57 to −1.25), p = 0.0006] and improved exercise time [mean difference 58.62 s, 95% CI (21.19 to 96.06), p = 0.02] compared with control group. However, there was no significant difference in the risk of myocardial infarction (MI) and stroke between groups.ConclusionIn a meta-analysis, intra-myocardial CD34+ cell therapy was superior to placebo in improving risk of all – cause mortality, angina frequency with an increase in exercise time, without a significant increase in adverse events. This analysis supports further trials of CD34+ cell therapy for ischemic heart disease.
       
  • Is there still a role for renal artery stenting in the management of
           renovascular hypertension – A single-center experience and where do we
           stand'
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Zubair Khan, Sunit Tolia, Kumar Sanam, Gunjan Gholkar, Marc Zughaib, Sunil Naik, Marcel ZughaibAbstractBackgroundRenal artery (RA) stenosis has been implicated in the pathophysiological mechanism for resistant hypertension. Despite the increasingly diagnosed frequency of hemodynamically significant lesions, the value of RA revascularization remains controversial. Our group had previously demonstrated significant blood pressure (BP) reduction in a retrospective cohort of appropriately selected patients undergoing RA stenting up to 18-months of follow-up. We herein present long-term clinical outcomes data 5-years post revascularization on 26 subjects who continued follow-up at our institution.MethodsRetrospective analysis was performed on subjects who underwent RA stenting at our institution for hemodynamically significant (≥70%) RA stenosis and systolic hypertension on ≥3 antihypertensive agents. Clinical outcome data for systolic blood pressure (SBP), diastolic blood pressure (DBP), creatinine level and number of antihypertensive drugs was assessed prior to and then later at 6–12 months and 3–5 years post RA stenting.ResultsMean age was 69 ± 9 years; 27% (7/26) were male. Median follow-up was 5.1 years. Blood pressure reduction was sustained at long-term follow-up (135/70 ± 18/11 mmHg) compared to initial reduction noted at 6-months (136/69 ± 16/8 mmHg; p ≤0.01 for both) and from baseline (162/80 ± 24/18 mmHg; p ≤0.001 for both). The number of antihypertensive agents also decreased from 4.1 ± 1.0 to 2.7 ± 2.1 (p = 0.002) at 6-months and was sustained at long-term follow-up, 3.4 ± 1.2 (p = 0.03) with no difference in renal function between short- and long-term follow-up compared to baseline.ConclusionsThis study shows sustained benefit of RA stenting in BP reduction in an appropriately selected cohort with significant stenosis ≥70% and uncontrolled hypertension on multiple medications on long-term follow-up.
       
  • The evolving approach to the evaluation of low-gradient aortic stenosis
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): William B. Cutting, Anthony A. BavryABSTRACTSevere aortic stenosis (AS) is typically identified by a low valve area (≤1.0 cm2) and high mean gradient (≥40 mm Hg). A subset of patients are found to have a less than severe mean gradient (
       
  • Transcatheter mitral valve replacement in severe mitral annular
           calcification and atrial septal defect closure
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Ozan M. Demir, Neil Ruparelia, Deepa Gopalan, Gherardo Busi, Angela Frame, Nilesh Sutaria, Ben Ariff, Sayan Sen, Iqbal Malik, Antonio Colombo, Ghada W. Mikhail
       
  • Updated meta-analysis of closure of patent foramen ovale versus medical
           therapy after cryptogenic stroke
    • Abstract: Publication date: March 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 3Author(s): Usama Bin Nasir, Waqas T. Qureshi, Humanatha Jogu, Elizabeth Wolfe, Abhishek Dutta, Chaudhry Nasir Majeed, Walter A. TanAbstractBackgroundAmong patients with cryptogenic stroke, PFO closure has remained controversial. We hypothesized that with the cumulative number of subjects in randomized controlled trials (RCTs), there is now sufficient power to ascertain whether PFO closure in patients with cryptogenic stroke improves the risk of stroke.MethodsWe performed an updated meta-analysis by including newer RCTs that examined the benefit of PFO closure compared with medical therapy for improvement in risk of stroke. We utilized random effects models to compute the association and performed subgroup analyses by medical therapy, shunt size and presence/absence of atrial septal aneurysm.ResultsOverall, 6 RCTS were included with 1839 patients that underwent PFO closure and 1671 patients that received medical therapy and were followed for a period of 2–6 years. The incidence of recurrent stroke was 1.52% among PFO closure group and 3.94% among medical therapy group. There was decreased risk of stroke in PFO closure group (OR 0.34, 95% CI 0.15–0.79, p = 0.012). Patients with larger shunt size derived more benefit from PFO closure than smaller or moderate sized shunts. There was no difference in outcomes by presence or absence of atrial septal aneurysm or type of medical therapy used i.e. antiplatelet therapy only vs. antiplatelet + anticoagulant therapy.ConclusionThis meta-analysis of 6 RCTs demonstrated benefits of PFO closure for secondary prevention of stroke among patients with cryptogenic stroke and small increase in risk of new onset atrial fibrillation.
       
  • Everolimus Eluting Stents in Patients with Diabetes Mellitus and Chronic
           Kidney Disease: Insights from the TUXEDO trial
    • Abstract: Publication date: Available online 28 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Sripal Bangalore, Rajpal Abhaichand, Ajit Mullasari, Rajneesh Jain, R.K. Prem Chand, Priyadarshini Arambam, Upendra KaulAbstractBackgroundPatients with diabetes and those with chronic kidney disease (CKD) are at increased risk of cardiovascular events. Everolimus eluting stents (EES) have been shown to be superior to paclitaxel eluting stents (PES) in patients with diabetes. However, it is not known if EES is as beneficial in diabetic patients with CKD compared with those without CKD.Methods and ResultsPatients enrolled in the TUXEDO-India trial, which is a clinical trial of patients with diabetes and coronary artery disease (CAD) randomly assigned to EES vs. thin-strut PES (Taxus Element), with data on baseline renal function were selected. CKD was defined as an estimated glomerular filtration rate (eGFR)
       
  • Unintended delivery of surgical towel fibers into a vein graft during
           cardiac catheterization
    • Abstract: Publication date: Available online 22 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Rosie Jasper, Sameer Ahmed, James C. BlankenshipAbstractForeign body introduction during coronary stent delivery is an uncommon, yet potentially fatal, complication of coronary angiography and interventions. Inadvertent introduction of gauze fibers, starch granules and other foreign materials into circulation has been reported in literature. The introduction of inorganic surgical debris can cause distal embolization, vessel occlusion and wall infiltration causing infarction, acute stenosis and granulomatous reaction. This report describes a case of successful extraction of inorganic blue filamentous material during coronary vein graft intervention detected as a filling defect in a filter during coronary vein graft intervention. The specimen represented fibers from blue surgical towels used on sterile field during cardiac catheterization.
       
