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Jolly SS, Lee SF, Mian R, Kedev S, Lavi S, Moreno R, Montalescot G, Hillani A, Henry TD, Asani V, Storey RF, Silvain J, Spratt JCS, d'Entremont MA, Stankovic G, Zafirovska B, Natarajan MK, Sabate M, Shreenivas S, Pinilla-Echeverri N, Sheth T, Altisent OAJ, Ribas N, Skuriat E, Tyrwhitt J, Mehta SR. SYNERGY-Everolimus-Eluting Stent With a Bioabsorbable Polymer in ST-Elevation Myocardial Infarction: CLEAR SYNERGY OASIS-9 Registry. Am J Cardiol 2024; 220:111-117. [PMID: 38447893 DOI: 10.1016/j.amjcard.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/23/2024] [Accepted: 02/17/2024] [Indexed: 03/08/2024]
Abstract
Our objective was to evaluate the clinical effectiveness of the SYNERGY stent (Boston Scientific Corporation, Marlborough, Massachusetts) in patients with ST-elevation myocardial infarction (STEMI). The only drug-eluting stent approved for treatment of STEMI by the Food and Drug Administration is the Taxus stent (Boston Scientific) which is no longer commercially available, so further data are needed. The CLEAR (Colchicine and spironolactone in patients with myocardial infarction) SYNERGY stent registry was embedded into a larger randomized trial of patients with STEMI (n = 7,000), comparing colchicine versus placebo and spironolactone versus placebo. The primary outcome for the SYNERGY stent registry is major adverse cardiac events (MACE) as defined by cardiovascular death, recurrent MI, or unplanned ischemia-driven target vessel revascularization within 12 months. We estimated a MACE rate of 6.3% at 12 months after primary percutaneous coronary intervention for STEMI based on the Thrombectomy vs percutaneous coronary intervention alone in STEMI (TOTAL) trial. Success was defined as upper bound of confidence interval (CI) to be less than the performance goal of 9.45%. Overall, 733 patients were enrolled from 8 countries with a mean age 60 years, 19.4% diabetes mellitus, 41.3% anterior MI, and median door-to-balloon time of 72 minutes. The MACE rate was 4.8% (95% CI 3.2 to 6.3%) at 12 months which met the success criteria against performance goal of 9.45%. The rates of cardiovascular death, recurrent MI, or target vessel revascularization were 2.7%, 1.9%, 1.0%, respectively. The rates of acute definite stent thrombosis were 0.3%, subacute 0.4%, late 0.4%, and cumulative stent thrombosis of 1.1% at 12 months. In conclusion, the SYNERGY stent in STEMI performed well and was successful compared with the performance goal based on previous trials.
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Affiliation(s)
- Sanjit S Jolly
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada.
| | - Shun Fu Lee
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Rajibul Mian
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Sasko Kedev
- Department of Cardiology, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Shahar Lavi
- Department of Medicine, Western University, London, Ontario, Canada
| | - Raul Moreno
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | | | - Ali Hillani
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Timothy D Henry
- Department of Cardiology, The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Health Network, Cincinnati, Ohio
| | - Valon Asani
- Department of Cardiology, Clinical Hospital Tetovo, Tetovo, Macedonia
| | - Robert F Storey
- Department of Cardiology, University of Sheffield, Sheffield, United Kingdom
| | - Johanne Silvain
- Department of Cardiology, Sorbonne University, ACTION Group, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - James C S Spratt
- Department of Cardiology, St. George's University of London, London, England
| | - Marc-André d'Entremont
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada; Department of Cardiology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Biljana Zafirovska
- Department of Cardiology, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Madhu K Natarajan
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Manel Sabate
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Satya Shreenivas
- Department of Cardiology, The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Health Network, Cincinnati, Ohio
| | - Natalia Pinilla-Echeverri
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Tej Sheth
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | | | - Núria Ribas
- Department of Cardiology, Hospital del Mar, Heart Disease Biomedical Research Group 8GRC), IMIM (Hospital del Mar Medical Research Institute), Universitat Pompeu Fabra, Barcelona, Spain
| | - Elizabeth Skuriat
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Jessica Tyrwhitt
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Shamir R Mehta
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
