Catheterization and Cardiovascular Interventions最新文献

{"title":"Development of machine learning models for fractional flow reserve prediction in angiographically intermediate coronary lesions","authors":"Marco Lombardi MD,&nbsp;Rocco Vergallo MD, PhD,&nbsp;Andrea Costantino MD,&nbsp;Francesco Bianchini MD,&nbsp;Tsunekazu Kakuta MD, PhD,&nbsp;Tomasz Pawlowski MD, PhD,&nbsp;Antonio M. Leone MD, PhD,&nbsp;Gennaro Sardella MD, PhD,&nbsp;Pierfrancesco Agostoni MD, PhD,&nbsp;Jonathan M. Hill MD,&nbsp;Giovanni L. De Maria MD, PhD,&nbsp;Adrian P. Banning MD,&nbsp;Tomasz Roleder MD, PhD,&nbsp;Anouar Belkacemi MD, PhD,&nbsp;Carlo Trani MD,&nbsp;Francesco Burzotta MD, PhD","doi":"10.1002/ccd.31167","DOIUrl":"10.1002/ccd.31167","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fractional flow reserve (FFR) represents the gold standard in guiding the decision to proceed or not with coronary revascularization of angiographically intermediate coronary lesion (AICL). Optical coherence tomography (OCT) allows to carefully characterize coronary plaque morphology and lumen dimensions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We sought to develop machine learning (ML) models based on clinical, angiographic and OCT variables for predicting FFR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from a multicenter, international, pooled analysis of individual patient's level data from published studies assessing FFR and OCT on the same target AICL were collected through a dedicated database to train (<i>n</i> = 351) and validate (<i>n</i> = 151) six two-class supervised ML models employing 25 clinical, angiographic and OCT variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 502 coronary lesions in 489 patients were included. The AUC of the six ML models ranged from 0.71 to 0.78, whereas the measured F1 score was from 0.70 to 0.75. The ML algorithms showed moderate sensitivity (range: 0.68–0.77) and specificity (range: 0.59–0.69) in detecting patients with a positive or negative FFR. In the sensitivity analysis, using 0.75 as FFR cut-off, we found a higher AUC (0.78–0.86) and a similar F1 score (range: 0.63–0.76). Specifically, the six ML models showed a higher specificity (0.71–0.84), with a similar sensitivity (0.58–0.80) with respect to 0.80 cut-off.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ML algorithms derived from clinical, angiographic, and OCT parameters can identify patients with a positive or negative FFR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional closure of an iatrogenic LAA-perforation by means of a PFO-occluder","authors":"Florian Genske MD,&nbsp;Christoph Marquetand MD,&nbsp;Tobias Schmidt MD,&nbsp;Thomas Stiermaier MD,&nbsp;Ingo Eitel MD","doi":"10.1002/ccd.31162","DOIUrl":"10.1002/ccd.31162","url":null,"abstract":"<p>Atrial fibrillation (AF) is the most common rhythm disorder with a high risk for cardioembolic strokes. Interventional occlusion of the left atrial appendage (LAA) is an alternative to the widely established stroke prevention with oral anticoagulation. Complications through LAA closure (LAAC) are rare and usually occur periinterventional. We present a case of an 87-year-old patient who presents for elective LAAC. After placement of the LAA occluder (Amplatzer Amulet device 25 mm) in the LAA and partial resheathing, the patient developed a pericardial effusion (PE), became hemodynamically unstable and went into cardiac arrest with the need for cardiopulmonary resuscitation (CPR). After drainage of the PE, we closed the causative LAA-perforation using a persistent foramen ovale (PFO)-occluder device (Amplatzer Talisman, 25 mm). Thereby we were able to successfully seal the perforation and stabilize the patient. The patient was monitored at our intensive care unit for 2 days and left the hospital in good condition a few days after. Procedural complications during interventional LAAC are rare but can be serious. The most common complication, PE, requires percutaneous drainage and often cardiac surgery. We present a case in which a perforation and following PE with hemodynamic relevance and need for CPR was resolved with an interventional strategy through implantation of a PFO-occluder into the perforation. With this approach we were able to show that in the right setting even serious complications can be treated by interventional measures, thereby not only saving the patient's life, but also avoiding cardiac surgery.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter closure management of mitral paravalvular leakage: A single center experience.","authors":"Yue Li, Ping Jin, Hong Guo, Yu Mao, Yang Liu, Mengen Zhai, Jian Yang","doi":"10.1002/ccd.31135","DOIUrl":"https://doi.org/10.1002/ccd.31135","url":null,"abstract":"<p><strong>Background: </strong>Paravalvular leakage (PVL) is a common complication after artificial valve replacement. Transcatheter paravalvular leak closure (PVT), an efficient, safe, and minimally invasive treatment for PVL patients.