Angioplasty Research Articles

Mapping quality of life after balloon dilatation in subglottic stenosis using Dyspnea index and Short Form Health Survey-36

PurposeAn accurate diagnosis and proper treatment plan are required to restore an adequate patent airway in fibrotic subglottic stenosis (SGS). Currently, the definitive treatment entails single-stage balloon dilatation with steroid injections. The primary aim was to evaluate successful airway restoration and general quality of life in cases with SGS in northern Sweden using robust patient reported outcomes.MethodsAll participants with need of surgical treatment due to SGS that had been referred to the department of otorhinolaryngology, University Hospital of Umeå from September 2020 to August 2023 was included. Exclusion criteria included malignant, extrathoracic or cartilaginous cause, age < 18 years, or incompetent to sign consent documents. We assessed the patient-reported outcome measures pre- as well as 3 months postoperatively.ResultsOf the 40 cases fulfilling the eligibility criteria’s, 33 cases completed the Dyspnea index (DI) and the short form health survey (SF-36) pre- as well as 3 months post-operatively. Receiver operating characteristics showed significant improvement in DI as well as in SF 36 scores post-operatively.ConclusionsEvaluation of balloon dilatation in SGS in this cohort follow-up analysis shows clear improvement in patient quality of life using robust PROM 3 months postoperatively, ensuring the use of a safe and well-tolerated procedure.

Revolutionizing Cardiovascular Frontiers: A Dive Into Cutting-Edge Innovations in Coronary Stent Technology.

Plain balloon angioplasty was the initial method used to enlarge the intracoronary lumen size. However, it was linked to acute coronary closure due to early vessel recoil. This led to the invention of coronary stents, which offer mechanical support to open and maintain the vascular lumen. Nevertheless, the metallic scaffold introduced other issues, such as thrombosis and restenosis caused by neointimal proliferation. To address these concerns, polymers were employed to cover the scaffold, acting as drug reservoirs and regulators for controlled drug release. The use of polymers prevents direct contact between blood and metallic scaffolds. Drugs within the stent were incorporated to inhibit proliferation and expedite endothelialization in the healing process. Despite these advancements, adverse effects still arise due to the inflammatory reaction caused by the polymer material. Consequently, resorbable polymers and scaffolds were later discovered, but they have limitations and are not universally applicable. Various scaffold designs, thicknesses, materials, polymer components, and drugs have their own advantages and complications. Each stent generation has been designed to address the shortcomings of the preceding generation, yet new challenges continue to emerge. Conflicting data regarding the long-term safety and efficacy of coronary stents, especially in the extended follow-up, further complicates the assessment.

Snuffbox distal transradial access (dTRA) for arteriovenous fistuloplasty in Singapore: Going distal is safe.

Arteriovenous fistula (AVF) dysfunction resulting from stenosis or occlusion, is a prevalent issue in end-stage renal failure patients reliant on autogenous AVFs for dialysis. Recently, a distal transradial approach (dTRA) has emerged, offering advantages such as diminished access site complications, better patient comfort and reduced risk of radial artery occlusion. Our study seeks to assess the effectiveness, outcomes and complication rates of employing dTRA for arteriovenous fistuloplasty in Singaporean patients. A retrospective review of all dTRA fistuloplasties performed on dysfunctional or slow to mature AVFs from 2017 to 2023 in our institution was performed. Patients with a distal radial artery measuring 2 mm or more with no evidence of occlusion or thrombosis were included. Patients who required central venoplasty or cutting balloon angioplasty were excluded. Outcome measures included technical success, mean procedure duration, complications and post-intervention primary patency at 1, 3 and 6 months. Patients were followed up for 12 months post-intervention. A total of 37 patients were included. 97.3% of patients undergoing dTRA fistuloplasty had radiocephalic fistulas while 2.7% had brachiobasilic fistulas. There was 100% technical success (defined as success in radial artery cannulation, sheath insertion and crossing of stenotic lesions) in our study as all patients successfully underwent fistuloplasty via dTRA approach. One-month patency rate was 97.4%, 3-month patency rate was 92.1% and 6-month patency rate was 86.8%. There were no immediate complications (haematoma, infection, bleeding, pseudoaneurysm, occlusion) of the radial artery post-intervention. Our paper illustrates the safety and efficacy of utilising dTRA for arteriovenous fistuloplasty. This approach offers distinct benefits in addressing non-mature or dysfunctional distal forearm arteriovenous fistulas and should be taken into account in anatomically suitable cases.