  • Feasibility of implanting 50–60 mm-tapered drug eluting stents in
           chronic total occlusions
    • Abstract: Publication date: Available online 20 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Gema Miñana, Luciano Consuegra-Sánchez, Eva Rumiz, Ernesto Valero, Sergio García-Blas, Vicente Pernias, Oliver Husser, Agustin Fernández-Cisnal, Juan Sanchis, Julio NúñezAbstractBackgroundPercutaneous coronary intervention (PCI) of chronic total occlusions (CTO) usually involves multiple overlapping stents implantation to cover long coronary segments. A higher rate of restenosis has been described with stent overlapping. Recently, new long tapered stents emerged as a potential tool for treating long coronary lesions. Feasibility of using these new devices for the CTO PCI has not been described. The aim of this work was to describe our initial experience with 50 and 60 mm-long tapered sirolimus-eluting stents (SES) in CTO PCI.MethodsWe included 54 consecutive patients who underwent a CTO PCI and in whom an attempt to implant a 50 or 60 mm-long tapered SES was performed. Baseline clinical, angiographic, and procedural characteristics were recorded.ResultsThe median (IQR) age was 64 (58–73) years, and 45 (83.3%) patients were male. The tapered SES 50 and 60 mm-long was successfully implanted in 51 (94.4%) patients. In three patients, a 60 mm-long stent could not be implanted, and two or three overlapped shorter drug-eluting stents were deployed instead. An average of 1.4 ± 0.6 stents per patient was implanted. A single stent was deployed in 32 (59.3%) patients. During a median follow-up of 330 (149–551) days, repeat PCI in the target vessel was performed in two patients.ConclusionsThe use of the new BioMime Morph™ tapered SES for the treatment of CTO appears to be feasible in a high proportion of procedures. Further studies confirming the feasibility of this approach and its potential clinical advantages are needed.
       
  • Magmaris edge vascular response at 12 months
    • Abstract: Publication date: Available online 18 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Alexandre Hideo-Kajita, Hector M. Garcia-Garcia, Michael Haude, Michael Joner, Jacques Koolen, Hüseyin Ince, Alexandre Abizaid, Ralph Toelg, Pedro A. Lemos, Clemens von Birgelen, Evald Høj Christiansen, William Wijns, Franz-Josef Neumann, Christoph Kaiser, Eric Eeckhout, Lim Soo Teik, Javier Escaned, Viana Azizi, Kayode O. Kuku, Yuichi OzakiAbstractIntroduction and Objective.The edge vascular response (EVR) remains unknown in second generation drug-eluting Resorbable Magnesium Scaffold (RMS), such as Magmaris. The aim of the study was to evaluate tissue modifications in the RMS edges over time, assessed by different invasive imaging modalities.MethodsThe patients treated with the device were assessed by optical coherence tomography (OCT), grayscale intravascular ultrasound (IVUS), and virtual histology IVUS at baseline and 12 months. The EVR study performed a segment- and frame-level analysis of the 5 mm segments proximal and distal of the actual RMS.ResultsThe segment-level grayscale IVUS(n = 10), virtual histology IVUS(n = 10), and OCT(n = 18) analysis did not show any significant changes after 12 months, except for a fibrous plaque area(FPA) reduction of 0.5mm2 (p = 0.017) in the proximal segment compared to baseline. In the frame-level analysis, IVUS evaluation revealed a vessel area decreased 2.80 ± 1.43 mm2 (p = 0.012) and 2.49 ± 1.53 mm2 (p = 0.022) in 2 proximal frames. This was accompanied by plaque area reduction of 0.88 ± 0.70 mm2 (p = 0.048) and a FPA decreased by 0.63 ± 0.48 mm2 (p = 0.004) in one proximal frame. In 1 distal frame, there was a dense calcium area reduction of 0.10 ± 0.12 mm2 (p = 0.045), FPA and fibrous fatty plaque increased 0.54 ± 0.53 mm2 (p = 0.023) and 0.17 ± 0.16 mm2 (p = 0.016), respectively. By OCT, there was a lumen area decrease of 0.76 ± 1.51 mm2 (p = 0.045) in a distal frame.ConclusionAt 12 months, Magmaris EVR assessment does not show overall significant changes, except for a fibrous plaque area reduction in the proximal segment. This could be translated as a benign healing process at the edges of the RMS.Summary: The edge vascular response (EVR) remains unknown in second generation drug-eluting absorbable metal scaffolds (RMS), such as Magmaris. Patients treated with the device were assessed by multi invasive imaging modalities [i.e. optical coherence tomography (OCT), grayscale intravascular ultrasound (IVUS), and virtual histology IVUS] evaluating the tissue changes over time in the segment- and frame-level analysis of the 5 mm segments proximal and distal of the actual RMS. As a result, after 12 months, Magmaris EVR assessment does not show overall significant changes, except for a fibrous plaque area reduction in the proximal segment, translating a benign healing process at the edges of the RMS.
       
  • Overview of the 2018 US Food and Drug Administration Circulatory System
           Devices Panel meeting on the INCRAFT AAA Stent Graft System
    • Abstract: Publication date: Available online 18 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Micaela Iantorno, Kyle D. Buchanan, Nelson L. Bernardo, Rebecca Torguson, Ron WaksmanAbstractOn June 12, 2018, the US Food and Drug Administration (FDA) convened a meeting of the Circulatory System Devices Panel to advise on the safety and effectiveness of the INCRAFT® AAA Stent Graft System for the treatment of abdominal aortic aneurysms (AAA) and to consider a premarket approval application sponsored by Cordis, Inc., for Unique identifier: NCT01664078 based on the results of the pivotal INSPIRATION trial (URL: https://clinicaltrials.gov/ct2/show/NCT01664078). The INCRAFT® AAA Stent Graft System is designed for endovascular repair of infrarenal AAAs with complex aortic anatomies. The stent-graft system utilizes nitinol stent and polyester graft technology in an ultra-low profile delivery system, with the goal of isolating the aneurysmal sac and preventing sac rupture. The multicenter, prospective, non-randomized investigation trial met its primary composite safety and effectiveness endpoints but also showed higher-than-anticipated rates of stent fracture and endoleaks. The committee discussion focused on how these events impact the long-term safety and effectiveness, as well as the benefit/risk profile, of the device. While the panel acknowledged the risk of the device, the panel's final vote supported that the benefits of the INCRAFT AAA Stent Graft System outweigh the risks and that a post-marketing study should be mandated. The FDA approved the device for use in complex access anatomies in December 2018.
       
  • Adverse Events Associated With the Use of Guide Extension Catheters During
           Percutaneous Coronary Intervention: Reports From the Manufacturer and User
           Facility Device Experience (MAUDE) Database
    • Abstract: Publication date: Available online 18 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Yuefeng Chen, Arhum A. Shah, Evan Shlofmitz, Nauman Khalid, Anees Musallam, Jaffar M. Khan, Micaela Iantorno, Deepakraj Gajanana, Toby Rogers, Hayder Hashim, Nelson L. Bernardo, Ron WaksmanAbstractBackground/PurposeWe aimed to assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters.Methods/MaterialsThe US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried for reported events.ResultsOf the 65 cases with reported GuideLiner-related issues, 15 (23%) involved the inability to pass equipment through or damage to percutaneous coronary intervention (PCI) devices in the GuideLiner catheter, 38 (58%) involved GuideLiner catheter fracture, 9 (14%) involved coronary artery dissection, 2 (3%) involved coronary artery perforation, and 1 (1.5%) involved thrombus formation in the catheter. Of the 408 cases with reported Guidezilla-related issues, 53 (13%) involved inability to pass or damaged PCI devices into the Guidezilla catheter, 117 (29%) involved inability to advance the Guidezilla catheter to the target lesion, 59 (14%) involved kinked Guidezilla catheter, mostly because of partial or complete catheter fracture upon further investigation, 164 (40%) involved a broken Guidezilla catheter, 10 (2.5%) involved coronary artery dissection, 2 (0.5%) involved coronary artery perforation, 1 (0.2%)involved aortic dissection, 1 (0.2%) involved thrombosis formation, and 1 (0.2%) involved no-reflow phenomenon.ConclusionsFindings from the MAUDE database highlight the complications and modes of events associated with the use of GuideLiner and Guidezilla extension catheters.SummaryTo assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters, the US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried. There were more reports on Guidezilla-related events during the search period. The events for both extension catheters mainly involved the inability to pass equipment through or damage to percutaneous coronary intervention (PCI) devices in the extension catheter, extension catheter fracture, coronary artery dissection and perforation and, occasionally, the death of the patients.
       
