Catheterization and Cardiovascular Interventions最新文献

{"title":"Clinical Significance of Coronary Flow Reserve Improvement After Elective Percutaneous Coronary Intervention.","authors":"Yoshihiro Hanyu, Masahiro Hoshino, Eisuke Usui, Tomoyo Sugiyama, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Kai Nogami, Hiroki Ueno, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta","doi":"10.1002/ccd.31500","DOIUrl":"https://doi.org/10.1002/ccd.31500","url":null,"abstract":"<p><strong>Background: </strong>Limited research has explored the prognostic significance of changes in coronary flow velocity reserve (CFVR), as measured by stress-transthoracic Doppler echocardiography (S-TDE), following elective percutaneous coronary intervention (PCI). This study aimed to assess whether post-PCI changes in CFVR are associated with major adverse cardiac events (MACE) and to identify baseline clinical factors that predict improvement of CFVR.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 184 patients who underwent elective FFR-guided PCI for the left anterior descending (LAD) artery. Standard pre-PCI TDE examinations and pre- and post-PCI physiological assessments using S-TDE were performed. Patients were categorized based on CFVR improvement, defined as an increase greater than the median value of CFVR changes. MACE, including all-cause death, myocardial infarction, ischemic stroke, and heart failure requiring hospitalization, was evaluated.</p><p><strong>Results: </strong>The median improvement in CFVR was 0.50 (28.8%). During a median follow-up period of 1.9 years, MACE occurred in 26 patients (14.1%). Patients without CFVR improvement had significantly worse outcomes (p = 0.029). In multivariate Cox regression analysis, both lower pre-PCI CFVR and lack of CFVR improvement were associated with poor prognosis. A multivariate logistic regression analysis identified absence of diabetes, lower pre-PCI FFR, lower pre-PCI CFVR, and longer pre-PCI deceleration time of diastolic coronary flow as predictors of CFVR increase, with an AUC of 0.814 (95% CI: 0.755-0.873).</p><p><strong>Conclusions: </strong>In patients undergoing elective FFR-guided LAD PCI, a lower pre-PCI CFVR and lack of CFVR improvement were associated with poor prognosis, whereas a comprehensive pre-PCI evaluation predicted CFVR improvement.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623550","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":"Long-Term Outcomes After Transcatheter Aortic Valve Replacement Complicated by New-Onset Persistent Left Bundle Branch Block.","authors":"Carmen Hodel, Federico Moccetti, Stephanie Brunner, Valentin Sandoz, Lucca Loretz, Mathias Wolfrum, Stefan Toggweiler","doi":"10.1002/ccd.31491","DOIUrl":"https://doi.org/10.1002/ccd.31491","url":null,"abstract":"<p><strong>Background: </strong>Long-term data on the relevance of new-onset persistent left bundle branch block (pLBBB) after transcatheter aortic valve replacement (TAVR) are sparse. This study aimed to assess the impact of pLBBB that occurs after TAVR on mortality, hospitalisation for heart failure, new permanent pacemaker (PPM) implantation, and left ventricular ejection fraction (LV-EF).</p><p><strong>Aims: </strong>To investigate the impact of pLBBB on long-term outcomes after TAVR.</p><p><strong>Methods: </strong>After exclusion of patients with baseline conduction disorders, a pre-existing PPM, valve-in-valve treatment, or in-hospital mortality, a total of 551 patients were analysed. Patients were divided into two groups (pLBBB and no/transient LBBB) and followed over 5 years.</p><p><strong>Results: </strong>A pLBBB occurred in 85 patients (15%). Patients with pLBBB had a significantly deeper valve implantation (4.0 ± 1.8 mm vs. 3.3 ± 1.8 mm, p < 0.01). pLBBB was associated with an increased risk for hospitalisation for heart failure (HR_adjusted 1.34, 95% CI 1.01-1.76, p = 0.04), whereas all-cause mortality was not elevated. The presence of pLBBB was linked to a significant decline in LV-EF over the follow-up period (58% ± 11% to 55% ± 12%, p = 0.03). There was a trend toward more new PPM implantation but no significant difference (HR_adjusted 1.45, 95% CI 0.96-2.18, p = 0.07). A transient LBBB did not affect the studied outcomes.</p><p><strong>Conclusions: </strong>During long-term follow-up, patients with a pLBBB were more often hospitalised for heart failure, and experienced a significant reduction in LV-EF in comparison to patients with no or only transient LBBB.