Treatment of intracranial aneurysms with large-diameter (≥5.5 mm) Derivo Embolization Devices, with particular focus on 7 and 8 mm diameter devices.

There are few studies on flow diverters with diameters >5 mm. We present our preliminary experience with the 5.5-8 mm Derivo Embolization Device (DED) implants for the treatment of cerebral aneurysms. A consecutive series of 26 patients (median age: 60 years) treated for 32 aneurysms in 26 procedures was retrospectively analyzed for procedural characteristics, complications, and mid-term angiographic results. The median aneurysm size was 10.5 mm, 2 of 30 (6%) aneurysms were ruptured and 9 (28%) had a fusiform or dissecting morphology. DED implantation was performed in the internal carotid artery in 18 of 26 (69%) procedures and in the vertebrobasilar artery in 8 (31%). Device deployment failed in 1 (4%) procedure. The 7 and 8 mm implants were successfully deployed in 5 cases. Additional balloon angioplasty or stent implantation was performed in 3 (12%) cases to improve wall apposition. Complications included 1 (4%) major stroke and 2 (8%) minor strokes. Angiographic follow up at a mean of 6 months showed complete occlusion in 8 of30 (27%) aneurysms and favorable occlusion in 14 (47%). The use of large diameter DEDs was safe and feasible. The mid-term occlusion rates are acceptable considering the complex subset of aneurysms studied. Further studies are warranted to define the indications for large-diameter DEDs and to evaluate their long-term efficacy.

3D-printed, citrate-based bioresorbable vascular scaffolds for coronary artery angioplasty

Fully bioresorbable vascular scaffolds (BVSs) aim to overcome the limitations of metallic drug-eluting stents (DESs). However, polymer-based BVSs, such as Abbott's Absorb, the only US FDA-approved BVS, have had limited use due to increased strut thickness (157 μm for Absorb), exacerbated tissue inflammation, and increased risk of major cardiac events leading to inferior clinical performance when compared to metallic DESs. Herein we report the development of a drug-eluting BVS (DE-BVS) through the innovative use of a photopolymerizable, citrate-based biomaterial and a high-precision additive manufacturing process. BVS with a clinically relevant strut thickness of 62 μm can be produced in a high-throughput manner, i.e. one BVS per minute, and controlled release of the anti-restenosis drug everolimus can be achieved by engineering the structure of polymer coatings to fabricate drug-eluting BVS. We achieved the successful deployment of BVSs and DE-BVSs in swine coronary arteries using a custom-built balloon catheter and BVS delivery system and confirmed BVS safety and efficacy regarding maintenance of vessel patency for 28 days, observing an inflammation profile for BVS and DE-BVS that was comparable to the commercial XIENCE™ DES (Abbott Vascular).

The durability of filter cap for OT-Balloon catheter, a novel urethral catheter for intermittent balloon catheterization