  • Incremental value of coronary microcirculation resistive reserve ratio in
           predicting the extent of myocardial infarction in patients with STEMI.
           Insights from the Oxford Acute Myocardial Infarction (OxAMI) study
    • Abstract: Publication date: Available online 16 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Roberto Scarsini, Giovanni Luigi De Maria, Alessandra Borlotti, Rafail A. Kotronias, Jeremy P. Langrish, Andrew J. Lucking, Robin P. Choudhury, Vanessa M. Ferreira, Flavio Ribichini, Keith M. Channon, Rajesh K. Kharbanda, Adrian P. BanningAbstractBackgroundResistive reserve ratio (RRR) is a novel index that expresses the ratio between basal and hyperemic microcirculatory resistance. We sought to compare the performance of RRR, coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in predicting the extent of infarct size (IS) after ST-elevation myocardial infarction.MethodsThermodilution parameters were measured after primary percutaneous coronary intervention (PPCI) in 45 patients. In 30 (67%) cases pre-stenting measurements were also performed to assess the effect of PPCI on myocardial reperfusion, defined by CFR. Cardiovascular magnetic resonance (CMR) was performed at 48-h to assess area-at-risk (AAR), microvascular obstruction (MVO) and IS. CMR was repeated at 6 months in 39/45 patients.ResultsRRR (AUCRRR = 0.85, CI: 0.71–0.99) performed better compared to CFR (AUCCFR = 0.67, CI: 0.48–0.86) and IMR (AUCIMR = 0.70, CI: 0.52–0.88) in predicting IS% at 6-months.Patients with impaired RRR showed larger acute-IS% (27.4 [14.5–42.5] vs 15.4 [8.3–26], p = 0.018), MVO% (3.44 [0–5.97] vs 0 [0–0.89], p = 0.026), AAR% (43 [35–52] vs 34 [25–46], p = 0.03) and 6-months-IS% (22.7 [10.2–35] vs 8.8 [6.9–12.3], p = 0.006), higher rate of adverse remodeling (22.2% vs 0%, p = 0.04) and lower myocardial salvage index (34% [22.8–59.2] vs 53.2% [37.7–71], p = 0.032) compared with other patients.Furthermore, RRR but not IMR or CFR resulted independently associated with 6-months-IS%.CFR (1.48 ± 0.87 vs 1.47 ± 0.61, p = 0.94) did not improve after PPCI in patients with impaired RRR, whereas it improved significantly in other patients (CFR: 1.37 ± 0.43 vs 1.93 ± 0.49, p = 0.018).ConclusionsPatients with post-PPCI impaired RRR were more likely to have suboptimal myocardial reperfusion and larger IS at follow-up. RRR may offer incremental prognostic value compared with other thermodilution-derived indices.
       
  • Incidence, technical safety and feasibility of coronary angiography and
           intervention following self-expanding transcatheter aortic valve
           replacement
    • Abstract: Publication date: Available online 14 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Akihito Tanaka, Richard J. Jabbour, Luca Testa, Mauro Agnifili, Federica Ettori, Claudia Fiorina, Marianna Adamo, Giuseppe Bruschi, Cristina Giannini, Anna Sonia Petronio, Marco Barbanti, Corrado Tamburino, Francesco De Felice, Bernhard Reimers, Arnaldo Poli, Antonio Colombo, Azeem LatibAbstractBackgroundTranscatheter aortic valve replacement (TAVR) is a well-established treatment option for severe aortic stenosis (AS). AS and coronary artery disease frequently coincide, and therefore some patients may require coronary angiography (CAG) and/or intervention (PCI) post-TAVR. Due to valve stent design, most self-expanding prostheses always cover the coronary ostium, and therefore may hinder future access. The objective of this research was to evaluate the incidence, safety and feasibility of CAG/PCI in patients with prior self-expanding TAVR valves.MethodsAmong 2170 patients (age 82 ± 6 years, 43% male) who underwent TAVR with Corevalve or Evolut prostheses, as part of the Italian CoreValve ClinicalService® framework (data from 13 Italian centers), the occurrence of CAG/PCI following TAVR and periprocedural characteristics were examined.ResultsDuring median follow-up of 379 days, 41 patients (1.9%) required CAG and/or PCI (total 46; 16 CAG, 14 PCI, 16 both PCI/CAG). 56.5% of the procedures were performed under emergency/urgency settings. Left system coronary angiography was successfully performed in most cases (28/32, 87.5%), while right coronary angiography was successful only in 50.0% (16/32). PCI procedures (20 for left system, 3 for right system, 4 for graft) were successfully performed in 93.3% (28/30) of the procedures. No CAG/PCI procedure-related complications including prosthesis dislodgment or coronary ostium dissection occurred.ConclusionsCAG and PCI procedures following CoreValve TAVR is safe and mostly feasible, although the success rate of selective right coronary angiography was relatively low when compared to the left system. Further investigations are required to explore this issue.
       
  • Safety and feasibility of coronary lithotripsy supported by guide
           extension catheter for the treatment of calcified lesion in angulated
           vessel
    • Abstract: Publication date: Available online 14 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Takayuki Warisawa, Sonoka Goto, Carlos H. Salazar, Yoshihiro J. Akashi, Javier EscanedAbstractWe report a case of successful coronary intervention with coronary lithotripsy facilitated by guide extension catheter for the treatment of severely calcified and bent vessel. Even though lithotripsy balloon currently available is relatively bulky, the contemporary rapid exchange guide extension catheter accommodated it with ease and helped smooth delivery of it. The present case showed the usefulness of this device combination for patients with complex coronary anatomies.
       
