Journal: Catheter Cardiovasc Interv

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<div><h4>Transcatheter aortic valve replacement-related aortic dissection: A clinical case series.</h4><i>Hiruma T, Higuchi R, Saji M, Takamisawa I, Shimokawa T, Nanasato M</i><br /><b>Objectives</b><br />We review our experience with 13 periprocedural aortic dissection (AD) cases caused by transcatheter aortic valve replacement (TAVR).<br /><b>Background</b><br />AD is a potentially lethal complication of TAVR; however, only sporadic case reports have been published to date.<br /><b>Methods</b><br />Among 1335 consecutive patients who underwent TAVR in 2013-2021, we retrospectively extracted 13 patients (1.0%) with TAVR-related AD (Stanford type A in 6 [46%], type B in 7 [54%]). AD was defined as a new-onset dissected layer of the aortic wall and diagnosed by aortography, computed tomography, or transesophageal echocardiography.<br /><b>Results</b><br />Five of the six type A AD cases (83%) were detected during TAVR versus only one of the seven type B AD cases (14%). Four of the seven type B AD cases (57%) were asymptomatic and incidentally detected on computed tomography. The presumed causes of AD were injury by the delivery sheath (39%), delivery catheter (23%), valve implantation (15%), stent edge (15%), and pre-dilation balloon (8%). Complicated AD occurred in only one patient (8%). Considering the patient\'s age and prohibitive surgical risk, all patients were treated conservatively and free of any aortic-related deaths or interventions during a follow-up of 1087 days.<br /><b>Conclusions</b><br />TAVR-related AD is a rare but life-threatening condition that may be underdiagnosed. Its optimal therapy remains unclear, and conservative management might be an option for selected patients. Further studies are needed to elucidate the incidence, risk factors, effective screening, optimal therapy, and outcomes of TAVR-related AD.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 26 Jan 2023; epub ahead of print</small></div>
Hiruma T, Higuchi R, Saji M, Takamisawa I, Shimokawa T, Nanasato M
Catheter Cardiovasc Interv: 26 Jan 2023; epub ahead of print | PMID: 36701398
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Abstract
<div><h4>Single vs. multiple operators for chronic total occlusion percutaneous coronary interventions: From the PROGRESS-CTO Registry.</h4><i>Karacsonyi J, Alaswad K, Krestyaninov O, Karmpaliotis D, ... Brilakis ES, Sandoval Y</i><br /><b>Background</b><br />There is limited data on the impact of a second attending operator on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes.<br /><b>Methods</b><br />We analyzed the association between multiple operators (MOs) (>1 attending operator) and procedural outcomes of 9296 CTO PCIs performed between 2012 and 2021 at 37 centers.<br /><b>Results</b><br />CTO PCI was performed by a single operator (SO) in 85% of the cases and by MOs in 15%. Mean patient age was 64.4 ± 10 years and 81% were men. SO cases were more complex with higher Japan-CTO (2.38 ± 1.29 vs. 2.28 ± 1.20, p = 0.005) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention scores (1.13 ± 1.01 vs. 0.97 ± 0.93, p < 0.001) compared with MO cases. Procedural time (131 [87, 181] vs. 112 [72, 167] min, p < 0.001), fluoroscopy time (49 [31, 76] vs. 42 [25, 68] min, p < 0.001), air kerma radiation dose (2.32 vs. 2.10, p < 0.001), and contrast volume (230 vs. 210, p < 0.001) were higher in MO cases. Cases performed by MOs and SO had similar technical (86% vs. 86%, p = 0.9) and procedural success rates (84% vs. 85%, p = 0.7), as well as major adverse complication event rates (MACE 2.17% vs. 2.42%, p = 0.6). On multivariable analyses, MOs were not associated with higher technical success or lower MACE rates.<br /><b>Conclusion</b><br />In a contemporary, multicenter registry, 15% of CTO PCI cases were performed by multiple operators. Despite being more complex, SO cases had lower procedural and fluoroscopy times, and similar technical and procedural success and risk of complications compared with MO cases.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 25 Jan 2023; epub ahead of print</small></div>
Karacsonyi J, Alaswad K, Krestyaninov O, Karmpaliotis D, ... Brilakis ES, Sandoval Y
Catheter Cardiovasc Interv: 25 Jan 2023; epub ahead of print | PMID: 36695421
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Abstract
