Clinical, angiographic, and procedural predictors of periprocedural complications during chronic total occlusion percutaneous coronary intervention.

Objectives: To identify clinical, angiographic, and procedural factors associated with increased risk of periprocedural complications during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Background: Successful CTO PCI can provide significant clinical benefit; however, procedural risks have received limited study. We sought to identify factors associated with increased CTO PCI periprocedural risk that could be utilized to guide patient and lesion selection.

Significance of an abnormal ankle-brachial index in patients with established coronary artery disease with and without associated diabetes mellitus.

An abnormal ankle-brachial index (ABI) is associated with higher risk for future cardiovascular (CV) events; however, it is unknown whether this association is true in patients with established coronary artery disease (CAD) and associated diabetes mellitus (DM). We evaluated 679 patients with stable CAD enrolled in the Excellence in Peripheral Arterial Disease and Veterans Affairs North Texas Healthcare System peripheral arterial disease databases. ABI and 12-month major adverse CV events (MACEs, a composite of all-cause death, nonfatal myocardial infarction, need for repeat coronary revascularization, and ischemic stroke) were assessed.

The efficacy of "hybrid" percutaneous coronary intervention in chronic total occlusions caused by in-stent restenosis: insights from a US multicenter registry.

Objectives: To examine the success and complication rates in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) caused by in-stent restenosis (ISR).

Background: PCI for in-stent total occlusive disease has traditionally been associated with low success rates. We sought to examine angiographic and procedural outcomes of patients who underwent CTO PCI due to ISR using the novel "hybrid" algorithm, and compare them with patients with de novo CTOs.

Pro-inflammatory interleukin-1 genotypes potentiate the risk of coronary artery disease and cardiovascular events mediated by oxidized phospholipids and lipoprotein(a).

Objectives: The aim of this study was to assess the influence of pro-inflammatory interleukin (IL)-1 genotype status on the risk for coronary artery disease (CAD), defined as >50% diameter stenosis, and cardiovascular events mediated by oxidized phospholipids (OxPLs) and lipoprotein (Lp) (a).

Background: OxPLs are pro-inflammatory, circulate on Lp(a), and mediate CAD. Genetic variations in the IL-1 region are associated with increased inflammatory mediators.

LDL cholesterol: should guidelines include targets?

Elevated low-density lipoprotein cholesterol (LDL-C) is associated with adverse cardiovascular outcomes. The strategy of target-based LDL-C lowering to reduce the risk of coronary heart disease and secondary event rates is now well established. However, the strategy for treating to a target LDL-C, and whether there is a lower threshold level for LDL-C continues to be debated.

Blunt microdissection for endovascular treatment of infrainguinal chronic total occlusions.

Purpose: To present a systematic safety evaluation of the CrossBoss blunt microdissection catheter for crossing peripheral chronic total occlusions (CTOs).

Methods: Between July 2010 and July 2011, 15 patients (all men; mean age 60.7±9.

Midterm outcomes of arthroscopic remplissage for the management of recurrent anterior shoulder instability.

Purpose: The purpose of the study was to present midterm results concerning the management of recurrent anterior shoulder instability with the remplissage technique in addition to the classic Bankart repair, in patients with engaging Hill-Sachs lesions.

Methods: During a time period of 4 years (January 2007-December 2010), 48 patients with an average age of 28.9 ± 7.

Giant intra-articular synovial osteochondromata of the knee.

Background/aim: Synovial chondromatosis associated, intra-articular loose bodies are usually small in size. Giant intra-articular loose bodies are rare.

Case Report: We present the case of a patient with synovial chondromatosis associated giant intra-articular loose bodies located under the patella and the intercondylar fossa, treated successfully with combined arthroscopic and open excision.

Application of the "hybrid approach" to chronic total occlusion interventions: a detailed procedural analysis.

Objective: To assess the outcomes of the "hybrid" approach to chronic total occlusion (CTO) percutaneous coronary interventions (PCIs).

Background: The "hybrid approach" to CTO PCI advocates appropriate and early change of crossing strategy to maximize success, safety, and efficiency.

Methods: We prospectively recorded and analyzed detailed step-by-step procedural data in 73 consecutive CTO PCI cases performed by a single operator between July 2011 and August 2012.

Impact of contrast agent viscosity on coronary balloon deflation times: bench testing results.

Objectives: To assess the impact of viscosity on angioplasty balloon deflation times.

Background: Lower contrast viscosity could result in more rapid coronary balloon deflation times.

Methods: We performed a bench comparison of coronary balloon deflation times using 2 contrast agents with different viscosity (ioxaglate and iodixanol), 3 contrast dilutions, and 2 inflation syringe filling volumes.

Temporal trends of fluoroscopy time and contrast utilization in coronary chronic total occlusion revascularization: insights from a multicenter United States registry.

Background: The impact of operator experience on fluoroscopy time and contrast utilization during percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) has received limited study.

