Catheterization and Cardiovascular Interventions最新文献

{"title":"Protocolised Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock in Australia-Initial Experience From a Hub-and-Spoke Model.","authors":"Brendan Backhouse, Fabien Dade, Jason E Bloom, Xiaoman Xiao, Kawa Haji, Yang Yang, Craig French, Dion Stub, Vinodh Nanjayya, Sidney Lo, Michael Chiang, Mir B Basir, William O'Neill, Samer Noaman, Omar Al-Mukhtar, David Kaye, Nicholas Cox, William Chan","doi":"10.1002/ccd.31462","DOIUrl":"https://doi.org/10.1002/ccd.31462","url":null,"abstract":"<p><strong>Background: </strong>Acute myocardial infarction complicated by cardiogenic shock (AMICS) confers short-term mortality of 40%-50%. Protocolised network management of AMICS patients as part of a hub-and-spoke model supported by upstream mechanical circulatory support (MCS) is gaining traction globally to treat AMICS.</p><p><strong>Method: </strong>We conducted a prospective multicenter study in Melbourne, Australia describing our 5-year experience utilizing a protocolised hub-and-spoke model of care for patients with AMICS supported by planned upstream use of Impella CP (Abiomed, Danvers, MA).</p><p><strong>Results: </strong>From December 2019 to August 2024, 31 patients were treated for AMICS with Impella MCS support. Median age was 60 years and 87% were males. ST-elevation myocardial infarction accounted for 84% of presentations, and 29% were complicated by cardiac arrest. The majority of patients treated were in SCAI-CSWG stage D (52%), and stage C (26%) shock. Upstream Impella prior to PCI occurred in 84% of patients. The 30-day survival rate was 74%. An adverse event occurred in 39% of patients. Device-related complications were due to hemolysis (32%) and arrhythmia (3%). Escalation of MCS support was required in five patients (16%). Multivariate analysis identified patients requiring transfer to the hub center prior to revascularisation as an independent predictor of mortality (OR 13.2 [1.34-129.3] p = 0.027).</p><p><strong>Conclusion: </strong>In this first protocolised hub-and-spoke model of care for AMICS supported by planned upstream use of Impella in Australia, 30-day survival was high compared to published historical rates. Patient and device-related complication rates were low. Expansion of the hub-and-spoke model for the treatment of AMICS appears warranted.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467156","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":"Comparative Efficacy and Safety of Low-Dose Direct Oral Anticoagulants Versus Dual Antiplatelet Therapy Following Left Atrial Appendage Occlusion in Patients With Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis.","authors":"Ahmed Ibrahim, Laila Shalabi, Sofian Zreigh, Shrouk Ramadan, Sohaila Mourad, Ghaith Eljadid, Mohammed Beshr, Ali Abdelaziz, Muhammed Elhadi, Pierre Sabouret, Mamas Mamas","doi":"10.1002/ccd.31461","DOIUrl":"https://doi.org/10.1002/ccd.31461","url":null,"abstract":"<p><strong>Background: </strong>Left atrial appendage occlusion (LAAO) is an alternative to chronic oral anticoagulation (OAT) for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients with contraindications to OAT. Postprocedure antithrombotic therapy (ATT) is essential to reduce the risk of device-related thrombosis (DRT), but the optimal regimen remains uncertain.</p><p><strong>Aims: </strong>This study aims to compare the safety and efficacy of low-dose direct oral anticoagulants (DOACs) versus dual antiplatelet therapy (DAPT) following LAAO.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Scopus, Cochrane, and Web of Science was conducted in August 2024. Studies comparing low-dose DOACs and DAPT post-LAAO were included. The primary outcomes were a composite efficacy endpoint (DRT, strokes, and systemic embolism [SE]) and major bleeding events as the safety endpoint. Secondary outcomes included all bleeding events, all-cause mortality, and a composite of efficacy and safety endpoints.</p><p><strong>Results: </strong>Four studies with 727 patients were included. Low-dose DOACs were associated with lower rates of the primary composite efficacy endpoint compared to DAPT (OR = 0.36; 95% CI [0.16, 0.85], p = 0.01). No significant difference in major bleeding events was observed (OR = 0.36; 95% CI [0.11, 1.18]; p = 0.091; I² = 0%). Compared to DAPT, low-dose DOACs were also associated with lower rates of DRT events (OR = 0.36; 95% CI [0.16, 0.79], p = 0.011).