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Abu-Much A, Grines CL, Batchelor WB, Maini AS, Zhang Y, Redfors B, Bellumkonda L, Bharadwaj AS, Moses JW, Truesdell AG, Li Y, Baron SJ, Lansky AJ, Basir MB, Cohen DJ, O'Neill WW. Influence of left ventricular ejection fraction in patients undergoing contemporary pLVAD-supported high-risk PCI. Am Heart J 2024; 269:139-148. [PMID: 38151142 DOI: 10.1016/j.ahj.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/12/2023] [Accepted: 12/23/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Left ventricular (LV) systolic dysfunction worsens outcomes in patients undergoing percutaneous coronary intervention (PCI). The objective of this study, therefore, was to evaluate outcomes of pLVAD-supported high-risk PCI (HRPCI) patients according to LV ejection fraction (LVEF). METHODS Patients from the PROTECT III study undergoing pLVAD-supported HRPCI were stratified according to baseline LVEF: severe LV dysfunction (LVEF <30%), mild and moderate LV dysfunction (LVEF ≥30% to <50%), or preserved LV function (LVEF ≥50%). Major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization), and PCI-related complications were assessed at 90 days and mortality was assessed at 1-year. RESULTS From March 2017 to March 2020, 940 patients had evaluable baseline LVEF recorded in the study database. Patients with preserved LV function were older, more frequently presented with myocardial infarction, and underwent more left main PCI and atherectomy. Immediate PCI-related coronary complications were infrequent (2.7%, overall), similar between groups (P = 0.98), and not associated with LVEF. Unadjusted 90-day MACCE rates were similar among LVEF groups; however, as a continuous variable, LVEF was associated with both 90-day MACCE (adj.HR per 5% 0.89, 95% CI [0.80, 0.98], P = 0.018) and 1-year mortality (adj.HR per 5% 0.84 [0.78, 0.90], P <0.0001). CONCLUSIONS Patients who underwent pLVAD-supported HRPCI exhibited low incidence of PCI-related complications, regardless of baseline LVEF. However, LVEF was associated with 90-day MACCE and 1-year mortality.
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Affiliation(s)
- Arsalan Abu-Much
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Cindy L Grines
- Department of Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, GA
| | - Wayne B Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA
| | - Aneel S Maini
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Yiran Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lavanya Bellumkonda
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Jeffrey W Moses
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY; St. Francis Hospital, Roslyn, NY
| | - Alexander G Truesdell
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA; Virginia Heart, Falls Church, VA
| | - Yanru Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | | | - Alexandra J Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Barts Heart Centre, London and Queen Mary University of London, London, United Kingdom
| | - Mir B Basir
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, MI
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; St. Francis Hospital, Roslyn, NY
| | - William W O'Neill
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, MI.