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Petkoska D, Zafirovska B, Vasilev I, Saylors E, Sachar R, Kedev S. Transradial carotid artery stenting using double layer micromesh stent and novel post-dilation balloon with integrated embolic protection. Cardiovasc Revasc Med 2024:S1553-8389(24)00007-1. [PMID: 38267286 DOI: 10.1016/j.carrev.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/02/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The highest rate of embolization during carotid artery stenting occurs during post-dilation. We evaluated the ability of the Paladin system (Contego Medical, Raleigh, NC), a novel PTA balloon with an integrated 40-ɥm pore filter, to collect microemboli that may pass into the cerebral circulation when used during post-dilation. METHODS 25 symptomatic patients underwent transradial CAS using the Paladin system in conjunction with the Roadsaver (Terumo Corporation, Tokyo, Japan) micromesh stent. No additional embolic protection was used. The Paladin filters were collected following the procedure and preserved in formalin for histological analysis. The contents were evaluated for particle count and size. Subjects were followed for 30 days and evaluated for major cardiac adverse events (death, stroke and MI). Secondary endpoints included procedure success, device success, access site complications according to EASY score classification, major vascular or ischemic complications at follow up and in-stent restenosis rate evaluated with duplex ultrasound. RESULTS Mean age of patients was 68,5 years. Type 2 aortic arch was present in 77 % of patients and type 1 and type 3 in 12 % and 11 % of patients respectively. Procedural and device success was obtained in all cases without complications. The 30-day MAE rate was 0 %. Twenty-three filters underwent histological analysis. Microscopic debris was present in 100 % of filters, and 75 % of particles were less than 100ɥm in size. The mean number of particles per filter was 3352 ± 1567 (IQR 4300-2343), and the mean number of particles between 40-100ɥm per filter was 2499 ± 1240 (IQR 3227-1575). CONCLUSION CAS through radial approach can be safely and effectively performed using the IEP technology Paladin device and double-layer micromesh Roadsaver stent. This strategy can simplify the procedure and decrease peri-procedural complications and procedural time.
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Affiliation(s)
- Danica Petkoska
- University Clinic of Cardiology, Medical Faculty, University Ss. Cyril and Methodius, Skopje, Macedonia
| | - Biljana Zafirovska
- University Clinic of Cardiology, Medical Faculty, University Ss. Cyril and Methodius, Skopje, Macedonia
| | - Ivan Vasilev
- University Clinic of Cardiology, Medical Faculty, University Ss. Cyril and Methodius, Skopje, Macedonia
| | | | - Ravish Sachar
- North Carolina Heart and Vascular, UNC-REX Healthcare, University of North Carolina, Raleigh, NC, USA
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University Ss. Cyril and Methodius, Skopje, Macedonia.
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Petkoska D, Zafirovska B, Vasilev I, Novotni G, Bertrand OF, Kedev S. Radial and ulnar approach for carotid artery stenting with Roadsaver™ double layer micromesh stent: Early and long-term follow-up. Catheter Cardiovasc Interv 2023; 101:154-163. [PMID: 36478513 DOI: 10.1002/ccd.30514] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022]
Abstract
AIMS We aimed to evaluate the feasibility and safety of carotid artery stenting (CAS) with a newly designed double-layer micromesh stent using wrist approach in patients with significant carotid disease. MATERIALS AND METHODS Between January 2016 and December 2021, 105 patients undergoing CAS with Roadsaver™ stent were enrolled in a single center prospective study. Follow-up assessments included neurological exams, duplex ultrasound (DUS), and 12-lead ECG. The primary endpoint was the 30-day composite rate of stroke, death, and myocardial infarction. Secondary endpoints included procedure success, access site complications, device success, target lesion revascularization, and in-stent restenosis evaluated with DUS. Long-term outcomes up to 72 months of follow-up were assessed in all eligible patients. RESULTS The study population was predominantly male (69.5%) with a median age of 68 ± 8 years. Patients were symptomatic in 80% of the cases, and 35% fulfilled the high-risk criteria for surgical endarterectomy. The right internal carotid artery was the target artery in 56 (53.4%), and the left in 49 (46.6%) of the cases. All procedures were successfully completed from the right wrist, with right radial access in 94 (89.5%) cases and ulnar artery access with previous radial artery occlusion in 11 (10.5%) cases. All patients were treated successfully with the study device. The primary endpoint was met with a 30-day major adverse event rate of 0.9% (1/105). Up to 72 months of follow-up (median 30 ± 20 months) there were no strokes, neurological deaths, or target lesion revascularization of the treated lesion. Doppler ultrasound examination revealed nonsignificant in-stent restenosis in two asymptomatic patients. There was no hand ischemia detected in any patient. CONCLUSION Results from this study demonstrate the radial and ulnar access for CAS with double layer micromesh Roadsaver™ stent is safe and feasible and associated with favorable early and long-term follow-up.