</p><p><strong>Conclusion: </strong>Low-dose DOACs effectively reduce thromboembolic events post-LAAO without increasing bleeding risk. These findings support their use as a viable ATT option, but larger trials are needed to confirm optimal regimens.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467186","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":"Optimizing Device Selection in Percutaneous Paravalvular Leak Closure: A Comparative Study of Different Transthoracic and Transesophageal Echocardiographic Techniques.","authors":"Meltem Tekin, Gamze Babur Güler, Mehmet Çiçek, İbrahim Halil Tanboğa, Piotr Pysz, Arda Güler, Ali Rıza Demir, Yusuf Efe, Sezgin Atmaca, Dilara Pay, Ali Kemal Kalkan, Mehmet Ertürk","doi":"10.1002/ccd.31448","DOIUrl":"https://doi.org/10.1002/ccd.31448","url":null,"abstract":"<p><strong>Background: </strong>Clinically significant paravalvular leak (PVL) may complicate both surgical and transcatheter valve implantation. Percutaneous PVL closure (PPVLC) is becoming an increasingly attractive alternative to redo surgery, with demonstrated lower mortality and morbidity rates. Echocardiographic techniques are crucial for accurate diagnosis, defect sizing, and determining the appropriate size of the sealing devices.</p><p><strong>Aims: </strong>There is no consensus on the optimal imaging modality for PVLs. We aimed to compare transthoracic and transesophageal echocardiographic measurements to accurately determine defect size and estimate device size.</p><p><strong>Methods: </strong>We reviewed hospital records to identify patients diagnosed with moderate to severe and severe PVL from 2018 to 2024. A total of 81 patients who underwent PPVLC were evaluated. Eight of these patients were excluded due to unsuccessful PPVLC, leaving 73 patients who were successfully treated. The defect size for all patients was evaluated using 2D transthoracic echocardiography (TTE), 2D transesophageal echocardiography (TEE), direct 3D TEE cropped volume rendering vena contracta (VC) measurement, and 3D TEE multiplanar reconstruction (3D TEE MPR).</p><p><strong>Results: </strong>Among the 73 patients, 42 underwent aortic PPVLC and 31 underwent mitral PPVLC. Proportional odds logistic regression analysis identified 3D TEE MPR measurement as the strongest predictor of device size accuracy, both overall and within the aortic/mitral subgroups. In the mitral subgroup, the predictive power of direct 3D TEE cropped volume rendering VC measurement and 3D TEE MPR measurement were similar. Furthermore, a cut-off value of 7 mm was identified for hemodynamically significant jets as measured by 3D methods.</p><p><strong>Conclusion: </strong>Our findings suggest that using 3D TEE MPR significantly improves the accuracy of device size selection in both mitral and aortic PVL. Additionally, direct 3D TEE cropped volume rendering VC measurement can serve as a viable alternative for patients with mitral PVL.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467151","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":"INtravaScular OptIcal Frequency Domain ImaGing EvaluaTion of the Femoropopliteal Lesion With JETSTREAM Atherectomy (INSIGHT JETSTREAM).","authors":"Koji Kuroda, Amane Kozuki, Kenzo Uzu, Takafumi Todoroki, Masamichi Iwasaki, Junichi Imanishi, Souichiro Yamashita, Wataru Fujimoto, Makoto Takemoto, Mayuka Masuda, Masanori Okuda","doi":"10.1002/ccd.31460","DOIUrl":"https://doi.org/10.1002/ccd.31460","url":null,"abstract":"<p><strong>Background: </strong>There have been no prior reports of detailed evaluations using intravascular imaging during Jetstream treatment.</p><p><strong>Aims: </strong>This study, therefore, aimed to investigate the effects of calcification characteristics and wire bias on lumen gain in Jetstream atherectomy using optical frequency domain imaging (OFDI).</p><p><strong>Methods: </strong>This study enrolled consecutive patients who underwent OFDI-guided Jetstream atherectomy with 1.85 mm, 2.4 mm blade down (BD), and 2.4 mm blade up (BU). Cross-sections were categorized into three groups based on OFDI findings before Jetstream atherectomy: fibrous plaques (FPs), calcified protrusions (CPs), and eruptive calcified nodules (ECNs).