Search

Objectives: To provide new strategies and techniques for the successful recanalization of chronic total occlusions (CTOs) with the sole use of the CrossBoss catheter. In addition, some common CTO scenarios are illustrated in detail., Background: CTOs are one of the most challenging complex coronary lesion subsets to intervene upon. Even with the innovation of specialized catheters, the success rate of antegrade recanalization remains low., Methods: Between June and December 2013, a retrospective analysis of 50 consecutive patients who presented with a planned percutaneous intervention (PCI) of a CTO was performed. In all patients, the CrossBoss catheter was used. No additional reentry devices were necessary. Procedural success was defined as <20% residual stenosis and TIMI-3 distal blood flow of the treated vessel at the end of the procedure., Results: The majority of the patients were male (72%), with an average age of 68 years. Thirty percent of patients presented with prior CTO-PCI failure. The average fluoroscopy time was 45.9 minutes and the average amount of contrast use was 273.8 mL. No patient suffered a coronary perforation from the CrossBoss catheter., Conclusions: With increased experience using the CrossBoss catheter, the antegrade success rate of CTOs can be improved. Some tips include identifying the likely course of the artery with the aid of retrograde injection, proper guidewire selection and manipulation, and redirecting the CrossBoss catheter if there is substantial deviation from the original path.

Objectives: To evaluate the use of extension catheters in transradial intervention of complex coronary lesions., Background: Complex percutaneous coronary intervention (PCI) via transradial approach remains a challenge for many interventionalists, primarily due to the difficulty in obtaining adequate guide catheter support., Methods: A retrospective case series identified 54 patients who presented for PCI of complex coronary lesions. A lesion was defined as complex if it contained severe calcification, proximal tortuosity, chronic total occlusion, or was located distal to a previously implanted stent. After identifying the complex lesions, a conversion to femoral approach was considered, but an attempt via the transradial approach with the use of an extension catheter was chosen as the initial strategy. Specific cases highlighting this approach are illustrated in detail., Results: The average age of the patients was 72 years old, with male predominance (55%). The success rate of completing the transradial intervention with the help of an extension catheter was 96%. Stent delivery failed due to severe tortuosity and calcification in only 2 cases. The coronary artery involved was either the left anterior descending (n = 25), the left circumflex (n = 10), the right coronary artery (n = 14), or a saphenous vein graft (n = 5). There were no coronary dissections evident from use of the extension catheter., Conclusion: In the treatment of complex coronary lesions via the transradial approach, the use of an extension catheter may assist in improving successful intervention and decrease the frequency of crossover to a femoral approach.

Objective: We sought to study the clinical outcomes of bifurcation stenting in patients who presented with stent thrombosis segment elevation myocardial infarction (STEMI)., Background: Patients with STEMI are usually excluded from randomized bifurcation studies. There is limited information for bifurcation stenting in this population., Methods: All STEMI patients who were randomized were retrospectively reviewed from DKCRUSH II (double kissing, double crush) database. DKCRUSH II is a multicenter, randomized study of provisional stenting (PS) versus the DK crush stenting techniques. A total of 370 patients with bifurcation lesions were randomized and of this group a total of 63 patients with STEMI were found. This group of STEMI included 30 patients in the PS group and 33 patients in the DK crush stenting group., Results: There were no differences in terms of contrast used, procedure time, and fluoroscopy time. Procedural success rates were 97% in all patients with STEMI, with 100% in the PS group and 94% in the DK crush stenting group. During the procedure, there were two patients with less than TIMI 3 (thrombolysis in myocardial infarction) flow in the main vessel of the DK crush group However, TIMI 3 flow was 100% in the side branch for both groups. Cumulative 12-month major adverse cardiac event (MACE) was 22% in the whole STEMI group, whereas PS and DK crush groups were 23% versus 21%, respectively (P = NS). There were no differences in in-hospital, 6-month, and 12-month MACE in these two groups. At 6 and 12 months, there were two cardiac deaths in the PS group but without statistical significance when compared with the DK crush stenting group (7% vs. 0%, P = NS)., Conclusion: Bifurcation stenting in patients with STEMI is safe and feasible. The immediate and midterm clinical outcomes were comparable between PS and DK crush stenting., (Copyright © 2013 Wiley Periodicals, Inc.)