<div><h4>Impact of complex percutaneous coronary intervention features on clinical outcomes in patients with or without chronic kidney disease.</h4><i>Chen H, Spirito A, Sartori S, Nicolas J, ... Dangas G, Mehran R</i><br /><b>Background</b><br />Patients with chronic kidney disease (CKD) are at higher risk of ischemic and bleeding events after percutaneous coronary intervention (PCI). Complex PCI (CPCI) is associated with higher rates of ischemic complications. Whether CPCI confers an additive risk of adverse events in CKD patients is unclear.<br /><b>Methods</b><br />Patients who underwent PCI at a single tertiary-care-center between 2012 and 2019 were stratified by CKD status and CPCI. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target-vessel revascularization (TVR) at 1-year follow-up. Secondary outcomes included the individual components of the primary outcome and major bleeding.<br /><b>Results</b><br />Out of 15,071 patients, 4537 (30.1%) had CKD and 10,534 (69.9%) had no CKD. Patients undergoing CPCI were 1151 (25.4%) and 2983 (28.3%) in the two cohorts, respectively. At one year, CPCI compared with no CPCI was associated with higher risk of MACE in both CKD (Adj. HR 1.72, 95% confidence interval [CI] 1.45-2.06, p < 0.001) and no-CKD patients (Adj. hazard ratios [HR] 2.19, 95% CI 1.91-2.51, p < 0.001; p of interaction 0.057), determined by an excess of death, MI and TVR in CKD patients and of TVR and MI only in no-CKD. CPCI was related with a consistent increase of major bleeding in the CKD (Adj. HR 1.49, 95% CI 1.18-1.87, p < 0.001) and no-CKD group (Adj. HR 1.23, 95% CI 0.98-1.54, p = 0.071, p of interaction 0.206).<br /><b>Conclusion</b><br />At 1-year follow-up, CPCI was associated with higher risk of MACE and major bleeding irrespective of concomitant CKD. CPCI predicted mortality in CKD patients only.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 24 Jan 2023; epub ahead of print</small></div>
Chen H, Spirito A, Sartori S, Nicolas J, ... Dangas G, Mehran R
Catheter Cardiovasc Interv: 24 Jan 2023; epub ahead of print | PMID: 36691863
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<div><h4>Novel dual guiding catheter technique for kissing balloon inflation in percutaneous coronary intervention for bifurcated chronic total occlusive lesion.</h4><i>Kawamura Y, Yoshimachi F, Kasai S, Ikari Y</i><br /><AbstractText>Traditionally, two bigger-sized guiding catheters (GCs) via the femoral artery have been used in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). However, those GCs are associated with an increased incidence of bleeding. Therefore, the use of smaller GCs (e.g., 5-Fr) may lessen the invasiveness of this procedure. However, the use of 5-Fr GCs in PCI is complicated by device limitations. A novel technique was developed to overcome the challenges with regard to kissing balloon inflation. This approach involves simultaneous balloon inflation through a dual 5-Fr GC technique for CTO-PCI. In our hospital, this technique was successfully performed in 9 cases of CTO with 10 bifurcated lesions (including four left main-related bifurcations). During the study period, there was no requirement for an additional invasive procedure or occurrence of complications related to the PCI procedure. This technique may be a good option for performing KBI during CTO-PCI through the use of two 5-Fr GCs.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 24 Jan 2023; epub ahead of print</small></div>
Kawamura Y, Yoshimachi F, Kasai S, Ikari Y
Catheter Cardiovasc Interv: 24 Jan 2023; epub ahead of print | PMID: 36691868
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<div><h4>Percutaneous treatment of multiple fistulas associated with a giant aneurysm.</h4><i>Vera-Vera S, Jurado-Roman A, Moreno R, Galeote G</i><br /><AbstractText>Coronary fistulas are not common in patients undergo coronary angiography. It is described, even less frequently, that coronary fistulas may be associated with giant aneurysms along their course. These cases classically are treated surgically. We present a case treated fully percutaneously in a novel fashion.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 24 Jan 2023; epub ahead of print</small></div>
Vera-Vera S, Jurado-Roman A, Moreno R, Galeote G
Catheter Cardiovasc Interv: 24 Jan 2023; epub ahead of print | PMID: 36691874
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