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Affiliation(s)
| | | | - Ivan Vasilev
- University Clinic of Cardiology, Skopje, North Macedonia
| | | | - Olivier F Bertrand
- Interventional Cardiology, Quebec Heart-Lung Institute, Quebec City, Quebec, Canada
| | - Sasko Kedev
- University Clinic of Cardiology, Skopje, North Macedonia
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Aminian A, Sgueglia GA, Wiemer M, Kefer J, Gasparini GL, Ruzsa Z, van Leeuwen MAH, Ungureanu C, Leibundgut G, Vandeloo B, Kedev S, Bernat I, Ratib K, Iglesias JF, Al Hage E, Posteraro GA, Pascut D, Maes F, Regazzoli D, Kakonyi K, Meijers TA, Colletti G, Krivoshei L, Lochy S, Zafirovska B, Horák D, Nolan J, Degrauwe S, Tobita K, Saito S. Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial. JACC Cardiovasc Interv 2022; 15:1191-1201. [PMID: 35595673 DOI: 10.1016/j.jcin.2022.04.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking. OBJECTIVES The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO. METHODS DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications. RESULTS Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups. CONCLUSIONS With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time.
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Affiliation(s)
- Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
| | | | - Marcus Wiemer
- Department of Cardiology and Intensive Care, Johannes Wesling University Hospital Ruhr University Bochum, Minden, Germany
| | - Joëlle Kefer
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Zoltan Ruzsa
- Invasive Cardiology Division, Internal Medicine Department, University of Szeged, Szeged, Hungary; Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | | | | | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sasko Kedev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, North Macedonia
| | - Ivo Bernat
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Prague, Czech Republic
| | - Karim Ratib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Elias Al Hage
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Dan Pascut
- Department of Cardiology and Intensive Care, Johannes Wesling University Hospital Ruhr University Bochum, Minden, Germany
| | - Frederic Maes
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Kornél Kakonyi
- Invasive Cardiology Division, Internal Medicine Department, University of Szeged, Szeged, Hungary; Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Thomas A Meijers
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | | | | | - Stijn Lochy
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Biljana Zafirovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, North Macedonia
| | - David Horák
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Prague, Czech Republic
| | - James Nolan
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Sophie Degrauwe
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
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5
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Nardai S, Zafirovska B, Pataki A, Nemes B, Tóth J, Deák M. Finding the Optimal Access for Proximal Upper Limb Artery (PULA) Interventions: Lessons Learned From the PULA Multicenter Registry. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nardai S, Zafirovska B, Pataki Á, Nemes B, Tóth J, Deák M, Kedev S, Bertrand OF, Pirlet C, Merkely B, Ruzsa Z. Finding the optimal access for proximal upper limb artery (PULA) interventions: Lessons learned from the PULA multicenter registry. Catheter Cardiovasc Interv 2021; 98:1375-1382. [PMID: 34585817 DOI: 10.1002/ccd.29967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The multicenter proximal upper limb artery (PULA) Registry was created to study the optimal puncture sites for the interventions involving the subclavian, axillary, and innominate arteries. BACKGROUND Little is known about the optimal vascular access for PULA interventions, despite the well-known technical complexity of these procedures. METHODS We performed the retrospective analysis of consecutive patients treated for symptomatic steno-occlusive disease of the proximal upper limb arteries between January 2015 and December 2019 in three high-volume centers. Acute thrombotic occlusions were excluded from the study. RESULTS Two hundred and seventy-two patients were treated for significant stenosis and 108 for total occlusion. The baseline patient's characteristics were similar, except for the higher median age of the stenotic patients: 68.5 years (31.1; 90.0) versus 64 years (38.0; 86.0) p = 0.0015. Successful revascularization rate was higher in the stenotic group 93.75% (255/272) versus 86.11% (93/108) p = 0.0230, while the procedure length 27 min (8; 133) versus 46 min (7; 140) p = 0.0001 and fluoroscopy times 439 s (92; 2993) versus 864 s (86; 4176) p = 0.0001 were higher in the occlusion group. The main adverse event rate was similarly low. Dual access was used more often to treat occlusions (60.19% (65/108) vs. 11.40% (31/272) p = 0.0001) without significantly increasing the complication rate. The safest access was ultrasound-guided distal radial artery puncture, significantly better than conventional radial access with 0% (0/31) versus 13.6% (18/131) p = 0.0253 complication. CONCLUSIONS The percutaneous revascularization of proximal upper limb arteries is a safe and effective. Dual access can be applied to increase treatment efficacy, without significantly compromising safety.