  • Meta-analysis of efficacy and safety of proton pump inhibitors with dual
           antiplatelet therapy for coronary artery disease
    • Abstract: Publication date: Available online 10 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Safi U. Khan, Ahmad N. Lone, Zain Ul Abideen Asad, Hammad Rahman, Muhammad Shahzeb Khan, Muhammad A. Saleem, Adeel Arshad, Najma Nawaz, Sudhakar Sattur, Edo KaluskiAbstractBackgroundThere is inconsistency in the literature regarding the clinical effects of proton pump inhibitors (PPI) when added to dual antiplatelet therapy (DAPT) in subjects with coronary artery disease (CAD). We performed meta-analysis stratified by study design to explore these differences.Methods and results39 studies [4 randomized controlled trials (RCTs) and 35 observational studies) were selected using MEDLINE, EMBASE and CENTRAL (Inception-January 2018). In 221,204 patients (PPI = 77,731 patients, no PPI =143,473 patients), RCTs restricted analysis showed that PPI did not increase the risk of all-cause mortality (Risk Ratio (RR): 1.35, 95% Confidence Interval (CI), 0.56–3.23, P = 0.50, I2 = 0), cardiovascular mortality (RR: 0.94, 95% CI, 0.25–3.54, P = 0.92, I2 = 56), myocardial infarction (MI) (RR: 0.97, 95% CI, 0.62–1.51, P = 0.88, I2 = 0) or stroke (RR: 1.11, 95% CI, 0.25–5.04, P = 0.89, I2 = 26). However, PPI significantly reduced the risk of gastrointestinal (GI) bleeding (RR: 0.32, 95% CI, 0.20–0.52, P 
       
  • Saphenous vein graft aneurysm: A case-based review of percutaneous
           management
    • Abstract: Publication date: Available online 8 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Daniel Walters, Mitul Patel, William PennyAbstractSVG aneurysms are relatively rare clinical entities most often encountered discovered as an incidental finding in patients with prior CABG surgery. There is a substantial risk of complications including rupture and death, thus surgical or percutaneous management may be considered in particular in symptomatic patients. Here, three cases are presented highlighting various percutaneous management options and considerations, including covered stent placement, coil occlusion, and a combined approach with the use of a peripheral covered stent. Intervention within this patient population lacks large population long-term outcomes and as such should be performed carefully by experienced operators, often the guidance of a Heart Team based approach.
       
  • Comparison of GuideLiner versus Guideplus catheter in complex percutaneous
           coronary interventions
    • Abstract: Publication date: Available online 8 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Zulkif Tanriverdi, Fatih Gungoren, Feyzullah Besli, Mustafa Begenc Tascanov
       
  • Spinal hematoma following coronary angioplasty: An uncommon complication
    • Abstract: Publication date: Available online 8 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Taran Kaur Nandra, Anenta Ramakrishnan, Ioannis Felekos, Antonis N. PavlidisAbstractWe report an unusual case of post-procedural spontaneous spinal epidural hematoma in a 65 year old man who presented with an acute coronary syndrome and underwent complex coronary intervention with adjunct use of a GPIIb/IIIa inhibitor. Although spontaneous spinal epidural hematoma (SSEH) following coronary intervention is extremely rare, clinicians should be aware of this unusual diagnosis. Prompt investigation with MRI and early referral for neurosurgical input are recommended to prevent potentially significant sequelae.
       
  • Novel insights of jailed balloon and jailed Corsair technique for
           percutaneous coronary intervention of bifurcation lesions
    • Abstract: Publication date: Available online 2 February 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Toshiki Kuno, Takehiro Sugiyama, Shohei Imaeda, Kenji Hashimoto, Toshinobu Ryuzaki, Souichi Yokokura, Tetsuya Saito, Hiroyuki Yamazaki, Ryota Tabei, Masaki Kodaira, Yohei NumasawaAbstractBackgroundThe optimal technique for percutaneous coronary intervention (PCI) of a bifurcation lesion remains uncertain. JBT/JCT techniques are now emerging for protection of the side branch (SB). We aimed to compare jailed balloon (JBT) and jailed Corsair (JCT) techniques to the conventional jailed wire technique.MethodsWe analyzed 850 consecutive patients (995 bifurcation lesions), who underwent PCI. The bifurcation lesions were classified as jailed wire (−), jailed wire (+), JBT, and JCT. We assessed temporary thrombolysis in myocardial infarction (TIMI) flow grade ≤2, permanent TIMI flow grade ≤2 in the SB, and SB occlusion related myocardial infarction and compared these endpoints with inverse probability treatment weighted analysis.ResultsThe percentage of each group is as follows: jailed wire (−); 44.7%; jailed wire (+) 50.9%; JBT 1.7%; JCT 2.7%. The Corsair could not be delivered with a stent because of severe calcifications (3.7%) and a jailed balloon was entrapped with the stent after dilatation (5.9%). Compared to the jailed wire (+), JBT/JCT had a higher percentage of true bifurcations, arterial sheath size ≥7 Fr, and a lower proportion of wire recrossing (all, P 
       
  • Comparison of the device performance between the conventional guide
           extension catheter and the soft guide extension catheter
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura, Hideo FujitaAbstractBackgroundThe guide extension catheter is frequently used in current percutaneous coronary intervention, and the GuideLiner (Vascular Solutions Inc., Minneapolis, MN) has been the standard guide extension catheter. Recently, the Guideplus (Nipro, Osaka, Japan) has emerged as a new guide extension catheter. The aim of the present study was to compare device performance between the Guideplus and GuideLiner.MethodsWe compared the purpose of guide extension catheter and the device unsuccessful rate between the Guideplus and GuideLiner. We classified the purpose of guide extension catheter into 4 categories: (1) to advance devices into the target lesion, (2) to engage guide catheter into the ostium, (3) to support the small profile balloon crossing the CTO or 99% stenosis that the microcatheter could not cross, and (4) others.ResultsNinety-two lesions were classified as the Guideplus group, whereas 103 lesions were classified as the GuideLiner group. The purpose of guide extension catheter was significantly different between the 2 groups (P 
       
  • Long-term clinical outcomes of permanent-polymer everolimus-eluting stent
           implantation following rotational atherectomy for severely calcified de
           novo coronary lesions: Results of a 22-center study (Tokyo-MD PCI Study)
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Yoichi Otaki, Takashi Ashikaga, Taro Sasaoka, Ken Kurihara, Shunji Yoshikawa, Mitsuaki Isobe, Tokyo-MD PCI Study InvestigatorsAbstractBackgroundLong-term clinical outcomes of permanent polymer everolimus-eluting stent (PP-EES) implantation after rotational atherectomy (RA) have not been fully evaluated. We sought to investigate the long-term clinical outcomes of PP-EES implantation after RA and assess the impact of hemodialysis on this treatment strategy.MethodsPatients who underwent percutaneous coronary intervention (PCI) with PP-EES at 22 institutions between January 2010 and December 2011 were enrolled in this multicenter, observational trial. From a total of 1918 registered patients, 113 patients with 115 de-novo lesions who underwent PCI with PP-EES following RA were retrospectively analyzed. The primary endpoint was a major adverse cardiac event (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically driven target lesion revascularization (TLR).ResultsLong-term follow-up was available for 112 patients (99.1%). The median follow-up period was 2.9 (interquartile range 1.9–3.6) years. The mean age of the patients was 72.3 ± 8.8 years and 64 patients (56.6%) had chronic kidney disease (≥stage 3, 42 on hemodialysis). The cumulative incidences of MACE, non-fatal MI, and TLR were 22.1%, 5.3%, and 10.6%, respectively. Cox's proportional hazards analysis showed that the independent predictors of TLR were hemodialysis and chronic total occlusion. (HR, 14.1; 95% CI, 1.74–155.5; p = 0.01, HR, 9.01; 95% CI, 1.34–62.5; p = 0.02).ConclusionsPP-EES implantation after lesion modification by RA is considered to be a feasible treatment strategy for heavily calcified lesions. Hemodialysis and chronic total occlusion appeared to be associated with TLR.
       