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2
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Amstutz C, Behr J, Krebs S, Haeberlin A, Vogel R, Zurbuchen A, Burger J. Design of percutaneous transluminal coronary angioplasty balloon catheters. Biomed Eng Online 2023; 22:94. [PMID: 37742021 PMCID: PMC10517552 DOI: 10.1186/s12938-023-01155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Eight commercially available percutaneous transluminal coronary angioplasty (PTCA), including semi-compliant and non-compliant balloons, have been assessed in detail on their tip, balloon, shaft, RX-Port, and hypotube design. Important performance characteristics such as tip deformation, balloon elongation, and deflation rate have been quantified. METHODS Five catheters of each model were evaluated during various tests. The robustness of the tips was evaluated through compression, measuring any occurrence of damage. The longitudinal growth of the balloons was recorded during inflation up to Rated Burst Pressure (RBP). The forces required to move the catheter forward and retract it into the guide catheter were measured in a simulated use test setup. The deflation behavior was studied by measuring extracted contrast media over time. Furthermore, balloon compliance and catheter dimensions were investigated. RESULTS The outer dimensions of the catheter were found to be smallest at the hypotube (0.59-0.69 mm) and highest at the balloon, respectively, the crossing profile (0.9-1.2 mm). The tip diameter increased after compression by 1.7-22%. Cross-sections of the folded balloons revealed a tri- and two-fold, respectively. The measured balloon elongation ranged from 0.6 to 2.0 mm. After the inflation of the balloon, an increase in friction between the guide wire and the catheter was observed on four catheters. A maximum increase of 0.12 N to 1.07 N was found. Cross-sections of the RX-Port revealed a semicircular-shaped inflation lumen and a circular guide wire lumen. The measured deflation rate ranged from 0.004 to 0.013 µL/s, resulting in an estimated balloon deflation time of 10.2-28.1 s. CONCLUSION This study provides valuable insights into the design characteristics of RX PTCA balloon catheters, which can contribute to facilitating the development of improved catheter designs and enhancing clinical outcomes. Distinctions between SC and NC catheters, such as balloon performance and dimensions, are evident. It is important to note that no single catheter excels in all aspects, as each possesses unique strengths. Therefore, it is essential to consider individual intervention requirements when selecting a catheter. The research also identifies specific catheter weaknesses, such as reduced wall thickness, fringes at the tip, and reduced performance characteristics.
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Affiliation(s)
- C. Amstutz
- School of Biomedical and Precision Engineering, University of Bern, Güterstrasse 24/26, CH-3008 Bern, Switzerland
| | - J. Behr
- SMD Swiss Medical Devices, Beringen, Switzerland
| | - S. Krebs
- School of Biomedical and Precision Engineering, University of Bern, Güterstrasse 24/26, CH-3008 Bern, Switzerland
| | - A. Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R. Vogel
- Department of Cardiology, Buergerspital Solothurn, Solothurn, Switzerland
| | - A. Zurbuchen
- School of Biomedical and Precision Engineering, University of Bern, Güterstrasse 24/26, CH-3008 Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J. Burger
- School of Biomedical and Precision Engineering, University of Bern, Güterstrasse 24/26, CH-3008 Bern, Switzerland
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3
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Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
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Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
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4
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Chen D, Gadeley R, Wang A, Jepson N. Coronary artery perforation after bioresorbable scaffold implantation treated with a new generation covered stent-OCT insights. BMC Cardiovasc Disord 2022; 22:66. [PMID: 35196989 PMCID: PMC8864843 DOI: 10.1186/s12872-022-02501-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Coronary artery perforation is a rare but potentially lethal complication of percutaneous coronary intervention (PCI) with an associated mortality of 7–17%. We report the case of coronary artery perforation complicating Absorb bioresorbable vascular scaffold (BVS) implantation and the associated technical challenges with managing this life-threatening complication. Case report A 46-year-old male was referred to our institution and underwent PCI with an Absorb bioabsorbable vascular scaffold (BVS) to a proximal LAD long segment bifurcation lesion. Following pre-dilation and deployment of the 3.5 × 28 mm Absorb BVS, high pressure post-dilation of the distal scaffold was complicated by a large, Ellis type III coronary perforation with no flow to the distal LAD beyond the rupture, and associated with a large pericardial effusion confirmed on bedside transthoracic echocardiogram (TTE). The insult was temporised with prolonged balloon inflation within the Absorb BVS immediately proximal to the site of perforation, permitting urgent insertion of a pericardial drain. After deflation of the balloon, a 3.0 × 21 mm BeGraft covered stent was deployed across the perforation, restoring normal LAD flow and abolishing the perforation. Cardio-pulmonary resuscitation was not required and the patient remained conscious throughout the procedure. TTE demonstrated normal left ventricular function and the patient was discharged 3 days later. Repeat angiography at 3 months showed patent stents with TIMI III flow, and optical coherence tomography (OCT) showed good expansion and apposition of the proximal Absorb BVS and BeGraft. The patient has remained well 4 years after PCI with no major cardiovascular events. Conclusion The utility of bioresorbable scaffold technology remains controversial although meticulous implantation techniques are associated with improved clinical outcomes. Adoption of the Pre-dilatation, Sizing and Post-dilatation (‘PSP’) method of BVS implantation with routine aggressive vessel preparation and scaffold optimization however may contribute to a higher risk of vessel perforation. The case emphasises the importance of accurate sizing of the vessel with intracoronary imaging and demonstrates the value of newer generation covered stents with single-layer design and slimmer crossing profile producing improved deliverability and procedural success. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02501-3.
