Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention of the Left Anterior Descending Artery.

The left anterior descending artery (LAD) subtends a large myocardial territory. The outcomes of LAD chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. We performed a retrospective analysis of all patients who underwent LAD CTO PCI at a high-volume single center.

Antegrade versus retrograde techniques for Chronic Total Occlusions (CTO): a review and comparison of techniques and outcomes.

: As the field of chronic total occlusion percutaneous coronary intervention has evolved, technical approaches have evolved and been refined.: In this review, we discuss the major techniques utilized in modern CTO PCI including antegrade wiring, antegrade dissection reentry, retrograde wiring, and retrograde dissection reentry. Retrograde techniques have been extensively studied in comparison to antegrade techniques.

Zero-iodinated contrast retrograde percutaneous coronary interventions of chronic total occlusions using gadolinium and imaging guidance: a case report of a patient with severe anaphylaxis to iodinated contrast.

Background: Gadolinium-based contrast agents have been used as an alternative to iodinated contrast agents for simple percutaneous coronary interventions (PCIs) in patients with obstructive coronary artery disease. Their use has been limited in complex PCI due to poor image quality with gadolinium contrast. Significant dilution of gadolinium is required in an effort to avoid malignant ventricular arrhythmias.

Chronic total occlusion percutaneous coronary interventions: identifying patients at risk of complications.

Introduction: Angina refractory to medical therapy and providing complete revascularization (after acute coronary syndrome or in patients with ischemic cardiomyopathy) are common indications for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Unfortunately, CTO PCI is associated with higher rates of complications when compared with non-CTO PCI.

Areas Covered: In this article, we review available studies on risk prediction in CTO PCI and outline strategies to avoid complications.

Safety and Effectiveness of MANTA Vascular Closure Device After Large-Bore Mechanical Circulatory Support: Real-World Experience.

Background: Real world safety and effectiveness of MANTA vascular closure device (VCD) for large bore arteriotomy closure after decannulation of mechanical circulatory support (MCS) devices is not known.

Methods: All consecutive patients who underwent large bore arteriotomy closure with MANTA VCD following decannulation of MCS between February to October 2019 at a large tertiary care academic medical center were included. Safety and effectiveness of MANTA VCD was assessed on immediate post-closure angiogram for 23 access sites, and immediate post-closure duplex arterial ultrasound or manual vascular examination for 1 access site each.

Feasibility and safety of orbital atherectomy for the treatment of in-stent restenosis secondary to stent under-expansion.

Background: Debulking and ablative techniques are sometimes used for the treatment of in-stent restenosis (ISR) secondary to resistant stent under-expansion (SU). The safety and effectiveness of orbital atherectomy (OA) in this cohort of patients has not been reported.

Methods: We retrospectively evaluated consecutive patients treated with OA for ISR secondary to balloon undilatable SU at two academic tertiary care centers between October 2016 and June 2019.

Electrocautery-Facilitated Crossing (ECFC) of Chronic Total Occlusions.

Background: The use of electrocautery (EC)-facilitated re-entry in an aorto-ostial chronic total occlusion (CTO) of the right coronary artery (RCA) was first described in 2016. Since then, it has been utilized sporadically, but little is reported about the use of EC in lesion crossing during CTO percutaneous coronary intervention (PCI). The objective of this study is to describe the efficacy of EC-facilitated crossing (ECFC) of CTOs.

High-Risk Chronic Total Occlusion Percutaneous Coronary Interventions Assisted With TandemHeart.

Background: Hemodynamic support is increasingly utilized to avoid hemodynamic collapse during high-risk chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Intermediate-term outcomes of Tandem Heart (TH)-supported CTO-PCI have not been previously reported.

Methods: We retrospectively evaluated procedural and clinical outcomes in consecutive patients undergoing TH-assisted CTO-PCI at our institution from April 1, 2016 to January 30, 2019.

Comparison of nationwide trends in 30-day readmission rates after carotid artery stenting and carotid endarterectomy.

Objective: Carotid revascularization procedures, carotid artery stenting (CAS) and carotid endarterectomy (CEA), are among the most common vascular interventions performed in the United States, with significant resource utilization. Whereas multiple studies have reported outcomes after these procedures, data regarding 30-day readmission rates after these interventions remain scant.

Methods: The U.

Meta-analysis of fractional flow reserve guided complete revascularization versus infarct related artery only revascularization in patients with ST-elevation myocardial infarction and multivessel coronary artery disease.

