Access-site complications of transradial percutaneous coronary intervention using sheathless guiding catheters for acute coronary syndrome: a prospective cohort study with radial ultrasound follow-up.

The advantages of sheathless guiding catheters over the conventional approach using sheaths in percutaneous coronary intervention (PCI) regarding access-site complications, particularly ultrasound-diagnosed radial artery occlusion (RAO), remain unknown. The present study investigated the incidence of access-site complications of transradial primary PCI using sheathless guiding catheters in acute coronary syndrome (ACS). This prospective study evaluated access-site complications in 500 patients with ACS undergoing sheathless transradial primary PCI.

A prospective interventional registry of short-term dual-antiplatelet treatment after implantation of drug-eluting stents in patients with atrial fibrillation requiring oral anticoagulation therapy.

There are limited data regarding the use of antithrombotic therapy in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES). In this prospective interventional study, we evaluated the feasibility of short-term dual-antiplatelet therapy (DAPT) after DES implantation in AF patients treated with oral anticoagulation (OAC). The antithrombotic regimen in the present study was 1-month DAPT, followed by single-antiplatelet therapy with OAC.

Spontaneous Resolution of Residual Shunting in 2 Compromised Patients after Amplatzer Occlusion of Postinfarction Ventricular Septal Defects.

Ventricular septal defect (VSD) is a rare, potentially fatal complication of acute myocardial infarction. When surgical closure is contraindicated, transcatheter closure may be an alternative. Residual shunting after transcatheter closure of postinfarction VSDs has been reported; however, we found few cases of this in patients who also had severe heart failure or hemolysis.

Utility of preprocedural multidetector computed tomography in alcohol septal ablation for hypertrophic obstructive cardiomyopathy.

Preprocedural computed tomography (CT) imaging appears to provide an advantage in localization of the appropriate septal branch targeted for alcohol septal ablation (ASA). The objective of this study was to compare the clinical backgrounds, procedural characteristics, and outcomes of patients who underwent ASA with preprocedural CT assessment against those without CT assessment. Thirty consecutive patients with obstructive hypertrophic cardiomyopathy who underwent ASA were retrospectively included.

Percutaneous WATCHMAN Left Atrial Appendage Closure for Japanese Patients With Nonvalvular Atrial Fibrillation at Increased Risk of Thromboembolism - First Results From the SALUTE Trial.

Background: The PROTECT AF and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage (LAA) closure device is a reasonable alternative to warfarin therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the USA and Europe. We conducted the SALUTE trial to confirm the safety and efficacy of the LAA closure therapy for patients with NVAF in Japan.

Methods and results: A total of 54 subjects (including 12 Roll-in) with NVAF who had a CHADS-VASc score ≥2 were enrolled.

Transradial Intervention in Patients With Non-ST Elevation Acute Coronary Syndrome Using One 4.0 Fr Sheath and One Sheathless Guide Catheter Via a Single Puncture Site: The 1-1-1 Strategy.

Objectives: The optimal primary transradial intervention (TRI) technique has not been established in non-ST segment elevation acute coronary syndrome (NSTEACS) patients, because they often, but not always, undergo immediate revascularization after coronary angiography (CAG). Moreover, TRI failure has been reported in 5%-10% of cases. We investigated whether a newly designed strategy of immediate TRI using one sheathless hydrophilic-coated guiding catheter (SH-GC) after diagnostic CAG with one 4.

Complete Atrioventricular Block Associated with Pembrolizumab-induced Acute Myocarditis: The Need for Close Cardiac Monitoring.

Pembrolizumab, a humanized monoclonal IgG4 antibody directed against programmed death-1, is an immune checkpoint inhibitor that has been introduced for the treatment of non-small-cell lung cancer. However, immune checkpoint inhibitors may cause severe immune-related adverse events. We herein present a case of lung cancer with complete atrioventricular block associated with acute myocarditis, which developed 16 days after the administration of pembrolizumab.

Anatomical features of the aortic root in aortic stenosis and a novel approach for transcatheter aortic valve implantation.

A narrow and calcified sinotubular junction (STJ) represents a risk for ascending aortic dissection after balloon-expandable transcatheter aortic valve implantation (TAVI). The aim of this study was to assess computed tomography (CT)-based aortic root morphology in patients with aortic stenosis (AS), and to evaluate the feasibility of a two-step inflation technique that we devised for TAVI using the SAPIEN 3 in patients with a narrow and calcified STJ. We retrospectively analyzed the STJ diameter (STJD) as well the as aortic annulus diameter (AAD) and STJ calcification using CT imaging in 412 patients undergoing TAVI.

A randomised comparison of incidence of radial artery occlusion and symptomatic radial artery spasm associated with elective transradial coronary intervention using 6.5 Fr SheathLess Eaucath Guiding Catheter vs. 6.0 Fr Glidesheath Slender.

Aims: The aim of this study was to compare incidences of radial artery occlusion (RAO) and spasm (RAS) associated with transradial coronary intervention (TRI) using a 6.5 Fr SheathLess hydrophilic-coated guide catheter (SH-GC) vs. a 6.

"Spaghetti twisting" technique: a novel method of catching pacemaker leads using a needle's eye snare.

The needle's eye snare has become an indispensable tool in contemporary pacemaker lead extraction techniques. Here, we present a modified method of using the needle's eye snare, named "spaghetti twisting" technique, to catch and secure pacemaker leads, which would help operators catch and secure leads much easily.