</p><p><strong>Aims: </strong>The purpose of this study was to present our experience with transcatheter closure of mitral paravalvular leakage (PVL) after surgical valve replacement in our center.</p><p><strong>Methods: </strong>A cohort of 81 consecutive patients with mitral PVLs was treated with transcatheter closure between September 2014 and December 2022. We reviewed the demographics, clinical features, therapeutic modalities and follow-up results. The patients' charts were used for retrospective analysis.</p><p><strong>Results: </strong>Eighty-one patients from one center were enrolled in this study. The median age of the patients was 63 ± 11 years. The median LVEF was 51% ± 7%, and the median regurgitation volume was 11.5 ± 10.1 mL. Sealing with occlusion was successful in 70 patients, and the technical success rate was 86.5%. The median regurgitation volume was reduced to 1.95 ± 2.6 mL. The major adverse event was hemolysis, which affected 19 patients, 17 of whom required blood transfusion. Three patients required secondary open surgery due to bleeding. Three patients died during the hospital stay, and all of their deaths were caused by hemolysis-related complications. The median hospital stay was 10.3 ± 6.3 days. During the follow-up period, 2 patients died, and none of their deaths were caused by surgery. The New York Heart Association classification increased in all patients during the 6-month follow-up.</p><p><strong>Conclusion: </strong>Transcatheter mitral PVL closure requires complex catheter techniques. However, this technique is minimally invasive and has a shorter hospital stay. Interventional mitral PVL closure is a safe and efficacious technique for high-risk surgical patients with symptomatic paravalvular regurgitation.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of in-hospital outcomes of ST-elevation myocardial infarction patients with cardiogenic shock receiving left ventricular mechanical circulatory support devices based on transfer status","authors":"Mukunthan Murthi MD,&nbsp;Naveen Prasath MD,&nbsp;Anisha Memdani MD,&nbsp;Aniesh Bobba MD,&nbsp;Laith Ali MD,&nbsp;Steve Attanasio MD","doi":"10.1002/ccd.31169","DOIUrl":"10.1002/ccd.31169","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We aimed to compare outcomes in patients who receive on-site left ventricular mechanical support versus those transferred to other facilities for mechanical support in ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed data from the 2016 to 2020 Nationwide Inpatient Sample (NIS) database. We identified patients with STEMI and cardiogenic shock who received Impella and LVAD placement during their hospital stay. They were divided into two groups: those with in-house (direct) placement and those transferred to higher-level medical centers. The primary goal was to compare mortality rates between these groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study, 15,934 (75.2%) received in-house left ventricular support, while 5255 (24.8%) were transferred. Mean age (63 vs. 64 years) and female percentage (25 vs. 26%) were similar. The average time from admission to receiving LV support was 0.8 days for direct group versus 2.8 days for transfer group (<i>p</i> &lt; 0.001). Transferred patients had a higher rate of prior heart failure (68 vs. 79%, <i>p</i> &lt; 0.001) and peripheral vascular disease (10 vs. 14%, <i>p</i> &lt; 0.001) but a lower rate of hypertension (23 vs. 17%, <i>p</i> = 0.003). There were no significant differences in other comorbidities. Primary outcome mortality did not significantly differ (44.9 vs. 44.2, <i>p</i> = 0.66). After multivariate analysis, transferred patients had higher rates of ECMO usage, acute kidney injury, renal replacement therapy, major bleeding, and ischemic stroke. Length of stay (8 vs. 15 days, <i>p</i> &lt; 0.001) and total charges ($391,472 vs. $581,183, <i>p</i> &lt; 0.001) were significantly higher in the transferred group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among STEMI patients with cardiogenic shock, our study found no significant difference in mortality between patients transferred for and those with on-site LV support. Those transferred patients experienced more complications, longer length of stay, and increased hospital costs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual Microcatheter-tip Modification: A bailout option for difficult “tip-in” technique during chronic total occlusion percutaneous coronary intervention","authors":"Vojtěch Novotný PhD,&nbsp;Claudiu Ungureanu MD,&nbsp;Aleš Král