Transradial access for peripheral and cerebrovascular interventions.

Objectives: In the present review, we report indications, equipment, techniques, results, and complications of transradial access (TRA) in peripheral as well as in cerebrovascular interventions.

Background: Percutaneous peripheral and cerebrovascular interventions are usually performed using transfemoral access; however, the risk of vascular complications with this approach is not negligible. Moreover, femoral access may be precluded by advanced vascular disease, and brachial access has been traditionally used as an alternative approach despite the risk of local complications.

Platypnea-orthodeoxia syndrome in the elderly treated by percutaneous patent foramen ovale closure: a case series and literature review.

Background: Platypnea-orthodeoxia syndrome (POS) is a rare clinical phenomenon, associating normal oxygen saturation in a supine position and arterial hypoxemia in an upright position. This pathology can be secondary to an intracardiac shunt, a pulmonary vascular shunt or a ventilation-perfusion mismatch. Cardiac POS occurs in the presence of a right-to-left cardiac shunt, most commonly through a patent foramen ovale (PFO).

Transcatheter aortic valve implantation in nonagenarians: effective and safe.

Background: The number of nonagenarians is rising dramatically. These patients often develop severe aortic stenosis for which transcatheter aortic valve implantation (TAVI) is an attractive option. The aim of this study was to analyze the outcome of TAVI performed in a cohort of nonagenarian patients.

Overcoming the Challenges of the Transfemoral Approach in Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) is performed through a retrograde transfemoral approach in approximately 80-90 % of cases thanks to the improvements in delivery catheter profile, size and steerability compared with the first generation devices. The aim of this review article is to describe the challenges of transfemoral TAVI and the options to overcome them. The difficulties may be related to the access itself or the placement of the valve using the transfemoral route.

[Role of percutaneous coronary intervention in diabetic patients].

Clinical outcomes after revascularization, both for surgery and percutaneous coronary intervention (PCI), is significantly worse in diabetic patients compared with non-diabetic patients. While in acute coronary syndrome, PCI is favored because of the increased risk of surgery performed during ongoing infarction, in stable patients assessment of clinical factors, such as coronary anatomy and comorbidities should guide decision of the revascularization modality (e.g.

AngioJet rheolytic thrombectomy in patients presenting with high-risk pulmonary embolism and cardiogenic shock: a feasibility pilot study.

Aims: Pulmonary embolism (PE) associated with haemodynamic instability has exceedingly high mortality. While intravenous thrombolysis is considered the therapy of choice, percutaneous mechanical thrombectomy may represent an alternative treatment.

Methods And Results: The impact of AngioJet® rheolytic thrombectomy (RT) in PE associated with cardiogenic shock was assessed in a single-centre prospective pilot study.

Massive aortic regurgitation following paravalvular balloon valvuloplasty of an Edwards SAPIEN valve treated by emergent CoreValve implantation: never cross a transcatheter aortic valve without a pigtail.

A 72-year-old patient, with a history of coronary artery bypass and aorto-bifemoral graft, was diagnosed with a symptomatic severe aortic valve stenosis in the presence of moderately decreased left ventricular function. The Heart team decision was to implant an Edwards SAPIEN XT 26 mm valve by transapical approach, therefore avoiding access through the aorto-bifemoral graft. At the end of the procedure, grades 2-3 aortic regurgitation was observed.

Scuba diving, acute left anterior descending artery occlusion and normal ECG.

We report the case of an acute proximal occlusion of the left anterior descending coronary (LAD) artery following a scuba diving decompression accident and associated with normal ECG. Following uneventful thromboaspiration and coronary stenting, the patient was discharged on day 4 with secondary preventative therapies. A transthoracic echocardiography performed at this point showed a complete recovery compared with an initial localised akinesia involving the anterior and apical portion of the left ventricle upon admission.

Angioplasty and provisional stent treatment of common femoral artery lesions.

Purpose: Isolated atherosclerotic common femoral artery (CFA) disease is a rare cause of symptomatic peripheral arterial disease. Although surgical endarterectomy is considered the therapy of choice, little is known about outcomes of percutaneous treatment.

Materials And Methods: A prospectively maintained single-center database was retrospectively analyzed for outcomes of consecutive patients undergoing isolated percutaneous revascularization of CFA disease between 1996 and 2007.

