Intravascular Imaging in the Diagnosis and Management of Patients With Suspected Intracoronary Pathologies: A CJC White Paper.

Intravascular imaging has become an integral part of the diagnostic and management strategies for intracoronary pathologies. In this White Paper we summarize current evidence and its implications on the use of intravascular imaging in interventional cardiology practice. The areas addressed are planning and optimization of percutaneous coronary intervention, management of stent failure, and evaluation of ambiguous coronary lesions and myocardial infarction with nonobstructive coronary disease.

Right Ventricular Assist Device With an Oxygenator for the Management of Combined Right Ventricular and Respiratory Failure: A Systematic Review.

Background: Severe lung disease frequently presents with both refractory hypoxemia and right ventricular (RV) failure. Right ventricular assist device with an oxygenator (OxyRVAD) is an extracorporeal membrane oxygenation (ECMO) configuration of RV bypass that also supplements gas exchange. This systematic review summarises the available literature regarding the use of OxyRVAD in the setting of severe lung disease with associated RV failure.

Perioperative Cardiovascular Risk Assessment and Management in Liver Transplant Recipients: A Review of the Literature Merging Guidelines and Interventions.

Liver transplantation (LT) is the second most performed solid organ transplant. Coronary artery disease (CAD) is a critical consideration for LT candidacy, particularly in patients with known CAD or risk factors, including metabolic dysfunction associated with steatotic liver disease. The presence of severe CAD may exclude patients from LT; therefore, precise preoperative evaluation and interventions are necessary to achieve transplant candidacy.

Evaluation and management of drug-eluting stent in-stent restenosis.

Purpose Of Review: In-stent restenosis (ISR) is the most common cause of stent failure. Although the rate of ISR is significantly lower with contemporary drug-eluting stents (DES), it remains a challenging clinical entity to treat.

Recent Findings: In this review, we focus on a practical approach to management of DES ISR with intravascular imaging at its core, as supported by several recently published articles.

Vascular Closure Devices For Axillary Artery Access: A Systematic Review and Meta-Analysis.

Purpose: To evaluate the technical success and complication rates of vascular closure devices (VCDs) in the axillary artery.

Materials And Methods: MEDLINE and Embase were searched independently by two reviewers to identify observational studies from inception through October 2021. The following outcomes were meta-analyzed: technical success, hematoma, dissection, pseudoaneurysm, infection, and local neurological complications.

Clinical expert consensus document on the use of percutaneous left ventricular assist devices during complex high-risk PCI in India using a standardised algorithm.

Over the past decade, percutaneous left ventricular assist devices (pLVAD), such as the Impella microaxial flow pump (Abiomed), have been increasingly used to provide haemodynamic support during complex and high-risk revascularisation procedures to reduce the risk of intraprocedural haemodynamic compromise and to facilitate complete and optimal revascularisation. A global consensus on patient selection for the use of pLVADs, however, is currently lacking. Access to these devices is different across the world, thus, individual health care environments need to create and refine patient selection paradigms to optimise the use of these devices.

Association between sex and survival after non-traumatic out of hospital cardiac arrest: A systematic review and meta-analysis.

Background: Existing studies have shown conflicting results regarding the relationship of sex with survival after out of hospital cardiac arrest (OHCA). This systematic review evaluates the association of female sex with survival to discharge and survival to 30 days after non-traumatic OHCA.

Methods: We searched Medline, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception through June 2021 for studies evaluating female sex as a predictor of survival in adult patients with non-traumatic cardiac arrest.

3D Printing of Subclavian Artery: Utility for Preprocedural Planning and Correlation With Subclavian Artery Percutaneous Vascular Interventions.

Background: Three-dimensional (3D) printing for subclavian artery (SA) percutaneous vascular interventions (PVI) may allow superior understanding of patient specific complex anatomy and aid with preprocedural planning.

Methods: Five patients with computed tomography angiography (CTA) of the neck who underwent SA PVI were queried retrospectively. 3D printing of aortic arch and great vessels was accomplished with 3D slicer software and painted with acrylic paint to highlight anatomic features.

Contemporary National Trends and Outcomes of Pulmonary Embolism in the United States.

Contemporary data on the national trends in pulmonary embolism (PE) admissions and outcomes are scarce. We aimed to analyze trends in mortality and different treatment methods in acute PE. We queried the Nationwide Readmissions Database (2016 to 2019) to identify hospitalizations with acute PE using the International Classification of Diseases, Tenth Revision, Clinical Modification codes.

3D Printing for Mesenteric Artery Endovascular Interventions: Feasibility and Utility for Preprocedural Planning and Angiographic Correlation.

Background: Three-dimensional (3D) printing of mesenteric artery (MA) anatomy preprocedurally for endovascular interventions can allow strategic preprocedure planning and improve procedure-related clinical outcomes.

Methods: Three patients with computed tomography angiography (CTA) of the abdomen and pelvis who subsequently underwent MA interventions were 3D printed retrospectively, and 2 patients with symptoms and severe MA stenosis on CTA, who had not undergone intervention, were 3D printed for procedure-related planning and anatomy-specific implications. The 3D-printed models (3D-PMs) were painted with acrylic paint to highlight anatomy.

