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Background: We examined the effect of atrial fibrillation on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We examined the baseline characteristics and procedural outcomes of 9,166 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023., Results: Atrial fibrillation was present in 1122 (12%) patients. These patients were older and had a higher incidence of comorbidities, such as hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease, lower left ventricular ejection fraction, and lower eGFR. Their CTOs were more likely to have moderate to severe calcification and longer lesion length. They also had higher mean J-CTO and PROGRESS-CTO complications (Acute MI, MACE, Mortality, Perforation, and Pericardiocentesis) scores. Patients with atrial fibrillation had higher prevalence of uncrossable and undilatable CTO lesions and required longer procedure (107 vs 119 min; P less than .001) and fluoroscopy (40 vs 43 min; P=.005) time. Technical success and MACE, including procedural/in-hospital bleeding, were similar in patients with and without atrial fibrillation. Although the crude incidence of MACE on follow-up (median 61 days) was significantly higher in patients with atrial fibrillation, the latter was not independently associated with adverse events on Cox proportional hazards analysis., Conclusions: Patients with atrial fibrillation undergoing CTO PCI are older, have more comorbidities, higher lesion complexity, and longer procedure time, but similar technical success and in-hospital MACE. They have higher MACE and mortality during follow-up, but the difference is not significant after adjusting for potential confounding variables.

Percutaneous pseudoaneurysm repair through the ipsilateral ulnar artery is an alternative to surgical repair; however, distal radial access, as described in this case, may offer increased safety.

Based on the patient's symptoms and examination, a decision was made to recanalize his totally occluded RCA via retrograde approach through the SVG to the OM. Due to inadequate visualization of the epicardial collaterals and distal RCA via SVG, triple-access was used and injection via left main. In selected CTO cases, triple access may facilitate the retrograde approach, allowing optimal collateral visualization.

We present a patient under triple-antithrombotic therapy who underwent prolonged mechanical compression after radial intervention; the subsequent necrosis at the access site required surgical repair.

To our knowledge, this is the first reported case of a dual injection using a single sheath approach, in order to evaluate a CTO and plan a future intervention.

Dissection re-entry is a widely used technique in many chronic total occlusion centers. This account of a failed re-entry attempt provides in vivo photographic evidence of how the vessel looked after such an attempt. Operators are advised to keep dissection of subintimal space and hematoma limited and use dedicated materials and techniques for controlled re-entry.

To our knowledge, this is the first reported case of a dual-access approach for CTO intervention using transradial and ipsilateral transulnar access. Although retrograde CTO intervention is a challenging procedure, a single arm-double access approach seems to be a feasible alternative that may be useful in patients with limited access-site availability.

This is the first reported case of severe hand hematoma after cardiac catheterization through the distal radial artery, with the hematoma extending distally to the sheath insertion site. The distribution of the hematoma in our case is completely different compared to the hematomas observed after traditional radial catheterization, which used to extend to the forearm. Therefore, the traditional EASY classification may not apply to hematomas after catheterization through the distal radial artery.

The compartment syndrome is a severe complication of transradial approach and can be prevented by prompt treatment of forearm hematoma; otherwise, fasciotomies are urgent.

Background: End-stage renal disease (ESRD) is considered a relative contraindication for forearm (radial or ulnar) cardiac catheterization. However, in everyday practice, many ESRD patients are catheterized from the forearm. The aim of this study was to compare femoral and forearm approach for cardiac catheterization in ESRD patients., Methods: All cardiac catheterization procedures performed in ESRD patients in three Greek hospitals in a 2-year period (2014-2015) were retrospectively evaluated. The primary endpoint of the study was major access-site complication, defined as any Blood Academic Research Consortium class ≥3 bleeding or limb ischemia requiring intervention or prolonging hospitalization., Results: During the study period, a total of 124 procedures were performed in 109 ESRD patients: 44 procedures (35.5%) were performed transfemorally and 80 procedures (64.5%) were performed from the forearm approach (77 transradial [96.3%] and 3 transulnar [3.7%]). Forearm access was always performed from the contralateral arm of a functional hemodialysis access site. Sixty-one procedures (49.6%) were diagnostic coronary artery angiographies (CAAs) and 63 procedures (50.4%) were percutaneous coronary interventions with or without CAA. Two deaths and 1 procedure-related myocardial infarction were recorded during hospitalization. Five patients suffered major access-site complications, all from the femoral group (5/44 vs 0/80; P<.01). Three transradial patients had asymptomatic radial artery occlusion after a diagnostic procedure. Five patients (4.0%) had problems with their hemodialysis access site during long-term follow-up, and required a new access site., Conclusion: Forearm approach for cardiac catheterization is feasible and safe in ESRD patients. All measures to preserve radial patency should be taken in this high-risk patient group, where a possible forearm artery occlusion might have serious consequences.

Bifurcation lesions may be encountered in approximately 15%-20% of percutaneous coronary interventions. A 2-stent approach is required in up to 30% of these procedures. We describe a novel technique based on a modification of TAP stenting, suitable for procedures where a 2-stent strategy is predetermined.

Aims: To evaluate the safety and efficacy of a novel technique with simultaneous compression of the ulnar artery in order to reduce the incidence of radial artery occlusion (RAO) after transradial cardiac catheterizations., Methods and Results: Ipsilateral ulnar artery transient compression for 1 hour facilitating radial artery patent hemostasis (ULTRA) was performed in all patients treated transradially in October 2015 and was compared with patients treated with conventional patent hemostasis in September 2015. The primary endpoint of the study was to evaluate the incidence of RAO within 1 hour after removing the closure device, confirmed by the absence of palpation and the consecutive absence of flow signal with Doppler examination. A total of 119 patients were treated with the ULTRA method and 121 patients with conventional patent hemostasis. None of the patients treated with ULTRA had RAO compared with 6 patients (5%) of those treated with conventional patent hemostasis (P=.01). No hematomas EASY class ≥3, nerve injury, or ischemic pain complications were recorded in either group., Conclusion: The ULTRA technique may reduce the incidence of RAO in patients treated with the radial approach compared with conventional patent hemostasis.