Jonathan A Mailey, Patrick Thompson, Paul W Johnston, Colum G Owens
{"title":"A Complex Case of Pregnancy-related Left Main Stem Spontaneous Coronary Artery Dissection.","authors":"Jonathan A Mailey, Patrick Thompson, Paul W Johnston, Colum G Owens","doi":"10.15420/icr.2021.33","DOIUrl":"https://doi.org/10.15420/icr.2021.33","url":null,"abstract":"<p><p>Spontaneous coronary artery dissection (SCAD) is a less common cause of acute coronary syndrome. Pregnancy-related SCAD is uncommon, but often presents with a more severe phenotype. This report describes a 30-year-old woman with an anterior ST elevation MI, presenting 1 day postpartum. Left main stem (LMS) SCAD with extensive intramural haematoma (IMH) and resultant LMS occlusion was confirmed by angiography and intravascular imaging. Given the extent of disease, the patient underwent emergency cardiac surgery. Coronary flow was initially improved by decompressing the IMH using cutting balloons. The coronary wires were successfully left <i>in situ</i> during transfer in an effort to both maintain flow and allow the surgeon to identify true LMS. Ideally, SCAD can be managed conservatively given the risk of intervention worsening IMH, and hence myocardial ischaemia/MI. However, emergency revascularisation is indicated in cases of persistent ischaemia. This case demonstrates percutaneous therapies to bridge towards and help with subsequent surgical revascularisation.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":" ","pages":"e09"},"PeriodicalIF":0.0,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/c4/icr-17-e09.PMC9306263.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40632958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helen Routledge, Andrew Sp Sharp, Jan Kovac, Mark Westwood, Thomas R Keeble, Raj Bathula, Hany Eteiba, Iris Q Grunwald, Nick Curzen
{"title":"Can Interventional Cardiologists Help Deliver the UK Mechanical Thrombectomy Interventional Programme for Patients with Acute Ischaemic Stroke? A Discussion Paper from the British Cardiovascular Interventional Society Stroke Thrombectomy Focus Group.","authors":"Helen Routledge, Andrew Sp Sharp, Jan Kovac, Mark Westwood, Thomas R Keeble, Raj Bathula, Hany Eteiba, Iris Q Grunwald, Nick Curzen","doi":"10.15420/icr.2021.35","DOIUrl":"https://doi.org/10.15420/icr.2021.35","url":null,"abstract":"<p><p>There is a willingness among UK interventional cardiologists to contribute to provision of a 24/7 mechanical thrombectomy (MT) service for all suitable stroke patients if given the appropriate training. This highly effective intervention remains unavailable to the majority of patients who might benefit, partly because there is a limited number of trained specialists. As demonstrated in other countries, interdisciplinary working can be the solution and an opportunity to achieve this is outlined in this article.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":" ","pages":"e07"},"PeriodicalIF":0.0,"publicationDate":"2022-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/ea/icr-17-e07.PMC9214600.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Best Practice in Intravascular Lithotripsy.","authors":"Benjamin Honton, Jacques Monsegu","doi":"10.15420/icr.2021.14","DOIUrl":"https://doi.org/10.15420/icr.2021.14","url":null,"abstract":"<p><p>Intravascular lithotripsy (IVL) is a novel approach to lesion preparation of severely calcified plaques in coronary and peripheral vessels. Lithotripsy is delivered by vaporising fluid to create an expanding bubble that generates sonic pressure waves that interact with arterial calcification. Available data indicate that IVL leads to increased vessel compliance before stent implantation with high efficacy and an excellent safety profile. Since it gained the CE mark in 2017, and with improved operator experience, the use of IVL has expanded into more complex clinical situations. This review focuses on the best practice for IVL use in the cath lab, based on 3 years of experience with the technology and the latest scientific data from the Disrupt CAD clinical trials.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":" ","pages":"e02"},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/ac/icr-17-e02.PMC8826142.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39611698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kush P Patel, Thomas A Treibel, Paul R Scully, Michael Fertleman, Samuel Searle, Daniel Davis, James C Moon, Michael J Mullen
{"title":"Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity.","authors":"Kush P Patel, Thomas A Treibel, Paul R Scully, Michael Fertleman, Samuel Searle, Daniel Davis, James C Moon, Michael J Mullen","doi":"10.15420/icr.2021.15","DOIUrl":"10.15420/icr.2021.15","url":null,"abstract":"<p><p>Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services. Several cardiac and extra-cardiac conditions and frailty increase the risk of mortality despite TAVI. Among the survivors, these comorbidities can inhibit improvements in symptoms and quality of life. However, certain conditions are reversible with TAVI (e.g. functional mitral regurgitation), attenuating the risk and improving outcomes. Quantification of disease severity, identification of reversible factors and a systematic evaluation of frailty can substantially improve risk stratification and outcomes. This review examines the contribution of pre-existing comorbidities towards futility in TAVI and suggests a systematic approach to guide patient evaluation.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":" ","pages":"e01"},"PeriodicalIF":0.2,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/4b/icr-17-e01.PMC8790725.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39579943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan Xinguo Fang, Arthur Sze-Yue Yung, Simon Cheung-Chi Lam, Frankie Chor-Cheung Tam