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Affiliation(s)
- Sándor Nardai
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Biljana Zafirovska
- University Clinic of Cardiology, Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Ákos Pataki
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Júlia Tóth
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Mónika Deák
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Sasko Kedev
- University Clinic of Cardiology, Ss. Cyril and Methodius University, Skopje, Macedonia
| | | | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Ruzsa
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary.,Department of Internal Medicine, Invasive Cardiology Division, University of Szeged, Szeged, Hungary
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Zafirovska B, Jovkovski A, Vasilev I, Taravari H, Kitanoski D, Petkoska D, Paljoskovska S, Kostov J, Ho KKL, Kedev S. Ipsilateral transulnar artery approach catheterizations after failure of the radial approach-Are two sheaths in the same arm safe? Catheter Cardiovasc Interv 2021; 99:411-417. [PMID: 34047429 DOI: 10.1002/ccd.29778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/09/2021] [Indexed: 11/11/2022]
Abstract
AIMS To assess the safety and feasibility of ipsilateral transulnar access (TUA) after failure of radial access (TRA), with two sheaths placed in the radial and ulnar arteries (RA and UA) in the same arm. MATERIALS AND METHODS All consecutive patients with TUA due to inability to cross from ipsilateral TRA in the period from March 2011 until September 2020 were included in the study. We examined clinical and procedure characteristics, access site bleeding and ischemic complications and failure mode of initial TRA. Patients were assessed by duplex ultrasound post-procedure (at an average of 56 ± 31 months) and followed clinically (functional and pain assessment). RESULTS In this period, out of 51,866 patients 112 (0.2%) had a transulnar artery approach due to inability to cross from ipsilateral radial approach. Mean age of patients was 65 ± 11 years with 44% females. Cause for crossover to ipsilateral TUA was inability to cross a RA anomaly in 107 (95%) patients, mostly due to the presence of a "360°" RA loop in 88 patients. Type 3 and 4 EASY Score hematoma was present in 3 patients (2.6%). Six (5.3%) of the patients had new ipsilateral radial artery occlusion noted on duplex on follow up. There were no ulnar artery occlusions detected. There were no clinical or ischemic hand complications seen during a median 4.3 years of follow up. CONCLUSION Ipsilateral transulnar artery access following failed radial artery access crossing is safe and successful for coronary angiography and intervention with low rates of complications.
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Affiliation(s)
- Biljana Zafirovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Aleksandar Jovkovski
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Ivan Vasilev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Hajber Taravari
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Darko Kitanoski
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Danica Petkoska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Savetka Paljoskovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Jorgo Kostov
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Kalon K L Ho
- Interventional Cardiology Department, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sasko Kedev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
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Abstract
In the past several decades there has been a continuous growth in the field of cardiac implantable electronic devices (CIED) implantation procedures as well as their technological development. CIEDs utilize transvenous leads that are introduced into the heart via the axillary, subclavian, or cephalic veins, as well as a devices generator that is implanted in a subcutaneous pocket, typically in the pre-pectoral region. Despite this significant improvement, complication rates range from 1-6% with current implant tools and techniques. In this review we will discuss the three central parts of the CIED implantation procedure, their impact on implantation site, infections, and possibilities for its prevention.