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623626","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":"Trends and Outcomes Following Percutaneous Coronary Intervention in Patients With Myeloproliferative Neoplasms: Insights From National Database.","authors":"Song Peng Ang, Jia Ee Chia, Chayakrit Krittanawong, Robert N Piana, Kwan Lee, Chadi Ayoub, Jr Exequiel Pineda, David Song, Debabrata Mukherjee","doi":"10.1002/ccd.31489","DOIUrl":"https://doi.org/10.1002/ccd.31489","url":null,"abstract":"<p><strong>Background: </strong>Myeloproliferative neoplasms (MPN) are associated with an increased cardiovascular risk including acute coronary syndrome. However, there is a lack of comprehensive data regarding the rate of percutaneous coronary intervention (PCI), as well as the in-hospital characteristics and outcomes for MPN patients.</p><p><strong>Aims: </strong>We aimed to evaluate the temporal trends and outcomes of PCI among patients with MPN.</p><p><strong>Methods and results: </strong>The National Inpatient Sample database from 2016 to 2020 was queried to identify all PCI hospitalizations. Temporal trends and outcomes of patients with and without MPN following PCI were analyzed. Propensity score matching (PSM) was implemented to compare outcomes between MPN and non-MPN groups. 2,237,210 PCI hospitalizations with 7560 (0.27%) patients with MPN were included in this study. Throughout the study period, the prevalence of MPN among PCI admissions remained stable (p-value for trend = 0.12). Within the MPN subgroup, essential thrombocythemia (ET) was the predominant condition (53.2). Patients with MPN had higher prevalence of cardiovascular comorbidities than non-MPN patients. Following PSM, MPNs were significantly associated with a higher risk of blood transfusions (OR: 1.66, 95% CI: 1.22-2.24, p = 0.001) and AKI (OR: 1.39, 95% CI: 1.17-1.65, p < 0.001). In contrast, the risk of in-hospital mortality (OR: 1.18, 95% CI: 0.83-1.69, p = 0.354 and bleeding (OR: 1.43, 95% CI: 0.90-2.27, p = 0.127) did not significantly differ between the two groups.</p><p><strong>Conclusions: </strong>Our study demonstrated that while the prevalence of MPN among patients undergoing PCI remained stable, those with MPN faced higher risks of bleeding, blood transfusion and acute kidney injury. Further research is warranted to explore the underlying reasons for these increased risks and to improve outcomes in this high-risk group.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623719","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":"A Young Male With SCAD: Challenging Conventional Risk Factors and Insights.","authors":"Namra Khan, Marcus St John","doi":"10.1002/ccd.31499","DOIUrl":"https://doi.org/10.1002/ccd.31499","url":null,"abstract":"<p><p>Spontaneous coronary artery dissection (SCAD) is a relatively rare and underdiagnosed condition that can lead to acute coronary syndrome (ACS), with a notable incidence in young female patients without traditional cardiovascular risk factors. We present an unusual case of SCAD in a young male patient in the absence of common predisposing factors such as fibromuscular dysplasia (FMD), connective tissue disorders, and systemic inflammatory conditions. A 29-year-old man presenting with chest pain was diagnosed with SCAD involving the left anterior descending artery (LAD), resulting in an acute myocardial infarction (MI). Coronary angiography revealed a 100% occlusion, and successful angioplasty and stenting were performed. The patient was started on dual antiplatelet therapy along with other therapeutic approaches. Seven months post-intervention, his ejection fraction improved, and statin therapy was discontinued due to the absence of atherosclerotic disease. SCAD should be suspected in younger patients with ACS-like symptoms in the absence of traditional risk factors. Tailored medical therapy, psychological support, and comprehensive evaluation for underlying causes, such as extracoronary vascular abnormalities (EVAs), are critical to recovery and prevention of recurrence. A multidisciplinary approach, balancing conservative, and interventional strategies is essential for optimizing outcomes in SCAD.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613478","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":"Impact of Post Percutaneous Coronary Intervention Fractional Flow Reserve on 5-Year Clinical Outcomes (The FFR SEARCH Study).","authors":"Frederik T W Groenland, Annemieke C Ziedses des Plantes, Tara Neleman, Alessandra Scoccia, Jari A van der Eijk, Kaneshka Masdjedi, Laurens J C van Zandvoort, Wijnand K den Dekker, Jeroen M Wilschut, Isabella Kardys, Paul Cummins, Roberto Diletti, Nicolas M Van Mieghem, Joost Daemen","doi":"10.1002/ccd.31493","DOIUrl":"https://doi.org/10.1002/ccd.31493","url":null,"abstract":"<p><strong>Background: </strong>Fractional flow reserve (FFR) following percutaneous coronary intervention (PCI) can be used to evaluate procedural success and to guide stent optimization. Several studies have demonstrated that lower FFR after stent implantation is associated with increased adverse event rates up to 2 years. However, the impact of post-PCI FFR on very long-term clinical outcome remains unknown.