Publications by authors named "Sahil A. Parikh"

Background: Recent data support both surgical-first and endovascular-first revascularization approaches for chronic limb-threatening ischemia (CLTI), but hospital-based practices are poorly described.

Objectives: This aim of this study was to characterize contemporary variations and outcomes associated with each strategy among U.S.

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Background: Reported results of clinical trials assessing higher-dose anticoagulation in patients hospitalized for COVID-19 have been inconsistent.

Purpose: To estimate the association of higher- versus lower-dose anticoagulation with clinical outcomes.

Data Sources: Randomized trials were identified from the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.

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Purpose: Intravascular lithotripsy (IVL) has shown promising safety and effectiveness in calcified peripheral artery disease (PAD) in large trials and small real-world experiences. Real-world evidence from a larger cohort is lacking, so we aimed to evaluate the real-world acute performance of IVL in the treatment of calcified PAD.

Materials And Methods: The Disrupt PAD III Observational Study (OS) is a prospective, multicenter, single-arm study.

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  • In 2019, the FDA warned that devices coated with paclitaxel for treating claudication might be linked to higher mortality rates over five years, prompting a study to explore patient preferences between risks of revascularization and mortality.
  • A survey involving 272 patients from seven medical centers used discrete-choice experiments to assess how much increased mortality risk they would accept in exchange for decreased chances of needing further procedures on their blood vessels.
  • Results indicated that patients would generally tolerate a small increase in 5-year mortality risk (up to 12.6%) to achieve significant reductions in treatment risks, though there was notable variability in individual risk tolerance, highlighting the need for tailored decision-making support.
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  • The field of interventional cardiology (IC) has seen significant advancements and improved training programs over the last 40 years, including accredited fellowship programs and subspecialty certification.
  • Despite these improvements, the application process for IC fellowships has been chaotic and inconsistent, causing stress and pressure on applicants due to competitive recruitment practices.
  • A task force from the Society for Cardiovascular Angiography & Interventions has initiated a grassroots movement to create a national Match system for IC fellowships, aiming to establish fairness and equity in the application process.
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Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS).

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Background: Advanced therapies are increasingly utilized to treat pulmonary embolism (PE). A unique data platform allows access to electronic health record data for comparison of the safety of PE therapies.

Methods: All data from Truveta (Truveta, Inc) were analyzed (16 systems, 83,612,413 patients, 535,567 with PE).

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Peripheral arterial disease (PAD) represents one of the most prevalent cardiovascular disease processes and carries a high burden of morbidity and mortality. Patients with chronic limb-threatening ischemia (CLTI), the most severe manifestation of PAD, have the highest rates of cardiovascular morbidity and mortality of the overall PAD population. Patients with below-the-knee (BTK) PAD have an increased propensity toward CLTI due to small-vessel caliber and the frequently comorbid conditions of end-stage renal disease and diabetes mellitus, which tend to affect small artery beds preferentially.

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  • The study investigates the use of off-label peripheral drug-coated balloons (P-DCB) for treating coronary in-stent restenosis (ISR) in patients, as dedicated drug-coated balloons are not available in the U.S.
  • Data from 31 patients treated at a high-volume center showed that a significant percentage had recurrent ISR and high-grade symptoms, with most lesions found in native coronary arteries.
  • Follow-up indicated that while no post-procedural heart attacks occurred, there was a notable recurrence rate of ISR, with only 44.7% of patients free from further issues at the time of follow-up.
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In recent years, there has been a shift in the epidemiology of patients with infective endocarditis (IE). This has been characterized by an alarming increase in IE in patients who inject drugs, cardiac implantable electronic device-related IE, and those with comorbid conditions and high surgical risk. This unmet need has mandated a reevaluation of complex management strategies in these patients and introduction of unconventional approaches in treatment.

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Despite recent advances in diagnosis and treatment, atherosclerotic coronary artery diseases remain a leading cause of death worldwide. Various imaging modalities and metrics can detect lesions and predict patients at risk; however, identifying unstable lesions is still difficult. Current techniques cannot fully capture the complex morphology-modulated mechanical responses that affect plaque stability, leading to catastrophic failure and mute the benefit of device and drug interventions.

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Objectives: Clot-in-transit (CIT) in patients with pulmonary embolism (PE) has been associated with a high mortality rate and poor prognosis. The aim of this study was to evaluate the pooled efficacy of each of the 4 interventions (anticoagulation [AC] alone, systemic thrombolytic [ST] therapy, surgical thrombectomy, and catheter-based thrombectomy [CBT]) using mortality as the primary outcome.

Methods: A time limited search until March 28, 2024 was conducted using PubMed (National Institutes of Health) and EMBASE (Elsevier) databases.

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Background: The extent and consequences of ischemia in patients with chronic limb-threatening ischemia (CLTI) may change rapidly, and delays from diagnosis to revascularization may worsen outcomes. We sought to describe the association between time from diagnosis to endovascular lower extremity revascularization (diagnosis-to-limb revascularization [D2L] time) and clinical outcomes in outpatients with CLTI.

Methods And Results: In the CLIPPER cohort, comprising patients between 66 and 86 years old diagnosed with CLTI betweeen 2010 and 2019, we used Medicare claims data to identify patients who underwent outpatient endovascular revascularization within 180 days of diagnosis.

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Article Synopsis
  • Catheter-based therapies (CBTs) are being analyzed for their effectiveness in treating patients with intermediate-risk or high-risk pulmonary embolism (PE), aiming to improve patient outcomes.
  • A large study utilized data from the National Readmission Database to compare in-hospital and 30- to 90-day readmission rates between patients who received CBT and those who did not.
  • Results indicated that CBT significantly reduced in-hospital mortality and the likelihood of 90-day readmissions for both high-risk and intermediate-risk PE patients.
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  • The study examines outcomes of percutaneous coronary intervention (PCI) for de novo ostial right coronary artery (RCA) lesions, which have previously shown poor outcomes.
  • Researchers utilized intravascular ultrasound (IVUS) to categorize 170 identified RCA stenoses into three morphological types: isolated ostial lesions, ostial lesions with calcified nodules (CN), and ostial lesions with diffuse disease.
  • Results indicated that patients with CN had a significantly higher two-year target lesion failure (TLF) rate compared to those with diffuse disease, while isolated lesions resulted in no events, highlighting that lesion morphology is crucial for predicting clinical outcomes.
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  • Intravascular ultrasound studies reveal that about 25% of the left anterior descending (LAD) arteries have a myocardial bridge, which can affect stent performance.
  • This study aimed to explore the relationship between myocardial bridges and chronic total occlusions (CTOs) in LAD lesions, as well as their impact on clinical outcomes after treatment.
  • Results indicated that myocardial bridges were more frequent in LAD CTOs, and stents that extended into these bridges were linked to higher rates of target lesion failure compared to stents not extending into them.
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Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS).

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