Catheterization and Cardiovascular Interventions最新文献

{"title":"Anatomy of Risk: Decoding the Predictors of Vascular Access Complications in Transcatheter Aortic Valve Replacement.","authors":"Hunter T Row, Anyamaria Edwards, Johnathan Beaudrie, Abe Sahmoun, Todd Reil, Thomas Haldis, Cornelius Dyke","doi":"10.1002/ccd.31397","DOIUrl":"https://doi.org/10.1002/ccd.31397","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in valve implantation devices, vascular access complications (VAC) remain a significant cause of morbidity and mortality for those undergoing transcatheter aortic valve replacement (TAVR). We describe pre-operative imaging analysis of the aortoiliac and femoral arterial beds using the TransAtlantic intersociety consensus (TASC) score, ilio-femoral tortuosity, and procedural characteristics to identify anatomic risk factors predictive of VAC in TAVR.</p><p><strong>Methods: </strong>Consecutive patients undergoing TAVR from 2012 to 2022 at a single North Dakota hospital were retrospectively reviewed. Pre-operative computed tomography angiography (CTA) was used for vascular analysis of the infrarenal aorta, iliac, and femoral vascular beds. Wilcoxon signed-rank test was used for non-normally distributed or t-test for normally distributed continuous variables and Chi-square or Fisher's exact tests for categorical variables were utilized to examine the association of each variable with vascular complications.</p><p><strong>Results: </strong>One thousand eighty-nine patients were evaluated with 80 patients identified with VAC. Aortoiliac disease burden of the iliac arteries and posterior wall calcification of the common femoral artery (CFA) were predictive of VAC. Iliofemoral tortuosity and skin to CFA depth were not. Left sided CFA versus right CFA access was associated (p < 0.001). Pretreatment of diseased iliac vessels decreased odds of VAC (OR 0.21, 95% CI, 0.08-0.56).</p><p><strong>Conclusion: </strong>Our study highlights the importance of preoperative peripheral vascular assessment for TAVR. We identify aortoiliac disease burden, posterior CFA calcification, and left sided common femoral access as risk factors for VAC. A structured approach to the preoperative assessment may optimize planning and enhance outcomes in TAVR.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906247","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":"Effect of Guiding Catheter Extubation During Physiological Assesment of Stenosis.","authors":"Salma Raghad Karim, Jelmer Sybren Westra, Laust Dupont Rasmussen, Ashkan Eftekhari, Martin Sejr-Hansen, Simon Winther, Morten Bøttcher, Evald Høj Christiansen","doi":"10.1002/ccd.31370","DOIUrl":"https://doi.org/10.1002/ccd.31370","url":null,"abstract":"<p><strong>Background: </strong>Extubation of the coronary guiding catheter may affect flow and pressure measurements in the coronary vessel during invasive coronary angiography (ICA).</p><p><strong>Aim: </strong>This study aims to investigate the impact of guiding catheter extubation on fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR).</p><p><strong>Methods: </strong>This predefined subgroup analysis of the Dan-NICAD 2 study included patients with chronic coronary syndrome referred to ICA based on a coronary computed tomography angiography. Thermodilution was performed in all vessels evaluated with 30%-90% diameter stenosis on a visual estimate. The primary endpoints were FFR, CFR, and IMR changes when the guiding catheter was extubated from the coronary ostium. Three-dimensional quantitative coronary angiography analysis was conducted to evaluate whether the proximal flow area, defined as the area of the guiding catheter subtracted from the area of the vessel ostium, correlated with the changes in FFR, CFR, and IMR.</p><p><strong>Results: </strong>In 84 patients, coronary physiological measurements were performed twice: once with the guiding catheter intubated and once extubated. FFR decreased during guiding catheter extubation (0.82 ± 0.09 vs. 0.80 ± 0.10) with a mean difference of 0.02, 95% CI [0.01-0.03], p < 0.001. Following extubation, eight patients (8.7%) showed FFR values shifting from > 0.80 to ≤ 0.80. IMR increased during guiding catheter extubation (16.8 ± 8.50 vs. 21.4 ± 16.1) with mean difference of 4.67 [95% CI 1.74-7.60], p = 0.002. No significant changes in CFR were observed; intubated 3.09 ± 1.31 vs 2.84 ± 1.30; difference mean 0.25, [95% CI -0.07 to 0.56], p = 0.12. No significant correlations were found between the proximal flow area and the difference in FFR, CFR, and IMR from intubated to extubated: (r -0.14, p = 0.23), (r -0.11, p = 0.34), and (r -0.16, p = 0.17), respectively.