{"title":"Coronary Intravascular Lithotripsy in a Tight Circumferential Calcified Lesion in the Presence of Haematoma Extending into Left Main Coronary Artery After Rotational Atherectomy.","authors":"Jonathan Xinguo Fang, Arthur Sze-Yue Yung, Simon Cheung-Chi Lam, Frankie Chor-Cheung Tam","doi":"10.15420/icr.2021.18","DOIUrl":"https://doi.org/10.15420/icr.2021.18","url":null,"abstract":"<p><p>Calcified disease increases procedural challenges and is associated with worse outcomes in percutaneous coronary intervention. Coronary intravascular lithotripsy is a new balloon-based modality for treating calcified disease with deep circumferential calcification. Its main benefit is simplicity and safety compared to atherectomy. However, atherectomy remains the modality of choice in balloon-uncrossable lesions. More than one modality is often needed for treatment of calcified disease. The authors present a case of a balloon-uncrossable calcified ostial left circumflex lesion which was first treated with rotational atherectomy. However, there was haematoma formation in the ostial circumflex extending into left main coronary artery, together with suboptimal preparation of calcified disease. Intravascular coronary lithotripsy was then used to successfully prepare the calcified lesion for stenting without causing extension of the haematoma.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"17 ","pages":"e12"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/25/7f/icr-17-e12.PMC10437410.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10405632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Mion, Rupert Simpson, Tom Johnson, Valentino Oriolo, Ellie Gudde, Paul Rees, Tom Quinn, Von Johannes Vopelius-Feldt, Sean Gallagher, Abdul Mozid, Nick Curzen, John Davies, Paul Swindell, Nilesh Pareek, Thomas R Keeble
{"title":"British Cardiovascular Intervention Society Consensus Position Statement on Out-of-hospital Cardiac Arrest 2: Post-discharge Rehabilitation.","authors":"Marco Mion, Rupert Simpson, Tom Johnson, Valentino Oriolo, Ellie Gudde, Paul Rees, Tom Quinn, Von Johannes Vopelius-Feldt, Sean Gallagher, Abdul Mozid, Nick Curzen, John Davies, Paul Swindell, Nilesh Pareek, Thomas R Keeble","doi":"10.15420/icr.2022.08","DOIUrl":"https://doi.org/10.15420/icr.2022.08","url":null,"abstract":"<p><p>Out-of-hospital cardiac arrest (OHCA) is a major public health issue that poses significant challenges both in immediate management and long-term follow-up. Survivors of OHCA often experience a combination of complex medical, physical and psychological needs that have a significant impact on quality of life. Guidelines suggest a multi-dimensional follow-up to address both physical and non-physical domains for survivors. However, it is likely that there is substantial unwarranted variation in provision of services throughout the UK. Currently, there is no nationally agreed model for the follow-up of OHCA survivors and there is an urgent need for a set of standards and guidelines in order to ensure equal access for all. Accordingly, the British Cardiovascular Interventional Society established a multi-disciplinary working group to develop a position statement that summarises the most up-to-date evidence and provides guidance on essential and desirable services for a dedicated follow-up pathway for survivors of OHCA.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"17 ","pages":"e19"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/25/icr-17-e19.PMC9820137.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9085616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effects of High- or Moderate-intensity Rosuvastatin on 1-year Major Adverse Cardiovascular Events Post-percutaneous Coronary Intervention.","authors":"Morteza Chehrevar, Reza Golchin Vafa, Mohammadhossein Rahmani, Mohammadjavad Mehdizadeh Parizi, Amin Ahmadi, Bardia Zamiri, Reza Heydarzadeh, Mohammad Montaseri, Seyed Ali Hosseini, Javad Kojuri","doi":"10.15420/icr.2022.13","DOIUrl":"https://doi.org/10.15420/icr.2022.13","url":null,"abstract":"<p><p><b>Background:</b> Although statins decrease mortality in coronary artery disease, the effect of high-dose statins and duration of therapy post-percutaneous coronary intervention (PCI) is not well addressed. <b>Aim:</b> To determine the effective dose of statin to prevent major adverse cardiovascular events (MACEs), such as acute coronary syndrome, stroke, myocardial infarction, revascularisation and cardiac death, after PCI in patients with chronic coronary syndrome. <b>Methods:</b> In this randomised, double-blind clinical trial, all chronic coronary syndrome patients with a recent history of PCI were randomly divided into two groups after 1 month of high-dose rosuvastatin therapy. Over the next year, the first group received rosuvastatin 5 mg daily (moderate intensity), while the second received rosuvastatin 40 mg daily (high intensity). Participants were evaluated in terms of high-sensitivity C-reactive protein and MACEs. <b>Results:</b> The 582 eligible patients were divided into group 1 (n=295) and group 2 (n=287). There was no significant difference between the two groups in terms of sex, age, hypertension, diabetes, smoking, previous history of PCI or history of coronary artery bypass grafting (p>0.05). There were no statistically significant differences in MACE and high-sensitivity C-reactive protein after 1 year between the two groups (p=0.66). <b>Conclusion:</b> The high-dose group had lower LDL levels. However, given the lack of association between high-intensity statins and MACEs in the first year after PCI among chronic coronary syndrome patients, the use of moderate-intensity statins may be as effective as high-intensity statins, and treatment based on LDL targets may suffice.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"17 ","pages":"e20"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/52/47/icr-17-e20.PMC9987507.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9089966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nilesh Pareek, Paul Rees, Tom Quinn, Johannes Von Vopelius-Feldt, Sean Gallagher, Abdul Mozid, Tom Johnson, Ellie Gudde, Rupert Simpson, Guy Glover, John Davies, Nick Curzen, Thomas R Keeble