</p><p><strong>Results: </strong>Twenty-seven patients (36 limbs) were enrolled, and 1502 cross-sections were serially analyzed. There were 186 FPs, 753 CPs, and 563 ECNs. The acquired lumen gain after all atherectomy steps was significantly larger in the ECNs group than in the CPs and FPs groups. ECNs had the strongest effect on the variability in the lumen gain. In the effect of wire bias on the degree of debulking, a significant correlation was observed between wire distance and lumen gain in 1.85- and 2.4-mm BD atherectomy procedures. However, in the 2.4-mm BU procedure, no significant correlation was recorded.</p><p><strong>Conclusions: </strong>Jetstream atherectomy for ECNs can result in greater lumen gain. In the 1.85- and 2.4-mm BD atherectomy procedures, wire bias may be involved in lumen gain, whereas in the 2.4-mm BU procedure, lumen gain is obtained regardless of wire bias. In Jetstream atherectomy procedures, a detailed assessment using OFDI may contribute to predicting the degree of debulking.</p><p><strong>Trial registration: </strong>UMIN ID: UMIN000054588. https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000061997.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448299","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":"Myocardial Infarction and All-Cause Mortality Following Percutaneous Coronary Intervention Versus Conservative Treatment of Chronic Total Occlusions: A West Denmark Heart Registry Study.","authors":"Marc Meller Søndergaard, Sanna Gunnarstein, Martin Kirk Christensen, Evald Høj Christiansen, Lisette Okkels Jensen, Karsten Tange Veien, Emil Nielsen Holck, Kristian Kragholm, Leif Thuesen, Ashkan Eftekhari","doi":"10.1002/ccd.31454","DOIUrl":"https://doi.org/10.1002/ccd.31454","url":null,"abstract":"<p><strong>Background: </strong>Chronic coronary total occlusions (CTO) represent a therapeutic challenge, and results of randomized clinical trials and observational studies comparing conservative treatment versus percutaneous coronary intervention (PCI) are underpowered.</p><p><strong>Aims: </strong>To assess myocardial infarction (MI) and all-cause mortality in consecutive patients with CTO lesions.</p><p><strong>Methods: </strong>Using data from the West Denmark Heart Registry, patients with chronic coronary syndrome and a 100% occluded vessel by invasive coronary angiography (ICA) were identified. Patients were stratified according to PCI within 90 days. Five-year risk of MI and all-cause mortality was calculated using cause-specific Cox-models and g-formula methods. Subsequently, models were stratified on sex, diabetes, estimated glomerular filtration rate above 60 mL/min, procedure before 2012, and history of cardiac surgery. The risk was calculated for patients who did not experience MI or death within 30 days of the initial ICA.</p><p><strong>Results: </strong>A total of 7675 patients were included in the study, of whom 3129 patients underwent PCI, and 4546 patients were treated conservatively. PCI- and conservatively treated patients had comparable risks of MI (13.1% [95% confidence interval [CI] 12.0%-14.3%] for patients who underwent PCI vs. 13.4% [95% CI 12.4%-13.4%] for patients who received conservative treatment). For all-cause mortality, results were 14.4% (95% CI 13.3%-15.5%) versus 18.9% (95% CI 17.8%-20.0%), respectively. Results were consistent across subgroups. However, CTO-PCI-treated patients with previous heart surgery were at higher risk of MI.</p><p><strong>Conclusions: </strong>Patients who underwent CTO-PCI had a comparable 5-year risk of MI and lower all-cause mortality as compared to conservatively treated patients.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448301","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":"Do We Need to Perform Control Angiography in Patients Undergoing Percutaneous Coronary Intervention After Tirofiban Infusion?","authors":"Gülden Güven, İlyas Çetin, Şevval Kılıç, Şeyma Acaroğlu, Kartal Emre Aslanger, Mehmet Rasih Sonsöz","doi":"10.1002/ccd.31445","DOIUrl":"https://doi.org/10.1002/ccd.31445","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the effect of control imaging after intravenous (IV) tirofiban infusion on the clinical outcome of patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>Patients who underwent PCI between June 2020 and October 2023 at our tertiary referral hospital and received tirofiban infusion were analyzed. Primary composite endpoint was the combination of cardiovascular death, myocardial infarction, cerebrovascular accident, or unplanned revascularization during follow-up.