A dual-center analysis of conservative versus liberal glycoprotein IIb-IIIa antagonist strategies in the treatment of ST-elevation myocardial infarction.

While the efficacy of GpIIb-IIIa-inhibitors during primary PCI (pPCI) for ST-elevated myocardial infarction (STEMI) has previously been demonstrated, its ongoing role and safety in combination with newer P2Y12-inhibitors is unclear. We therefore sought to compare outcomes between two centers with divergent approaches to the use of GpIIbIIIa antagonists in pPCI. We performed a retrospective chart review of all-comer STEMI patients treated with pPCI at two high-volume Montreal academic tertiary care centers.

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review.

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.

Inaccuracy of brachial blood pressure and its potential impact on treatment and aortic blood pressure estimation.

Objective: Although brachial cuff SBP is universally used to guide hypertension management, it can differ significantly from intraarterial SBP. We examine the potential impacts of cuff-to-intraarterial brachial SBP (bSBP) mismatch on hypertension treatment and accuracy towards central SBP.

Methods: In 303 individuals, cuff bSBP (CUFF-bSBP) and central SBP were measured using a Mobil-o-Graph simultaneously to intraarterial bSBP (IA-bSBP) and aortic SBP.

A case report of right ventricular compression from a septal haematoma during retrograde coronary intervention to a chronic total occlusion.

Background: Septal haematomas causing left ventricular or biventricular outflow obstruction are rare but known complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can be life-threatening.

Case Summary: In this case, we describe the formation of a septal haematoma during retrograde CTO PCI. The patient was initially managed conservatively but became progressively unstable, for which she underwent coiling of the inflow and outflow of the septal perforator.

Novel Approaches to Define Outcomes in Coronary Revascularization.

Coronary revascularization is done to alleviate the patient symptoms or to improve prognosis. Despite these clinical indications, significant variability exists in the risk assessment tools used to select patients for coronary revascularization, to the extent of revascularization performed and, in our approaches to define "optimal" revascularization. The goal of this review is to evaluate novel approaches that can assess coronary artery disease before and after revascularization, define the thresholds of these approaches that have been shown to improve morbidity and mortality, and highlight future directions for research in this area.

Intravascular ultrasound analysis of intraplaque versus subintimal tracking in percutaneous intervention for coronary chronic total occlusions: One year outcomes.

Objectives: We sought to determine the 1-year outcomes of patients receiving successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures comparing subintimal versus intraplaque wire tracking patterns.

Background: CTO PCI utilizes both intraluminal and subintimal wire tracking to achieve successful percutaneous revascularization. Intravascular ultrasound (IVUS) can be used to precisely determine the path of wire tracking.

Zero contrast retrograde chronic total occlusions percutaneous coronary intervention: a case series.

Introduction: Percutaneous coronary intervention (PCI) in patients with advanced chronic kidney disease (CKD) is associated with a high risk of contrast-induced nephropathy and resulting progression of CKD to need for renal replacement therapy. Chronic total occlusions (CTO) PCI is increasingly utilized in the treatment of refractory stable angina and ischaemic heart failure. Recent studies have described the feasibility of 'minimal' or 'zero' contrast PCI by employing intravascular imaging and intra-coronary physiology to guide successful stent implantation with resolution of ischaemia.

Retrograde CTO-PCI of Native Coronary Arteries Via Left Internal Mammary Artery Grafts: Insights From a Multicenter U.S. Registry.

Background: Retrograde percutaneous coronary intervention (PCI) of native coronary artery chronic total occlusion (CTO) via left internal mammary artery (LIMA) graft has received limited study.

Methods And Results: We compared the clinical and procedural characteristics and outcomes of retrograde CTO-PCI through LIMA grafts vs other conduits in a contemporary multicenter CTO registry. The LIMA was used as the collateral channel in 20 of 990 retrograde CTO-PCIs (2.

Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention.

Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery.

Intravascular Ultrasound Analysis of Intraplaque Versus Subintimal Tracking in Percutaneous Intervention for Coronary Chronic Total Occlusions and Association With Procedural Outcomes.

Objectives: Using intravascular ultrasound (IVUS), the authors compared outcomes by observed wire position (intraplaque vs. subintimal) achieved during successful chronic total occlusion (CTO) lesion treatment.

Background: Recent successes in CTO percutaneous coronary intervention (PCI) have used both intraluminal and subintimal wire tracking to improve procedural success.

Potential Sunitinib-Induced Coronary Artery and Aortic Dissections.

Small-molecule multitargeted tyrosine kinase inhibitor (TKI) therapy is used in different types of cancer. These drugs have been associated with cardiovascular toxicity, including aortic dissection. To our knowledge, this is the first time that a coronary dissection potentially associated with a TKI treatment has been described.

Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry.

Background: High patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) might lead to procedural failure and radiation skin injury.

Methods: We examined the association between several clinical and angiographic variables on patient air kerma (AK) radiation dose among 748 consecutive CTO PCIs performed at 9 experienced US centres between May 2012 and May 2015.

Results: The mean age was 65 ± 10 years, 87% of patients were men, and 35% had previous coronary artery bypass graft surgery (CABG).

Prognostic impact of the residual SYNTAX score on in-hospital outcomes in patients undergoing primary percutaneous coronary intervention.

Objectives: This study sought to assess the impact of residual coronary artery disease (CAD), using the residual SYNTAX score (rSS), on in-hospital outcomes after primary percutaneous intervention (PPCI). The study also aimed to determine independent predictors for high rSS. Residual CAD has been associated with worsened prognosis in patients undergoing PCI for non-ST acute coronary syndromes.

Effect of radial-to-femoral access crossover on adverse outcomes in primary percutaneous coronary intervention.

We aimed to describe the impact of the vascular access used when patients are treated with primary percutaneous coronary intervention (PPCI) and to assess whether this translates into differences in angiographic outcomes. Patients with ST-elevation myocardial infarction who underwent PPCI were divided into 3 groups: successful radial access (RA), successful femoral access (FA), and Crossover (failed RA with need for bailout FA) groups. Vascular access-related time (VART) was defined as the delay in PPCI that can be attributed to vascular access-related issues.

Porcine model of intracoronary pulverization of stent struts by rotablation atherectomy.

Objective: To evaluate the feasibility and safety of rotablation atherectomy in a suboptimally expanded stent.

Methods: Seven pigs underwent suboptimal stent expansion in the left anterior descending coronary. Pulverization of the stent struts was performed by rotablation atherectomy with two different burr sizes.

The transformation of a unilateral locomotor command into a symmetrical bilateral activation in the brainstem.

A unilateral activation of the mesencephalic locomotor region (MLR) produces symmetrical bilateral locomotion in all vertebrate species tested to date. How this occurs remains unresolved. This study examined the possibility that the symmetry occurred at the level of the inputs from the MLR to reticulospinal (RS) cells.