Objective:The OT-Balloon Catheter is a novel urethral catheter designed for intermittent balloon catheterization. It has a filter permeable to gases but not liquids, enabling patients to confirm adequate catheterization without the flow of urine. This study examined the characteristics of the filter cap for OT-Balloon Catheter by repeatedly exposing filters to urine samples in 2 different conditions. Methods:Urine samples were collected from 10 patients who required clean intermittent catheterization and visited Okayama University Hospital in 2023. Filters of the cap for OT-Balloon Catheter were exposed to urine samples for 30 times under 2 conditions, as follows: condition A, filters were rinsed with running water after exposure to urine; condition B, filters were never rinsed throughout the experiment. The permeability of the filters during and after the exposure was examined. The filter surface was also analyzed by stereomicroscopy. Results:None of the filters were blocked after treatment in condition A. More than 50% of the filters remained permeable after 20 and 30 exposures even in condition B. Long-term storage did not lead to increased rates of blockage. Microscopic examination found minimal urine stains on the surface of filters under condition B. Conclusion:The filter cap for OT-Balloon Catheter was resistant to blockage and maintained permeability after exposure to urine when adequately rinsed, and also when never rinsed after exposure to most samples. The durable permeability of the filter enables patients to achieve rapid, safe, and easy intermittent balloon catheterization.

Impact of Tissue Damage and Hemodynamics on Restenosis Following Percutaneous Transluminal Angioplasty: A Patient-Specific Multiscale Model.

Multiscale agent-based modeling frameworks have recently emerged as promising mechanobiological models to capture the interplay between biomechanical forces, cellular behavior, and molecular pathways underlying restenosis following percutaneous transluminal angioplasty (PTA). However, their applications are mainly limited to idealized scenarios. Herein, a multiscale agent-based modeling framework for investigating restenosis following PTA in a patient-specific superficial femoral artery (SFA) is proposed. The framework replicates the 2-month arterial wall remodeling in response to the PTA-induced injury and altered hemodynamics, by combining three modules: (i) the PTA module, consisting in a finite element structural mechanics simulation of PTA, featuring anisotropic hyperelastic material models coupled with a damage formulation for fibrous soft tissue and the element deletion strategy, providing the arterial wall damage and post-intervention configuration, (ii) the hemodynamics module, quantifying the post-intervention hemodynamics through computational fluid dynamics simulations, and (iii) the tissue remodeling module, based on an agent-based model of cellular dynamics. Two scenarios were explored, considering balloon expansion diameters of 5.2 and 6.2mm. The framework captured PTA-induced arterial tissue lacerations and the post-PTA arterial wall remodeling. This remodeling process involved rapid cellular migration to the PTA-damaged regions, exacerbated cell proliferation and extracellular matrix production, resulting in lumen area reduction up to 1-month follow-up. After this initial reduction, the growth stabilized, due to the resolution of the inflammatory state and changes in hemodynamics. The similarity of the obtained results to clinical observations in treated SFAs suggests the potential of the framework for capturing patient-specific mechanobiological events occurring after PTA intervention.

Nutritional Strategies to Mitigate Complications and Improve Long-Term Functionality of Autologous Arteriovenous Fistula Post Ultrasound and DSA Guided Balloon Dilation

This prospective cohort study evaluated the efficacy of omega-3 fatty acid supplementation on arteriovenous fistula patency and systemic inflammation in 220 hemodialysis patients undergoing ultrasound and digital subtraction angiography-guided balloon dilation. The participants were randomized into an intervention group receiving 2,000 mg of omega-3 fatty acids daily and a placebo group. The primary outcome measures were arteriovenous fistula patency at 12- and 24-months post-dilation, while secondary outcomes included thrombosis incidence, changes in inflammatory markers (c-reactive protein and interleukin-6), lipid profiles, and health-related quality of life (HRQoL). Results indicated a significant improvement in arteriovenous fistula patency in the omega-3 group at 24 months (80.9 vs. 68.2%, P &lt; 0.05). Additionally, there was a significant reduction in thrombosis rates (7.3 vs. 16.4%, P &lt; 0.05) and inflammatory markers (c-reactive protein and interleukin-6) in the omega-3 group compared to the placebo. Lipid profile analysis showed a decrease in total cholesterol and low-density lipoprotein levels with omega-3 supplementation, with significant changes at 12 months (P &lt; 0.05). HRQoL scores also improved significantly in the omega-3 group at both 12 and 24 months (P &lt; 0.05). These findings suggest that omega-3 fatty acids can enhance arteriovenous fistula functionality and reduce cardiovascular risk factors in hemodialysis patients. And its integration into standard care protocols for patients with arteriovenous fistulas would improve long-term outcomes.