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Affiliation(s)
- Jane Taleski
- Electrophysiology and Electrostimulation, University Clinic of Cardiology, Skopje, MKD
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Ruzsa Z, Sandor N, Toth J, Deak M, Zafirovska B, Nemes B, Pirlet C, Merkely B, Bertrand O, Kedev S. Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention.
Methods
The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days.
Results
The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p<0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p<0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p<0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p<0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p<0.05).
Conclusions
Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Z Ruzsa
- Semmelweis University, Heart Center, Budapest, Hungary
| | - N Sandor
- County Hospital of Kecskemet, Kecskemet, Hungary
| | - J Toth
- County Hospital of Kecskemet, Kecskemet, Hungary
| | - M Deak
- County Hospital of Kecskemet, Kecskemet, Hungary
| | - B Zafirovska
- University Clinic of Cardiology, Cardiology, Skopje, North Macedonia
| | - B Nemes
- Semmelweis University, Heart Center, Budapest, Hungary
| | - C.H Pirlet
- Quebec Heart and Lung Institute, Quebec, Canada
| | - B Merkely
- Semmelweis University, Heart Center, Budapest, Hungary
| | | | - S Kedev
- University Clinic of Cardiology, Cardiology, Skopje, North Macedonia
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Zafirovska B, Otljanska M, Petkoska D, Kedev S. RISK FACTOR DISTRIBUTION AND LONG-TERM OUTCOMES IN YOUNG PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN MACEDONIA. Acta Clin Croat 2019; 58:583-589. [PMID: 32595241 PMCID: PMC7314289 DOI: 10.20471/acc.2019.58.04.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim was to assess coronary artery disease (CAD) risk factor distribution and long-term outcomes in young patients undergoing percutaneous coronary intervention (PCI) in Macedonia. A total of 12,361 PCI patients (from March 2011 to December 2017) were included in the study. Group 1 included 309 young patients aged ≤40 as the main study group, comparing them to 12,052 older PCI patients (group 2) during the study period. We compared CAD risk factor distribution, clinical and procedure characteristics. Additionally, angiographic data, long-term major adverse cardiac and cerebrovascular events (MACCE) and mortality were analyzed in group 1 patients. Median age was 36±4 years in group 1 and 62±11 years in group 2. Male patients predominated in both groups (88% vs.73%). Positive family history for CAD, smoking and obesity was much more common in the young group (p<0.0001). ST segment elevation myocardial infarction (STEMI) primary PCI was also more frequent with 48% of PCI in the young group (p<0.0001). Multivessel CAD and chronic total occlusion interventions were more common in the older group (51% and 28%, respectively; p<0.0001). Procedure duration (31±0.4 vs. 35±22 min) and fluoroscopy time (9±4 vs. 9±12 min) were similar in both groups. There was no difference in access site bleeding (4.8% vs. 4.3%). During the 3.5-year median follow up, MACCE was present in 1.9% of young patients. In conclusion, positive family history for CAD, obesity and smoking were the most common risk factors in the young PCI population. Young PCI patients usually had single vessel CAD with STEMI being more frequent as the cause for primary PCI. Long-term annual survival exceeded 99% in these patients with excellent prognosis after PCI.