A "tetra-axial" system in transfemoral lead extraction.

Pacemaker lead extractors must become familiar with transfemoral approaches for lead extraction as a bail-out procedure for a failed superior approach. We presented a "tetra-axial" system for transfemoral lead extraction. This system would be more widely applicable in cases with difficulties in extraction, resulting in more procedural success.

A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions.

Antegrade crossing is the most common approach to chronic total occlusions (CTOs). However, it is sometimes difficult to penetrate the proximal hard cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe a novel, modified reverse controlled antegrade and retrograde subintimal tracking (CART) technique in which the dissection reentry was intentionally created in the proximal segment of the vessel, not within the occluded segment, using retrograde guidewire and the aid of an antegrade balloon.

Apixaban for the treatment of saphenous vein graft thrombosis presenting as unstable angina: a case report.

Background: Saphenous vein graft thrombosis can present as unstable angina. However, percutaneous coronary intervention for saphenous vein graft lesions poses a high risk of slow flow related to the procedure. Here we present the utilization of the novel oral anticoagulant, apixaban, in the treatment of unstable angina with extensive saphenous vein graft thrombus, leading to considerable thrombus resolution and eliminating the need of percutaneous coronary intervention.

A case of double stent implantation for left main coronary artery occlusion in transcatheter aortic valve implantation using SAPIEN XT device.

Transcatheter aortic valve implantation is an established alternative and less invasive procedure to replace heart valves in symptomatic aortic stenosis patients; however, severe, life-threatening complications still exist. Coronary artery occlusion is a primary complication. We report a case of left main coronary artery occlusion after transcatheter aortic valve replacement, which was ameliorated using a double stent implantation technique.

AVJ-514 Trial - Baseline Characteristics and 30-Day Outcomes Following MitraClip Treatment in a Japanese Cohort.

Background: The MitraClipsystem is a transcatheter-based therapeutic option for patients with chronic mitral regurgitation (MR) who are at high risk for surgery. A prospective, multicenter, single-arm study was initiated to confirm the transferability of this system to Japan.Methods and Results:Patients with symptomatic chronic moderate-to-severe (3+) or severe (4+) functional or degenerative MR with a Society of Thoracic Surgery (STS) score ≥8%, or the presence of 1 predefined risk factor were enrolled.

Transcatheter closure of an atrial septal defect with high risk of erosion using a Figulla Flex II atrial septal defect occluder.

An 85-year-old man with a high risk for open heart surgery underwent a percutaneous closure of an atrial septal defect that lacked adequate aortic and superior rims. To avoid the risk for erosion, a Figulla Flex II ASD occluder was selected for the procedure. Implantation was successful, and no complications were observed during the 6 months of follow-up.

Delayed-Onset Left Main Coronary Artery Obstruction More than 24 Hours after Balloon-Expandable Transcatheter Aortic Valve Replacement.

Coronary obstruction during or after transcatheter aortic valve replacement is a rare and catastrophic sequela that occurs most frequently just after valve implantation. Even rarer is the delayed clinical presentation, in some few patients, of coronary obstruction on the day after self-expandable valve implantation. Here we describe a case of balloon-expandable (not self-expandable) transcatheter aortic valve replacement, followed by partial obstruction of the left main coronary artery on the day after that procedure in a 93-year-old man, despite normal left ventricular contraction just after valve implantation.

Transcatheter valve-in-valve implantation for failed mitral prosthesis: the first experience in Japan.

An 82-year-old woman had a history of mitral valve replacement with a 25-mm MOSAIC (Medtronic, USA) for severe mitral regurgitation (MR) 8 years previously. Recently, she developed heart failure due to MR secondary to prosthetic valve failure. She underwent transcatheter valve-in-valve implantation with a 23-mm SAPIEN XT (Edwards Lifesciences, USA) to the prosthetic mitral valve by transapical approach.

Transradial Approach of Alcohol Septal Ablation Using a Sheathless Guiding Catheter: A Feasibility Study.

Objectives: We aimed to investigate the feasibility and safety of alcohol septal ablation (ASA) via transradial approach using a sheathless guiding catheter.

Background: Although ASA is conventionally performed via the femoral artery, there is a potential risk of bleeding and other vascular complications. The transradial approach may be associated with a lower rate of such complications.

Sheathless guide catheter coronary intervention via radial artery: single-center experience with 9658 procedures.

Objectives: To evaluate the efficacy and safety of transradial coronary intervention (TRI) using a sheathless guide catheter (sheathless TRI) in a large, retrospective, single-center study.

Background: The sheathless guide catheter was designed to be inserted without an introducer sheath to decrease stress to the radial artery. Although the sheathless guide catheter has some potential limitations, such as its procedural complexity or the risk of coronary ostial dissection, no large studies have been reported.

Successful penetration and bougie dilatation with Brockenbrough needle for severely calcified occlusion in superficial femoral artery.

A 75-year-old hemodialysis patient with right critical limb ischemia received endovascular therapy for a chronic total occlusion (CTO) in a diffusely calcified superficial femoral artery (SFA). During a retrograde approach, a Brockenbrough needle (BN) was able to penetrate the calcified hard plaque formed in the middle segment of the CTO. Moreover, bougie dilatation with the BN allowed balloon crossing and stent deployment, even after failure to pass a 2.