1
|
d'Entremont MA, Alrashidi S, Seto AH, Nguyen P, Marquis-Gravel G, Abu-Fadel MS, Juergens C, Tessier P, Lemaire-Paquette S, Heenan L, Skuriat E, Tyrwhitt J, Couture ÉL, Bérubé S, Jolly SS. Ultrasound guidance for transfemoral access in coronary procedures: an individual participant-level data metaanalysis from the femoral ultrasound trialist collaboration. EUROINTERVENTION 2024; 20:66-74. [PMID: 37800723 PMCID: PMC10758987 DOI: 10.4244/eij-d-22-00809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/12/2022] [Accepted: 09/01/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Randomised controlled trials of ultrasound (US)-guided transfemoral access (TFA) for coronary procedures have shown mixed results. AIMS We aimed to compare US-guided versus non-US-guided TFA from randomised data in an individual participant-level data (IPD) meta-analysis. METHODS We completed a systematic review and an IPD meta-analysis of all randomised controlled trials comparing US-guided versus non-US-guided TFA for coronary procedures. We performed a one-stage mixed-model meta-analysis using the intention-to-treat population from included trials. The primary outcome was a composite of major vascular complications or major bleeding within 30 days. RESULTS A total of 2,441 participants (1,208 US-guided, 1,233 non-US-guided) from 4 randomised clinical trials were included. The mean age was 65.5 years, 27.0% were female, and 34.5% underwent a percutaneous coronary intervention. The incidence of major vascular complications or major bleeding (34/1,208 [2.8%] vs 55/1,233 [4.5%]; odds ratio [OR] 0.61, 95% confidence interval [CI]: 0.39-0.94; p=0.026) was lower in the US-guided TFA group. In the prespecified subgroup of participants who received a vascular closure device, those randomised to US-guided TFA experienced a reduction in the primary outcome (2.1% vs 5.6%; OR 0.36, 95% CI: 0.19-0.69), while no benefit for US guidance was observed in the subgroup without vascular closure devices (4.1% vs 3.3%; OR 1.21, 95% CI: 0.65-2.26; interaction p=0.009). CONCLUSIONS In participants undergoing coronary procedures by TFA, US guidance decreased the composite outcome of major vascular complications or bleeding and may be especially helpful when using vascular closure devices.
Collapse
Affiliation(s)
- Marc-André d'Entremont
- Population Health Research Institute, Hamilton, ON, Canada
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
- McMaster University, Hamilton, ON, Canada
| | | | | | - Phong Nguyen
- Western Sydney University, Campbelltown, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | | | - Mazen S Abu-Fadel
- Oklahoma Heart Hospital, Oklahoma City, OK, USA and University of Oklahoma, Norman, OK, USA
| | - Craig Juergens
- University of New South Wales, Sydney, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
| | - Pierre Tessier
- Hôpital du Sacré-Coeur-de-Montréal, Montreal, QC, Canada
| | | | - Laura Heenan
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | - Étienne L Couture
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Simon Bérubé
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
| |
Collapse
|
2
|
Abstract
Superior vena cava syndrome has typically been associated with malignant conditions; however, the number of benign cases has started to grow as the use of upper-extremity venous lines and implantable cardiac devices increases. Whereas endovascular techniques are standardly used to treat patients with malignancies, the optimal care of patients with benign causes is less clear because they typically have longer life expectancies. We describe 2 cases of benign superior vena cava syndrome successfully managed with endovascular stenting, and we review the relevant literature. Of 145 cases in 10 series (average follow-up time, 24 mo), 96% of patients experienced symptomatic relief after endovascular management, with a primary patency rate of 66% and a secondary rate of 93%. Although few data exist to compare open surgical and endovascular techniques directly, both approaches appear to produce similar rates of patency. Both approaches frequently necessitate secondary intervention to maintain patency, but endovascular management is associated with fewer complications. We conclude that endovascular management of benign superior vena cava syndrome is a safe, effective, and reasonable initial management approach.
Collapse
|
3
|
Sandoval Y, Burke MN, Lobo AS, Lips DL, Seto AH, Chavez I, Sorajja P, Abu-Fadel MS, Wang Y, Poulouse A, Gössl M, Mooney M, Traverse J, Tierney D, Brilakis ES. Contemporary Arterial Access in the Cardiac Catheterization Laboratory. JACC Cardiovasc Interv 2018; 10:2233-2241. [PMID: 29169493 DOI: 10.1016/j.jcin.2017.08.058] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/03/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022]
Abstract
Obtaining femoral and radial arterial access in the cardiac catheterization laboratory using state-of-the-art techniques is essential to optimize outcomes, patient satisfaction, and procedural efficiency. Although transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, femoral access remains necessary for numerous procedures, many requiring large-bore access, including complex high-risk coronary interventions, structural procedures, and procedures involving mechanical circulatory support. For femoral access, contemporary access techniques should combine the use of fluoroscopy, ultrasound, micropuncture needle, femoral angiography, and vascular closure devices, when feasible. For radial access, ultrasound may reveal important anatomic features and expedite access. Despite randomized controlled trials supporting use of routine ultrasound guidance for femoral and/or radial arterial access, ultrasound remains underused in cardiac catheterization laboratories. This article reviews contemporary techniques to achieve optimal arterial access in the cardiac catheterization laboratory.