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Affiliation(s)
| | - Magdalena Otljanska
- University Clinic of Cardiology, Faculty of Medicine, University of St Cyril & Methodius, Skopje, Macedonia
| | - Danica Petkoska
- University Clinic of Cardiology, Faculty of Medicine, University of St Cyril & Methodius, Skopje, Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, Faculty of Medicine, University of St Cyril & Methodius, Skopje, Macedonia
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Zafirovska B, Antov S, Kostov J, Spiroski I, Vasilev I, Jovkovski A, Kitanoski D, Petkoska D, Bertrand OF, Kedev S. Benefit of routine preprocedural radial artery angiography in STEMI patients. Catheter Cardiovasc Interv 2018; 93:25-31. [DOI: 10.1002/ccd.27711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/26/2018] [Accepted: 05/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Jorgo Kostov
- University Clinic of Cardiology; Skopje Macedonia
| | | | - Ivan Vasilev
- University Clinic of Cardiology; Skopje Macedonia
| | | | | | | | | | - Sasko Kedev
- University Clinic of Cardiology; Skopje Macedonia
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Kedev S, Zafirovska B, Antov S, Kostov J, Spiroski I, Boshev M, Vasilev I, Jovkovski A, Taravari H, Kitanoski D, Petkoska D, Ho KK. Total wrist access for angiography and interventions: Procedural success and access site crossover in a high volume transradial center. Cardiovascular Revascularization Medicine 2018; 19:570-574. [DOI: 10.1016/j.carrev.2017.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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Kedev S, Zafirovska B, Kalpak O, Antov S, Kostov J, Spiroski I, Pejkov H, Boshev M, Vasllev I, Jovkovski A, Taravari H, Petkoska D, Kitanoski D. Macedonia: coronary and structural heart interventions from 2010 to 2015. EUROINTERVENTION 2017; 13:Z47-Z50. [DOI: 10.4244/eij-d-16-00827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kalpak O, Pejkov H, Spiroski I, Kostov J, Zafirovska B, Kalpak G, Antov S, Kedev S. TCT-368 Ulnar Rather Than Femoral for Artery Access Crossover. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kedev S, Zafirovska B, Petkoska D, Vasilev I, Bertrand OF. Results of Transradial Subclavian Artery Percutaneous Interventions After Bilateral or Single Access. Am J Cardiol 2016; 118:918-923. [PMID: 27471055 DOI: 10.1016/j.amjcard.2016.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 12/29/2022]
Abstract
Percutaneous treatment of subclavian artery stenosis or occlusion has become more popular compared with surgical correction. We compared the early and late results of subclavian artery stenting with bilateral or single transradial access. From 2010 to 2015, we recruited 54 consecutive patients. In 35 cases, we used bilateral access, and in 19 cases, ipsilateral single access was used. Left subclavian artery was the culprit vessel in 72% of cases. There were more chronic total occlusions in the bilateral group (77% vs 21%, p = 0.0001). Transradial-only approach was used in all cases, except in 2 cases in the bilateral group where crossover to femoral access was required. Stents were implanted in 94% in bilateral group and 84% in single group (p = 0.47). Procedure duration (40 [35 to 60] vs 20 [15 to 30] minutes), contrast volume (200 [200 to 350] vs 150 [100 to 200] ml and fluoroscopy time (20 [12 to 30] vs 8 [4 to 11] minutes) were higher in bilateral group (all p values <0.0001). Procedural success was 96%. Overall, we observed three <5-cm hematomas and 3 asymptomatic radial artery occlusions at hospital discharge. After successful procedure, blood pressure equalized in 94% in bilateral group and 100% in single group (p = 0.54). Major cardiovascular and cerebrovascular event-free survival up to 5 years was 97% in bilateral group compared with 84% in single group (p = 0.12). Subclavian artery patency at late follow-up was 91% in bilateral group and 95% in single group (p = 1.00). Using single or bilateral transradial approach, subclavian artery lesions or occlusions can be effectively and safely treated without the risks of femoral or brachial access.