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Affiliation(s)
- D Chen
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia.,Eastern Heart Clinic, Barker Street, Randwick, NSW, 2031, Australia
| | - R Gadeley
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia. .,University of New South Wales, Sydney, NSW, 2052, Australia.
| | - A Wang
- University of New South Wales, Sydney, NSW, 2052, Australia
| | - N Jepson
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia.,Eastern Heart Clinic, Barker Street, Randwick, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia
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5
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Alavi SH, Hassanzadeh M, Dehghani P, Mehdipour Namdar Z, Aslani A. A Novel Technique for Managing Guidewire-Induced Distal Coronary Perforation Using Coronary Balloon Pieces. JACC Case Rep 2022; 4:137-141. [PMID: 35199004 PMCID: PMC8853944 DOI: 10.1016/j.jaccas.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/17/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
We report the case of a 49-year-old female patient who underwent percutaneous coronary intervention of the right coronary and posterior descending arteries complicated with guidewire-induced coronary artery perforation. We successfully managed and sealed this perforation through the embolization of balloon pieces into the target vessel. (Level of Difficulty: Advanced.)
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Affiliation(s)
| | | | | | | | - Amir Aslani
- Address for correspondence: Dr Amir Aslani, Cardiovascular Research Center, Shiraz University of Medical Sciences, Zand Street, Shiraz, Iran.
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Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. (DGK). DER KARDIOLOGE 2021. [DOI: 10.1007/s12181-021-00504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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7
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Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. (DGK). DER KARDIOLOGE 2021. [PMCID: PMC8319902 DOI: 10.1007/s12181-021-00493-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dieses Manual zur diagnostischen Herzkatheteruntersuchung (Teil 1) ist eine Anwendungsempfehlung für interventionell tätige Ärzte, die den gegenwärtigen Kenntnisstand unter Berücksichtigung neuester Studienergebnisse wiedergibt. Hierzu wurde in den einzelnen Kapiteln speziell auf die Alltagstauglichkeit der Empfehlungen geachtet, sodass dieses Manual jedem interventionell tätigen Kardiologen als Entscheidungshilfe im Herzkatheterlabor dienen soll. Trotz der von vielen Experten eingebrachten praktischen Hinweise kann dieses Manual dennoch nicht die ärztliche Evaluation des individuellen Patienten ersetzen und damit eine Anpassung der Diagnostik bzw. Therapie ersetzen.