BLOOD PRESSURE AND RENAL FUNCTION CHANGES AFTER REVASCULARIZATION OF RENAL ARTERY STENOSIS IN 3 DIFFERENT COHORTS OF PATIENTS

Objective: To analyze the effects at 12 months on blood pressure (BP) and renal function in patients with renal artery stenosis (RAS) undergoing percutaneous transluminal angioplasty (PTA), recruited from 3 different sources (Vascular Surgery Department, Hypertension Unit and Renal Transplantation Department). Design and method: Observational, retrospective study of patients undergoing PTA because of RAS mostly detected when screening patients with peripheral artery disease (G.1, n=20), when studying patients with resistant hypertension or with clinical suspicion of RAS (G.2, n=28) or in kidney transplant patients (G.3, n=21) with renal function impairment and/or elevation of BP. RAS is defined as a reduction of &gt;70% of the renal artery lumen. Results: Sixty-nine patients were analyzed (mean age: 67±12yr, 64% male). Overall, mean±S.D. SBP/DBP (mmHg) was 147.4±20.6 and 75.7±11.8, and the estimated glomerular filtration rate (eGFR) was 48.7±27.0 mL/min/1.73m2. At baseline, G.1 had a higher prevalence of smoking patients (90%) and patients with a history of major vascular events (100%), lower DBP (70.0±9.8 mmHg) and better renal function (eGFR: 62.5±23.2 mL/min/1.73m2), compared to G.2 and G.3. 12-months after PTA, patients in G.2 and G.3 (but not those in G.1) showed a decrease in BP: variation (δ) SBP(mmHg): mean (95%CI)= -18.9 (-26.7 to -11.0) and -20.0 (-29.8 to -10.1), respectively; p&lt;0.001 for both; δDBP (mmHg): mean (95%CI)= -6.6(-10.7 to -2.4),p=0.003 and -6.3 (-11.7 to -0.8), p=0.027. Regarding renal function, it only improved in G.3 group: δeGFR (mL/min/1.73m2): mean (95%CI)= 8.9(1.5 to 16.4),p=0.022, and showed a trend to become worst in G.1 group: -6.5(-13.4 to 0.3),p=0.061. After adjusting for confounding variables, δSBP was associated with baseline SBP (r= -0.709,p&lt;0.001) and the origin group (Rho = -0.362,p = 0.003); δeGFR was associated with baseline eGFR (r= -0.508,p&lt;0.001) and the origin group (Rho= 0.356, p= 0.004). Conclusions: BP decreased 12-months after PTA in patients with suspected RAS because of resistant hypertension. BP and renal function improved after PTA in kidney transplant patients with diagnosis of RAS. Higher BP levels and lower eGFR correlated with better results. Patients with peripheral artery disease screened for RAS showed no change in BP or renal function after PTA.

Predictors of late lumen enlargement after drug-coated balloon angioplasty for de novo coronary lesions.

Late lumen enlargement (LLE) - a positive remodelling phenomenon - after drug-coated balloon (DCB) angioplasty for stable coronary disease contributes to a lower restenosis rate. However, lesion characteristics promoting LLE remain unclear. This study aimed to investigate predictive lesion characteristics for LLE using serial optical frequency domain imaging (OFDI) following DCB angioplasty for de novo coronary artery lesions. This retrospective, single-centre observational study included patients with angina pectoris who underwent paclitaxel-coated balloon angioplasty without stenting under OFDI guidance as well as follow-up OFDI. OFDI endpoints were lumen volume, plaque phenotype, and procedure-associated dissection. LLE was defined as a ≥10% increase in the lumen volume of the treated lesion at follow-up. Between August 2016 and December 2019, among patients with successful DCB angioplasty, 108 lesions (83 patients) had available follow-up imaging after a median of 6.1 months. LLE was detected in 44 (40.7%) lesions. Fibrous/fibrocalcific and layered plaques had significantly larger lumen volumes at follow-up than immediately after the index procedure, whereas lipid plaques exhibited no significant difference. Medial dissection with an arc >90° revealed an increased lumen volume. Multivariate analysis showed that layered plaques (odds ratio [OR] 8.73, 95% confidence interval [CI]: 1.92-39.7; p=0.005) and medial dissection with an arc >90° (OR 4.65, 95% CI: 1.63-13.3; p=0.004) were independent LLE predictors. Layered plaques and extensive medial dissection after DCB angioplasty were associated with higher LLE occurrence in de novo coronary lesions. These findings may be clinically applicable to DCB therapeutic strategies based on plaque features.

