Histopathologic Characterization of Chronic Total Occlusions by Directional Atherectomy: The HIPACT Study.

Background: Chronic total occlusions (CTOs) and long lesions have been associated with higher reocclusion rates in femoropopliteal arteries and increased need for revascularization. While several studies have analyzed atherectomy samples, no study to date has correlated the tissue characteristics of CTOs with clinical outcomes. This pilot study assessed lesions in order to predict clinical outcomes based on lesion characteristics.

Facilitated Intravascular Ultrasound-Guided Balloon-Assisted Re-Entry Technique for Complex Lower-Extremity Chronic Total Occlusions: The FIBRE Technique.

Purpose: To examine the efficacy and safety of the facilitated intravascular ultrasound (IVUS)-guided balloon assisted-re-entry (FIBRE) technique in the treatment of complex, chronic total occlusion (CTO) peripheral arterial lesions.

Methods: A retrospective analysis of 150 patients undergoing peripheral intervention for lower extremity CTO was performed from 2014 to 2017 at two institutions. From the selected population, 10 patients with complex CTOs were identified using the FIBRE technique.

Predictors of reduced cardiac index in patients with acute submassive pulmonary embolism.

Objectives: Determine the baseline clinical, laboratory, and echocardiographic values that predict reduced cardiac index (CI) among subjects with acute submassive pulmonary embolism (PE).

Background: Submassive PE represents a large portion of acute PE population and there is controversy regarding optimal treatment strategies for these patients. There is significant heterogeneity within the submassive PE population and further refinement of risk stratification may aid clinical decision-making.

Femoral Artery Chronic Total Occlusion Revascularization (FACTOR) Score and Algorithm: Feasibility and Validation in a Single-Center Study of Femoropopliteal Occlusions.

Objectives: To develop and validate a hybrid algorithm to approach complex superficial femoral artery (SFA) chronic total occlusions (CTOs) in a step-wise fashion.

Background: SFA-CTO represents one of the most challenging subsets of lower-extremity peripheral arterial disease. Depending on lesion characteristics, successful percutaneous crossing of the occluded segment may prove to be very difficult.

Effect of hemostatic device on radial artery occlusion: A randomized comparison of compression devices in the radial hemostasis study.

Background: Asymptomatic radial artery occlusion (RAO) is a major limitation of transradial catheterization (TRC). Two radial compression hemostatic devices are compared for their respective effects on RAO.

Methods: In a prospective, randomized, single center, blinded trial, 320 patients were randomly treated with a TR band (Terumo Corporation) or Safeguard Radial (Merit Medical).

Randomized Comparison of a CrossBoss First Versus Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions: The CrossBoss First Trial.

Objectives: The authors performed a multicenter, randomized-controlled, clinical trial comparing upfront use of the CrossBoss catheter versus antegrade wire escalation for antegrade crossing of coronary chronic total occlusions.

Background: There is equipoise about the optimal initial strategy for crossing coronary chronic total occlusions.

Methods: The primary endpoints were the time required to cross the chronic total occlusion or abort the procedure and the frequency of procedural major adverse cardiovascular events.

The Medusa Multi-Coil Versus Alternative Vascular Plugs for Iliac Artery Aneurysm Embolization (MVP-EMBO) Study.

Transcatheter embolization has evolved from the use of autologous clot as the embolic agent, to stainless-steel coils, to braided-nitinol vascular plugs. However, there are disadvantages to platinum and metal coils, including procedural time, radiation exposure, mass effect, risk of distal embolization, recanalization, imaging artifacts, and cost. Therefore, a large vessel-occluding device is needed to mitigate these current disadvantages.

Intracardiac echocardiography: evolving use in interventional cardiology.

Intracardiac echocardiography (ICE) uses a catheter-based steerable ultrasound probe that is passed into the right heart chambers to image intracardiac structures. The transducer can be variably positioned for optimal imaging: in the inferior vena cava to visualize the abdominal aorta; in the right atrium for the interatrial septum, aortic, mitral, and tricuspid valves, and pulmonary veins; or in the right ventricle for the left ventricular function, outflow tract, or pulmonary artery. Intracardiac echocardiography is primarily used for imaging during an invasive cardiac procedure using conscious sedation, when transthoracic image quality would likely be inadequate, and transesophageal imaging would require general anesthesia.

Regional cardiac tamponade resulting in hypoxia from acute right to left inter-atrial shunting.

Loculated pericardial effusion, as a cause of acute hypoxia, is an unusual finding. Here, we describe the case of a patient who underwent percutaneous coronary intervention, complicated by a localized pericardial hematoma compressing the right atrium, resulting in right to left shunting of blood through a patent foramen ovale and subsequent hypoxia. Evacuation of the hematoma was eventually performed via a pericardial window with resolution of hypoxia.

Purulent pericarditis caused by Haemophilus influenzae type B.

Purulent pericarditis, once a common entity associated with intrathoracic infections, such as pneumonia and empyema, has become an infrequent illness in the post-antibiotic era. Prompt recognition and therapy are vital in improving disease-related mortality. Herein, we describe a rare case of Haemophilus influenzae type B purulent pericarditis and associated cardiac tamponade.