PhD,&nbsp;Ivo Varvařovský PhD","doi":"10.1002/ccd.31172","DOIUrl":"10.1002/ccd.31172","url":null,"abstract":"<p>The retrograde approach in chronic total occlusion (CTO) interventions often encounters significant challenges, particularly, when aligning the retrograde microcatheter (MC) with the antegrade system is difficult, complicating or even preventing standard externalization. To address these issues, techniques like the “tip-in” have proven to be effective backup strategies. We introduce the “Manual Microcatheter-tip Modification” (MMM) technique as an alternative when the “tip-in” method faces complications. We present a case of a left anterior descending CTO where MMM was successfully employed for the first time, enabling successful revascularization by manually modifying the MC tip to engage the retrograde guidewire. We explore the technical details within the framework of contemporary CTO PCI. This new technique could enhance the management of CTO interventions, offering innovative solutions when traditional externalization methods are problematic.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary angiography following transcatheter aortic valve replacement: Insights from the SWEDEHEART registry","authors":"Antros Louca MD,&nbsp;Monér Alchay MD,&nbsp;Truls Råmunddal MD, PhD,&nbsp;Araz Rawshani MD, PhD,&nbsp;Henrik Hagström MD, PhD,&nbsp;Magnus Settergren MD, PhD,&nbsp;Konrad Nilsson MD, PhD,&nbsp;Bahira Shahim MD, PhD,&nbsp;Stefan James MD, PhD,&nbsp;Sasha Koul MD, PhD,&nbsp;Anna Myredal MD, PhD,&nbsp;Björn Redfors MD, PhD,&nbsp;Dan Ioanes MD, PhD,&nbsp;Sebastian Völz MD, PhD,&nbsp;Petur Petursson MD, PhD,&nbsp;Oskar Angerås MD, PhD","doi":"10.1002/ccd.31171","DOIUrl":"10.1002/ccd.31171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transcatheter aortic valve replacement (TAVR) is the most common treatment in patients with symptomatic severe aortic stenosis (AS). As concomitant coronary artery disease is common in AS patients, access to the coronary arteries following TAVR is of increasing importance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study evaluated the incidence and risk factors for unplanned coronary angiography following TAVR and, using fluoroscopic time as a surrogate, analyzed the complexity of coronary artery cannulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients who underwent TAVR in Sweden between 2008 and 2022 were identified using the SWEDEHEART registry. The cumulative incidence of coronary angiography after TAVR was analyzed with mortality as a competing risk. Angiography and PCI complexity were analyzed using fluoroscopic time and compared across different transcatheter heart valve designs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 9806 patients, 566 subsequently required coronary angiography. The incidence was highest for three-vessel and/or left main disease. Younger age, the extent of prior coronary artery disease, and peripheral vascular disease were associated with an increased risk of coronary angiography. Fluoroscopy time was increased in TAVR patients compared to the control group with the longest fluoroscopy times observed in cases involving supra-annular and self-expanding valves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence of coronary angiography following TAVR is still low. Younger patients and patients with concomitant coronary artery disease have a higher risk. Procedural time is longer in patients with a previous THV replacement. As TAVR is emerging as the first-line treatment in patients with longer life expectancy, facilitating coronary access is an important factor when considering which THV device to implant</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes after transcatheter mitral valve implantation in valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification","authors":"Hector A. Alvarez-Covarrubias MD, MSc, PhD,&nbsp;Michael Joner MD,&nbsp;Marius Lutz MD,&nbsp;Erion Xhepa MD, PhD,&nbsp;N. Patrick Mayr MD,&nbsp;Mark Lachmann MD,&nbsp;Salvatore Cassese MD, PhD,&nbsp;Tobias Rheude MD,&nbsp;Costanza Pellegrini MD,&nbsp;Sebastian Kufner MD,&nbsp;Heribert Schunkert MD,&nbsp;Adnan Kastrati MD,&nbsp;Magdalena Erlebach MD,&nbsp;Rüdiger Lange MD,&nbsp;Hendrik Ruge MD","doi":"10.1002/ccd.31166","DOIUrl":"10.1002/ccd.31166","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to evaluate transcatheter mitral valve implantation (TMVI) using predominantly balloon-expandable transcatheter heart valves (THV) in patients with a landing zone for a percutaneously delivered prosthesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with a degenerated mitral valve bioprosthesis, annuloplasty ring, and mitral annulus calcification (MAC) considered at high surgical risk currently represent a treatment challenge. TMVI is an alternative treatment option.