{"title":"British Cardiovascular Interventional Society Consensus Position Statement on Out-of-Hospital Cardiac Arrest 1: Pathway of Care.","authors":"Nilesh Pareek, Paul Rees, Tom Quinn, Johannes Von Vopelius-Feldt, Sean Gallagher, Abdul Mozid, Tom Johnson, Ellie Gudde, Rupert Simpson, Guy Glover, John Davies, Nick Curzen, Thomas R Keeble","doi":"10.15420/icr.2022.09","DOIUrl":"https://doi.org/10.15420/icr.2022.09","url":null,"abstract":"<p><p>Out-of-hospital cardiac arrest (OHCA) affects 80,000 patients per year in the UK; despite improvements in care, survival to discharge remains lower than 10%. NHS England and several societies recommend all resuscitated OHCA patients be directly transferred to a cardiac arrest centre (CAC). However, evidence is limited that all patients benefit from transfer to a CAC, and there are significant organisational, logistic and financial implications associated with such change in policies. Furthermore, there is significant variability in interventional cardiovascular practices for OHCA. Accordingly, the British Cardiovascular Interventional Society established a multidisciplinary group to address variability in practice and provide recommendations for the development of cardiac networks. In this position statement, we recommend: the formal establishment of dedicated CACs; a pathway of conveyance to CACs; and interventional practice to standardise our approach. Further research is needed to understand the role of CACs and which interventions benefit patients with OHCA to support wide-scale changes in networks of care across the UK.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"17 ","pages":"e18"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/37/9a/icr-17-e18.PMC9820135.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9099883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erik J Simon, Mary Rodriguez Ziccardi, Saagar Sanghvi, Amer K Ardati
{"title":"Coronary Stent Placement in an Interarterial Anomalous Right Coronary Artery: An Alternative Approach in a Multimorbid High-risk Surgical Patient.","authors":"Erik J Simon, Mary Rodriguez Ziccardi, Saagar Sanghvi, Amer K Ardati","doi":"10.15420/icr.2021.24","DOIUrl":"https://doi.org/10.15420/icr.2021.24","url":null,"abstract":"<p><p>Anomalous aortic origin of a coronary artery is a rare congenital anomaly and potential aetiology for sudden cardiac death. However, the mere presence of this anomaly does not portend clinical significance, and there are many factors that contribute to limiting coronary blood flow in these patients. The standard of care for symptomatic individuals is surgical management with coronary unroofing although not all cases are amenable to surgery. We report the case of an anomalous right coronary artery with interarterial course managed by percutaneous coronary intervention due to surgical contraindication secondary to comorbidities. The proposed mechanism of action culminating in aborted sudden cardiac death is unique and involves aggravated pulmonary hypertension in an individual with severe comorbid pulmonary disease.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"17 ","pages":"e16"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7f/5f/icr-17-e16.PMC9820114.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10540963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammed Shamim Rahman, Ruben de Winter, Alex Nap, Paul Knaapen
{"title":"Advances in the Post-coronary Artery Bypass Graft Management of Occlusive Coronary Artery Disease.","authors":"Mohammed Shamim Rahman, Ruben de Winter, Alex Nap, Paul Knaapen","doi":"10.15420/icr.2021.12","DOIUrl":"10.15420/icr.2021.12","url":null,"abstract":"<p><p>Revascularisation of chronic total occlusion (CTO) represents one of the most challenging aspects of percutaneous coronary intervention, but advances in equipment and an understanding of CTO revascularisation techniques have resulted in considerable improvements in success rates. In patients with prior coronary artery bypass grafting (CABG) surgery, additional challenges are encountered. This article specifically explores these challenges, as well as antegrade methods of CTO crossing. Techniques, equipment that can be used and reference texts are highlighted with the aim of providing potential CTO operators adequate information to tackle additional complexities likely to be encountered in this cohort of patients. This review forms part of a wider series where additional aspects of patients with prior CABG should be factored into decisions and methods of revascularisation.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"16 ","pages":"e33"},"PeriodicalIF":0.2,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/13/icr-16-e33.PMC8785096.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39580613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}