Collapse
Affiliation(s)
- Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Angie S Lobo
- Department of Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Daniel L Lips
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Arnold H Seto
- Division of Cardiology, Department of Medicine, Veterans Affairs Long Beach Healthcare System and University of California, Irvine Medical Center, Long Beach, California
| | - Ivan Chavez
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mazen S Abu-Fadel
- Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Anil Poulouse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mario Gössl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - David Tierney
- Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
| |
Collapse
|
4
|
Enezate TH, Omran J, Mahmud E, Patel M, Abu-Fadel MS, White CJ, Al-Dadah AS. Endovascular versus surgical treatment for acute limb ischemia: a systematic review and meta-analysis of clinical trials. Cardiovasc Diagn Ther 2017; 7:264-271. [PMID: 28567352 DOI: 10.21037/cdt.2017.03.03] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A number of small studies have suggested that outcomes following endovascular (ENDO) therapy are comparable to those following surgical (SURG) revascularization for patients presenting with acute limb ischemia (ALI). We sought to compare mortality, limb amputation and recurrent ischemia across both revascularization strategies. METHODS A comprehensive database search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases from January 1990 through January 2016 was performed to identify studies of ENDO versus SURG for ALI. Two independent reviewers selected studies and extracted the data. Random-effects meta-analysis was used to pool results across studies. Heterogeneity of treatment effect among trials was assessed using the I2 statistics. The primary endpoints were mortality and limb amputation at 1 month, 6 and 12 months. Secondary endpoint was recurrent ischemia at one year. RESULTS A total of 1,773 patients were included from six studies (five randomized prospective and one observational retrospective) comparing ENDO and SURG in the setting of ALI. The mean age was 67 years and 65% of patients were male. There were no differences in mortality between the two groups at 1 month [risk ratio (RR) for ENDO vs. SURG is 0.70; 95% confidence interval (CI), 0.33 to 1.50], 6 months (RR 1.12; CI, 0.78 to 1.61) or 12 months (RR 0.74; CI, 0.29 to 1.85). Similarly, there was no significant difference in amputation rates between ENDO and SURG at 1 month (RR 0.75; CI, 0.40 to 1.42), 6 months (RR 0.87; CI, 0.52 to 1.48) or 12 months (RR 0.81; CI, 0.55 to 1.18). When looking into secondary outcomes, recurrent ischemia was not different between the two groups (RR 1.12; CI, 0.75 to 1.67). CONCLUSIONS In patients presenting with ALI (<2 weeks of duration), ENDO and SURG approaches have similar rates of short-term and 12 month mortality, limb amputation and recurrent ischemia.
Collapse
Affiliation(s)
- Tariq H Enezate
- Cardiovascular Medicine Department, University of Missouri- Columbia School of Medicine, Columbia, Missouri, USA
| | - Jad Omran
- Cardiovascular Medicine Department, University of Missouri- Columbia School of Medicine, Columbia, Missouri, USA
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California, USA
| | - Mitul Patel
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California, USA
| | - Mazen S Abu-Fadel
- Section of Cardiovascular Disease, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Christopher J White
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | | |
Collapse
|
5
|
Ganguli S, Hawkins BM, Abtahian F, Abu-Fadel MS, Walker TG, MacKay C, Jaff MR, Weinberg I. Comparison of Inferior Vena Cava Filters Placed at the Bedside via Intravenous Ultrasound Guidance Versus Fluoroscopic Guidance. Ann Vasc Surg 2017; 39:250-255. [DOI: 10.1016/j.avsg.2016.06.013] [Citation(s) in RCA: 6] [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] [Received: 02/05/2016] [Revised: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022]
|
6
|
Abdalla M, Kovach N, Liu C, Damp JB, Jahangir E, Hilliard A, Gopinathannair R, Abu-Fadel MS, El Chami MF, Gafoor S, Vedanthan R, Sanchez-Shields M, George JC, Priester T, Alasnag M, Barker C, Freeman AM. The Importance of Global Health Experiences in the Development of New Cardiologists. J Am Coll Cardiol 2016; 67:2789-2797. [PMID: 26763797 DOI: 10.1016/j.jacc.2015.10.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 09/21/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022]
Abstract
As the global burden of cardiovascular disease continues to increase worldwide, nurturing the development of early-career cardiologists interested in global health is essential to create a cadre of providers with the skill set to prevent and treat cardiovascular diseases in international settings. As such, interest in global health has increased among cardiology trainees and early-career cardiologists over the past decade. International clinical and research experiences abroad present an additional opportunity for growth and development beyond traditional cardiovascular training. We describe the American College of Cardiology International Cardiovascular Exchange Database, a new resource for cardiologists interested in pursuing short-term clinical exchange opportunities abroad, and report some of the benefits and challenges of global health cardiovascular training in both resource-limited and resource-abundant settings.
Collapse
Affiliation(s)
- Marwah Abdalla
- Department of Medicine/Division of Cardiology, Columbia University Medical Center, New York, New York.