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Affiliation(s)
- Holger M. Nef
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Stephan Achenbach
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen Nürnberg, Erlangen, Deutschland
| | | | - Alexander Bufe
- Medizinische Klinik I, Helios Klinikum Krefeld, Krefeld, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - Oliver Dörr
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Albrecht Elsässer
- Herz- Kreislauf-Zentrum, Universitätsklinik für Innere Medizin – Kardiologie, Klinikum Oldenburg, Oldenburg, Deutschland
| | - Luise Gaede
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen Nürnberg, Erlangen, Deutschland
| | - Tommaso Gori
- Zentrum für Kardiologie – Kardiologie I, Universitätsmedizin Mainz, Mainz, Deutschland
- Standort Rhein-Main, DZHK, Frankfurt am Main, Deutschland
| | - Hans M. Hoffmeister
- Klinik für Kardiologie und allgemeine Innere Medizin, Städtisches Klinikum Solingen gemeinnützige GmbH, Solingen, Deutschland
| | - Felix J. Hofmann
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Hugo A. Katus
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Pneumologie), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Christoph Liebetrau
- Standort Rhein-Main, DZHK, Frankfurt am Main, Deutschland
- Abteilung für Kardiologie, Campus der JLU, Kerkhoff Bad Nauheim, Bad Nauheim, Deutschland
- CCB – Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Deutschland
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, München, Deutschland
| | - Matthias Pauschinger
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland
| | - Thomas Schmitz
- Klinik für Kardiologie und Angiologie, Contilia Herz- und Gefäßzentrum, Essen, Deutschland
| | - Tim Süselbeck
- Kardiologische Praxisklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Wolfram Voelker
- Medizinische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Jens Wiebe
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen am Rhein gemeinnützige GmbH, Ludwigshafen, Deutschland
- Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland
| | - Christian Hamm
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Andreas M. Zeiher
- Klinik für Kardiologie, Angiologie und Nephrologie, Universitätsklinik Frankfurt, Frankfurt, Deutschland
| | - Helge Möllmann
- Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Deutschland
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8
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Simeone S, Vellone E, Pucciarelli G, Alvaro R. Emergency percutaneous coronary intervention and stent implantation: Patients' lived experiences. Nurs Crit Care 2021; 27:148-156. [PMID: 33780092 DOI: 10.1111/nicc.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/11/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Given that emergency procedures must be performed immediately and without the possibility of sufficiently informing and preparing a patient, the lived experiences of patients who undergo emergency procedures and those who undergo elective procedures may well differ. Elucidating the lived experiences of patients who underwent percutaneous coronary intervention (PCI) with stent implantation in an emergency situation is crucial because such knowledge might prove helpful in tailoring post-procedure interventions intended to improve the lives of PCI patients. AIM To describe the experiences of patients 1 month after they underwent emergency PCI with coronary stent implantation. METHODS Cohen's phenomenology was applied in this study. This method combines the characteristics of descriptive (Husserlian) phenomenology with those of interpretative (Gadmerian) phenomenology, and it is by nature an inductive approach. The participants were enrolled 1 month after undergoing PCI with coronary stent implantation. They were interviewed using open-ended questions to provide them full freedom of expression. They were asked to describe their experiences of the PCI and stent implementation they have gone through. This study followed the recommendations of the Standard for Reporting Qualitative Research. RESULTS Our sample consisted of 15 participants. Data analysis revealed three main themes: (1) catheter lab and pain, (2) anxiety and feeling uncertain about the future, and (3) lifestyle changes. The anxiety theme encompassed two subthemes: (a) anxiety related to the procedure and (b) anxiety related to the continuation of life. CONCLUSION Our study is one of the first works to explicitly investigate the lived experiences of patients who underwent emergency PCI. Understanding the experiences of these patients is key in understanding their realistic needs and concerns. RELEVANCE TO CLINICAL PRACTICE Knowledge of the lived experiences of patients who underwent emergency PCI with coronary stent implantation is fundamental in identifying aspects that warrant tailored interventions.