  • Impact of device-host interaction on paravalvular aortic regurgitation
           with different transcatheter heart valves
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Ramón Rodríguez-Olivares, Nahid El Faquir, Zouhair Rahhab, Lennart van Gils, Ben Ren, Rafi Sakhi, Marcel L. Geleijnse, Ron van Domburg, Peter P.T. de Jaegere, Jose L. Zamorano Gómez, Nicolas M. Van MieghemAimsWe sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation.Methods and resultsWe included 392 patients with a SEV (N = 205), BEV (N = 107) or MEV (N = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography (primary analysis) and transthoracic echocardiography (secondary analysis).In mildly calcified roots paravalvular regurgitation incidence was similar for all transcatheter heart valves (SEV 8.4%; BEV 9.1%; MEV 2.0% p = 0.27). Conversely, in heavily calcified roots paravalvular regurgitation incidence was significantly higher with SEV (SEV 45.9%; BEV 0.0%; MEV 0.0% p 
       
  • Optimal TR-band weaning strategy while minimizing vascular access site
           complications
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Sunay Shah, Ryan Gindi, Mir B. Basir, Akshay Khandelwal, Mohammad Alqarqaz, Mohammad Zaidan, Michele Voeltz, Gerald Koenig, Henry E. Kim, William W. O'Neill, Khaldoon AlaswadAbstractIntroductionThe purpose of the study is to develop an optimal TR-Band weaning strategy while minimizing vascular access site complications of hematoma or radial artery occlusion (RAO).MethodsThe trial was a randomized, prospective, single center study of 129 patients who underwent cardiac catheterization via the radial artery. Group A was an accelerated protocol in which weaning was initiated 20 min after sheath removal. Group B was an adjusted protocol, in which weaning was dependent on the amount of anti-platelet or anti-coagulation used. All patients underwent radial artery ultrasound to demonstrate arterial patency.ResultsBaseline characteristics were similar in both groups, and PCI was performed in 36.7% of patients in Group A and 37.7% of patients in Group B. RAO occurred in 7.7% of patients overall, with no statistical difference between groups (Group A 5% versus Group B 10.1%, p-value = 0.337). Hematoma formation>5 cm in diameter occurred in 4.6% of patients in the overall cohort, without statistical difference between groups (Group A 5% versus Group B 4.3%, p-value = 1). The TR-Band duration was significantly shorter in Group A compared to Group B (112.9 ± 50.7 versus 130.7 ± 51.1 in minutes, respectively, p-value = 0.013).ConclusionWe have demonstrated an accelerated weaning protocol is simple to utilize for nursing staff without increased vascular site complications of RAO or hematoma formation.
       
  • Takotsubo syndrome: State-of-the-art review by an expert panel –
           Part 2
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Andre Dias, Ivan J. Núñez Gil, Francesco Santoro, John E. Madias, Francesco Pelliccia, Natale Daniele Brunetti, Elena Salmoirago-Blotcher, Scott W. Sharkey, Ingo Eitel, Yoshihiro J. Akashi, Ibrahim El-Battrawy, Emiliana Franco, Ibrahim Akin, Milosz Jaguszewski, Dana Dawson, Vincent M. Figueredo, L. Christian Napp, Thomas Emil Christensen, Kathy Hebert, Itsik Ben-DorAbstractIn part 2 of this two-part manuscript on takotsubo syndrome (TTS), we discuss typical biomarkers (particularly excess catecholamines and what kinds of electrocardiographic information operators should look for) and numerous complications the syndrome can cause. This consensus paper is the result of a multinational effort aiming to summarize the current state of the art on TTS. Several novel and unique sections are emphasized in this document, including the current state of the art on genetics of takotsubo syndrome, microRNAs (miRs), racial differences, role of cardiac spectroscopy and intracoronary imaging, as well as mechanical circulatory support.New structured algorithms are also proposed to aid clinicians in the decision-making process as well as future directions for research given the current lack of evidence-based medical approaches.
       
  • Techniques of Impella removal while preserving arterial access
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Jad Omran, Ryan ReevesAbstractPreservation of the arterial access site after removal of large caliber mechanical circulatory devices (MCD) can be challenging. In this paper, we describe two novel techniques and review the current literature focusing on the maintenance of arterial access after Impella removal.
       
  • On location, territory, and significance
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Scott W. Shurmur
       
  • Antegrade fenestration and re-entry for bailout treatment of iatrogenic
           coronary dissection
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Pierluigi Merella, Giovanni Lorenzoni, Gabriele Luigi Gasparini, Jacopo Andrea Oreglia, Gavino Casu
       
  • Make Perfection More Perfect
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Shao-Liang Chen
       
  • Advances in Vascular Post-Closure With Impella
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Navin K. Kapur, Colin Hirst, David Zisa
       
  • Sex differences in the outcome after percutaneous coronary intervention
           – A propensity matching analysis
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Gjin Ndrepepa, Sebastian Kufner, Katharina Mayer, Salvatore Cassese, Erion Xhepa, Massimiliano Fusaro, Endri Hasimi, Stefanie Schüpke, Karl-Ludwig Laugwitz, Heribert Schunkert, Adnan KastratiAbstractBackgroundWhether there are sex differences in the outcome of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains controversial. We undertook this study to assess whether there are sex-related differences in the long-term mortality in a large series of patients with CAD after PCI.MethodsThe study included 18,334 patients (4735 women and 13,599 men) with CAD treated with PCI. Propensity matching was performed to obtain a group of patients (3000 women and 3000 men) matched for all characteristics available in database. The primary outcome was a composite of cardiac mortality, myocardial infarction or stroke at 3 years of follow-up.ResultsThe primary outcome occurred in 660 women and 1440 men (Kaplan-Meier [KM] estimates, 15.2% in women and 11.6% in men, unadjusted hazard ratio [HR] = 1.35, 95% confidence interval [CI] 1.24 to 1.49; P 
       
  • Shorter Radial compression Time: Is Chemistry the Solution'
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Samir B. Pancholy
       
  • Cracking the Calcified Plaque
    • Abstract: Publication date: February 2019Source: Cardiovascular Revascularization Medicine, Volume 20, Issue 2Author(s): Pieter Cornelis Smits
       
  • Mechanisms of myocardial ischemia inducing sudden cardiac death in
           athletes with anomalous coronary origin from the opposite sinus: Insights
           from a computational fluid dynamic study
    • Abstract: Publication date: Available online 31 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Gianluca Rigatelli, Marco Zuin, Paola Galasso, Mauro Carraro, Katia D'Elia, Lanza Daniela, Loris Roncon, Tai T.T.T. Truyen, Thach NguyenAbstractAimsThe left coronary anomalous origin from the opposite sinus (L- ACAOS) constitutes the most clinically relevant arterial abnormality among the wide spectrum of coronary artery anomalies. We investigated the physiology of L-ACAOS with and without intramural course (IM) in athletes, using the computational fluid dynamic (CFD) analysis.Methods and resultsThe coronary artery circulation with L-ACAOS with and without IM has been segmented and then reconstructed, after reviewing both the angiographic and computed tomography findings of 13 consecutive athletes (10 males, mean age 45.1 ± 8.2 years) with L-ACAOS collected in our institution between 1st January 2003 and 1st January 2018. Vorticity magnitude, static pressure and wall shear stress (WSS) have been analysed in a model of L-ACAOS with no IM course and in L-ACAOS-IM at rest and during exercise. The mean vorticity magnitude and WSS significantly increased from rest to exercise in both models, in right coronary artery, left anterior descending and left circumflex coronary arteries. The mean static pressure significantly increased with exercise in IM (1.118e + 004 vs 1.164e + 004 Pa, p 
       
