First application of the distal radial approach for severe mechanical surgical aortic valve paravalvular leak transcatheter closure with a double vascular plug: a case report.

Background: Severe aortic paravalvular leaks (PVLs) after surgical mechanical aortic valve replacement (AVR) represent a high risk for congestive heart failure, haemolysis, and infective endocarditis. This is the first reported case of distal radial artery (DRA) access for severe mechanical aortic PVL closure with a sequential double vascular plug guided by computed tomography angiography (CTA), transoesophageal echocardiography (TOE), and 3D TOE in an acute setting.

Case Summary: A 51-year-old male presented with significant mixed aortic valve disease.

Stent graft implantation from distal radial access-A novel way to treat femoral access site complication during transcatheter aortic valve replacement: A case report.

In this paper, a case of an 82-year-old man who was admitted to our department with sever symptomatic degenerative aortic valve stenosis is presented and discussed. After all screening procedures, a successful transfemoral transcatheter aortic valve replacement was performed, but the closure of the femoral access was unsuccessful due to suture-based device failure. We decided to perform a prolonged balloon dilatation and external compression at the bleeding site, but the bleeding did not stop; therefore, an iCover stent graft was implanted from distal radial artery access using slender technique.

Combination of Laser Atherectomy and Super High-pressure Non-compliant Balloon to Treat Stent Under-expansion in Cases of Failed Interventional Options.

Patients with calcified, fibrotic native coronary vessels with prior suboptimal stenting outcomes are at major risk of stent thrombosis and could face serious consequences if untreated. In cases of multiple layers of under-expanded stents, the risk is multiplied. If conventional balloon post-dilatation is unsuccessful after stent implantation without proper lesion preparation, few interventional options remain.

The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions.

In an effort to refine transcatheter vascular interventions, radial artery access has moved more distally at the anatomical snuffbox. Here, more challenges appear as the artery is smaller, more angulated, and more difficult to palpate. Including ultrasound guidance as a mandatory step during puncture may encourage more operators to switch to this approach.

Anatomical classification of chronic total occlusions in coronary bifurcations.

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) in coronary bifurcation lesions (CBL) is undergoing substantial technical progress and standardization, paralleling the evolution of dedicated devices, tools, and techniques. A standard consensus to classify CTO-CBL might be instrumental to homogenize data collection and description of procedures for scientific and educational purposes. The Medina-CTO classification replicates the classical three digits in Medina classification for bifurcations, representing the proximal main vessel, distal main vessel, and side branch, respectively.

Simultaneous Dual Distal Radial Balloon Aortic Valvuloplasty for Larger Aortic Annuli.

Dual distal mini-balloon aortic valvuloplasty stabilized an 85-year-old patient with severe aortic stenosis. Puncturing both radial arteries solves the issue of large diameters at the aortic ring, introducing a feasible strategy in selected cases of fragile octogenarian patients with a high hemorrhagic risk. Moving at the anatomical snuffbox offers better postprocedural occlusion rates and better workspace ergonomics during the procedure.

Distal Radial Artery Access for Coronary and Peripheral Procedures: A Multicenter Experience.

Introduction: Distal radial access (dRA) has recently gained global popularity as an alternative access route for vascular procedures. Among the benefits of dRA are the low risk of entry site bleeding complications, the low rate of radial artery occlusion, and improved patient and operator comfort. The aim of this large multicenter registry was to demonstrate the feasibility and safety of dRA in a wide variety of routine procedures in the catheterization laboratory, ranging from coronary angiography and percutaneous coronary intervention to peripheral procedures.

Distal Radial Secondary Access for Transcatheter Aortic Valve Implantation: The Minimalistic Approach.

Background: Although not yet recommended by the guidelines, distal radial access, a new site for cardiovascular interventions, has been rapidly acknowledged and adopted by many centers due to its high rate of success, safety and fewer complications. We present our experience using secondary distal radial access during transcatheter aortic valve implantation (TAVI), proposing a new, even more minimal approach.

Methods: As of November 2020, a systematic distal radial approach as secondary access site for TAVI was adopted in our center.

Double-kissing culotte technique for coronary bifurcation stenting.

Aims: The aim of this study was to assess whether the culotte technique could be improved by an additional kissing dilation prior to main branch (MB) stenting.