Background: Multivessel coronary artery disease is found in 30-50% of patients with ST-elevation myocardial infarction (MI) and is associated with adverse outcomes. It is not yet clear if outcomes are improved by utilizing fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) of noninfarct related artery (non-IRA) along with primary PCI.

Methods And Results: To evaluate this, we performed a metanalysis of published randomized controlled trials by performing systematic search of PubMed, Medline, Google Scholar and Cochrane Central.

Meta-analysis of drug eluting stents compared with bare metal stents in high bleeding risk patients undergoing percutaneous coronary interventions.

Objectives: To determine the efficacy and safety of drug-eluting stents (DESs) and bare metal stents (BMSs) when used with short or tailored dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients.

Background: DES have been shown to reduce target lesion revascularization (TLR) as well as stent thrombosis (ST) compared to BMS in patients undergoing percutaneous coronary intervention (PCI). However, patients at HBR continue to receive BMS given the fear of bleeding or ST from premature discontinuation of DAPT in patients receiving DES.

Superficial Femoral Artery Aneurysm as a Cause of Deep Vein Thrombosis Treated With a Covered Stent.

Deep vein thrombosis due to superficial femoral artery aneurysm is an extremely rare condition that develops due to aneurysm direct compression of a segment of the venous system. We present a 57-year-old female patient who had recently undergone a left superficial femoral artery (SFA) intervention at an outside institution due to significant peripheral artery disease. Imaging revealed a 3.

Tryton dedicated bifurcation stent in treatment of unprotected distal left main bifurcation disease.

Percutaneous coronary interventions involving coronary bifurcation lesions are more complex and associated with adverse outcomes (both angiographic and clinical) compared to non-bifurcation lesions. Tryton, a dedicated bifurcation stent, has been introduced with the aim to simplify treatment of bifurcation lesions. Tryton stent in combination with conventional drug eluting stent is safe and associated with reduced stenosis and bail-out stenting of side branch compared to provisional stenting involving a large side.

Meta-Analysis of Transcatheter Valve-in-Valve Implantation Versus Redo Aortic Valve Surgery for Bioprosthetic Aortic Valve Dysfunction.

Transcatheter valve-in-valve implantation (ViV-TAVI) has evolved as an alternative to redo surgical valve replacement (redo-SAVR) for high-risk patients with aortic bioprosthetic valve (BPV) dysfunction. The differences in procedural success and outcomes in a large number of patients who underwent ViV-TAVI compared with redo-SAVR for aortic BPV dysfunction are not known. We conducted a meta-analysis of the previously reported studies to determine outcomes after ViV-TAVI and redo-SAVR.

Long-term outcomes of patients with diabetes mellitus undergoing percutaneous intervention for popliteal and infrapopliteal peripheral arterial disease.

Objectives: To evaluate the association of diabetes mellitus (DM) with clinical and angiographic characteristics and outcomes of patients with popliteal and infrapopliteal peripheral arterial disease (PAD) undergoing peripheral vascular intervention (PVI).

Background: Clinical features and outcomes in patients with DM and popliteal or infrapopliteal PAD undergoing PVI are not well described.

Methods: Using the data from the laser in popliteal and infrapopliteal stenosis study, we retrospectively examined the association of diabetes with clinical and angiographic characteristics and risk adjusted short- and intermediate term outcomes (all cause death, major adverse events (MAE) [composite of death, ipsilateral major amputation, or repeat revascularization]) in patients with popliteal and infrapopliteal PAD undergoing PVI for critical limb ischemia treated either with laser-assisted balloon angioplasty or balloon angioplasty alone.

Caught in Time: When IVC Filters Save Lives.

Inferior vena cava filters are indicated in patients with venous thromboembolic disease in whom anticoagulation is a contraindication. This case highlights the importance of inferior vena cava filter placement in patients with extensive proximal deep vein thromboses in order to prevent massive pulmonary emboli, possibly associated with sudden cardiac death.

ST-elevation Myocardial Infarction: An Unusual Presentation of Infective Endocarditis.

Acute coronary syndrome is an uncommon complication in patients with infective endocarditis, either in the acute phase of infection or later in the course. We describe a case of unusual presentation of infective endocarditis as ST-elevation myocardial infarction secondary to coronary embolization from mitral valve endocarditis.

Left ventricular pseudoaneurysm after mitral valve replacement.

Development of left ventricular pseudoaneurysm is a rare complication of mitral valve surgery and requires urgent surgical intervention. We describe a case of pseudoaneurysm of membranous septum following repeat mitral valve replacement with the use of multimodality imaging.