Current concepts on the management of concomitant carotid and coronary disease.

In the absence of randomized data, the optimal management of patients with severe carotid and coronary artery disease (CAD), especially those undergoing coronary bypass grafting (CABG), remains unsettled. As a general rule, in patients with multilevel atherosclerotic disease the symptomatic vascular discrict should be treated first. The entirely surgical approach with carotid endarterectomy (CEA) and CABG is associated with high event rates.

History of carotid artery stenting.

The history of carotid artery stenting (CAS) was made by brave men and women who believed in a less invasive treatment modality than carotid endarterectomy (CEA) to treat carotid stenosis despite the risk--which was obviously present also with surgery--to cause a stroke, the very event that the procedure aimed to prevent. The bulky equipment, the lack of knowledge about the appropriate antithrombotic regimen, and the impossibility at early stage to influence distal embolization added to the pressure on the investigators. At times, the confrontation with the surgical community has been hard.

Effect of biolimus-eluting stents with biodegradable polymer vs bare-metal stents on cardiovascular events among patients with acute myocardial infarction: the COMFORTABLE AMI randomized trial.

Context: The efficacy and safety of drug-eluting stents compared with bare-metal stents remains controversial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Objective: To compare stents eluting biolimus from a biodegradable polymer with bare-metal stents in primary PCI.

Design, Setting, And Patients: A prospective, randomized, single-blinded, controlled trial of 1161 patients presenting with STEMI at 11 sites in Europe and Israel between September 19, 2009, and January 25, 2011.

[Percutaneous left atrial appendage closure: an alternative in patients with atrial fibrillation and high bleeding risk?].

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence increases with age. AF increases the risk of stroke by a factor of 5 and strokes related to AF are associated with higher mortality and morbidity when compared with strokes in patients with sinus rhythm. Oral anticoagulation is efficient to reduce the risk of stroke in AF patients, but with a substantial risk of bleeding.

[Role of endovascular therapy in the management of patients with lower extremity atherosclerotic disease according to new European guidelines].

For the first time, the European Society of Cardiology has edited guidelines on the treatment of peripheral artery disease. With respect to the treatment of lower extremity disease, the endovascular approach is recommended in the majority of cases, independently of clinical presentation (claudication or critical limb ischemia) and of lesion complexity (TASC II A-B-C). For very complex lesions (TASC II D) surgery remains preferred.

Pharmacologic preconditioning therapy prior to atrial septal defect closure in patients at high risk for acute pulmonary edema.

Objectives: The aim of this study was to assess whether transient atrial septal defect (ASD) occlusion and, if required, vasodilator therapy would improve the safety of percutaneous ASD closure in high-risk subsets.

Background: While percutaneous ASD closure is generally considered a low risk intervention, hypertensive and elderly patients may develop pulmonary edema following the procedure because of underlying left ventricular (LV) diastolic dysfunction.

Methods: Fifty-two consecutive patients who underwent successful percutaneous ASD closures were enrolled into a single-center prospective registry.

Carotid artery stenting: a single center "real world" experience.

Background: Percutaneous carotid artery stenting (CAS) became a widely used procedure in patients with symptomatic and asymptomatic carotid artery stenosis. However its role compared to carotid endarterectomy (CAD) remains questioned. We analysed the safety of carotid artery stenting program of a prospective CAS register program of a tertiary teaching hospital.

Left-to-right shunt reduction with intra-aortic balloon pump in postmyocardial infarction ventricular septal defect.

This case aims to describe the hemodynamic effects of intra-aortic balloon pump (IABP) in patients with ventricular septal defect (VSD) complicating myocardial infarction (MI). A 79-year-old man with no previous cardiovascular history presented to the emergency department with subacute inferior myocardial infarction associated with mild signs of systemic hypoperfusion. A transthoracic echocardiography revealed a large akinesia of the left ventricular inferior wall with preserved global left ventricular ejection fraction, as well as a large VSD in the midinferior portion of the interventricular septum.

Influence of plaque volume on hemodynamic response and stress hormone release in patients undergoing carotid artery stenting.

Aim: Carotid artery stenting (CAS) may cause bradycardia and hypotension due to barostimulation. The impact of periprocedural hypotension on CAS outcome remains controversial. The role of carotid plaque volume and catecholamine hormone release during CAS on hemodynamic changes has not been investigated so far.