| | - Neal Kovach
- International Affairs, American College of Cardiology, Washington, DC
| | - Connie Liu
- International Affairs, American College of Cardiology, Washington, DC
| | - Julie B Damp
- Department of Medicine/Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eiman Jahangir
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, Louisiana
| | - Anthony Hilliard
- Division of Cardiology, Loma Linda University, Loma Linda, California
| | | | - Mazen S Abu-Fadel
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mikhael F El Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Sameer Gafoor
- Cardiovascular Center Frankfurt, Frankfurt, Germany, and the Swedish Heart and Vascular Institute, Seattle, Washington
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Monica Sanchez-Shields
- Department of Medicine/Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jon C George
- Deborah Heart and Lung Center, Browns Mills, New Jersey
| | - Tiffany Priester
- Division of Cardiology, Loma Linda University, Loma Linda, California; School of Medicine, Loma Linda University, Loma Linda, California, and Department of Cardiology, Blantyre Adventist Hospital, Blantyre, Malawi
| | - Mirvat Alasnag
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Andrew M Freeman
- Department of Medicine/Division of Cardiology, National Jewish Health, Denver, Colorado
| |
Collapse
|
7
|
Seto AH, Roberts JS, Abu-Fadel MS, Czak SJ, Latif F, Jain SP, Raza JA, Mangla A, Panagopoulos G, Patel PM, Kern MJ, Lasic Z. Real-Time Ultrasound Guidance Facilitates Transradial Access. JACC Cardiovasc Interv 2015; 8:283-291. [DOI: 10.1016/j.jcin.2014.05.036] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/25/2014] [Accepted: 05/08/2014] [Indexed: 11/28/2022]
|
8
|
Banerjee S, Pershwitz G, Sarode K, Mohammad A, Abu-Fadel MS, Baig MS, Tsai S, Little BB, Gigliotti OS, Soto-Cora E, Foteh MI, Rodriguez G, Klein A, Addo T, Luna M, Shammas NW, Prasad A, Brilakis ES. Stent and Non-Stent Based Outcomes of Infrainguinal Peripheral Artery Interventions From the Multicenter XLPAD Registry. J Invasive Cardiol 2015; 27:14-18. [PMID: 25589695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND There are limited data regarding contemporary use of stent and non-stent based treatment strategies of infrainguinal peripheral artery disease (PAD). METHODS We analyzed data from the ongoing multicenter XLPAD registry between July 2005 and October 2013 to report on the use of non-stent (atherectomy ± balloon angioplasty) and stent-based treatment of superficial femoral artery (SFA), popliteal, and below-the-knee (BTK) vessels in contemporary clinical practice. RESULTS A total of 584 interventions (SFA, 82.5%; popliteal, 7.2%; BTK, 9.9%) were performed in 372 patients (mean age, 63.2 years; diabetes mellitus, 57.7%; Rutherford category 1-3, 73.5%; Rutherford category 4-6, 20.1%). Stents were deployed in 389 lesions (66.6%; SFA, 90.5%; popliteal, 5.1%; BTK, 4.1%) and non-stent strategy (atherectomy, 49%) in 195 lesions (33.4%; SFA, 66.7%; popliteal, 11.3%; BTK, 21.5%). In the stent and non-stent groups, mean lesion lengths were 133.9 mm and 86.0 mm (P<.001), chronic total occlusions (CTOs) constituted 63.0% and 49.7% (P<.01), and restenotic lesions were 12.6% and 32.3% (P<.001), respectively. At a mean follow-up of 260 ± 130 days, in the stent and non-stent treated patients, all-cause mortality was 4.3% and 3.5% (P=.65), clinically indicated repeat revascularization was 17.5% and 14.9% (P=.42), and amputation was 4.6% and 9.2% (P<.01), respectively. SFA lesion location, long lesion length, and CTO were associated with the use of stents. Advanced Rutherford class was associated with a non-stent treatment strategy. CONCLUSION The majority of endovascular peripheral arterial interventions are performed in the SFA; most include a CTO and in patients with diabetes mellitus. Operators use stents to primarily treat complex SFA lesions with overall similar outcomes, except for fewer amputations compared to a non-stent strategy.
Collapse
Affiliation(s)
- Subhash Banerjee
- University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Banerjee S, Thomas R, Sarode K, Mohammad A, Sethi S, Baig MS, Gigliotti OS, Ali MI, Klein A, Abu-Fadel MS, Shammas NW, Prasad A, Brilakis ES. Crossing of infrainguinal peripheral arterial chronic total occlusion with a blunt microdissection catheter. J Invasive Cardiol 2014; 26:363-369. [PMID: 25091095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Crossing of lower-extremity arterial chronic total occlusion (CTO) can be challenging. Use of the Viance peripheral CTO crossing device (Covidien) in the superficial femoral (SFA), popliteal, and below-the knee (BTK) arterial locations has received limited study. METHODS Fifty-eight patients from the Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) were treated between April 2010 and November 2013 with the Viance device. The procedural and 30-day clinical outcomes were collected. RESULTS Mean age was 65.5 ± 8.7 years and 55.1% had diabetes mellitus. Most lesions (n = 58) were TASC classification type C (n = 16; 27.6%) and D (n = 16; 27.6%), with mean lesion length 140.0 ± 71.0 mm; 93.1% of lesions were de novo and 81.0% were severely calcified. Technical success (crossing without the use of a reentry device) was achieved in 87.9% of cases and procedural success was obtained in 86.2%; 51.7% of lesions received stents, with the remaining treated with balloon angioplasty and/or atherectomy. Average fluoroscopy time was 39.1 ± 21.2 min, with 187.8 ± 72.0 mL of contrast and 210.0 ± 212.0 Gy cm² radiation dose-area product. There was 1 periprocedural complication (access-site hematoma treated conservatively without blood transfusion). At 30 days post procedure, there was significant improvement in ankle-brachial index (0.72 ± 0.30 to 0.84 ± 0.16; P=.01) and Rutherford class (3.33 ± 0.81 to 1.54 ± 1.47; P<.001). Clinically-indicated target vessel revascularization, surgical intervention or amputation at 30 days was 5.2%. CONCLUSION Use of Viance to cross infrainguinal arterial CTO was associated with high success, low complication rates, and significant symptom improvement.