  • Initial intravascular ultrasound without a routine early baseline study in
           the evaluation of cardiac transplant vasculopathy has prognostic valve
    • Abstract: Publication date: Available online 25 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Reza Arsanjani, Avinash Khitri, Mehrnoosh Hashemzadeh, Mohammad Reza MovahedAbstractBackgroundAbnormal minimal intimal thickening (MIT) on intravascular ultrasound (IVUS) defined as difference of ≥0.5 mm between baseline and one-year post-transplantation has been shown to have prognostic value. The goal of this retrospective cohort study was to evaluate whether abnormal MIT found on routine IVUS studies in cardiac transplant patients after 6 months without an early baseline study (modified MIT or MMIT), has any prognostic value. Furthermore, we evaluated the prognostic effect of serial IVUS performed beyond one year.MethodsA cohort of 149 cardiac transplant patients who underwent IVUS examination > 6 months post-transplant were evaluated retrospectively. Of these 149 patients, 109 patients underwent a subsequent IVUS study approximately 1 year following the initial study. MMIT values of ≥0.5 mm without an early baseline study were correlated with major adverse cardiac event (MACE).ResultsThe all-cause mortality was 4.7% (5/107) in patients with MMIT of
       
  • Outcomes of coronary artery revascularization procedures in patients with
           antiphospholipid syndrome
    • Abstract: Publication date: Available online 25 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Navid Ahmed, Himali Gandhi, Eliany Mejia Lopez, Neeraja Yedlapati, Daniel SpevackAbstractBackgroundPublished data on the outcome of coronary artery revascularization in patients with antiphospholipid syndrome (APS) are limited. Because APS is associated with a high rate of arterial thrombosis, there is concern that coronary revascularization in this group may be complicated by increased need for repeat revascularization. We aimed to determine the incidence and timing of repeat revascularization performed in patients with APS undergoing percutaneous coronary interventions (PCI) or coronary artery bypass grafting (CABG).MethodsOur institutional database was queried for individuals (n = 575) testing positive for antiphospholipid antibodies between 2000 and 2012. From this group, 46 patients underwent cardiac catheterization. Charts were reviewed to identify subsequent revascularization procedures.ResultsThe study sample consisted of 15 patients (67 ± 11 years, 11 females) who underwent revascularization. All of the study subjects had prior history of arterial (stroke, TIA n = 7) or venous (n = 10) thrombosis. Ten of the subjects had initial revascularization (6 CABG, 4 PCI) at an outside facility, while another five underwent initial PCI at our hospital. Repeat revascularization occurred in five patients (33%) at a median of 6 years (range 4, 13) following the initial revascularization. The median follow-up for patients who did not require repeat revascularization (n = 10) was 10 years (range 2, 15).ConclusionAmongst patients with APS who underwent CABG or PCI the need for repeat revascularization was infrequent and occurred several years after initial procedure. Based on this small sample size the periprocedural risk associated with coronary artery revascularization in subjects with APS is not prohibitively high.
       
  • Reproducibility of semi-automated three-dimensional volumetric analysis
           using cardiac computed tomography in patients with left ventricular assist
           device
    • Abstract: Publication date: Available online 23 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Gauravpal S. Gill, Gaby Weissman, Yael F. Meirovich, Diego Medvedofsky, Selma F. Mohammed, Ron Waksman, Hector M. Garcia-GarciaAbstractBackgroundMulti-detector gated cardiac computed tomography (CCT) allows three-dimensional (3D) quantification of cardiac chambers and is clinically indicated to assess left ventricular assist device (LVAD) malfunction and complications. Automated volumetric analysis is, however, disrupted by inflow cannula artifact in patients with LVAD. With this study, we evaluated intra-observer variability in semi-automated 3D cardiac volumetric analysis using CCT in patients with LVADs.MethodsTen clinically indicated CCTs were studied retrospectively from 9 patients with LVADs. 3D chamber quantification included left and right ventricles end-systolic and end-diastolic volumes (ESV, EDV); and left and right atrial ESV. Derived measurements included cardiac output (CO), ejection fraction (EF), and stroke volume (SV). Automated volumetric analysis was performed, and manual corrections were added when necessary. Absolute and relative differences, Bland-Altman plots, and interclass correlation coefficients (ICCs) were used to assess intra-observer reproducibility for these measurements.ResultsIntra-observer reproducibility was excellent for volumetric (ICC>0.99) and derived data (ICC>0.91). Comparing right vs left heart volumetric assessments, the former had a higher relative difference (atria 2.8% vs 1.6%, ESV 3.0% vs 1.9%, EDV 2.7% vs 1.3%), which also translated to a greater relative difference in right-side derived data (CO 11.1% vs. 8.8%, EF 10.5% vs. 9.9%, SV 10.9% vs. 9.0%). The mean difference in left ventricular ejection fraction was 0.4% (limits of agreement [LOA]: −2 and 3.2) and right ventricular ejection fraction was 1.2% (LOA: −4.7 and 7.1).ConclusionsOur results for semi-automated 3D volumetric analysis showed excellent reproducibility for both volumetric and derived data.SummaryElectrocardiography-gated cardiac computed tomography with semi-automated volumetric analysis has excellent reproducibility in patients with left ventricular assist device making it imaging modality of choice for functional assessment in this patient population, where cardiac magnetic resonance imaging is contraindicated and transthoracic echocardiography may be limited by poor acoustic windows.
       
  • Impact of predilation before transcatheter aortic valve implantation with
           new-generation devices
    • Abstract: Publication date: Available online 23 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Arturo Giordano, Nicola Corcione, Paolo Ferraro, Alberto Morello, Sirio Conte, Francesco Bedogni, Luca Testa, Alessandro Iadanza, Gennaro Sardella, Massimo Mancone, Fabrizio Tomai, Giovanni De Persio, Tiziana Attisano, Martino Pepe, Giacomo Frati, Giuseppe Biondi-Zoccai, RISPEVA (Registro Italiano GISE sull'impianto di Valvola Aortica Percutanea) Study InvestigatorsAbstractBackgroundSignificant aortic stenosis can be effectively treated with transcatheter aortic valve implantation (TAVI) in patients at high or intermediate surgical risk. Predilation is often performed to facilitate TAVI implantation, but its risk-benefit balance with new-generation devices is detabed. We aimed to appraise whether predilation is still needed with new-generation devices for TAVI.Methods/MaterialsWe queried the prospective multicenter RISPEVA (Registro Italiano GISE sull'impianto di Valvola Aortica Percutanea) Study, comparing patients with vs without predilation receiving Acurate, Evolut, Lotus, Portico, or Sapien3. Baseline, procedural features and early clinical and echocardiographic results were compared with unadjusted and adjusted analyses.ResultsA total of 1409 subjects were included, 1055 (74.9%) receiving predilation, and 354 (25.1%) undergoing direct TAVI. Several baseline and procedural differences were evident at unadjusted analysis between the two groups, including device success, procedural success, contrast volume, procedural time, mean post-procedural gradient, and prevalence of aortic regurgitation 2+ (all p 
       