</p><p><strong>Methods: </strong>The FFR SEARCH study is a single-center, prospective, observational study including consecutive patients undergoing PCI with stent implantation from 2016 to 2017. FFR measurement was performed after angiographically successful PCI using a dedicated microcatheter. The primary endpoint was target vessel failure (TVF) at 5 years, a composite of cardiovascular death, target vessel myocardial infarction and target vessel revascularization. The optimal post-PCI FFR cutoff value to predict 5-year TVF was determined based on the maximum log-rank statistic.</p><p><strong>Results: </strong>Post-PCI FFR measurements were successfully performed in 959 patients. Mean age was 64.0 ± 11.9 years, 72.5% of the patients were male and 33.6% presented with ST-segment elevation myocardial infarction. The left anterior descending artery was the target vessel in 53.5%. The optimal post-PCI FFR cutoff value was ≤ 0.90. TVF occurred in 18.4% of patients with a post-PCI FFR ≤ 0.90 versus 11.6% in patients with a post-PCI FFR > 0.90 (adjusted HR 1.65 (95% CI 1.11-2.48, p = 0.014)).</p><p><strong>Conclusions: </strong>This large prospective observational study demonstrates that post-PCI FFR ≤ 0.90 is associated with a higher TVF rate at 5 years.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613480","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":"Cerebral Protection Devices in Case of Left Sided Intracardiac Thrombus: A Multicentre Experience From the Cath Lab and EP Lab.","authors":"Patrizio Mazzone, Alberto Preda, Giacomo Giovanni Boccuzzi, Andrea Montabone, Andrea Dell'Aquila, Nicolai Fierro, Alessandra Marzi, Andrea Radinovic, Arianna Giannitto, Fabrizio Ugo, Paolo Della Bella, Jan Berg","doi":"10.1002/ccd.31487","DOIUrl":"https://doi.org/10.1002/ccd.31487","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Performing a left atrial appendage occlusion (LAAO) or catheter ablation with left-sided intracardiac thrombus is considered very-high risk for periinterventional stroke. Cerebral embolic protection (CEP) devices are designed to prevent cardioembolic stroke and have been widely studied in TAVR procedures. However, their role in LAAO and catheter ablation of ventricular tachycardia (VT) or in pulmonary vein isolation (PVI) with cardiac thrombus present remains unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;to study utility and safety of CEP devices during LAAO and catheter ablation in patients with left sided intracardiac thrombus in a multicenter setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two different CEP devices were used according to the physician's discretion: (1) a capture device consisting of two filters for the brachiocephalic and left common carotid arteries placed from a radial artery; or (2) a deflection device covering all three supra-aortic vessels placed over a femoral artery. Periprocedural and safety data from 2019 to 2023 were retrospectively obtained from procedural reports and discharge letters for all patients with left-sided intracardiac thrombus undergoing LAAO, VT ablation, or PVI under protection with a CEP device. Long-term safety data were obtained by clinical follow-up in the respective institutions and telephone consultations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixty-five patients were enrolled in five centers in Italy. Fifty-two patients underwent LAA closure, 12 patients underwent VT ablation and one patient underwent PVI. Mean age was 73 ± 10 years and 43 (66%) were male, mean LVEF was 46 ± 13%. The location of the cardiac thrombus was the LAA in all 52 patients (100%) undergoing LAA closure whereas in patients undergoing VT ablation, thrombus was present in the LAA in five cases (42%), left ventricle (n = 6; 50%) and aortic arch (n = 1;8%). One patient developed left atrial thrombus during PVI. The capture device was used in 39 out of 65 (60%) and the deflection device in 26 out of 65 cases (40%). There were no periprocedural strokes or transitory ischemic attacks (TIA). CEP-related complications at the arterial access site were noted in 4 cases (6%) and were minor, not requiring surgery. Other periprocedural events were one transient ST-elevation caused by coronary spasm in a patient undergoing LAA closure, not related to the CEP device. There was one in-hospital death after VT ablation due to cardiogenic shock, not related to the CEP device. At long-term follow-up, one TIA and three non-cardiovascular deaths occurred with a mean follow-up time of 455 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This is the first multicentre experience showing that LAA closure or catheter ablation with cerebral protection in patients with cardiac thrombus is feasible without thromboembolic complications. The possibility of safely performing an intervention in this high-risk setting is promising and should be teste","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603070","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":"Prospective