Collapse
Affiliation(s)
- Subhash Banerjee
- University of Texas Southwestern Medical Center, Dallas, Texas 75216 USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
|
11
|
Wayangankar SA, Abu-Fadel MS, Aronow HD, Kennedy KF, Gupta R, Yeh RW, Gray WA, Rosenfield K, Hennebry TA. Hemorrhagic and Ischemic Outcomes After Bivalirudin Versus Unfractionated Heparin During Carotid Artery Stenting. Circ Cardiovasc Interv 2013; 6:131-8. [DOI: 10.1161/circinterventions.112.974857] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 11/16/2022]
Abstract
Background—
The direct thrombin inhibitor, bivalirudin, is associated with similar efficacy and superior safety in patients undergoing percutaneous coronary intervention. However, the role of direct thrombin inhibitors in carotid artery stenting is not well defined. The objective of this study was to compare the safety and effectiveness of bivalirudin and unfractionated heparin (UFH) for carotid artery stenting. We hypothesized that bivalirudin would be associated with less in-hospital postprocedure bleeding than UFH but similar rates of in-hospital and 30-day ischemic outcomes.
Methods and Results—
We compared the incidence of in-hospital hemorrhagic and in-hospital/30-day ischemic outcomes among patients in the CARE Registry who underwent carotid artery stenting between May 2005 and March 2012 using bivalirudin or UFH. Propensity score matching was used to obtain a balanced cohort of 3555 patients in each treatment group. Patients treated with bivalirudin had a significantly lower incidence of bleeding or hematoma requiring red blood cell transfusions (0.9% versus 1.5%; odds ratio, 0.57 [0.36–0.89];
P
=0.01) when compared with UFH-treated patients. The incidence of in-hospital and 30-day ischemic outcomes, including death, myocardial infarction, stroke, transient ischemic attack, and the composite outcome, death/myocardial infarction/stroke, did not differ significantly between groups.
Conclusions—
Bivalirudin was associated with lower rates of hemorrhagic outcomes compared with UFH during the index hospitalization for carotid artery stenting. In-hospital and 30-day ischemic events were similar between the 2 groups. Randomized comparisons of these agents are needed to confirm these findings.
Collapse
Affiliation(s)
- Siddharth A. Wayangankar
- From the University of Oklahoma Health Sciences Center, Oklahoma City, OK (S.A.W., M.A.F., R.G.); Michigan Heart & Vascular Institute, Ann Arbor, MI (H.D.A.); Mid America Heart and Vascular Institute, St. Luke’s Hospital, Kansas City, MO (K.F.K.); Columbia University Medical Center, New York, NY (W.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., K.R.); and Oklahoma Heart Hospital, Oklahoma City, OK (T.A.H.)
| | - Mazen S. Abu-Fadel
- From the University of Oklahoma Health Sciences Center, Oklahoma City, OK (S.A.W., M.A.F., R.G.); Michigan Heart & Vascular Institute, Ann Arbor, MI (H.D.A.); Mid America Heart and Vascular Institute, St. Luke’s Hospital, Kansas City, MO (K.F.K.); Columbia University Medical Center, New York, NY (W.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., K.R.); and Oklahoma Heart Hospital, Oklahoma City, OK (T.A.H.)
| | - Herbert D. Aronow
- From the University of Oklahoma Health Sciences Center, Oklahoma City, OK (S.A.W., M.A.F., R.G.); Michigan Heart & Vascular Institute, Ann Arbor, MI (H.D.A.); Mid America Heart and Vascular Institute, St. Luke’s Hospital, Kansas City, MO (K.F.K.); Columbia University Medical Center, New York, NY (W.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., K.R.); and Oklahoma Heart Hospital, Oklahoma City, OK (T.A.H.)
| | - Kevin F. Kennedy
- From the University of Oklahoma Health Sciences Center, Oklahoma City, OK (S.A.W., M.A.F., R.G.); Michigan Heart & Vascular Institute, Ann Arbor, MI (H.D.A.); Mid America Heart and Vascular Institute, St. Luke’s Hospital, Kansas City, MO (K.F.K.); Columbia University Medical Center, New York, NY (W.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., K.R.); and Oklahoma Heart Hospital, Oklahoma City, OK (T.A.H.)
| | - Raghav Gupta
- From the University of Oklahoma Health Sciences Center, Oklahoma City, OK (S.A.W., M.A.F., R.G.); Michigan Heart & Vascular Institute, Ann Arbor, MI (H.D.A.); Mid America Heart and Vascular Institute, St. Luke’s Hospital, Kansas City, MO (K.F.K.); Columbia University Medical Center, New York, NY (W.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., K.R.); and Oklahoma Heart Hospital, Oklahoma City, OK (T.A.H.)
| | - Robert W. Yeh
- From the University of Oklahoma Health Sciences Center, Oklahoma City, OK (S.A.W., M.A.F., R.G.); Michigan Heart & Vascular Institute, Ann Arbor, MI (H.D.A.); Mid America Heart and Vascular Institute, St. Luke’s Hospital, Kansas City, MO (K.F.K.); Columbia University Medical Center, New York, NY (W.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., K.R.); and Oklahoma Heart Hospital, Oklahoma City, OK (T.A.H.)
| | - William A. Gray
- From the University of Oklahoma Health Sciences Center, Oklahoma City, OK (S.A.W., M.A.F., R.G.); Michigan Heart & Vascular Institute, Ann Arbor, MI (H.D.A.); Mid America Heart and Vascular Institute, St. Luke’s Hospital, Kansas City, MO (K.F.K.); Columbia University Medical Center, New York, NY (W.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., K.R.); and Oklahoma Heart Hospital, Oklahoma City, OK (T.A.H.)
| | - Kenneth Rosenfield
- From the University of Oklahoma Health Sciences Center, Oklahoma City, OK (S.A.W., M.A.F., R.G.); Michigan Heart & Vascular Institute, Ann Arbor, MI (H.D.A.); Mid America Heart and Vascular Institute, St. Luke’s Hospital, Kansas City, MO (K.F.K.); Columbia University Medical Center, New York, NY (W.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., K.R.); and Oklahoma Heart Hospital, Oklahoma City, OK (T.A.H.)