</p><p><strong>Results: </strong>A total of 217 patients (22.6% female, mean age: 58 ± 13 years) with ACS who received IV tirofiban therapy after PCI were compared in three groups: Patients without additional procedure (n = 131), patients undergoing control coronary angiography after index PCI (n = 43), and patients undergoing additional PCI after index PCI (n = 43). The most common reason for clinical intervention was STEMI (65.9%). After approximately 1 year of follow-up, primary composite endpoint of cardiac death, myocardial infarction, cerebrovascular accident, or unplanned revascularization was similar in all groups (30 [22.9%] vs. 15 [35%] vs. 12 [28%], p = 0.290).</p><p><strong>Conclusion: </strong>Repeat coronary angiography and additional PCI after tirofiban infusion in patients undergoing index PCI were associated with similar cardiovascular outcomes at 1-year follow-up compared with no repeat coronary angiography.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439878","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":"Optimizing Stent Placement in Ostial Coronary Lesions With the Floating Balloon Technique: The OSTIAL (Optimizing Stent In Aorto-Ostial Lesion) Pivotal Study","authors":"Franck Digne,&nbsp;Arthur Darmon,&nbsp;Salim Belguidoum,&nbsp;Mohammed Nejjari,&nbsp;Jacques Feignoux","doi":"10.1002/ccd.31449","DOIUrl":"10.1002/ccd.31449","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Managing aorto-ostial coronary lesions during percutaneous coronary interventions (PCI) presents significant challenges due to complex anatomy, catheter instability, and risks of stent misplacement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The OSTIAL pivotal study aimed to assess the feasibility and precision of the floating balloon technique for optimizing stent placement in aorto-ostial lesions (AOL), with post-procedural coronary computed tomography angiography (CCTA) used to evaluate stent positioning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, dual-center observational study included 12 patients undergoing PCI for AOL using the floating balloon technique. The technique stabilizes the guiding catheter by positioning a balloon in the aorta, thereby defining the aorto-ostial landing zone (AOLZ) for precise stent placement. Post-procedural CCTA were systematically performed to assess the positioning of the stent. The primary outcome was technical success including optimal stent placement within the AOLZ and proximal anatomy-dependent geographic miss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The primary outcome was achieved in 83% of cases, with 66% showing complete AOLZ coverage and 17% classified as a proximal anatomy-dependent geographic miss. Proximal procedure-dependent geographic miss occurred in only 17% of cases, with limited stent protrusion into the aorta (2.3 and 2.9 mm).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The floating balloon technique demonstrated feasibility and precision in optimizing stent placement in AOL, as assessed by CCTA. It offers a promising, cost-effective, and practical alternative to other techniques. Larger studies are required to confirm its efficacy and long-term benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1269-1277"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439883","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":"First Application of Combined Cutting Balloon and Rotational Atherectomy and Intravascular Lithotripsy in Old Degenerated Saphenous Venous Graft","authors":"Ayman Helal,&nbsp;Aaysha Cader,&nbsp;Simon Hetherington,&nbsp;Kai Hogrefe","doi":"10.1002/ccd.31455","DOIUrl":"10.1002/ccd.31455","url":null,"abstract":"<div>\u0000 \u0000 <p>Saphenous venous grafts (SVGs) are prone to progressive degeneration, leading to complex calcified lesions, which present a therapeutic challenge during percutaneous coronary interventions (PCI). Calcium modification techniques such as cutting balloons, intravascular lithotripsy (IVL), and rotational atherectomy have been employed in native coronary arteries; however, the use of rotational atherectomy in SVGs is controversial. This case report presents a novel approach where calcium modification techniques were successfully used to treat calcified stenosis in 30 years old SVG. The case demonstrates safe and effective use of rotational atherectomy in an SVG, possibly making it the first documented application of this technique in such a context. The report explores the rationale, procedural details, and potential risks of this approach, supported by a review of the existing literature.