Analysis of the Feasibility of the PASCAL System for Transcatheter Mitral Valve Repair (OneForAll-Registry).","authors":"Katharina Hellhammer, Florian Schindhelm, Matthias Riebisch, Rolf Alexander Janosi, Alexander Y Lind, Matthias Totzeck, Peter Luedike, Tienush Rassaf, Amir Abbas Mahabadi","doi":"10.1002/ccd.31468","DOIUrl":"https://doi.org/10.1002/ccd.31468","url":null,"abstract":"<p><strong>Background: </strong>Mitral valve transcatheter edge-to-edge repair (M-TEER) is increasingly applied in patients with high surgical risk. We aimed to evaluate whether the PASCAL system can be applied in an all-comers cohort irrespective of the underlying anatomy and whether technical features influence therapeutic success.</p><p><strong>Methods: </strong>In this prospective, observational study we enrolled consecutive patients (n = 80) with mitral regurgitation (MR) 3+ and 4+ scheduled for M-TEER. All patients were allocated to be treated with the PASCAL system irrespective of the underlying anatomy. Complexity of mitral valve anatomy was assessed according to the proposed complexity scale and the ESC/EACTS complexity scale. All patients underwent intraprocedural analysis of application of technical features of the PASCAL technology and 1-year follow-up.</p><p><strong>Results: </strong>M-TEER was successful in 98.8% of the patients. Reduction of MR 3+/4+ to MR≤ 2+ was achieved in 92.5%. Independent leaflet grasping was applied in 60.0% of procedures. The median number of grasping attempts was 4.0 ± 3.1 for the first device. Classification in degenerative, functional, or mixed MR did not correlate with procedure time and grasping attempts. In contrast, the presence of complexity criteria was linked with a longer procedure time (p = 0.002) and required more grasping attempts (p = 0.010).</p><p><strong>Conclusions: </strong>M-TEER with the PASCAL technology was possible in 98.8% of consecutive, all-comers patients irrespective of the underlying anatomy. Technical features were applied frequently with increasing application in complex anatomical cases. Classifications taking the anatomical complexity into account rather than the pathophysiological entity of MR seem superior to predict the technical challenges of a M-TEER procedure.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603506","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":"30-Day DAPT in Patients at High Bleeding Risk Undergoing PCI With Biodegradable-Polymer Sirolimus-Eluting Ultra-Thin Stent.","authors":"Andrea Erriquez, David M Leistner, Valeria Paradies, Rita Pavasini, Matteo Serenelli, Gianni Casella, Simone Biscaglia, Christoph Naber, Gianluca Campo, Pieter C Smits","doi":"10.1002/ccd.31481","DOIUrl":"https://doi.org/10.1002/ccd.31481","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence on the safety and efficacy of biodegradable-polymer sirolimus-eluting ultra-thin stent (BP-SES) in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI).</p><p><strong>Aims: </strong>This study aims to evaluate the clinical outcomes of HBR patients treated with BP-SES and ≤ 30-day dual antiplatelet therapy (DAPT) regimen.</p><p><strong>Methods: </strong>A systematic review was conducted to identify relevant studies involving HBR patients who underwent PCI with BP-SES (Supraflex Cruz). Individual patient-level data were extracted from the included studies. The primary endpoint was the composite of cardiovascular death, myocardial infarction, or clinically driven target lesion revascularization at 1-year. The safety endpoint was the 1-year occurrence of Bleeding Academic Research Consortium (BARC) type 3-5.</p><p><strong>Results: </strong>The study population included 1691 patients. Of these, 928 patients (55%) received a ≤ 30-day DAPT, while 763 patients (45%) received a longer DAPT regimen. In the ≤ 30-day DAPT group, primary outcome events occurred in 89 patients (9.5%, 95% CI: 7.7%-11.6%). The upper limit of the one-sided 95% CI of 11.6% was below the pre-specified non-inferiority margin of 14%. There was no significant difference in the primary endpoint between the ≤ 30-day DAPT group and the >30-day DAPT group (propensity score adjusted HR: 0.95, 95% CI: 0.67-3). Notably, the incidence of BARC 3-5 bleeding events was significantly lower in the ≤ 30-day DAPT group.</p><p><strong>Conclusions: </strong>In HBR patients treated with BP-SES, a ≤ 30-day DAPT regimen is associated with a low rate of ischemic events and a significant reduction in major bleeding events.</p><p><strong>Trial registration: </strong>PROSPERO CRD42024524208.