  • Real world utilization of computed tomography derived fractional flow
           reserve: Single center experience in the United States
    • Abstract: Publication date: Available online 17 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Anas Fares, Mohamad Amer Alaiti, Ahmad Alkhalil, Sadeer Al-Kindi, Tarek Chami, Bradley Martin, Prashanth Thakker, Fahd Nadeem, Sanjay Rajagopalan, Daniel Simon, Robert Gilkeson, Hiram G. BezerraAbstractBackgroundFractional flow reserve derived from computed tomography (FFRct) has shown higher accuracy for detection of significant coronary artery disease (CAD) compared to coronary computed tomography angiography (CCTA). The performance of a combined comprehensive qualitative interpretation of both CCTA and FFRct in patient management is unknown. We aimed to explore the clinical application of this combined approach.MethodsWe retrospectively reviewed cases referred to FFRct testing at our institution over a one-year period. Patients had documentation of whether invasive coronary angiography (ICA) was performed and revascularization were needed. Interpretations and recommendations of the adopted comprehensive approach (C-FFRct), that took into account focal versus diffuse disease, depth of ischemia and myocardium at risk, were compared to those of CCTA (binary > 50% stenosis) alone and FFRct binary approach (FFRct ≤ 0.8). C-FFRct performance was measured against the decision made upon revascularization.ResultsA total of 207 cases were referred to FFRct testing, 163 (79%) accepted and 44 (21%) rejected for quality. C-FFRct changed interpretations and recommendations of 39 (24%) and 14 (9%) CCTA and FFRct, respectively. ICA was deferred in 32 (59%) and 13 (32%) cases; whereas ICA referral rate was 7 (6%) and 1 (0.8%) cases, based on CCTA and FFRct, respectively. No major cardiac events were observed during follow up time (median = 6 months). C-FFRct sensitivity, specificity, and accuracy compared to decision upon revascularization were 89%, 79% and 82%. C-FFRct number needed to treat was 4, and 6, compared to CCTA and FFRct, respectively.ConclusionFFRct is a feasible tool to improve the diagnostic performance of CCTA in CAD real-world workup. However, qualitative interpretation of the FFRct report combined with CCTA findings may yield more impactful results on patient management. Further prospective studies are warranted to validate the application of this approach and better define its components.
       
  • Resting Full Cycle Ratio (RFR) and instantaneous wave-free ratio (iFR):
           Simultaneous measurements for assessment of coronary stenosis
    • Abstract: Publication date: Available online 17 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Grigoris V. Karamasis, Thomas R. Keeble, Andreas S. Kalogeropoulos, John R. Davies, Gerald J. Clesham
       
  • Safety and efficacy of stentablation with rotational atherectomy for the
           management of underexpanded and undilatable coronary stents
    • Abstract: Publication date: Available online 15 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Hoyle L. Whiteside, Arun Nagabandi, Deepak KapoorAbstractIntroductionCoronary stent underexpansion is associated with in-stent restenosis and few interventions are available for the management of undilatable underexpanded stents. Stentablation (SA) with rotational atherectomy (RA) is a unique application and has previously been described with encouraging results. Data regarding SA is limited to case reports and small case series; therefore, reasonable concern persists regarding procedural safety and long-term outcomes.MethodsThis is a single-center retrospective study analyzing twenty consecutive patients who underwent SA with RA. The primary endpoint was procedural success and secondary endpoints included procedural safety outcomes and major adverse cardiac events (MACE) over a 12-month follow-up period.ResultsStentablation and secondary stenting were guided by intravascular ultrasound and procedural success was achieved in all cases. No in-hospital death or MACE was observed. The prevalence of MACE was 5% at 30 days as one patient developed recurrent MI without target lesion revascularization (TLR). At 12 months, MACE had occurred in 40% of patients, however this was strongly driven by a high prevalence of TLR (30%). Only one cardiac death (5%) and one additional NSTEMI were observed during the 11 additional months of follow up.ConclusionStentablation with RA is a feasible and effective option for the acute management of symptomatic, underexpanded, and undilatable coronary stents. SA is associated with a high rate of procedural success as well as excellent in-hospital and short-term outcomes. However, our study population demonstrated substantial MACE at 12 months which was strongly driven by TLR and associated with minimal mortality.
       
  • How should we treat heavily calcified coronary artery disease in
           contemporary practice' From atherectomy to intravascular lithotripsy
    • Abstract: Publication date: Available online 10 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): George Kassimis, Tushar Raina, Nestoras Kontogiannis, Gopendu Patri, Joanna Abramik, Alex Zaphiriou, Adrian P. BanningHeavily calcified and densely fibrotic coronary lesions continue to represent a challenge for percutaneous coronary intervention (PCI), as they are difficult to dilate, and it is difficult to deliver and implant drug-eluting stents (DES) properly. Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes. Thanks to the introduction of several adjunctive PCI tools, like cutting and scoring balloons, atherectomy devices, and to the novel intravascular lithotripsy technology, the treatment of such lesions has become increasingly feasible, predictable and safe. A step-wise progression of strategies is described for coronary plaque modification, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. We highlight these techniques in the setting of clinical examples how best to apply them through better patient and lesion selection, with the main objective of optimising DES delivery and implantation, and subsequent improved outcomes.Graphical abstractUnlabelled Image
       
  • Left bundle branch block after transcatheter aortic valve implantation
           with Edwards Sapien 3 valve: Influence of the valve depth implantation
    • Abstract: Publication date: Available online 9 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Leire Unzué, Eulogio García, Belén Díaz-Antón, Francisco José Rodríguez-Rodrigo, Miguel Rodríguez del Río, Rodrigo Teijeiro, Juan Medina, Francisco Javier ParraAbstractObjectivesThe aim of this study is to determine the relation between the valve depth implantation and the new-onset left bundle branch block (LBBB) in patients treated with transcatheter aortic valve implantation (TAVI) using Edwards Sapien 3 (S3) prosthesis.BackgroundLBBB is the most common conduction disturbance after TAVI. The S3 has been associated with a higher incidence of LBBB. A deep valve implant could be related to new-onset LBBB with S3.MethodsSeventy-six consecutive patients treated with transfemoral TAVI with S3 were included. Electrocardiogram (ECG) registries were recorded at baseline, after the procedure, and before discharge. Valve depth implantation was determined in 40 patients by off-line analysis of the two/three-dimensional transeophageal echocardiogram (TEE) images, with measure of the valve stent percentage under the aortic annulus. Previous and new conduction anomalies were documented; and patient, anatomic and procedural characteristics were retrospectively analyzed.ResultsComplete atrioventricular block (AVB) incidence was 2.9%. LBBB after TAVI appeared in 39% of patients, being transient in almost half of the cases (permanent LBBB rate 20%).Patients with new-onset LBBB after TAVI were older, with a higher STS Score and a wider basal QRS.A deep valve position was associated with new-onset LBBB, with a ROC curve establishing a cut-off point of 34% of depth implant as risk factor for new-onset LBBB (sensitivity and specificity 0.8).ConclusionsIn transfemoral TAVI with S3 prosthesis, a higher valve implantation (
       
  • Transcatheter closure of left ventricular apical pseudoaneurysm with an
           amplatzer vascular plug
    • Abstract: Publication date: Available online 6 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Francesco Negri, Carlo Cernetti, Luca Favero, Giuseppe Minniti, Alessandro De Leo, Giovanna De Simone, Gianfranco SinagraAbstractWe report the case of a 66-year-old man, with a history of previous chest radiation therapy admitted to ED for heart failure. The patient was diagnosed with severe aortic stenosis and multivessel coronary disease and underwent surgical aortic valve replacement and coronary artery by pass grafts.Cardiac surgery was complicated by a left ventricular perforation by a venting catheter. The laceration was repaired with a Teflon patch apparently successful. Four months later, a CT scan performed for oncological follow-up demonstrated the complete detachment of the Teflon patch and the formation of a left ventricular pseudoaneurysm. The pseudoaneurysm was effectively treated percutaneously using an Amplatzer Vascular Plug 4.
       