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective analysis of patients with symptomatic degenerated mitral valve bioprosthesis, or annuloplasty ring, and MAC treated with TMVI between November 2011 and April 2021. Endpoints were defined according to Mitral Valve Academic Research Consortium (MVARC) criteria and included device and procedure success at 30 days as well as mortality at 30 days and 1 year after the procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 77 patients underwent TMVI (valve in valve [ViV = 56], valve in ring [ViR = 11], and valve in MAC [ViMAC = 10]). There was a trend toward higher technical success (all = 93.5%, ViV = 96.4%, ViR = 90.9%, ViMAC = 80%, <i>p</i> = 0.06) and lower 30-day (all = 11.7%, ViV = 10.7%, ViR = 9.1%, ViMAC = 20%, <i>p</i> = 0.49) and 1-year mortality (all = 26%, ViV = 23.2%, ViR = 27.3%, ViMAC= 40%, <i>p</i> = 0.36) after ViV and ViR compared to ViMAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TMVI represents a reasonable treatment option in selected patients with MAC or who are poor candidates for redo mitral valve surgery. Technical success and survival up to 1 year were not significantly dependent on the subgroup in which TMVI was performed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating challenges in drug-coated balloon technology: The saga between paclitaxel and sirolimus continues","authors":"Bernardo Cortese MD,&nbsp;Gabriel Rodrigues Pereira Tensol MD,&nbsp;Luis Augusto Palma Dallan MD,&nbsp;Pedro Rafael Vieira de Oliveira Salerno MD,&nbsp;Aloke Finn MD","doi":"10.1002/ccd.31164","DOIUrl":"10.1002/ccd.31164","url":null,"abstract":"","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the letter, “Residual shunt after patent foramen ovale closure: The devil is in the details!” regarding article “Relationship between patent foramen ovale anatomical features and residual shunt after patent foramen ovale closure”","authors":"Rie Nakayama MD, PhD,&nbsp;Yoichi Takaya MD, PhD,&nbsp;Teiji Akagi MD, PhD,&nbsp;Rika Takemoto RDCS,&nbsp;Madoka Haruna RDCS,&nbsp;Mitsutaka Nakashima MD, PhD,&nbsp;Takashi Miki MD, PhD,&nbsp;Koji Nakagawa MD, PhD,&nbsp;Norihisa Toh MD, PhD,&nbsp;Kazufumi Nakamura MD, PhD,&nbsp;Shinsuke Yuasa MD, PhD","doi":"10.1002/ccd.31163","DOIUrl":"10.1002/ccd.31163","url":null,"abstract":"","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of microcirculatory protection in percutaneous revascularisation: A stent implantation technique and device comparison","authors":"Muhammad Aetesam-ur-Rahman MBBS,&nbsp;Tian X. Zhao PhD,&nbsp;Kitty Paques BSc,&nbsp;Joana Oliveira BSc,&nbsp;Yi-Da Chiu PhD,&nbsp;Melissa Duckworth BSc,&nbsp;Bharat Khialani MPH,&nbsp;Stephen Kyranis MClinEpi,&nbsp;Martin R. Bennett PhD,&nbsp;Nick E. J. West MD,&nbsp;Stephen P. Hoole MD","doi":"10.1002/ccd.31155","DOIUrl":"10.1002/ccd.31155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is prognostically important and may also be a cause of persistent angina. The stent balloon inflation technique or material properties may influence the degree of CMD post-PCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty-six patients with stable angina attending for elective PCI were randomized to either slow drug eluting stent (DES) implantation technique (DES slow group): +2 atm. every 5 s., maintained for a further 30 s or a standard stent implantation technique (DES std group): rapid inflation and deflation. PressureWire X with thermodilution at rest and hyperemia and optical coherence tomography (OCT) were performed pre- and post-PCI. Combined primary endpoints were changes in index of microvascular resistance (delta IMR) and coronary flow reserve (delta CFR) following PCI. The secondary endpoints included differences in cardiac troponin I (delta cTnI) at 6 h post-PCI, Seattle angina questionnaire (SAQ) at 1, 3, 6, and 12 months and OCT measures of stent results immediately post-PCI and at 3 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both groups were well matched, with similar baseline characteristics and OCT-defined plaque characteristics. Delta IMR was significantly better in the DES slow PCI arm with a median difference of −4.14 (95% CI -10.49, −0.39, <i>p</i> = <i>0.04</i>). Delta CFR was also numerically higher with a median difference of 0.47 (95% CI −0.52, 1.31, <i>p</i> = 0.46). This did not translate to improved delta median cTnI (1.5 (34.8) vs. 0 (27.5) ng/L, <i>p</i> = 0.75) or median SAQ score at 3 months, (85 (20) vs. 95 (17.5), <i>p</i> = 0.47).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Slow stent implantation is associated with less CMD after elective PCI in patients with stable angina.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}