| | - Thomas A. Hennebry
- From the University of Oklahoma Health Sciences Center, Oklahoma City, OK (S.A.W., M.A.F., R.G.); Michigan Heart & Vascular Institute, Ann Arbor, MI (H.D.A.); Mid America Heart and Vascular Institute, St. Luke’s Hospital, Kansas City, MO (K.F.K.); Columbia University Medical Center, New York, NY (W.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., K.R.); and Oklahoma Heart Hospital, Oklahoma City, OK (T.A.H.)
| |
Collapse
|
12
|
Banerjee S, Das TS, Abu-Fadel MS, Dippel EJ, Shammas NW, Tran DL, Zankar A, Varghese C, Kelly KC, Weideman RA, Little BB, Reilly RF, Addo T, Brilakis ES. Pilot trial of cryoplasty or conventional balloon post-dilation of nitinol stents for revascularization of peripheral arterial segments: the COBRA trial. J Am Coll Cardiol 2012; 60:1352-9. [PMID: 22981558 DOI: 10.1016/j.jacc.2012.05.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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] [Received: 03/06/2012] [Revised: 05/08/2012] [Accepted: 05/23/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study is to compare post-dilation strategies of nitinol self-expanding stents implanted in the superficial femoral artery of diabetic patients with peripheral arterial disease. BACKGROUND Endovascular treatment of superficial femoral artery disease with nitinol self-expanding stents is associated with high rates of in-stent restenosis in patients with diabetes mellitus. METHODS We conducted a prospective, multicenter, randomized, controlled clinical trial of diabetic patients to investigate whether post-dilation of superficial femoral artery nitinol self-expanding stents using a cryoplasty balloon reduces restenosis compared to a conventional balloon. Inclusion criteria included diabetes mellitus, symptomatic peripheral arterial disease, and superficial femoral artery lesions requiring implantation of stents>5 mm in diameter and >60 mm in length. Primary endpoint was binary restenosis at 12 months, defined as ≥2.5-fold increase in peak systolic velocity by duplex ultrasonography. RESULTS Seventy-four patients, with 90 stented superficial femoral artery lesions, were randomly assigned to post-dilation using cryoplasty (n=45 lesions) or conventional balloons (n=45 lesions). Mean lesion length was 148±98 mm, mean stented length was 190±116 mm, mean stent diameter was 6.1±0.4 mm, and 50% of the lesions were total occlusions. Post-dilation balloon diameters were 5.23±0.51 mm versus 5.51±0.72 mm in the cryoplasty and conventional balloon angioplasty groups, respectively (p=0.02). At 12 months, binary restenosis was significantly lower in the cryoplasty group (29.3% vs. 55.8%, p=0.01; odds ratio: 0.36, 95% confidence interval: 0.15 to 0.89). CONCLUSIONS Among diabetic patients undergoing implantation of nitinol self-expanding stents in the superficial femoral artery, post-dilation with cryoplasty balloon reduced binary restenosis compared to conventional balloon angioplasty. (Study Comparing Two Methods of Expanding Stents Placed in Legs of Diabetics With Peripheral Vascular Disease [COBRA]; NCT00827853).
Collapse
Affiliation(s)
- Subhash Banerjee
- University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
OBJECTIVES Our goal was to describe a single-center's experience in managing acute and chronic mesenteric ischemia with endovascular therapies. BACKGROUND Open surgical revascularization has been considered the historical gold standard treatment for mesenteric ischemia though it poses considerable morbidity and mortality risk. An aging population with increased comorbidities makes endovascular treatment a more attractive treatment option. METHODS Consecutive subjects receiving percutaneous mesenteric interventions for acute and chronic mesenteric ischemia from 2004 to 2010 were identified retrospectively. Information on comorbidities, symptoms, screening tests, procedural outcomes, and follow up was obtained. RESULTS Thirty-one patients received percutaneous mesenteric interventions during this period. The mean age of the population was 65.0 years with roughly equal proportions of males (48.4%) and females (51.6%). Traditional cardiovascular risk factors were highly prevalent (hypertension 45.2%, diabetes 25.8%, dyslipidemia 38.7%, nicotine use 45.2%). Procedural success was 93.5%; no periprocedural complications were reported. During a mean follow up of 13 months, 16.1% required repeat revascularization and 22.6% died. Endovascular treatment of acute mesenteric ischemia was successful (n = 8) and no patient required open surgical revascularization acutely or during follow-up. CONCLUSIONS Endovascular treatment of mesenteric ischemia is a safe and effective therapy with acceptable long-term results. Our experience with acute mesenteric ischemia suggests that percutaneous treatment may be an effective alternative to surgical revascularization in appropriately selected patients.
Collapse
Affiliation(s)
- Beau M Hawkins
- Department of Internal Medicine, Section of Cardiovascular Disease, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA.