Endoscopic treatment of bile duct stones with benign choledochojejunal anastomotic stenosis

Endoscopic interventions for bile duct stones (BDSs) with benign choledochojejunal anastomotic stenosis (bCJS) are challenging. Therefore, we investigated endoscopic interventions for BDSs with bCJS. Seventeen patients with BDSs with bCJS were retrospectively analyzed. Patient characteristics, technical success, adverse events (AEs), and recurrence were evaluated. In 17 patients, the median diameters of the bile duct and BDSs were both 8mm. The median number of BDSs was 3. The technical success rate was 94% (16/17). Ten patients underwent balloon dilation at the choledochojejunal anastomotic site (CAS), the median diameter of balloon dilation was 10.5mm, and waist disappearance was achieved in 2. Six patients had fully covered self-expandable metal stents (FCSEMSs) with a diameter of 10mm placed at the CAS. BDSs were removed after balloon dilation or FCSEMS removal, and 6 of 16 patients were treated with a combination of lithotripsy and 5 with peroral direct cholangioscopy (PDCS). Regarding AEs, perforation at the CAS by balloon dilation occurred in 1 patient. The median follow-up was 3701 days. Nine of 16 patients (56%) had recurrence. The patients treated with a combination of PDCS at BDS removal (P= .022) and waist disappearance at the CAS by balloon dilation (P= .035) had significantly fewer recurrences. Endoscopic interventions for BDSs with bCJS are useful and relatively safe; however, long-term follow-up showed frequent recurrences. Recurrence was common in patients not treated with the combination of PDCS at BDS removal and those without waist disappearance at the CAS by balloon dilation.

Abstract 1140: Contrast-induced Nephropathy Among Hospitalized Patients With Chronic Limb Threatening Ischemia Undergoing Percutaneous Transluminal Angioplasty - A Nationwide Analysis

Introduction: Among patients with chronic limb-threatening ischemia (CTLI) who are not responsive to lifestyle changes and pharmacotherapy, surgical or endovascular treatment are indicated. Contrast-induced nephropathy (CIN) is a known complication of endovascular interventions. In this study, we examine the prevalence of CIN among hospitalized patients with CTLI undergoing percutaneous transluminal angioplasty (PTA). Methods: Using the International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM) diagnosis and procedure codes, we queried the National Inpatient Sample 2016 to 2020 for hospitalizations among patients ≥18 years old with a diagnosis of contrast-induced nephropathy and chronic limb-threatening ischemia and a procedure code for lower extremity PTA. We identified the prevalence of CIN among patients with CTLI undergoing endovascular treatment. Sociodemographic differences were examined among patients with CTLI undergoing PTA with and without CIN. Results: Our study included 500,690 weighted hospitalizations with CTLI, of which 57,020 (11.4%) underwent PTA. CIN was observed among 690 (1.2%) of patients with CTLI and was more common among males compared to females (53.6% vs. 46.4%) Patients with CIN were older compared to those without CIN (mean [SD] age: 70.7 [11.9] vs 68.8 [11.8] years, p=0.06 ). Among hospitalizations for CTLI who underwent PTA, the proportion of patients with CIN was higher than those without CIN for Blacks (28.4% vs. 21.1%) and Hispanics (14.2% vs. 13.2%) but not for Whites (53.0% vs. 60.1%) and Asian/Pacific Islanders (0.8% vs. 1.4%) ( p=0.4 ). CIN was more common among those with Medicaid (65.2%) compared to those with private insurance (17.4%), Medicare (10.1%), and self-pay (2.9%) ( p=0.4 ). Conclusion: Disparities exist in the prevalence of contrast-induced nephropathy among hospitalized patients with chronic limb-threatening ischemia undergoing percutaneous transluminal angioplasty. Results could be used to support future research to examine factors driving these disparities.