</p><p><strong>Conclusion: </strong>Extubating the guiding catheter decreased FFR and increased IMR. This resulted in an FFR decrease from > 0.80 to ≤ 0.80 in 8.7% of patients. CFR remained unchanged. No significant correlation was found between FFR/IMR changes and proximal flow area.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906254","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":"Steerable Delivery Sheath for Optimized LAA Closure: First Experience and Procedural Outcomes.","authors":"Matthias Mezger, Christina Paitazoglou, Christian Frerker, Thomas Stiermaier, Ingo Eitel","doi":"10.1002/ccd.31390","DOIUrl":"https://doi.org/10.1002/ccd.31390","url":null,"abstract":"<p><strong>Background: </strong>The new Amplatzer Steerable Delivery Sheath is a delivery system designed to improve ease-of-use and procedural results of left atrial appendage closure (LAAC). We aimed to compare procedural results after switching our LAAC program at a tertiary care center with the Amulet device to the Steerable Delivery Sheath, with a control group of LAAC employing the standard sheath.</p><p><strong>Methods: </strong>The first n = 32 consecutively treated patients at our site using the Amulet device with the Steerable Delivery Sheath were included in this retrospective analysis. As a control-group, n = 39 consecutive patients treated with the Amulet device before the switch to the new sheath were used.</p><p><strong>Results: </strong>LAAC was successful in all patients in both groups (100%). Contrast use and fluoroscopy time were numerically higher in the steerable sheath group (steerable sheath vs. control group: contrast use 70 ± 23 vs. 55 ± 50 mL, p = 0.09, fluoroscopy time 12.7 ± 4.6 vs. 10.2 ± 6.6 min, p = 0.3). Fluoroscopy time and dose decreased after 3 months while contrast use remained unchanged. Complete sealing rate was high in both groups (steerable sheath vs. control group 97% vs. 95%, p > 0.9) and periprocedural complication rate was low, without any periprocedural stroke, vascular complications, or death in both cohorts.</p><p><strong>Conclusions: </strong>LAAC with the Amplatzer Amulet steerable delivery sheath is feasible and safe. Fluoroscopy time and dose suggest a learning curve with the new sheath.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906263","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 Plaque Characteristics Assessed by Optical Coherence Tomography and Plasma Lipoprotein(a) Levels in Patients With Acute Coronary Syndrome.","authors":"Francesca Maria Di Muro, Maria Federica Crociani, Giulia Nardi, Niccolo' Ciardetti, Lucrezia Biagiotti, Elisa Bigi, Francesco Meucci, Miroslava Stolcova, Francesca Ristalli, Emanuele Cecchi, Iacopo Muraca, Renato Valenti, Carlo Di Mario, Alessio Mattesini","doi":"10.1002/ccd.31363","DOIUrl":"https://doi.org/10.1002/ccd.31363","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) [Lp(a)] is associated with increased cardiovascular risk, but its influence on plaque characteristics at optical coherence tomography (OCT) evaluation is not fully understood.</p><p><strong>Aims: </strong>This study seeks to explore the impact of Lp(a) levels on plaque morphology as assessed by OCT in a very high-risk subset of patients.</p><p><strong>Methods: </strong>Consecutive patients admitted for acute coronary syndrome (ACS) and undergoing OCT-guided percutaneous coronary intervention (PCI) at a large tertiary care center between 2019 and 2022 were deemed eligible for the current analysis. The overall population was categorized into two subgroups according to baseline Lp(a) levels: (1) lower Lp(a) (Lp(a) ≤ 300 mg/L) and (2) elevated Lp(a) (Lp(a)  <math> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> <annotation>$ge $</annotation></semantics> </math>  300 mg/L). Predictors of lipid-rich plaques were identified using multivariable logistic regression with stepwise selection of candidate covariates.</p><p><strong>Results: </strong>A total of 202 patients were included in this study. OCT findings revealed that patients with elevated Lp(a) had a higher prevalence of lipid-rich plaques, a significantly greater mean lipid arc, along with increased macrophage infiltration and thin-cap fibroatheroma (TCFA). In contrast, calcific plaque prevalence was higher in the lower Lp(a) group. Multivariable regression analysis identified low-density lipoprotein cholesterol ≥ 70 mg/dL, and elevated Lp(a) as strong predictors of lipid-rich plaques at OCT.