| | | | | | | | | | | |
Collapse
|
14
|
Dib C, Hanna EB, Chaudhry MA, Hennebry TA, Stavrakis S, Abu-Fadel MS. Culprit-vessel percutaneous coronary intervention followed by contralateral angiography versus complete angiography in patients with ST-elevation myocardial infarction. Tex Heart Inst J 2012; 39:359-364. [PMID: 22719144 PMCID: PMC3368457] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In patients with ST-elevation myocardial infarction, delay in door-to-balloon time strongly increases mortality rates. To our knowledge, no randomized studies to date have focused on reducing delays within the catheterization laboratory.We performed a retrospective analysis of all patients who presented with ST-elevation myocardial infarction at our institution from July 2006 through June 2010, looking primarily at time differences between percutaneous coronary intervention in the culprit vessel on the basis of ECG criteria, followed by contralateral angiography (Group 1), versus complete coronary angiography followed by culprit-vessel percutaneous intervention (Group 2).There were 49 patients in Group 1 and 57 patients in Group 2. No major differences in baseline characteristics were observed between the groups, except a higher prevalence of diabetes mellitus in Group 2. There was a statistically significant difference between Groups 1 and 2 in door-to-balloon time (median and interquartile range, 75 min [61-89] vs 87 min [70-115], P=0.03, respectively) and access-to-balloon time (12 min [9-18] vs 21 min [11-33], P=0.0006, respectively). Five Group 1 patients (10%) with inferior myocardial infarction had a contralateral culprit vessel. There were no differences in mortality rate or ejection fraction at the median 1-year follow-up. Four patients in Group 1 and 3 patients in Group 2 were referred for coronary artery bypass grafting after percutaneous intervention.This study suggests that performing culprit-vessel percutaneous intervention on the basis of electrocardiographic criteria, followed by angiography in patients with anterior ST-elevation myocardial infarction, might be the preferred approach, given the door-to-balloon time that is saved.
Collapse
Affiliation(s)
- Chadi Dib
- Department of Internal Medicine, Section of Cardiovascular Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | | | | | | | | | | |
Collapse
|
15
|
Golwala H, Hawkins BM, Stavrakis S, Abu-Fadel MS. Embolic protection device use and outcomes in patients receiving saphenous vein graft interventions--a single-center experience. J Invasive Cardiol 2012; 24:1-3. [PMID: 22210580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Percutaneous treatment of saphenous vein graft disease is hampered by high rates of periprocedural myocardial infarction (MI). The use of embolic protection devices (EPD) during these interventions is a class IB recommendation when technically feasible, yet they are used routinely in less than half of all cases. Our aim was to explore whether or not the under-utilization of EPDs led to any untoward cardiovascular events. METHODS Consecutive vein graft interventions from 2003-2008 were identified and stratified by EPD use. Information pertaining to demographics, comorbidities, medication use, and procedural details was collected. Primary endpoint was to compare the incidence of periprocedural MI, defined as any creatinine kinase-MB fraction elevation greater than 3 times the upper limit of normal between patients who underwent percutaneous coronary intervention (PCI) for saphenous vein grafts (SVG) with EPD versus patients who underwent PCI for SVG without EPD. Secondary endpoints included comparison of the incidence of recurrent ischemia, MI, revascularization (PCI or coronary artery bypass graft [CABG]), and mortality in the above 2 groups by the end of 1 year. RESULTS A total of 164 consecutive vein graft interventions were identified. EPDs were used in 71 cases (43.4%). The EPD group was further out since their CABG and had a higher prevalence of hypertension and diabetes. Periprocedural MI occurred in 22 cases; 12 in the non-EPD group and 10 in the EPD group (14.1 vs. 12.9%; P=.82). The composite endpoint of death, MI, or target vessel revascularization at 12 months was significantly lower when EPDs were used (11.3 vs. 25.8%; P=.03). On multivariate analysis, chronic kidney disease increased the risk of periprocedural MI (odds ratio [OR], 5.36; 95% confidence interval [CI], 1.90-15.13; P=.002), whereas the use of beta-blockers was protective (OR, 0.22; 95% CI, 0.07-0.70; P=.011). CONCLUSIONS EPD use during vein graft interventions did not improve periprocedural MI rates. However, the composite endpoint of adverse cardiovascular outcomes at 1 year was significantly reduced. EPDs are used in a minority of vein graft interventions. Efforts aimed at improving adherence to EPD use may improve long-term outcomes, though this hypothesis should be tested using prospective, randomized studies.
Collapse
Affiliation(s)
- Harsh Golwala
- Department of Internal Medicine, 920 Stanton L. Young Boulevard, WP 3010, Oklahoma City, OK 73104, USA
| | | | | | | |
Collapse
|
16
|
Patel JH, Pappy RM, Abu-Fadel MS. Use of a novel adjunctive kissing-balloon technique with the Trellis device to successfully prevent embolization across juxtaposed kissing aortoiliac stents. J Invasive Cardiol 2012; 24:32-35. [PMID: 22210587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Trellis thrombectomy system (Covidien) has been used successfully to perform isolated pharmacomechanical thrombectomy of both venous and arterial thrombi. The device is designed to provide localized treatment while preventing both systemic spread of the thrombolytic agent and also distal embolization. However, when this device is utilized to remove thrombi at bifurcation lesions, embolization into the contralateral vessel can potentially occur. We describe a novel and simple technique of adjunctive kissing balloon inflation while using the Trellis device for the management of an aortoiliac occlusion that occurred in one of two juxtaposed stents previously placed in the distal aorta into the bilateral iliac arteries. This technique prevented distal embolization into the contralateral iliac artery.
Collapse
Affiliation(s)
- Jigar H Patel
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | |
Collapse
|
17
|
Pappy R, Abu-Fadel MS. Additional data supporting the use of statins to prevent contrast induced nephropathy. Int J Cardiol 2011; 152:265-6. [DOI: 10.1016/j.ijcard.2011.07.101] [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] [Received: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 11/27/2022]
|
18
|
Pappy R, Stavrakis S, Hennebry TA, Abu-Fadel MS. Effect of statin therapy on contrast-induced nephropathy after coronary angiography: A meta-analysis. Int J Cardiol 2011; 151:348-53. [DOI: 10.1016/j.ijcard.2011.05.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
|
19
|
Pappy R, Hennebry TA, Abu-Fadel MS. Retrograde access via the popliteal artery to facilitate the re-entry technique for recalcitrant superficial femoral artery chronic total occlusions. Catheter Cardiovasc Interv 2011; 78:625-31. [PMID: 21648050 DOI: 10.1002/ccd.23039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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] [Received: 10/30/2010] [Accepted: 01/31/2011] [Indexed: 11/09/2022]
Abstract
Subintimal recanalization is beneficial in selected patients with peripheral chronic total occlusions (CTO). However, in complex cases, re-entry into the true arterial lumen may prove to be unsuccessful with a conventional guidewire or a re-entry catheter when using standard femoral artery access. Our case series describes these technical dilemmas along with strategies that can be utilized to overcome these challenges.