Overview of Contemporary Chronic Total Occlusion Percutaneous Coronary Intervention Techniques: A Narrative Systematic Review.

Background: Despite the abundance of coronary chronic total occlusions (CTO) percutaneous coronary intervention (PCI) studies, the literature is not easy to digest for both general PCI operators and CTO PCI specialists because of the many varied terms used for approaches and inconsistency in terminology. This inconsistency makes it challenging to understand the advantages and disadvantages of these different approaches and, most importantly, their downstream clinical outcomes. Accordingly, we conducted a systematic review of all published studies on CTO PCI to describe techniques and algorithms used in the last decade to provide an overview on the efficacy and safety of contemporary CTO PCI techniques.

3D Printing of Renal Arteries for Endovascular Interventions: Feasibility, Utility, and Correlation With Renal Arteriograms.

Background: Three-dimensional (3D) printing technology is increasingly being utilized for preprocedural planning of interventional procedures. However, utility of 3D models of obstructive and clinically relevant renal artery disease has not been evaluated and could potentially assist in preprocedural planning of renal artery endovascular interventions.

Methods: Five patients with computed tomography angiography (CTA) of abdomen and pelvis who also subsequently underwent renal artery interventions were 3D printed retrospectively.

Complications of Penumbra Indigo Aspiration Device in Pulmonary Embolism: Insights From MAUDE Database.

Background: The Penumbra Indigo aspiration system (Penumbra Inc., Alameda, CA, USA) is a suction embolectomy device that was cleared by the Food and Drug Administration for use in acute pulmonary embolism (PE). While this device has proven to be safe in clinical trials, real-world data are minimal.

Risk Prediction in Cardiogenic Shock: Current State of Knowledge, Challenges and Opportunities.

Cardiogenic shock (CS) is a condition associated with high mortality rates in which prognostication is uncertain for a variety of reasons, including its myriad causes, its rapidly evolving clinical course and the plethora of established and emerging therapies for the condition. A number of validated risk scores are available for CS prognostication; however, many of these are tedious to use, are designed for application in a variety of populations and fail to incorporate contemporary hemodynamic parameters and contemporary mechanical circulatory support interventions that can affect outcomes. It is important to separate patients with CS who may recover with conservative pharmacological therapies from those in who may require advanced therapies to survive; it is equally important to identify quickly those who will succumb despite any therapy.

3D Printing of Carotid Artery and Aortic Arch Anatomy: Implications for Preprocedural Planning and Carotid Stenting.

Background: Carotid artery stenting (CAS) has been associated with increased periprocedural stroke in comparison with carotid endarterectomy (CEA). Three-dimensional (3D) printing of aortic arch and carotid artery may aid with preprocedural planning and adaptive learning, possibly reducing procedure-related complications.

Methods: Five CAS cases with available computed tomography angiography (CTA) were retrospectively evaluated and 3D-printed models (3D-PMs) were made.

Coronary artery disease in patients with cancer: challenges and opportunities for improvement.

Purpose Of Review: Coronary artery disease (CAD) is a common comorbidity in patients with cancer. We review shared risk factors between the two diseases and cancer treatments that increase the risk of CAD. We also discuss outcomes and management considerations of patients with cancer who develop CAD.

Patient-Specific Coronary Artery Bypass Graft 3D Printing: Implications for Procedural Planning in Complex Percutaneous Coronary Interventions.

Background: Three-dimensional (3D) printing technology has seen tremendous growth in augmenting didactics, research, and preprocedural planning with structural heart procedures. Limited investigative efforts have been made in other areas of the cardiovascular spectrum. 3D-printed models (PMs) of anatomically complex coronary artery bypass graft (CABG) patients from coronary computed tomography angiography (CCTA) have implications for adaptive learning and preprocedural planning.

Peripheral Administration of Nitroglycerin in Pulseless Ventricular Tachycardia due to Cocaine-Induced Coronary Vasospasm.

Cocaine use accounts for 40% of the annual drug use related emergency department visits in the United States. Cocaine use is hence recognized as a major health problem. Cocaine blocks the presynaptic reuptake of norepinephrine and dopamine.

Antegrade and retrograde in-stent tibial artery chronic total occlusion recanalization with double kiss crush (DK crush) stenting of previous stent.

Below the knee (BTK) peripheral arterial disease often presents with critical limb ischemia (CLI) clinically with involvement of more than one tibial vessels. Drug eluting stent (DES) technology for treatment of BTK disease has shown promising long-term durable results; however, currently only coronary DESs are available for application in the United States. Although coronary bifurcation stenting techniques are backed by extensive data in literature, there is a scarcity of data for the treatment of tibial bifurcation disease.

Transulnar Versus Transradial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials.

Objectives: To compare the outcomes of transulnar access (TUA) versus transradial access (TRA) for coronary angiography (CA) and percutaneous coronary intervention (PCI).

Background: TUA has emerged as an alternative access site in patients who fail TRA or not candidates for it. Data comparing both approaches have been limited.