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Affiliation(s)
- Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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9
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Das D, Acharya D, Singh J, Pramanik S. A detailed review of management of coronary perforations by gelfoam closure. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_45_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Taxiarchi P, Martin GP, Curzen N, Kinnaird T, Ludman P, Johnson T, Kwok CS, Rashid M, Kontopantelis E, Mamas MA. Rotational atherectomy and same day discharge: Safety and growth from a national perspective. Catheter Cardiovasc Interv 2020; 98:678-688. [PMID: 32845064 DOI: 10.1002/ccd.29228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We explore whether same day discharge (SDD) is a feasible and safe practice following rotational atherectomy (ROTA) treatment during elective percutaneous coronary intervention (PCI), and examine which baseline characteristics are independently associated with SDD. BACKGROUND SDD following elective ROTA PCI is not recommended as per the recent SCAI consensus. However, reports show it is practiced and no previous study has evaluated its safety and feasibility. METHODS Our dataset included 4,591 patients undergoing elective ROTA PCI in England & Wales within an 8-years period. Independent associations with SDD were quantified via a multiple logistic regression model and the BCIS 30-day mortality risk model was used to evaluate the safety of SDD. RESULTS The majority of elective ROTA PCI cases remain at the hospital for overnight (ON) observation, although SDD rates increased substantially from 6.7% in 2007 to 35.5% in 2014. The use of glycoprotein IIb/IIIa antagonists, Q wave AMI, left main PCI and valvular heart disease were independently associated with ON, while patients operated underwent transradial PCI were more likely to be SDD (OR = 1.77, 95% CI [1.45-2.15]). Over the study period, observed mortality rates were not significantly higher than those expected from the BCIS risk model. CONCLUSIONS Our findings did not show superiority of the ON strategy over SDD for higher risk cases undergoing elective ROTA PCI, in terms of 30-day mortality. This is the first study to examine the safety of SDD after elective ROTA PCI and more should follow.
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Affiliation(s)
- Paraskevi Taxiarchi
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK.,Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK.,Thomas Jefferson University, Philadelphia, Pennsylvania
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11
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Szczechowicz MP, Mkalaluh S, Torabi S, Zhigalov K, Mashhour A, Karck M, Easo J, Weymann A. Bailout bypass surgery for complications of coronary interventions. Asian Cardiovasc Thorac Ann 2020; 28:205-212. [PMID: 32276539 DOI: 10.1177/0218492320919200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mechanical complications of percutaneous coronary interventions are treated percutaneously in most cases. If the rescue intervention is unsuccessful, bailout bypass surgery is necessary to restore the coronary flow. The surgical risk in these cases is higher than that of patients operated on for other indications. The aim of our study was to characterize patients who underwent surgical treatment at our institution and to compare their long-term outcomes with patients who underwent emergency bypass surgery for other indications. METHODS We analyzed 707 consecutive patients who underwent isolated emergency bypass surgery at our institution from 2007 to 2015. In 44 of these cases, the surgery was necessitated by mechanical complications of percutaneous coronary interventions. There were 31 coronary dissections, 5 entrapped guidewires, and 8 coronary perforations. We compared patients in these three groups with one another. Follow-up was performed to assess long-term outcomes. RESULTS The median age of the cohort was 68 years (range 59-75 years), and 36 (81.8%) patients presented in cardiogenic shock. Thirty-seven (84.1%) patients had history of a percutaneous coronary intervention. The courses were typical for bypass patients. The long-term survival was similar in all three subgroups (p = 0.16). The survival profiles within our sample did not differ significantly from that in patients who underwent emergency bypass surgery for other indications. CONCLUSIONS Surgical risk and short- and long-term outcomes of patients undergoing emergency bypass surgery due to mechanical complications of percutaneous coronary interventions are similar to those of patients receiving the same surgery for other indications.
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Affiliation(s)
- Marcin P Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Saeed Torabi
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Konstantin Zhigalov
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Ahmed Mashhour
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Jerry Easo
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
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12
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Kumar B, Kodliwadmath A, Singh A, Duggal B. Acute adrenal insufficiency as a mysterious cause of shock following percutaneous coronary intervention: a cardiologist's nightmare. BMJ Case Rep 2020; 13:13/3/e233585. [PMID: 32169991 DOI: 10.1136/bcr-2019-233585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The differential diagnosis of shock following percutaneous coronary intervention (PCI) is vast. Access site complications and bleeding can cause hypovolemic shock. Peri-procedural myocardial infarction, abrupt closure, stent thrombosis, coronary dissection and coronary perforation have a stormy presentation. Vasovagal shock is manifested by bradycardia and hypotension and quickly responds to atropine. Anaphylactic shock secondary to contrast administration can be stormy but usually responds to steroids or adrenaline. Septicemia due to unsterile techniques can cause a less dramatic shock. Acute adrenal insufficiency causing shock following PCI has not been described to the best of our knowledge. We report the case of a 54-year-old woman who underwent successful multivessel PCI. She had refractory unexplained shock following the PCI with no much response from inotropic or intra-aortic balloon pump. After ruling out all possible causes of shock and clinical suspicion of adrenal insufficiency, she was treated with steroids resulting in dramatic improvement in her hemodynamics.
