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Craig M Walker,1,2 Frank T Bunch,3 Nick G Cavros,4 Eric J Dippel5 1Cardiovascular Institute of the South, Tulane University School of Medicine, New Orleans, LA, 2Louisiana State University School of Medicine, New Orleans, LA, 3Cardiology Associates, Mobile, AL, 4Cardiovascular Institute of the South, Lafayette General Medical Center, Lafayette, LA, 5Cardiovascular Medicine, PC Genesis Heart Institute, Davenport, IA, USA Abstract: Peripheral arterial disease (PAD) is frequently diagnosed after permanent damage has occurred, resulting in a high rate of morbidity, amputation, and loss of life. Early and ongoing diagnosis and treatment is required for this progressive disease. Lifestyle modifications can prevent or delay disease progression and improve symptoms. Limb-sparing endovascular interventions can restore circulation based on appropriate diagnostic testing to pinpoint vascular targets, and intervention must occur as early as possible to ensure optimal clinical outcomes. An algorithm for the diagnosis and management of PAD was developed to enable a collaborative approach between the family practice and primary care physician or internist and various specialists that may include a diabetologist, endocrinologist, smoking cessation expert, hypertension and lipid specialist, endovascular interventionalist, vascular surgeon, orthopedist, neurologist, nurse practitioner, podiatrist, wound healing expert, and/or others. A multidisciplinary team working together has the greatest chance of providing optimal care for the patient with PAD and ensuring ongoing surveillance of the patient’s overall health, ultimately resulting in better quality of life and increased longevity for patients with PAD. Keywords: peripheral arterial disease, diagnosis, endovascular intervention

Objective: The objective of this study was to assess the effectiveness of mechanical thrombectomy using the Aspire mechanical thrombectomy device (Control Medical) for the treatment of acute myocardial infarction (AMI) as measured by Thrombolysis in Myocardial Infarction (TIMI) flow post procedure compared with baseline., Methods: This is a retrospective study for the treatment of acute myocardial infarction (AMI) in ST-segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) patients. The study was approved by an independent ethical review board. Data were collected retrospectively from 48 subjects at three study sites. The primary endpoint was TIMI flow post thrombectomy compared with baseline. The safety endpoint was 30-day major adverse cardiac event, defined as death, MI, and target-vessel revascularization (TVR). Eligibility criteria included AMI patients ages 18-90 years who had previous treatment with the Aspire mechanical thrombectomy device, preprocedure TIMI flow 0 to 2, and ability to tolerate antiplatelet therapy., Results: Of the 48 subjects, 81.2% were male, 33.3% were diabetics, 64.6% were hypertensive, 52.1% had hyperlipidemia, and 85.4% had STEMI, with 38.0% anterior and 56.0% inferior AMI. Baseline TIMI flow was 0-1 in 89.6% of subjects. Post-thrombectomy TIMI flow 2-3 was achieved in 85.4% and all subjects had TIMI flow 3 at the end of the intervention. The device did not track in 1 patient and was not used. There were 5 deaths (10.4%), all unrelated to the aspiration thrombectomy procedure, and 0% experienced a stroke., Conclusion: The Aspire mechanical thrombectomy device demonstrated initial effectiveness and safety. Further prospective studies using objective performance criteria to demonstrate effectiveness and safety using the Aspire mechanical thrombectomy device are necessary to determine whether short-term and long-term outcomes improve over previously published clinical trials.

Objectives: To evaluate the safety and effectiveness of the Closer Vascular Sealing System (VSS) against prespecified performance goals (PGs) in sealing femoral arterial access following 5-7 Fr procedures., Background: Inconsistent safety profiles, costs and learning curves of earlier generation vascular closure devices have limited their widespread use following transfemoral procedures., Methods: In this prospective single-arm, multi-center trial, we compared the clinical outcomes in patients undergoing 5-7 Fr transfemoral diagnostic or interventional procedures and access sites managed with Closer VSS against pre-specified PGs. The primary endpoints were time to hemostasis (TTH) and 30-day access site closure-related major complications; secondary endpoints included time to ambulation (TTA), time to discharge eligibility (TTDE), time to discharge (TTD), 30-day access site minor complications, procedure and device success., Results: A total of 220 subjects (49.5% interventional) were enrolled. The mean TTH was 1.78 ± 7.81 min in the intention to treat and 0.98 ± 3.71 min in the per protocol cohort. Median TTH was 0 min with immediate hemostasis achieved in 80.5% of subjects, mean TTA was 2.50 ± 1.05 hr, and mean TTDE was 2.83 ± 1.54 hr. Thirty-day follow-up was completed on 219 subjects. There were no access site closure-related major complications, minor complication rate was 0.0% for diagnostic and 2.75% for interventional procedures., Conclusions: In patients undergoing 5-7 Fr transfemoral diagnostic and interventional procedures, the CLOSER Trial met both its primary effectiveness and safety PGs. Immediate hemostasis was achieved in the majority of patients without major complication., (© 2017 Wiley Periodicals, Inc.)