</p><p><strong>Conclusion: </strong>In this observational study including ACS patients undergoing OCT-guided PCI, those with elevated Lp(a) levels exhibited a higher prevalence of lipid-rich plaques, increased macrophage infiltration, and TCFA, thereby indicating a more vulnerable plaque phenotype. Additionally, elevated Lp(a) levels and LDL-C levels ≥ 70 mg/dL were each independently associated with lipid enrichment of coronary plaques. These findings suggest Lp(a), beyond other well-known risk factors, as a key marker for risk stratification, potentially informing optimal medical management strategies.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892299","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":"Transcatheter Approaches to Atrial Functional Mitral Regurgitation: How Far Have We Come?","authors":"Alberto Preda, Francesca Coppi, Francesco Melillo, Giulio Leo, Davide Margonato, Fabio Alfredo Sgura, Carmine Galdieri, Luca Liberale, Fabrizio Montecucco, Italo Porto, Pietro Ameri, Paolo Di Donna, Eustachio Agricola, Patrizio Mazzone, Francesco Maisano, Cosmo Godino","doi":"10.1002/ccd.31368","DOIUrl":"https://doi.org/10.1002/ccd.31368","url":null,"abstract":"<p><p>Functional mitral regurgitation (MR) is associated with increased cardiovascular morbidity and mortality and over the past decade, the diagnosis of atrial functional mitral regurgitation (aFMR) has been increasingly observed in the elderly, especially in those with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering distinguish the pathophysiology of aFMR from the one of ventricular origin. However, no consensus provides recommendations regarding the differential diagnosis and the subsequent management of aFMR. The advent of transcatheter mitral valve repair has paved the way for various treatments including edge-to-edge repair (TEER), mitral annuloplasty, and replacement, with optimistic results on short-medium-term outcome provided by preliminary studies. In parallel, rhythm control of AF for paroxysmal and persistent types, should be pursued to induce reverse remodeling and restoring the normal leaflet coaptation. In this setting, catheter ablation aiming for electrical isolation of the pulmonary veins is the most widely recognized and effective strategy for maintaining sinus rhythm. Nevertheless, arrhythmia-free survival is lower in patients with persistent and long-term persistent AF, leading to the adoption of hybrid strategies combining transcatheter endocardial ablation and thoracoscopic epicardial surgical ablation. This review provides an update on the diagnosis and treatment of aFMR, focusing on available transcatheter approaches that can be performed in the catheterization lab and electrophysiology lab.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892353","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":"Comparing Real-World Outcomes of Catheter-Directed Thrombolysis and Catheter-Based Thrombectomy in Acute Pulmonary Embolism: A Post PEERLESS Analysis.","authors":"Robert S Zhang, Peter Zhang, Eugene Yuriditsky, Bedros Taslakian, Aaron J Rhee, Allison A Greco, Lindsay Elbaum, Vikramjit Mukherjee, Radu Postelnicu, Nancy E Amoroso, Thomas S Maldonado, Carlos L Alviar, James M Horowitz, Sripal Bangalore","doi":"10.1002/ccd.31386","DOIUrl":"https://doi.org/10.1002/ccd.31386","url":null,"abstract":"<p><strong>Background: </strong>The recently published PEERLESS trial compared catheter-directed thrombolysis (CDT) and catheter-based thrombectomy (CBT) in acute pulmonary embolism (PE). However, it included a low proportion of patients with contraindications to thrombolytic therapy (4.4%), leaving uncertainty about how CDT would perform relative to CBT in a real-world cohort with higher bleeding risk.</p><p><strong>Aims: </strong>This study aims to address this gap by comparing real-world outcomes of CDT and CBT in patients with acute PE.</p><p><strong>Methods: </strong>This retrospective analysis included patients who underwent CDT and CBT at two tertiary care centers from January 2020 to January 2024. The primary outcome was a composite of 30-day mortality, resuscitated cardiac arrest, or hemodynamic decompensation. Secondary outcomes included major bleeding and intracranial hemorrhage (ICH). Inverse probability treatment weighting (IPTW) was used to adjust for baseline variables.</p><p><strong>Results: </strong>A total of 162 (mean age 58 years, 45.7% women, 17.3% high-risk, 28% contraindication to lytics, 28% CDT, 72% CBT) patients were included, with 12.4% patients experiencing the primary outcome. There was no difference in the rates of the primary outcome between CBT versus CDT (11.2% vs. 15.2%, IPTW HR: 0.80; 95% CI: 0.27-2.38, p = 0.69). CBT was associated with a lower risk of hemodynamic decompensation (5% vs. 21.7%, p = 0.036), major bleeding (7.8% vs. 17.4%, IPTW HR 0.26; 95% CI: 0.07-0.95, p = 0.042) and ICH (0 vs. 4.3%, p = 0.024) compared to CDT.