  • Transcatheter versus surgical aortic valve replacement in low-risk
           surgical patients: A meta-analysis of randomized clinical trials
    • Abstract: Publication date: Available online 4 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Babikir Kheiri, Mohammed Osman, Hossam Abubakar, Ahmed Subahi, Adam Chahine, Sahar Ahmed, Ghassan Bachuwa, Mohammad L. Alkotob, Mustafa Hassan, Deepak L. BhattAbstractBackgroundTranscatheter aortic valve replacement (TAVR) is a valid option for patients with high or intermediate surgical risk. However, clinical outcomes of TAVR in low-risk patients are lacking. Our aim was to evaluate the efficacy and safety of TAVR versus surgical aortic valve replacement (SAVR) in low-surgical-risk patients.MethodsElectronic database review was conducted for all randomized clinical trials (RCTs) that compared TAVR versus SAVR in low-risk patients. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.ResultsWe included 3 RCTs totaling 604 patients (310 TAVR and 294 SAVR). Our results showed no significant difference in mortality between TAVR compared with SAVR (RR = 0.71; 95% CI = 0.22–2.30; P = 0.56), however, there was a significantly increased risk of pacemaker implantation (RR = 7.28; 95% CI = 3.94–13.42; P 
       
  • Feasibility of a porcine arteriovenous shunt model for assessment of acute
           thrombogenicity in bifurcation stenting technique by optical coherence
           tomography
    • Abstract: Publication date: Available online 4 January 2019Source: Cardiovascular Revascularization MedicineAuthor(s): Kazuhiro Dan, Hector M. Garcia-Garcia, Evan Shlofmitz, Takayuki Okamura, Kayode O. Kuku, David Hellinga, Frank D. Kolodgie, Alexandre Hideo-Kajita, Sameer Desale, Ron WaksmanAbstractBackgroundDouble kissing (DK) crush stenting has been reported as a superior bifurcation stenting strategy compared to culotte stenting. However, the mechanism associated with the reduction of clinical events by DK crush stenting remains unclear. We therefore investigated the thrombogenicity of DK crush stenting and culotte stenting with both bare-metal stents (BMS) and drug-eluting stents (DES) and the feasibility of a novel porcine arteriovenous shunt model.MethodsHigh-resolution intracoronary imaging with optical coherence tomography (OCT) evaluated the bifurcation stenting models for thrombogenicity.ResultsAll porcine models retained continuous circulation without blood leakage. Thrombus was macroscopically demonstrated around the bifurcation in all settings. The volume of thrombus (mm3) with BMS using DK crush/culotte and DES using DK crush/culotte were 1.38/1.19 and 0.09/0.15, respectively. Culotte stenting had more thrombus in the proximal main branch, and DK crush stenting had more at the bifurcation. Unlike DK crush stenting, culotte stenting showed malapposition in the proximal main branch and bifurcation segments.ConclusionThe feasibility of a porcine arteriovenous shunt model to assess thrombogenicity by OCT in bifurcation stenting technique was confirmed. OCT detected less thrombogenicity in DES when used in the bifurcation model when compared to BMS.
       
  • “Y-pattern, 4-quadrant, multiple points” is the answer
    • Abstract: Publication date: Available online 28 December 2018Source: Cardiovascular Revascularization MedicineAuthor(s): Ivo Petrov
       
  • The relation between optical coherence tomography-detected layered pattern
           and acute side branch occlusion after provisional stenting of coronary
           bifurcation lesions
    • Abstract: Publication date: Available online 28 December 2018Source: Cardiovascular Revascularization MedicineAuthor(s): Yang Cao, Gary S. Mintz, Mitsuaki Matsumura, Wenbin Zhang, Yongqing Lin, Xiao Wang, Akiko Fujino, Tetsumin Lee, Tadashi Murai, Masahiro Hoshino, Eisuke Usui, Yoshihisa Kanaji, Taishi Yonetsu, Tsunekazu Kakuta, Akiko MaeharaAbstractBackground/purposeLayered pattern (presumed to be healed plaque after a thrombotic event) can be observed by optical coherence tomography (OCT). We sought to assess the ability of OCT-detected plaque composition to predict acute side branch (SB) occlusion after provisional bifurcation stenting.MethodsThis is a retrospective observational study using pre-intervention OCT in the main vessel to predict Thrombolysis in Myocardial Infarction (TIMI) flow grade ≤1 in a SB (diameter ≥ 1.5 mm) after provisional bifurcation stenting. OCT-detected layered pattern was defined as plaque with a superficial layer that had a different optical intensity and a clear demarcation from underlying tissue.ResultsOverall, 207 patients with stable coronary disease were included. SB occlusion occurred in 26/207 (12.6%) bifurcation lesions. Operators decided not to perform additional treatment, and TIMI flow did not improve to ≥2 in cases with SB occlusion. The prevalence of OCT-detected layered pattern was more common in lesions with versus without SB occlusion (88.5% versus 33.7%, p 
       
  • Development and validation of a novel risk score for primary percutaneous
           coronary intervention for ST elevation myocardial infarction
    • Abstract: Publication date: Available online 27 December 2018Source: Cardiovascular Revascularization MedicineAuthor(s): Michael Andrews, Javaid Iqbal, Joshua J. Wall, Dawn Teare, Magdi El-Omar, Farzin Fath-Ordoubadi, Julian GunnAbstractBackgroundPrimary percutaneous coronary intervention (PPCI) is the default treatment for patients with ST elevation myocardial infarction (STEMI) and carries a higher risk of adverse outcomes when compared with elective and urgent PCI. Conventional PCI risk scores tend to be complex and may underestimate the risk associated with PPCI due to under-representation of patients with STEMI in their datasets. This study aimed to develop a simple, practical and contemporary risk model to provide risk stratification in PPCI.MethodsDemographic, clinical and outcome data were collected for all patients who underwent PPCI between January 2009 and October 2013 at the Northern General Hospital, Sheffield. Multiple regression analysis was used to identify independent predictors of mortality and to construct a risk model. This model was then separately validated on an internal and external dataset.ResultsThe derivation cohort included 2870 patients with a 30-day mortality of 5.1% (145 patients). Only four variables were required to predict 30-day mortality: age [OR:1.047, 95% CI:1.031–1.063], call-to-balloon (CTB) time [OR:1.829, 95% CI:1.198–2.791], cardiogenic shock [OR:13.886, 95% CI:8.284–23.275] and congestive heart failure [OR:3.169, 95% CI:1.420–7.072]. Internal validation was performed in 693 patients and external validation in 660 patients undergoing PPCI. Our model showed excellent discrimination on ROC-curve analysis (C-Stat = 0.87 internal and 0.86, external), and excellent calibration on Hosmer-Lemeshow testing (p = 0.37 internal, 0.55 external).ConclusionsWe have developed a bedside risk model which can predict 30-day mortality after PPCI using only four variables: age, CTB time, congestive heart failure and shock.
       
 
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