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1260-1264"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439882","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":"Overcoming Uncrossable Calcified RCA Using Orbital Atherectomy After Failure of Rotational Atherectomy","authors":"Ayman Helal,&nbsp;Javed Ehtisham,&nbsp;Naeem Shaukat","doi":"10.1002/ccd.31463","DOIUrl":"10.1002/ccd.31463","url":null,"abstract":"<div>\u0000 \u0000 <p>Severe calcified lesions in the coronary arteries often pose significant challenges for successful percutaneous coronary interventions. In this case, a 78-year-old woman presented with severe calcific disease in the right coronary artery and underwent two sequential interventions. The initial procedure involved rotational atherectomy but failed to fully cross the lesion. The procedure was complicated by an ostial dissection that was treated by stent. Subsequently, orbital atherectomy was employed, successfully crossing the lesion through a newly deployed ostial stent. Additionally, upfront intracoronary adenosine was administered to prevent no-reflow, achieving optimal procedural outcomes. This case highlights the utility of orbital atherectomy as a rescue technique after failed rotational atherectomy and the effectiveness of proactive pharmacological intervention for no-reflow prevention. To our knowledge there were no case reports addressing successful orbital atherectomy following failed rotational atherectomy.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1265-1268"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439929","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 of Stent-Less Strategy Using Directional Coronary Atherectomy for the Ostial Left Circumflex Artery","authors":"Hidenari Matsumura,&nbsp;Kenichiro shimoji","doi":"10.1002/ccd.31450","DOIUrl":"10.1002/ccd.31450","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Long-term outcomes of percutaneous coronary intervention (PCI) for left circumflex artery (LCX) ostial lesions remain suboptimal. While a stent-less strategy using directional coronary atherectomy (DCA) and drug-eluting balloon (DEB) may offer a potential solution, no studies have reported on its long-term outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aims to evaluate the long-term outcomes of a stent-less PCI strategy using DCA and DEB for LCX ostial lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed consecutive patients treated for LCX ostial lesions with DCA to reduce plaque area to &lt; 60%, followed by DEB angioplasty, at Saiseikai Utsunomiya Hospital, Tochigi, Japan, between January 2019 and January 2024. The primary endpoint was clinically driven target lesion revascularization. Secondary endpoints included major adverse cardiac events, defined as a composite of cardiac death, myocardial infarction (MI), and ischemia-driven target vessel revascularization, as well as bleeding complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten patients were included, five of whom had diabetes mellitus. A total of 80% had concomitant left main trunk (LMT) to left anterior descending artery (LAD) lesions; 60% underwent crossover stenting for LMT-LAD after LCX DCA, while two were treated with DCA and DEB for both LCX and LMT-LAD. All patients underwent follow-up using coronary computed tomography or angiography, with a follow-up period ranging from 8 to 56 months (median: 22 months, IQR: 21.7). TLR occurred in one patient (10%). No cases of cardiac death, MI, or bleeding complications were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DCA followed by DEB demonstrated favorable long-term outcomes for LCX ostial lesions, providing a viable alternative to conventional stent-based PCI strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1255-1259"},"PeriodicalIF":2.1,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413448","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}