</p><p><strong>Conclusion: </strong>Among a real-world cohort of patients with acute PE with higher bleeding risk than PEERLESS undergoing catheter-based therapies, CBT was associated with a lower rate of hemodynamic deterioration, major bleeding, and ICH with similar rate of primary composite outcome when compared with CDT. Additional randomized controlled trials are needed to validate these findings.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892285","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":"Endovascular Treatment of Malfunctioning Dialysis Fistulas: A Multicenter Retrospective Analysis Comparing Transradial and Conventional Transvenous Access.","authors":"Roberto Minici, Massimo Venturini, Federico Fontana, Giuseppe Guzzardi, Federico Torre, Marco Spinetta, Andrea Coppola, Filippo Piacentino, Pasquale Guerriero, Nicola De Rosi, Biagio Apollonio, Marco Franchin, Francesco Giurazza, Luca Brunese, Domenico Laganà","doi":"10.1002/ccd.31349","DOIUrl":"https://doi.org/10.1002/ccd.31349","url":null,"abstract":"<p><strong>Background: </strong>Venous outflow is the favored access for endovascular management of dialysis fistulas. However, transradial access (TRA) offers advantages in specific clinical scenarios. The study aims to compare the efficacy, feasibility, and safety of TRA and transvenous access (TVA) in the endovascular management of malfunctioning dialysis fistulas, addressing the existing gap in comprehensive literature.</p><p><strong>Methods: </strong>A retrospective multi-center analysis included prospectively collected data (January 2021-November 2023) from patients undergoing endovascular management of malfunctioning dialysis fistulas with TRA. Control groups comprised patients with TVA.</p><p><strong>Results: </strong>Of 206 patients, 62 underwent TRA, and 144 underwent TVA. Baseline demographics showed a well-matched distribution. TRA exhibited longer cannulation times but similar procedural and fluoroscopy times. Technical success rates were high for both TRA (98.4%) and TVA (97.2%). Clinical success rates were comparable (96.8% vs. 95.8%). Postprocedure access flow rates and complications demonstrated no significant differences.</p><p><strong>Conclusions: </strong>This study provides the first direct comparison of TRA and TVA in malfunctioning dialytic fistulas. While venous outflow remains the standard vascular access site for managing malfunctioning dialysis fistulas, TRA shows comparable efficacy, safety, and feasibility, making it a viable alternative in specific clinical contexts. Further studies are needed to confirm these findings and to determine the long-term durability of TRA.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892346","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":"Closure of a Late-Onset Iatrogenic Left Ventricular Pseudoaneurysm Caused by Erosion of an Apical Muscular VSD Device.","authors":"Raymond N Haddad, Haytham Bou Houssein, Ahmed Adel Hassan, Mohamed Kasem","doi":"10.1002/ccd.31383","DOIUrl":"https://doi.org/10.1002/ccd.31383","url":null,"abstract":"<p><p>We report the case of a 3-year-old asymptomatic girl (12 kg, 96 cm) who was diagnosed with a large iatrogenic left ventricular pseudoaneurysm (LVP) on follow-up ultrasound, 14 months after apical muscular ventricular septal defect (VSD) closure with a 10 mm Amplatzer Muscular VSD occluder (Abbott, USA) due to device erosion. The LVP was successfully occluded using detachable Penumbra coils, with complete thrombo-exclusion confirmed at 12-month follow-up.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892280","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":"Fractional Flow Reserve Directed Percutaneous Coronary Intervention Optimization Using High-Definition Intravascular Ultrasound in Non-ST-Segment Elevation Acute Coronary Syndrome Versus Chronic Coronary Syndrome.","authors":"Frederik T W Groenland, Tara Neleman, Annemieke C Ziedses des Plantes, Alessandra Scoccia, Isabella Kardys, Wijnand K den Dekker, Jeroen M Wilschut, Roberto Diletti, Nicolas M Van Mieghem, Joost Daemen","doi":"10.1002/ccd.31357","DOIUrl":"https://doi.org/10.1002/ccd.31357","url":null,"abstract":"<p><strong>Background: </strong>Intravascular ultrasound (IVUS)-guided optimization of suboptimal fractional flow reserve (FFR) following percutaneous coronary intervention (PCI) results in a significant increase in both post-PCI FFR and minimal lumen and stent areas (MLA and MSA, respectively). However, the impact of clinical presentation with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) versus chronic coronary syndrome (CCS) on the efficacy of PCI optimization remains unknown.