Objectives: This multicenter registry aimed to assess the ClearWay™ (CW) perfusion catheter in reduction of thrombus burden and improvement of the coronary flow during percutaneous coronary intervention (PCI)., Background: The presence or development of thrombus during PCI is associated with poor prognosis., Methods: The utility of the CW perfusion catheter was assessed in patients who presented with intracoronary thrombus and were subjected to PCI. Data were collected by online survey from 15 US sites. Angiographic assessment of the coronary thrombus burden and the coronary flow after intracoronary infusion of glycoprotein (GP) IIb/IIIa inhibitors via the CW catheter was evaluated at baseline, immediately after infusion, and at the end of the procedure. The cohort included 102 patients; 71.6% presented with ST-elevation myocardial infarction (MI), 21.6% with non-ST-elevation MI, 5.9% with stable angina pectoris, and 2.9% with silent ischemia. The mean cohort age was 59.9±14.5years and comprised mostly of men (72.5%)., Results: GP IIb/IIIa inhibitors were infused via the CW catheter on average 1.1±0.3 times, with a mean pressure of 4.2±2.7atm and a mean infusion time of 55±55s. Following the infusion, Thrombolysis In Myocardial Infarction (TIMI) flow improved by 1° in 71 patients (69.6%) and by 2° in 51 patients (50%), while visible thrombus was reduced by 52% (p<0.001). In the final angiogram, TIMI flow was restored in 90.2% and clearance of a visible thrombus was obtained in 91.8% of the lesions., Conclusion: Intracoronary infusion of GP IIb/IIIa inhibitors via the perfusion CW catheter is associated with significant reduction in thrombus burden and with improvement of the coronary flow in patients presenting or developing thrombus burden during PCI., (Copyright © 2013. Published by Elsevier Inc.)

We report our early experience of a new technique of renal angioplasty utilizing the radial approach. Certain anatomic considerations continue to make access from above via the arm the preferable approach in selected patients in renal artery stenosis. We have utilized the transradial technique for renal artery angioplasty and stenting successfully in four patients. The development of coronary guidewire (0.014")-based peripheral balloons and stent delivery systems has miniaturized equipment sufficiently to make the transradial approach attractive. Present equipment allows for stenting of renal arteries of up to 7 mm with the use of 6 Fr guiding catheters. Present equipment length remains a limitation in taller patients. The transradial approach should be considered in those patients with renal artery or aortoiliac anatomy favoring an approach from the arm., (Copyright 2001 Wiley-Liss, Inc.)

Congestive heart failure is a relatively uncommon manifestation of thyrotoxic heart disease, and different mechanisms have been proposed. The authors present a possible explanation of congestive heart failure in some cases of thyrotoxicosis. A 39 year-old woman with Graves' disease was hypermetabolic, in atrial fibrillation, and had signs of congestive heart failure. She had a loud murmur of mitral regurgitation, clinical cardiomegaly, accentuated pulmonic sound, and peripheral edema. Propranolol reduced the heart rate to 60 beats per minute, but the loud mitral regurgitation murmur persisted. Echocardiographic and angiographic data were consistent with moderate to severe mitral regurgitation, serious enough to consider mitral valve replacement. As the patient's hyperthyroid state came under control, weight increased and the cardiac murmur resolved. After radioactive iodine treatment and the return to a eumetabolic state, an echocardiogram revealed only trace mitral regurgitation, with near normal left ventricular function and pulmonary arterial systolic pressures. These findings were confirmed by subsequent cardiac catheterization. The authors believe that mitral regurgitation, perhaps secondary to intrinsic papillary muscle dysfunction from hyperthyroidism, was the major cause of reversible congestive heart failure in this case. Valvular disease may play a more substantive role in thyrotoxic heart disease than previously recognized.