Methods And Results: Double-kissing (DK) culotte was compared to the culotte and DK-crush techniques in a bench model (n=24). Results were evaluated for stent apposition, luminal opening and flow dynamics.

Management of a Balloon Shaft Fracture During Subintimal Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention Due to In-stent Restenosis.

Balloon shaft fracture can be challenging to treat in the setting of retrograde CTO-PCI with guidewire externalization; withdrawal of the guide catheter may allow successful removal of the balloon shaft fragment.

Serum lipids and cardiac function correlate with nitrotyrosine and MMP activity in coronary artery disease patients.

Aims: Peroxynitrite-matrix metalloproteinase (MMP) signalling has been shown to contribute to myocardial ischaemia/reperfusion injury and heart failure and to be influenced by hyperlipidaemia in preclinical models. Therefore, here we investigated the correlation between the markers of peroxynitrite-MMP signalling and hyperlipidaemia in patients with significant coronary stenosis.

Methods: Five minutes before percutaneous coronary intervention (PCI), arterial blood samples were collected from 36 consecutive patients with coronary artery disease (CAD) selected for elective PCI.

Functional assessment of a left coronary-pulmonary artery fistula by coronary flow reserve.

We report a 71-year-old man who presented with atypical chest pain. Coronary angiography did not reveal left main or proximal left anterior descending coronary artery stenosis, but a fistulous communication with a stronger tube-like fistula was present originating from the proximal left anterior descending coronary artery and emptying into the main pulmonary artery. Fractional flow reserve and coronary flow reserve measurements were performed to gain more data on the potential functional aspects of this fistula.

[Relationship between early myocardial reperfusion assessed by videodensitometry and late left ventricular function. Results following invasive treatment of acute myocardial infarction].

Introduction: It is known that there is a relationship between myocardial perfusion and left ventricular function.

Aim: The aim of the current study was to examine the relationship between myocardial reperfusion as assessed by videodensitometry on coronary angiograms following invasive treatment of ST elevation myocardial infarction and magnetic resonance imaging-derived late left ventricular function.

Method: The study included 25 patients with ST elevation myocardial infarction.

[Aortic valve stenosis is associated with reduced myocardial perfusion as assessed by videodensitometry in coronary angiograms].

Unlabelled: Aortic valve stenosis may be accompanied by angina despite coronary arteries free of significant stenosis due to microvascular abnormalities.

Aims: The aim of the current study was to test whether densitometry-derived myocardial perfusion on coronary angiogram is reduced in patients with aortic valve stenosis.

Methods: The study comprised 20 patients with aortic valve stenosis (mean transvalvular gradient: 47.

Multiple coronary fistulas originating from all major coronary arteries.

Coronary fistulas to one of the cardiac chambers are infrequent anomalies and usually are found unexpectedly. Fistulas communicating between coronary artery and left heart chambers are extremely rare, especially those emptying into the left ventricle. We report a case in which all three major coronary arteries emptied into the left ventricle through multiple microfistulas.

Comparison of two visual angiographic perfusion grades in acute myocardial infarction.

Introduction: Prognosis after opening the obstructed coronary artery in acute myocardial infarction (AMI) is influenced by several factors. In routine clinical practice, revascularization is considered to be successful when the restoration of epicardial blood-flow is complete. However, the patent epicardial artery does not always provide functional recovery in the myocardium.

Five-year experience with transradial coronary angioplasty in ST-segment-elevation myocardial infarction.

Background And Purpose: Percutaneous coronary intervention (PCI) via radial approach has been shown to be an alternative to femoral approach in emergency cases; however, its feasibility has been questioned. This single-center study was performed to compare the outcomes and complication rates between transradial (TR) and transfemoral (TF) PCI in ST-segment-elevation myocardial infarction (STEMI).

Methods And Materials: The clinical and angiographic data of 582 consecutive STEMI patients treated with PCI between 2001 and 2006 were evaluated in a retrospective study.

Myocardium selective densitometric perfusion assessment after acute myocardial infarction.

Background: Myocardial perfusion is an important prognostic factor after recanalisation in acute myocardial infarction patients. We present a computerized, densitometric measurement method to assess myocardial perfusion on phase-matched digitally subtracted coronary angiograms.

Methods And Materials: Quantitative myocardial perfusion was assessed by the G(max)/T(max) parameter of the time-density curves (TDCs) in infarct-related myocardial regions on X-ray coronary angiograms.