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Affiliation(s)
- Barun Kumar
- Cardiology, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Anupam Singh
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, India
| | - Bhanu Duggal
- Cardiology, All India Institute of Medical Sciences, Rishikesh, India
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13
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Wu JJ, Way JAH, Brieger D. A Review of the Ultrathin Orsiro Biodegradable Polymer Drug-eluting Stent in the Treatment of Coronary Artery Disease. Heart Int 2019; 13:17-24. [PMID: 36274821 PMCID: PMC9559229 DOI: 10.17925/hi.2019.13.2.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/25/2019] [Indexed: 09/26/2023] Open
Abstract
Drug-eluting stents (DES) have revolutionised the treatment of coronary artery disease (CAD) in patients undergoing percutaneous coronary intervention. In recent years, there has been a focus on a new generation of DES, such as biodegradable polymer DES (BP-DES). This novel stent platform was developed with the hope of eliminating the risk of very late stent thrombosis associated with the current gold-standard durable polymer DES (DP-DES). Ultrathin Orsiro BP-DES (Biotronik, Bülach, Switzerland) are based on a cobalt-chromium stent platform that is coated with a bioresorbable polymer coating containing sirolimus. These devices have one of the thinnest struts available in the current market and have the theoretical benefit of reducing a chronic inflammatory response in the vessel wall. In 2019, the United States Food and Drug Administration (FDA) approved the use of Orsiro BP-DES in patients with CAD based on promising results in recent landmark trials, such as BIOFLOW V and BIOSTEMI. The aim of the present review article was to discuss the history of stent technology and the continued opportunities for improvements, focusing on the potential benefits of Orsiro BP-DES.
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Affiliation(s)
- James J Wu
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Concord, Australia
| | - Joshua AH Way
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - David Brieger
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Concord, Australia
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14
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Jia S, Guan C, Yuan J, Cao X, Qin L, Li Y, Li Z, Nie S, Hou S, Zhang M, Brouwer M, Suryapranata H, Xu B, Gao R. Two-year safety evaluation of a biodegradable polymer sirolimus-eluting stent with increased drug elution and polymer absorption kinetics in complex patient and lesion cohort. Catheter Cardiovasc Interv 2019; 95:206-215. [PMID: 30990245 DOI: 10.1002/ccd.28288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/26/2019] [Accepted: 04/04/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of the present report was to compare 2-year safety outcomes of two biodegradable polymer (BP) sirolimus-eluting stents (SESs) with different drug eluting and polymer absorption kinetics in a subgroup of complex patients and lesions. BACKGROUND The previously published PANDA III study showed the BuMA BP SES, with faster drug elution and polymer absorption, was non-inferior to the Excel SES in target lesion failure (TLF). METHODS In PANDA III trial, patients who fulfilled one or more of the following criteria were included: Small vessel disease (reference vessel diameter ≤ 2.5 mm); long lesion (lesion length ≥ 20 mm); chronic total occlusion lesion; and diabetic patients. RESULTS Among 2,348 patients randomly assigned to treatment with BuMA (n = 1,174) or Excel SES (n = 1,174) in the PANDA III study, 858 in the BuMA group and 855 in the Excel group satisfied the inclusion criteria. At 2-year follow-up, the incidence of definite/probable stent thrombosis (ST) was significantly lower with BuMA SES as compared with Excel SES (0.7% vs. 1.9%, p = 0.03). This difference was mainly caused by decreased subacute stent thrombosis rate (0% vs. 0.6%, p = 0.03). In patients who did not fulfill the complex patient and lesion criteria, there were no between-group difference in ST (0.7% vs. 0%, p = 0.50). Myocardial infarction and TLF rates were similar (5.7% vs. 6.0%, p = 0.79 and 8.8% vs. 7.5%, p = 0.34, respectively), whereas patient-oriented composite endpoint was higher with BuMA SES mainly due to high risk of revascularization (15.6% vs. 11.4%, p = 0.01; 8.4% vs. 4.6%, p < 0.01). CONCLUSIONS Two-year subgroup analysis of the all-comer PANDA III trial revealed the increased safety benefit of the BuMA SES is more prominently seen in complex patient and lesion population. CLINICAL TRIAL ClinicalTrial.gov, Identifier-NCT02017275.