</p><p><strong>Methods: </strong>This was a prespecified subgroup analysis of the FFR REACT trial comparing IVUS-guided PCI optimization versus no further treatment in 291 patients with a post-PCI FFR < 0.90. Post-PCI physiology and pre optimization IVUS findings were compared between patients presenting with NSTE-ACS versus CCS, as well as optimization strategy, final FFR and IVUS findings.</p><p><strong>Results: </strong>Out of 291 patients, 130 (44.7%) presented with NSTE-ACS. Median post-PCI FFR was similar in patients with NSTE-ACS and CCS (0.85 for both, p = 0.55). Pre optimization IVUS findings did not differ significantly between both groups and subsequent optimization strategy was comparable (p = 0.71). In both NSTE-ACS and CCS, optimization resulted in a significant increase (p < 0.01 for all) of similar magnitude in median FFR (0.02 vs. 0.03, p = 0.80), MLA (0.37 vs. 0.50 mm², p = 0.46) and MSA (0.29 vs. 0.32 mm², p = 0.61), respectively. The clinical impact of IVUS-guided optimization on 2-year target vessel failure showed no signs of heterogeneity based on clinical presentation (interaction p = 0.36).</p><p><strong>Conclusions: </strong>In patients undergoing FFR-directed IVUS-guided optimization, post-PCI FFR, pre optimization IVUS findings and optimization strategy did not differ significantly between patients presenting with either NSTE-ACS or CCS, with comparable improvements in FFR, MLA and MSA.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892349","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":"Transcatheter Aortic Valve Implantation in Small and Very Small Aortic Valve Annuli: A Propensity-Matched Analysis Between Self-Expanding Versus Balloon-Expandable Valves","authors":"Tamar Itach,&nbsp;Itamar Loewenstein,&nbsp;David Zahler,&nbsp;Ariel Finkelstein,&nbsp;Israel Barbash,&nbsp;Gabby Elbaz Greener,&nbsp;Hana Assa-Vaknin,&nbsp;Ran Kornowski,&nbsp;Anna Turyan,&nbsp;Arie Steinvil","doi":"10.1002/ccd.31374","DOIUrl":"10.1002/ccd.31374","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The management of Transcatheter Aortic Valve Implantation (TAVI) patients with a small aortic annulus (SAA) postures a substantial challenge, increasing the risk of patient- prosthesis mismatch (PPM) and overall mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to compare the hemodynamic and clinical outcomes of transcatheter balloon-expandable valve (BEV) versus transcatheter self-expandable valve (SEV) in SAA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted propensity score matching (PSM) of severe AS patients with SAA who underwent trans-femoral TAVR and enrolled to the Israeli TAVR registry between the years 2008 and 2023. SAA was defined as an aortic-valve annulus area ≤ 430 mm². Since the BEV used have a smaller size cut-off, an additional analysis on very small aortic annulus (vSAA) as defined as aortic-valve annulus area ≤ 345 mm² was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 1364 consecutive patients with SAA of (BEV <i>n</i> = 485; SEV <i>n </i>= 879) at a mean age of 82 ± 7 years, of whom the vast majority were female (83%). Propensity-matched groups comprised of 329 and 122 paired for the SAA and vSAA patients, respectively. As compared to BEV in the SAA and vSAA analyses, SEV showed lower rates of postprocedural of LBBB (32% vs. 22% and 41% vs. 22%; both <i>p</i> &lt; 0.01, respectively), however, higher rates of major vascular complications (2% vs. 7% and 2% vs. 12%; both <i>p</i> &lt; 0.01, respectively) and major or life-threatening bleeding but only in vSAA group (17% vs. 9.1%, <i>p</i> = 0.009). One-month mortality was higher in the SEV versus BEV in both SAA and vSAA comparisons (2% vs. 0.6%, <i>p</i> = 0.048 and 3% vs. 0%, <i>p</i> = 0.018; respectively). A nonsignificant trend of higher 5-year mortality was observed in univariate models, noted mainly in vSAA patients (22% vs. 19%, <i>p</i> = 0.385; 24% vs. 15%, <i>p</i> = 0.073).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The present analysis observed higher rates of major vascular complications and 1-month mortality in SAA and vSAA treated with SEV. A similar nonsignificant trend toward long-term mortality for the vSAA group was observed and should be evaluated in larger cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"624-632"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881375","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}