Collapse
Affiliation(s)
- Reji Pappy
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | |
Collapse
|
20
|
Hawkins BM, Golwala HB, Stavrakis S, Abu-Fadel MS. EMBOLIC PROTECTION DEVICE USE AND OUTCOMES IN SUBJECTS RECEIVING SAPHENOUS VEIN GRAFT INTERVENTIONS. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61054-1] [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: 10/18/2022]
|
21
|
Pappy R, Wayangankar S, Kalapura T, Abu-Fadel MS. Rapidly evolving coronary aneurysm in a patient with rheumatoid arthritis. Cardiol Res Pract 2011; 2011:659439. [PMID: 21403892 PMCID: PMC3043288 DOI: 10.4061/2011/659439] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 12/31/2010] [Accepted: 01/11/2011] [Indexed: 11/24/2022] Open
Abstract
Coronary artery aneurysm (CAA) formation in the setting of an acute inflammatory state due to connective tissue disease is rare. We report a case of rapid progression from an ectatic to an aneursymatic left circumflex coronary artery leading to an acute coronary event in a patient with rheumatoid arthritis (RA). We report the accelerated growth of the aneurysm as it was temporally related to the lapse in treatment and the management strategies involved with this entity.
Collapse
Affiliation(s)
- Reji Pappy
- Section of Cardiovascular Medicine, Department of Medicine, University of Oklahoma Health Sciences Center, 920 S. L. Young Boulevard., WP 3010 Oklahoma City, OK 73104, USA
| | | | | | | |
Collapse
|
22
|
Abstract
Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for ST-elevation myocardial infarction (MI), but most patients do not arrive at a PCI facility within the recommended 90 minutes of first medical contact. If delay is expected, timely thrombolysis is recommended, followed by early transfer for PCI. The authors review the rationale behind three combined reperfusion strategies-facilitated PCI, pharmacoinvasive therapy, and rescue PCI-and data on their effectiveness.
Collapse
Affiliation(s)
- Elias B Hanna
- Department of Medicine, Cardiovascular Section, Louisiana State University, New Orleans, LA 70112, USA.
| | | | | |
Collapse
|
23
|
Seto AH, Abu-Fadel MS, Sparling JM, Zacharias SJ, Daly TS, Harrison AT, Suh WM, Vera JA, Aston CE, Winters RJ, Patel PM, Hennebry TA, Kern MJ. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). JACC Cardiovasc Interv 2010; 3:751-8. [PMID: 20650437 DOI: 10.1016/j.jcin.2010.04.015] [Citation(s) in RCA: 296] [Impact Index Per Article: 21.1] [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] [Received: 02/03/2010] [Revised: 03/17/2010] [Accepted: 04/07/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to compare the procedural and clinical outcomes of femoral arterial access with ultrasound (US) guidance with standard fluoroscopic guidance. BACKGROUND Real-time US guidance reduces time to access, number of attempts, and complications in central venous access but has not been adequately assessed in femoral artery cannulation. METHODS Patients (n = 1,004) undergoing retrograde femoral arterial access were randomized 1:1 to either fluoroscopic or US guidance. The primary end point was successful common femoral artery (CFA) cannulation by femoral angiography. Secondary end points included time to sheath insertion, number of forward needle advancements, first pass success, accidental venipunctures, and vascular access complications at 30 days. RESULTS Compared with fluoroscopic guidance, US guidance produced no difference in CFA cannulation rates (86.4% vs. 83.3%, p = 0.17), except in the subgroup of patients with CFA bifurcations occurring over the femoral head (82.6% vs. 69.8%, p < 0.01). US guidance resulted in an improved first-pass success rate (83% vs. 46%, p < 0.0001), reduced number of attempts (1.3 vs. 3.0, p < 0.0001), reduced risk of venipuncture (2.4% vs. 15.8%, p < 0.0001), and reduced median time to access (136 s vs. 148 s, p = 0.003). Vascular complications occurred in 7 of 503 and 17 of 501 in the US and fluoroscopy groups, respectively (1.4% vs. 3.4% p = 0.04). CONCLUSIONS In this multicenter randomized controlled trial, routine real-time US guidance improved CFA cannulation only in patients with high CFA bifurcations but reduced the number of attempts, time to access, risk of venipunctures, and vascular complications in femoral arterial access. (Femoral Arterial Access With Ultrasound Trial [FAUST]; NCT00667381).
Collapse
Affiliation(s)
- Arnold H Seto
- Department of Medicine, Division of Cardiology, University of California, Irvine Medical Center, Orange, California 92868, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Pappy R, Gautam A, Abu-Fadel MS. AngioSculpt PTCA Balloon Catheter entrapment and detachment managed with stent jailing. J Invasive Cardiol 2010; 22:E208-E210. [PMID: 20944201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The AngioSculpt PTCA Scoring Balloon Catheter is an FDA-approved device for plaque modulation. We describe the first case of AngioSculpt EX catheter entrapment and detachment in the right coronary artery during PCI that was successfully managed with stent jailing of the entrapped balloon catheter and its shaft against the vessel wall.