Intravascular Ultrasound Use is Associated with Improved Patency in Lower Extremity Peripheral Arterial Interventions

ObjectivesIntravascular ultrasound (IVUS) facilitates detailed visualization of endoluminal anatomy not adequately appreciated on conventional angiography. However, it is unclear if IVUS use improves clinical outcomes of peripheral vascular interventions (PVI) for peripheral arterial disease (PAD). This study aimed to evaluate the impact of IVUS on 1-year outcomes of PVI in the vascular quality initiative (VQI). MethodsThe VQI-PVI modules were reviewed (2016-2020). All patients with available one-year follow up after lower extremity PVI were included and grouped as IVUS-PVI or non-IVUS PVI based on use of IVUS. Propensity matching (1:1) was performed using demographics and comorbidities. One-year major amputation and patency rates were compared. A generalized estimating equation (GEE) model was used to identify predictors of 1-year outcomes. Subgroup analysis based on Trans-Atlantic Inter-Society Consensus (TASC) classification, treatment length and treatment modalities were performed using same modeling approaches. ResultsThere were 56,633 procedures (non-IVUS PVI=55,302 vs IVUS-PVI=1,331) in 44,042 patients. Propensity matching yielded a total cohort of 1,854 patients matched (1:1), with no baseline differences. LER for claudication was performed in 60.4%, while one-third (33.9%) had chronic limb threatening ischemia (CLTI). IVUS was more commonly used for lesions >15cm in length (46.6% vs 43.3%) and for aortoiliac disease (31.8% vs 27.2%). Rates of atherectomy and stenting were significantly higher with IVUS-PVI (21.1% vs 16.8%), while balloon angioplasty was less common (13.5% vs 24.4%). One-year patency was better with IVUS-PVI (97.7% vs 95.2%, p=0.004). On subgroup analysis, IVUS (OR 2.20, 95% CI 1.29- 3.75) was associated with improved patency in CLTI patients, TASC C or D lesions, and treatment length >15cm. Adjunctive IVUS use during PVI did not significantly impact 1-year amputation (OR 1.7, 95%CI 0.78-3.91). On multivariable regression, adjunctive use of IVUS (OR 2.46 95%CI 1.43-4.25) and aortoiliac interventions (OR 2.91, 95%CI 1.09-7.75) were independent predictors of patency. Treatment modalities such as atherectomy, stenting or balloon angioplasty did not significantly impact patency at 1-year. ConclusionIVUS during lower extremity PVI is associated with improved 1-year patency, when compared to angiography alone. Certain subgroups, such as CLTI patients, lesions>15cm, and TASC C or D lesions might benefit from adjunctive use of IVUS.

D-49 | Drug eluting stent (DES) vs Balloon angioplasty (BA) in patients with in-stent restenosis (ISR): A systematic review and Meta Analysis of Randomized Controlled Trials

D-49 | Drug eluting stent (DES) vs Balloon angioplasty (BA) in patients with in-stent restenosis (ISR): A systematic review and Meta Analysis of Randomized Controlled Trials

Abstract 1156: Akkermansia (Strain BAA835) And The Microbial ADP-heptose Pathway Are Associated With Reduced Neointimal Hyperplasia After Arterial Injury