Methods: We evaluated temporal trends in fluoroscopy time and contrast utilization among 1,363 consecutive CTO PCIs performed at three US institutions between January 2006 and November 2011.

Results: Mean age was 65 ± 11 years, 85% of patients were men, 40% had diabetes, 37% had prior coronary artery bypass graft surgery, and 42% had prior PCI.

Conversations in cardiology: bridging antiplatelet therapy before surgery.

Bridging for antiplatelet therapy remains a subject of debate with data favoring GP blockers but at a risk of bleeding. This Conversation in Cardiology addresses a key and often asked question about use of alternatives to P2Y12 agents in patients requiring surgery within 6 months after drug eluting stent implantation.

Periprocedural myocardial injury in chronic total occlusion percutaneous interventions: a systematic cardiac biomarker evaluation study.

Objectives: This study sought to evaluate the incidence, correlates, and clinical implications of periprocedural myocardial injury (PMI) during percutaneous coronary intervention (PCI) of chronic total occlusions (CTO).

Background: The risk of PMI during CTO PCI may be underestimated because systematic cardiac biomarker measurement was not performed in published studies.

Methods: We retrospectively examined PMI among 325 consecutive CTO PCI performed at our institution between 2005 and 2012.

Frequency and outcomes of aortocoronary dissection during percutaneous coronary intervention of chronic total occlusions: a case series and systematic review of the literature.

Background: Aortocoronary dissection can complicate percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs).

Methods: We retrospectively examined the frequency and outcomes of aortocoronary dissection among 336 consecutive CTO PCIs performed at our institution between 2005 and 2012 and performed a systematic review of the published literature.

Results: Aortocoronary dissection occurred in six patients (1.

Magnetic navigation facilitates percutaneous coronary intervention for complex lesions.

Background: We sought to determine the utility of a magnetic navigation system (MNS) in treating a variety of coronary artery lesions including those that could not be revascularized with standard percutaneous coronary intervention (PCI). MNS may add value in the treatment of tortuous arteries and bifurcation lesions; however its widespread adoption has lagged because of cost and a lack of clear advantage over conventional PCI. We performed a retrospective analysis to determine whether MNS improved procedural success for highly complex lesions.

Stent loss and retrieval during percutaneous coronary interventions: a systematic review and meta-analysis.

Objective: We present a systematic review and meta-analysis of the frequency, consequences, and treatment of stent loss during percutaneous coronary intervention (PCI).

Background: Stent loss during PCI has received limited study.

Methods: We conducted a meta-analysis of 18 case series and 45 case reports published between 1991 and 2012 on stent loss during PCI.

Long-term outcomes with use of the CrossBoss and stingray coronary CTO crossing and re-entry devices.

Background: The Boston Scientific CrossBoss and Stingray Coronary CTO Crossing and Re-Entry devices (formerly the BridgePoint Medical System) can improve success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but there are no published data on long-term clinical outcomes.

Methods: The acute and long-term outcomes of 170 consecutive patients who underwent CTO PCI at our institution were reviewed, including 60 patients in whom the CrossBoss and Stingray devices were used and 110 patients treated with other crossing strategies.

Results: Baseline characteristics were similar between the two cohorts.

Prevalence and management of coronary chronic total occlusions in a tertiary Veterans Affairs hospital.

Objectives: We sought to determine the contemporary prevalence and management of coronary chronic total occlusions (CTO) in a veteran population.

Background: The prevalence and management of CTOs in various populations has received limited study.

Methods: We collected clinical and angiographic data in consecutive patients that underwent coronary angiography at our institution between January 2011 and December 2012.

A randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: the RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention).

Objectives: This study sought to compare and contrast use and radiation exposure using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft (CABG) surgery.

Background: Limited information is available on the relative merits of radial compared with femoral access for cardiac catheterization in patients who had previously undergone CABG surgery.

Methods: Consecutive patients (N = 128) having previously undergone CABG surgery and referred for cardiac catheterization were randomized to radial or femoral access.

The role of drug-eluting stents for the treatment of coronary chronic total occlusions.

First generation drug-eluting stents (DES) had a major impact on our capacity to percutaneously treat coronary chronic total occlusions by significantly reducing the risk for in-stent restenosis compared to bare metal stents. Second generation drug-eluting stents further improved our capacity to treat these complex lesions by providing improved deliverability and enhanced efficacy and safety. The ongoing development of bioabsorbable stents will likely be the next major advancement to improve the durability of chronic total occlusion interventions.

Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI).

Numerous definitions have been proposed for the diagnosis of myocardial infarction (MI) after coronary revascularization. The universal definition for MI designates post procedural biomarker thresholds for defining percutaneous coronary intervention (PCI)-related MI (type 4a) and coronary artery bypass grafting (CABG)-related MI (type 5), which are of uncertain prognostic importance. In addition, for both the MI types, cTn is recommended as the biomarker of choice, the prognostic significance of which is less well validated than CK-MB.