Collapse
Affiliation(s)
- Reji Pappy
- University of Oklahoma Health Sciences Center, and Veteran Affairs Medical Center, Cardiovascular Section, Oklahoma City, Oklahoma, USA
| | | | | |
Collapse
|
25
|
Hanna EB, Abu-Fadel MS. Management of severe bilateral carotid artery stenosis concomitant to severely symptomatic coronary arterial disease requiring coronary artery bypass grafting: a case-based review. J Invasive Cardiol 2010; 22:E192-E196. [PMID: 20944197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Patients with significant carotid disease have an increased risk of stroke during coronary artery bypass grafting (CABG). However, due to its inherent risk and to the variety of mechanisms responsible for postoperative stroke, prophylactic carotid endarterectomy has an uncertain value, particularly in cases of asymptomatic unilateral carotid disease. In addition, the timing and sequence of coronary and carotid surgeries are controversial matters. Prophylactic carotid artery stenting is emerging as a potentially safer strategy. The major limitation of carotid stenting is the need for one month of dual antiplatelet therapy and the potential need to postpone CABG, which is not possible in patients with refractory unstable coronary syndromes. We describe the case of a patient with severe unstable coronary artery disease and bilateral carotid artery disease who was successfully managed with stenting of the most critical coronary lesion, staged bilateral carotid stenting, followed by CABG three weeks later.
Collapse
Affiliation(s)
- Elias B Hanna
- Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, 920 S.L. Young Boulevard, WP No. 3010, Oklahoma City, OK 73104, USA.
| | | |
Collapse
|
26
|
Abstract
Thrombo-reduction in the setting of deep vein thrombosis (DVT) to prevent the postthrombotic syndrome has not been traditionally managed by interventional cardiologists. We report a case series of successful chronic DVT management with pharmacomechanical thrombectomy utilizing the Trellis device.
Collapse
Affiliation(s)
- Reji Pappy
- University of Oklahoma Health Sciences Center, Department of Medicine, Section of Cardiovascular Medicine, Oklahoma City, Oklahoma, USA.
| | | | | | | |
Collapse
|
27
|
Te CC, Bauer CE, Abu-Fadel MS, Peyton M, Sivaram CA. Prolonged postsurgical survival without a pulmonic valve: case report and review of the literature. Clin Cardiol 2010; 33:E1-5. [PMID: 20552586 DOI: 10.1002/clc.20699] [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: 11/10/2022] Open
Abstract
Pulmonic valve stenosis is usually congenital and causes right-sided heart failure secondary to pressure overload. We report the case of a 56-year-old male with congenital pulmonary valve stenosis who presented with severe right heart failure 32 years after pulmonary valvectomy. He subsequently underwent pulmonary valve replacement and did well. Pulmonary valvectomy is an uncommon treatment for pulmonary stenosis and this is the longest documented survival of a patient without a pulmonic valve.
Collapse
Affiliation(s)
- Charles C Te
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA.
| | | | | | | | | |
Collapse
|
28
|
Abu-Fadel MS, Sparling JM, Zacharias SJ, Aston CE, Saucedo JF, Schechter E, Hennebry TA. Fluoroscopy vs. Traditional guided femoral arterial access and the use of closure devices: A randomized controlled trial. Catheter Cardiovasc Interv 2009; 74:533-9. [DOI: 10.1002/ccd.22174] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
29
|
Latif F, Abu-Fadel MS, Hennebry TA. Stenting led to more stroke or death than did carotid endarterectomy in symptomatic carotid stenosis > 60%. ACP J Club 2007; 147:A11. [PMID: 17764119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
30
|
Ayers NP, Zacharias SJ, Abu-Fadel MS, Hennebry TA. Successful use of blunt microdissection catheter in a chronic total occlusion of a celiomesenteric artery. Catheter Cardiovasc Interv 2007; 69:546-9. [PMID: 17192962 DOI: 10.1002/ccd.20954] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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] [Indexed: 11/06/2022]
Abstract
Chronic mesenteric ischemia is often a disabling condition associated with intestinal angina, weight loss, and sitophobia (a morbid aversion of food). Significant stenosis of two of the three main arteries of the gut is usually required to produce symptoms. Surgical therapy has included reimplantation and bypass grafting, usually with synthetic conduits and occasionally endarterectomy. Newer techniques have made endovascular treatment an emerging modality in managing some of the difficult lesions in the mesenteric circulation that cause chronic mesenteric ischemia. We describe the first reported case of blunt microdissection using a Frontrunner XP(R) CTO Catheter (Lumend, Redwood City, CA) to successfully cross, subsequently wire and stent a four-year-old chronic total occlusions in a celiac trunk, which also gave origin to the superior mesenteric artery.
Collapse
Affiliation(s)
- N P Ayers
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA
| | | | | | | |
Collapse
|
31
|
Abu-Fadel MS, Hennebry T. To close or not to close? A common question after cardiac catheterization. Catheter Cardiovasc Interv 2006; 67:650; author reply 650-1. [PMID: 16534814 DOI: 10.1002/ccd.20655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
32
|
Abu-Fadel MS, Hawkins B, Lozano P, Sivaram CA. MID-CAVITY OBSTRUCTION WITH APICAL LEFT VENTRICULAR ANEURYSM: AN UNCOMMON FORM OF HYPERTROPHIC CARDIOMYOPATHY. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.415s] [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: 11/01/2022] Open
|
33
|
Abu-Fadel MS, Gibbson MF, Michel LB, Peyton MD, Sivaram CA. Right Sided Hemothorax: An Uncommon Manifestation of Type B Aortic Dissection (Descending Aortic Dissection). Chest 2004. [DOI: 10.1378/chest.126.4_meetingabstracts.958s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|