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596181","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":"Traditional Versus Dual Lumen Microcatheter-Assisted Parallel Wiring in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry.","authors":"Deniz Mutlu, Dimitrios Strepkos, Ozgur Selim Ser, Pedro E P Carvalho, Michaella Alexandrou, Sandeep Jalli, Lorenzo Azzalini, Luiz Ybarra, Khaldoon Alaswad, Farouc A Jaffer, Rhian Davies, Bavana V Rangan, Yader Sandoval, M Nicholas Burke, Sevket Gorgulu, Emmanouil S Brilakis","doi":"10.1002/ccd.31472","DOIUrl":"https://doi.org/10.1002/ccd.31472","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness and safety of traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.</p><p><strong>Aims: </strong>To compare traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring.</p><p><strong>Methods: </strong>We compared the clinical and angiographic characteristics and outcomes of traditional versus DLMC-assisted parallel wiring after failed antegrade wiring (AW) in a large, multicenter CTO PCI registry.</p><p><strong>Results: </strong>Among 1353 CTO PCIs with failed AW with a single wire, traditional parallel wiring (n = 1081) or DLMC-assisted parallel wiring (n = 272) were utilized at the operator's discretion. The baseline characteristics of patients were similar in both groups except for higher prevalence of diabetes mellitus, and lower prevalence of hypertension, prior heart failure, prior MI and cerebrovascular disease in DLMC patients. Lesions in the DLMC group were more likely to have proximal cap ambiguity, side branch at the proximal cap, blunt/no stump, moderate/severe calcification, and had higher J-CTO score (2.6 ± 1.0 vs. 2.1 ± 1.3, p < 0.001). Technical (87.1% vs. 74.3%, p < 0.001) and procedural (83.8% vs. 75.5%, p = 0.001) success and the incidence of in-hospital major cardiac adverse events (MACE) (4.8% vs. 2.0%, p = 0.020) were higher in the DLMC group. In propensity score matching analysis, DLMC-assisted wiring was associated with higher technical success (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.33-3.54, p = 0.002) and no significant difference in MACE (OR 2.00, 95% CI 0.89-4.50, p = 0.093).</p><p><strong>Conclusions: </strong>In lesions that could not be crossed with AW, DLMC-assisted parallel wiring was associated with a higher likelihood of technical success, without an increased risk of MACE, compared with traditional parallel wiring.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596274","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":"Correlates of Hemodynamic Instability During Non-Emergent Percutaneous Coronary Intervention: Refining High-Risk Criteria for Utilizing Mechanical Circulatory Support.","authors":"Pavan Reddy, Waiel Abusnina, Felipe Quinones, Kalyan R Chitturi, Ilan Merdler, Cheng Zhang, Matteo Cellamare, Itsik Ben-Dor, Nelson Bernardo, Hayder D Hashim, Lowell F Satler, Ron Waksman","doi":"10.1002/ccd.31478","DOIUrl":"https://doi.org/10.1002/ccd.31478","url":null,"abstract":"<p><strong>Background: </strong>Previous studies using high-risk criteria to select patients for mechanical circulatory support (MCS) during percutaneous coronary intervention (PCI) have not consistently shown a benefit in reducing adverse outcomes. Identifying correlates for intra-procedural hemodynamic instability (HI) may improve patient selection for MCS.</p><p><strong>Methods: </strong>Consecutive, hemodynamically stable patients undergoing non-emergent PCI between 2018 and 2022 were reviewed. High-risk patients, defined by left ventricular ejection fraction ≤ 35% with unprotected left main intervention or LVEF ≤ 35% with 3-vessel disease, were compared to the non-high-risk patients. The primary outcome was HI during PCI, a composite outcome defined by the occurrence of death, cardiac arrest, emergent MCS, or the need for sustained vasopressor support.</p><p><strong>Results: </strong>A total of 278 high-risk patients were compared to 2854 non-high-risk patients. The high-risk group was older with more comorbidities and poorer left ventricular ejection fraction (24.7% vs. 51.5%). The occurrence of HI was overall low but occurred more frequently in high-risk patients (4.3% vs. 2.2%, p = 0.025), mostly driven by sustained vasopressor need (75% vs. 66%, p = 0.023). Post-procedural adverse clinical events were more common in the high-risk group, including death (4.7% vs. 0.7%, p < 0.001). A predictive model for intraprocedural HI included: ejection fraction ≤ 25%, left main intervention, and atherectomy (AUC = 0.703), while 3-vessel disease, age and other clinical comorbidities were not strongly associated with HI.</p><p><strong>Conclusion: </strong>The rate of HI during contemporary, non-emergent PCI is very low. While Traditional high-risk PCI criteria are associated with HI, prediction may be improved by including only very low EF, left main intervention and atherectomy. Further studies are needed to evaluate whether utilizing risk factors for HI could be a more effective strategy for selecting patients of MCS during PCI.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572157","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}