Introduction: Despite advances in surgical therapy for atherosclerosis, up to 50% of procedures such as balloon angioplasty, stenting, and bypass fail due to restenosis from neointimal hyperplasia, a cell proliferative process potentiated by inflammation. We hypothesized that neointimal hyperplasia is associated with a distinct gut microbiome profile and can be modulated by fecal transplantation. Methods: We performed fecal transplantation (FT) of C57BL6 mice using donors with differential microbiome profiles and susceptibility to neointimal hyperplasia (Sprague-Dawley [SD] and Lewis [LE] rats, high and low susceptibility, respectively). In separate experiments, germ-free mice underwent FT using C57BL6 donors with and without Akkermansia muciniphila BAA835 ( Amuc ) prior to arterial injury. Microbial communities were characterized using 16S rRNA gene amplicon and shotgun metagenome sequencing. Arterial and immune effects were assessed using frozen arterial sections, multi-parameter flow cytometry of mesenteric lymph nodes, or multiplex cytokine assays after ex vivo stimulation of whole blood with lipopolysaccharide. Results: Paradoxically, neointimal hyperplasia after injury was 67.7% greater in FT recipients of low- compared to high-susceptibility stools (P=0.01). In fecal communities of both FT recipient groups, relative abundance of A. muciniphila (r=-0.66, P&lt;0.001) and of the ADP-heptose biosynthesis pathway (r=-0.7, P&lt;0.001) were negatively associated with neointimal hyperplasia. A. muciniphila was differentially elevated (P&lt;0.001) in SD compared to LE FT recipients and was the main contributing taxa for the enrichment (P&lt;0.001) of the ADP-heptose biosynthesis pathway in the SD recipient group. In mice colonized with communities that differed only by the presence of Amuc , neointimal hyperplasia was 57.8% greater in the Amuc - group compared to Amuc+ (P=0.01). Amuc+ recipients had lower levels of IL-12, MIP-1beta, and MCP-1 in unstimulated blood and higher IP-10 and MCP-1 levels in stimulated blood. Conclusion: A. muciniphila and microbial ADP-heptose biosynthesis pathway are inversely associated with neointimal hyperplasia and are potential targets for novel microbe-based strategies to mitigate restenosis risk.

Management of high thrombus burden during primary percutaneous coronary intervention

Abstract Managing high thrombus burden during primary percutaneous coronary intervention (PCI) poses significant challenges and is associated with increased procedural complications and adverse clinical outcomes. This abstract reviews current strategies and controversies surrounding the treatment of high thrombus burden in patients undergoing PCI. It discusses pharmacological approaches such as potent antiplatelet agents, glycoprotein IIb/IIIa inhibitors, and novel antithrombotic therapies, alongside mechanical strategies including thrombus aspiration and balloon angioplasty. The importance of individualized treatment based on clinical presentation, thrombus characteristics, and procedural factors is emphasized. Clinical trials and guidelines are reviewed to provide evidence-based recommendations for optimizing outcomes in this complex patient population. Future directions in research and technology aimed at further refining management strategies are also explored.

Real-World Experience and Complications with Intermittent Balloon Catheters : A Predictor Analysis

Intermittent balloon catheterization with a reusable and temporary balloon catheter that could be implanted and removed by the patient was developed in Japan in 1995. Although the intermittent balloon catheter has the potential to improve the patient's quality of life (QOL), appropriate information and guidelines are needed to prevent complications such as hematuria and urinary tract infection. This study aimed to assess the real-world practice, complications, and problems associated with the use of intermittent balloon catheters and provide useful information for future medical care. We conducted a questionnaire survey on patients with spinal cord lesions who currently use or have used intermittent balloon catheters in the past. Seventy-six patients with spinal cord lesions who visited Kanagawa Rehabilitation Hospital from August 2020 to March 2021 and gave consent for participating in this study were included. QOL scores before and after intermittent balloon catheter use showed significant improvement after use. Forty-six of the 76 (61.3%) patients had complications. Overall complications were significantly associated with male sex and possibly linked to non-traumatic spinal cord lesions.