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Zafirovska B, Petkoska D, Antov S, Vasilev I, Jovkovski A, Kalpak O, Kostov J, Spiroski I, Pejkov H, Bosev M, Taravari H, Kitanoski D, Kedev S. Radial artery anomalies in the Macedonian population during transradial angiography procedures. SANAMED 2016. [DOI: 10.5937/sanamed1602087z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Pancholy SB, Zafirovska B, Antov S, Kalpak O, Kedev S. TCT-432 Predictors Of Upper Extremity Arterial Tortuosity Encountered During Transradial Access: Results From A Large National Registry. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kedev S, Petkoska D, Zafirovska B, Vasilev I, Bertrand OF. Safety of Slender 5Fr Transradial Approach for Carotid Artery Stenting With a Novel Nitinol Double-Layer Micromesh Stent. Am J Cardiol 2015; 116:977-81. [PMID: 26189035 DOI: 10.1016/j.amjcard.2015.05.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 05/31/2015] [Accepted: 05/31/2015] [Indexed: 11/17/2022]
Abstract
We aimed to evaluate the feasibility and safety of performing percutaneous carotid stent implantation with a newly designed double-layer stent using transradial slender 5Fr techniques. We recruited 10 consecutive patients who underwent percutaneous carotid stenting using nitinol double-layer micromesh (Roadsaver) stents. Mean age of patients was 66 years. Seven patients had ≥2 high-risk criteria according to SAPPHIRE classification. Indication was neurologic symptoms in 7 and severe lesion without symptoms in 3 cases. Type 2 aortic arch was present in 8 patients and type 1 in 2 patients. Access was right radial artery in 9 cases and right ulnar artery in 1 case. Right carotid artery was stented in 4 cases and left carotid artery in 6 cases. Embolic protection device (EPD) was used in 6 cases. Nine stents were successfully delivered using 5Fr destination sheath (n = 7) or shuttle sheath (n = 2), and 1 was implanted using Mo-Ma 8Fr proximal EPD. Procedural success was obtained in all cases with only 1 case of temporary vasospasm due to distal EPD. Total procedural time was 21 minutes (13 to 30 minutes) with filter time of 5 ± 1 minutes. Fluoroscopy time was 8 minutes (5 to 12 minutes) and contrast volume was 150 ml (100 to 200 ml). Hospital stay was 1 ± 1 day with 4 patients discharged on the same day of the procedure. Using right transradial approach and slender 5Fr techniques, this new double-layer micromesh stent can be implanted in left and right carotid arteries with promising results.
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Affiliation(s)
- Sasko Kedev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia.
| | - Danica Petkoska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Biljana Zafirovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Ivan Vasilev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Olivier F Bertrand
- Interventional Cardiology, Quebec Heart-Lung Institute, Quebec, Quebec, Canada
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Kedev S, Jovkovski A, Zafirovska B. Bilateral trans-radial approach in stenting of occluded right axillary artery. J Cardiothorac Surg 2014; 9:138. [PMID: 25149874 PMCID: PMC4164749 DOI: 10.1186/s13019-014-0138-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 07/18/2014] [Indexed: 12/04/2022] Open
Abstract
With recent advancement in percutaneous endovascular interventions, angioplasty and stenting of axillary artery lesions could become the treatment of choice vs. surgical intervention owing to its lower complication and mortality rates and shorter hospital stay. We report a Caucasian female case with axillary artery chronic total occlusion (CTO) with dual etiology (atherosclerotic and radiation induced), which was successfully managed with stent angioplasty. The strategy used was right radial retrograde approach with contralateral injections from left radial catheter. Two year follow-up revealed widely patent axillary stents.
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Affiliation(s)
- Sasko Kedev
- Interventional Cardiology Department, University Clinic of Cardiology, Medical Faculty, University of St,Cyril & Methodius, Vodnjanska 17, Skopje 1000, Macedonia.
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Kedev S, Zafirovska B, Dharma S, Petkoska D. Safety and feasibility of transulnar catheterization when ipsilateral radial access is not available. Catheter Cardiovasc Interv 2013; 83:E51-60. [DOI: 10.1002/ccd.25123] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/24/2013] [Accepted: 06/30/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Sasko Kedev
- University Clinic of Cardiology; Medical Faculty, University of St.Cyril & Methodius; Skopje Macedonia
| | - Biljana Zafirovska
- University Clinic of Cardiology; Medical Faculty, University of St.Cyril & Methodius; Skopje Macedonia
| | - Surya Dharma
- Department of Cardiology and Vascular Medicine; Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita; Jakarta Indonesia
| | - Danica Petkoska
- University Clinic of Cardiology; Medical Faculty, University of St.Cyril & Methodius; Skopje Macedonia
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Petkoska D, Zafirovska B, Jovkovski A, Kedev S. Bilateral retrograde radial approach in stenting of occluded subclavian artery. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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