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Affiliation(s)
- Sida Jia
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Changdong Guan
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinqing Yuan
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuebin Cao
- Department of Cardiology, Chinese PLA 252 Hospital, Baoding, China
| | - Lei Qin
- Department of Cardiology, Kaifeng Central Hospital, Kaifeng, China
| | - Yi Li
- Department of Cardiology, Yunnan St. John's Hospital, Kunming, China
| | - Zhanquan Li
- Department of Cardiology, Liaoning Provincial People's Hospital, Shenyang, China
| | - Shaoping Nie
- Department of Cardiology, Affiliated Anzhen Hospital of Capital Medical University, Beijing, China
| | - Shuang Hou
- Department of Statistical Analysis, China Cardiovascular Research Foundation Inc, Beijing, China
| | - Min Zhang
- Department of Statistical Analysis, China Cardiovascular Research Foundation Inc, Beijing, China
| | - Marc Brouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry Suryapranata
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bo Xu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
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15
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Tabet R, Nalluri N, Daneshvar F, Malpeso J. Interventional Approach to Left Main Coronary Artery Dissection. Cureus 2018; 10:e3410. [PMID: 30538898 PMCID: PMC6281447 DOI: 10.7759/cureus.3410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A left main coronary artery (LMCA) iatrogenic dissection is a rare but potentially life-threatening complication of coronary angioplasty. It can range from a simple tear in the artery wall to a severe dissection, causing complete blood flow obstruction. We report the case of a 63-year-old male patient who was presented to our catheterization laboratory following a positive stress test. An angiogram showed a proximal left anterior descending (LAD) artery tight lesion. Balloon inflation was complicated by an ostial LAD dissection that rapidly extended into the left main and the left circumflex arteries treated with angioplasty and stenting. Cardiac catheterization four days later showed a residual LMCA intimal flap that remained asymptomatic and stable. This is an interesting case of a stable LMCA dissection with the intimal flap intermittently obstructing the ostium of the left anterior descending artery. In addition, we will discuss the factors that increase the risk of coronary dissection and focus on methods to help prevent the occurrence of such complications.