Abstract 2112: Silent Killer: The Rare And Potentially Lethal Right Coronary Artery Aneurysm

Giant coronary artery aneurysms, defined as diameters larger than 20 mm, are exceedingly rare and constitute a life-threatening occurrence. This case involves a patient with a giant right coronary artery (RCA) aneurysm and multivessel coronary artery disease, successfully managed by surgical intervention through quintuple coronary artery bypass grafting (CABG). A 65-year-old male with a history of hypertension presented with acute-onset chest pain. The initial workup revealed an inferolateral ST-segment elevation myocardial infarction (STEMI). The patient underwent emergency coronary angiography revealing a high-grade stenosis in the proximal and mid left anterior descending coronary artery, along with a remarkably tortuous and enlarged mid to distal RCA aneurysm measuring (21mm wide x 20mm long) and featuring significant post aneurysmal stenosis. Attempts at percutaneous angioplasty were unsuccessful due to extensive thrombosis in the RCA. The patient continued to experience active chest pain, necessitating the placement of an intra-aortic balloon pump in the right common femoral artery, the insertion of a temporary pacemaker wire to address bradycardia, and the initiation of pressor support for hypotension. Additionally, intravenous heparin and antiplatelet therapy were administered. Finally, the patient underwent a quintuple CABG to address the multivessel disease. Coronary artery aneurysm is an uncommon yet potentially perilous condition. The selection of appropriate management and intervention is crucial for averting fatal consequences associated with coronary artery aneurysms.

MULTIDRUG RESISTANT DYSLIPIDEMIA: A CASE REPORT

Objective: Recently introduced lipid-lowering agents (PCSK9-i, bempedoic acid) can efficiently treat statin-intolerant patients, who couldn’t reach LDL target before. Nonetheless, there are still cases where the pharmacological management may have strong limitations. Design and method: A 71 year-old woman, with multiple cardiovascular risk factors (diabetes, hypertension and familial dylipidemia, LDL-C 276) underwent heart transplantation for a hypertrophic cardiomyopathy with an evolution towards a dilated phenotype in 2005. Before the transplant, she was on low-dose statin treatment (pravastatin 10 mg/die) that was suspended years later owing to hyper-CKemia (600 U/L), despite her being totally asymptomatic. A second attempt with simvastatin/ezetimibe 40/10 mg resulted again in elevation of CK levels, associated with significant muscular pain. Thus, just ezetimibe was continued. In 2020, 15 years after the transplant, the patient underwent a coronary angiography showing a moderate coronary allograft vasculopathy (ISHLT CAV2). Specifically, a sub occlusive ostial left main coronary artery lesion was treated by percutaneous angioplasty and stent implantation. Since a lower LDL target was needed (LDL-C 55 mg/dL), Results: Alirocumab was introduced. However, 6 months later, no significant LDL levels reduction had been observed. The shift to evolocumab led to the same result, although the patient reported full therapeutic compliance. In the suspicion of anti-drug antibodies development, we opted for Inclisiran without achieving a significant decrease in LDL-C levels. In parallel with the search for genetic mutations in the PCSK9 gene and other genes involved in cholesterol metabolism (including LDLR, APOB, and LDLRAP1 and resulting positive only for common variants in LDLR receptor), therapy with bempedoic acid was initiated, again without substantial benefit (LDL-C 118 mg/dL). Conclusions: Despite cholesterol management has been simplified by the introduction of new drugs, it may still be complex in patients requiring very low LDL-C levels in some specific cases. Drugs with a LDL receptor-independent mechanism of action (e.g., evinacumab) may allow the achievement of therapeutic goals suggested by clinical guidelines.

Continuous heart monitoring to evaluate treatment effects in pulmonary hypertension

BackgroundThe treatment of pulmonary hypertension (PH) has improved rapidly in recent decades. There is increasing evidence to support the role of early intervention and treatment in affecting clinical outcomes in...