Objectives: The aim of our study is to assess the feasibility and safety of transradial intervention (TRI) of coronary ostial lesions using the Szabo technique., Background: When performing TRI of coronary ostial lesions, precise stent positioning is of paramount importance. TRI has experienced increasing popularity in the U.S.; however, utilization of the Szabo technique has not been systematically evaluated in this setting. We report the results of ostial stent deployment using the Szabo technique for 2 experienced TRI operators and centers., Methods: This was a retrospective analysis of 40 consecutive patients who underwent PCI from April 2009 to September 2011. All patients who underwent PCI via the transradial route with the Szabo technique for ostial lesions performed by experienced transradial operators (>200 cases/yr) were included., Results: In our study of 40 patients with 41 coronary ostial lesions, overall procedural success rate was 100%. Stent dislodgement was seen in 1 patient. Clinical follow up was 100%, with a mean duration of 292.7±200 days. Target lesion revascularization (TLR) was seen in 2 patients (5%). One patient had an episode of transient ischemic attack (TIA) at 33 days after PCI; another experienced subacute stent thrombosis at 81 days while on dual antiplatelet therapy. MACE was 7.5% overall., Conclusion: In our study, treatment of coronary ostial lesions with the Szabo technique via TRI is associated with a high procedural success rate and a low MACE of 7.5%., (©2012, Wiley Periodicals, Inc.)

Background: The sheathless approach to transradial percutaneous coronary intervention (PCI) has recently gained popularity among interventionalists. However, technical problems and lack of approved equipment in the United States has limited its applicability. We describe a new approach, balloon-assisted sheathless transradial intervention (BASTI) that can ease the use of 5 Fr sheathless guiding catheters and decrease complication rates., Methods: Twenty-seven consecutive patients undergoing staged elective PCI were enrolled. Radial artery access was obtained using the BASTI method - inflation of a compliant coronary balloon at the tip of the guiding catheter was used to ease the transition of the catheter into the skin. The guidewire and coronary balloon were reused during the PCI. Each of the patients had clinical postprocedure follow-up at radial compression device release, and at 1 day, 7 days, and 30 days. Major adverse cardiac events and access-site complications, including radial artery occlusion (RAO), were documented., Results: In this consecutive series, we successfully attempted (27/27) BASTIs. There were no difficulties in obtaining radial artery access with the 5 Fr sheathless guiding catheter. Two patients had balloon rupture during initial radial artery access, but were successfully re-attempted with a higher balloon inflation pressure. All patients then underwent successful coronary intervention. There were no adverse events or procedure-related complications at any time period during follow-up., Conclusion: BASTI is a feasible alternative to conventional techniques and may reduce vascular access-site complications and patient morbidity in a cost-effective manner.

Transradial catheterization (TRC) has been associated with a lower incidence of major access site related complications as compared to the transfemoral approach. With the increased adoption of transradial access, it is essential to understand the potential major and minor complications of TRC. The most common complication is asymptomatic radial artery occlusion, which rarely leads to clinical events, owing to the dual collateral perfusion of the hand. Adequate anticoagulation, appropriate compression techniques, and smaller sheath size can minimize the risk of radial artery occlusion. Hand ischemia with necrosis has never been reported during TRC with thorough pre-examination of intact collateral circulation. Radial artery spasm is relatively common, and can result in access and procedural failure. It can be prevented by the use of vasodilator cocktails and hydrophilic sheaths. Radial artery perforation can lead to severe forearm hematoma and compartment syndrome if not managed promptly. Careful observation, prompt detection of the hematoma, and management with a pressure bandage dressing are critical to avoid serious complications. Pseudoaneurym and arteriovenous fistula are rare complications, which can likely be managed conservatively without surgical intervention. Nerve injury occurring during access has been reported. Close observation for improvement is necessary, although symptoms usually improve over time. In summary, to prevent access site complications, avoidance of multiple punctures, gentle catheter manipulation, use of guided compression, coupled with careful observation for adverse warning signs such as hematoma, loss of pulse, pain, are critical for safe and effective TRC., (Copyright © 2011 Wiley Periodicals, Inc.)

Although the provisional stenting technique to treat coronary bifurcation lesions is the preferred method, many bifurcation lesions still require a two-stent technique to optimize the result and clinical outcome. This manuscript summarizes the tips and tricks of bifurcation stenting with cases illustrations. As interventionists are encountering more complex and difficult cases, one may find the tips and tricks in this manuscript helpful in daily practice.

Strict glycemic control improves outcomes in critically ill patients. We evaluated the hypothesis that strict glycemic control might be similarly beneficial after percutaneous coronary intervention. This study reports the correlation of periprocedural blood glucose with long-term survival in 1,746 patients who underwent percutaneous coronary intervention from 1990 to 2003 in a Department of Veterans Affairs hospital.

We report the use of the Export catheter as an urgent modality to aspirate thrombus that embolized down the left anterior descending artery during acute myocardial infarction.