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Affiliation(s)
- Rabih Tabet
- Internal Medicine, Staten Island University Hospital / Northwell Health, Staten Island, USA
| | - Nikhil Nalluri
- Cardiology, Staten Island University Hospital / Northwell Health, Staten Island, USA
| | - Farshid Daneshvar
- Cardiology, Staten Island University Hospital / Northwell Health, Staten Island, USA
| | - James Malpeso
- Cardiology, Staten Island University Hospital / Northwell Health, Staten Island, USA
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16
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Hiraide T, Sawano M, Shiraishi Y, Ueda I, Numasawa Y, Noma S, Negishi K, Ohki T, Yuasa S, Hayashida K, Miyata H, Fukuda K, Kohsaka S. Impact of catheter-induced iatrogenic coronary artery dissection with or without postprocedural flow impairment: A report from a Japanese multicenter percutaneous coronary intervention registry. PLoS One 2018; 13:e0204333. [PMID: 30265698 PMCID: PMC6162084 DOI: 10.1371/journal.pone.0204333] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/05/2018] [Indexed: 12/22/2022] Open
Abstract
Despite the ever-increasing complexity of percutaneous coronary intervention (PCI), the incidence, predictors, and in-hospital outcomes of catheter-induced coronary artery dissection (CICAD) is not well defined. In addition, there are little data on whether persistent coronary flow impairment after CICAD will affect clinical outcomes. We evaluated 17,225 patients from 15 participating hospitals within the Japanese PCI registry from January 2008 to March 2016. Associations between CICAD and in-hospital adverse cardiovascular events were evaluated using multivariate logistic regression. Outcomes of patients with CICAD with or without postprocedural flow impairment (TIMI flow ≤ 2 or 3, respectively) were analyzed. The population was predominantly male (79.4%; mean age, 68.2 ± 11.0 years); 35.6% underwent PCI for complex lesions (eg. chronic total occlusion or a bifurcation lesion.). CICAD occurred in 185 (1.1%), and its incidence gradually decreased (p < 0.001 for trend); postprocedural flow impairment was observed in 43 (23.2%). Female sex, complex PCI, and target lesion in proximal vessel were independent predictors (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.53–3.10; OR, 2.19; 95% CI, 1.58–3.04; and OR, 1.55; 95% CI, 1.06–2.28, respectively). CICAD was associated with an increased risk of in-hospital adverse events (composite of new-onset cardiogenic shock and new-onset heart failure) regardless of postprocedural flow impairment (OR, 10.9; 95% CI, 5.30–22.6 and OR, 2.27; 95% CI, 1.20–4.27, respectively for flow-impaired and flow-recovered CICAD). In conclusion, CICAD occurred in roughly 1% of PCI cases; female sex, complex PCI, and proximal lesion were its independent risk factors. CICAD was associated with adverse in-hospital cardiovascular events regardless of final flow status. Our data implied that the appropriate selection of PCI was necessary for women with complex lesions.
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Affiliation(s)
- Takahiro Hiraide
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Kouji Negishi
- Department of Cardiology, Yokohama Municipal Citizens' Hospital, Kanagawa, Japan
| | - Takahiro Ohki
- Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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17
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Shaukat A, Mooney M, Burke MN, Brilakis ES. Use of chronic total occlusion percutaneous coronary intervention techniques for treating acute vessel closure. Catheter Cardiovasc Interv 2018; 92:1297-1300. [DOI: 10.1002/ccd.27868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/09/2018] [Accepted: 08/10/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Arslan Shaukat
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation Minneapolis Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation Minneapolis Minnesota
| | - M. Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation Minneapolis Minnesota
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation Minneapolis Minnesota
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18
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Dash D. Complications encountered in coronary chronic total occlusion intervention: Prevention and bailout. Indian Heart J 2016; 68:737-746. [PMID: 27773418 PMCID: PMC5079195 DOI: 10.1016/j.ihj.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 11/30/2022] Open
Abstract
Despite the continuing developments of improved medical devices and increasing operator expertize, coronary chronic total occlusion (CTO) remains as one of the most challenging lesion subsets in interventional cardiology. Percutaneous coronary intervention (PCI) of CTO is a complex procedure carrying the risk of complications that are responsible for significant morbidity and mortality. The complications can be classified as coronary (such as coronary occlusion, perforation, device embolization, or entrapment); cardiac non-coronary (such as periprocedural myocardial infarction); extra cardiac (such as vascular access complications, systemic embolization, contrast-induced nephropathy, and radiation-induced injury). Further, certain complications (such as donor vessel dissection or thrombosis) are unique to CTO-PCI. There are also complications related to specialized techniques, such as dissection/reentry and retrograde crossing techniques. A thorough understanding of the potential complications is critical to mitigate risk during these complex procedures.
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Affiliation(s)
- Debabrata Dash
- Interventional Cardiologist, S. L Raheja (A Fortis Associate) Hospital, Nanavati Superspeciality Hospital, Mumbai, India; Guest Professor of Cardiology, Beijing Tiantan Hospital, Beijing, China.
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