Balloon Profile Research Articles

Antegrade Wire Tracking of the Retrograde Tract (ATRT): A Novel Technique for Percutaneous Coronary Intervention for Chronic Total Occlusion.

Chronic total occlusion (CTO) lesions are the most challenging subset of coronary lesions. For lesions with a failed antegrade approach, the initial retrograde, followed by a combined retrograde and antegrade approach, remains the mainstay of therapy. The study evaluated a technique of initial retrograde followed by an antegrade approach to treat lesions with a failed antegrade approach. We have adopted this technique to treat 31 CTO lesions with a failed antegrade approach, where a floppy wire was advanced antegrade through the tract created by a retrograde balloon advanced over the retrograde wire (antegrade wire tracking of the retrograde tract (ATRT)), which was advanced into the aorta retrogradely. In 31 patients with failed antegrade approaches, the ATRT technique was tried, which was successful in 25 patients (the success rate was 80.6%). There was a failure to cross the microchannel in four patients, although angiographically, it looked promising. In two patients, it was impossible to advance the microcatheter or the smallest profile balloon retrogradely until the entire length of the CTO body. So, a reverse controlled antegrade and retrograde subintimal tracking (CART) was performed on these two patients excluded from the study. ATRT is a useful technique for CTO percutaneous coronary intervention (PCI) for patients with failed antegrade approaches with acceptable success rates. The procedure is safe in terms of procedural complications.

Exploring indicators of success in chronic total occlusion percutaneous coronary intervention with Stingray system-based antegrade dissection re-entry: Insights from retrospective analysis.

The predictors of success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) through antegrade dissection and re-entry (ADR) using the Stingray system (Stingray ADR) remain elusive, mainly owing to the lack of consecutive angiographic and procedural records of patients. This study aimed to identify indicators that can determine the success of CTO PCI performed using the Stingray ADR technique. The clinical data of 115 patients who underwent CTO PCI through Stingray ADR at the same cardiac center were retrospectively and consecutively collected. Multivariate logistic regression analysis was performed to investigate the indicators of the success of ADR attempts. The technical success rate of Stingray ADR in CTO PCI was 72.2%. The overall technical success rate of CTO recanalization was 78.3% in all CTO PCIs having used Stingray Low Profile balloon. Vessel calcification (odds ratio [OR]: 4.03; 95% confidence interval [CI]: 1.49-11.88; p = 0.008), and retrograde puncture indicator (OR: 4.89; 95% CI: 1.51-17.11; p = 0.009) were identified as independent positive predictors. Blunt/no stump proximal to the occlusion segment (OR: 0.22; 95% CI: 0.06-0.64; p = 0.009), decision time before Stingray ADR (per 1 h increase) (OR: 0.54; 95% CI: 0.31-0.92; p = 0.026), operation duration of Stingray ADR (per 10 min increase) (OR: 0.62; 95% CI: 0.40-0.94; p = 0.028), and puncture site at the intraplaque region (OR: 0.24; 95% CI: 0.06-0.84; p = 0.026) were identified as the four negative independent predictors. This study revealed independent predictors of the success of CTO PCI performed using the Stingray ADR technique. As for CTO characteristics, the presence of calcification in the CTO segment and a tapered stump proximal to the lesion site can facilitate successful Stingray ADR. As for the procedures, the success rate of Stingray ADR can be improved by initiating the technique decisively and promptly, operating the system quickly and accurately and creating a puncture in the distal cap region of CTO under retrograde guidance.

Rescue Balloon Aortic Valvuloplasty for Malignant Ventricular Arrhythmias and Cardiogenic Shock

Introduction: Severe Calcific Aortic Stenosis (AS) remains a major cause of morbidity and mortality in aged population. Asymptomatic with reduced LVEF has high risk of sudden death. Aim: To study the complexity of clinical course of Severe Calcific AS with LV Dysfunction. Case Report: A Seventy-Six-year-old male was admitted with ACS, NSTEMI, LVEF 35% and Severe Calcific AS. With plan of AVR, CAG was done and showed Mild CAD. Post-procedure he had sequence of catastrophic clinical events that includes, A systolic Cardiac Arrest (reverted after CPR) and Protracted Pulmonary edema (Connected to Mechanical Ventilation). Later had Malignant Ventricular Arrhythmias, treated with 34 times DC Shocks. He was not suitable for Surgical AVR or TAVI. After high-risk consent, he successfully underwent emergency Aortic Balloon Valvuloplasty (ABV) with significant drop in AV gradients. Post ABV, also had Paroxysmal AF. Arrhythmias were also treated with Beta blocker, Antiarrhythmics, Digoxin and Potassium supplementation. Gradually stabilized, discharged and followed up. Discussion: Aortic stenosis, a disease of elderly age group. Symptomatology varies widely. It has limited management options. In our case, Post CAG critical illness was probably due to “Pre -CAG” LV dysfunction with subclinical symptoms. ABV used as bail out the procedure in high-risk patients. Conclusion: ABV is considered as a viable palliative option, with the introduction of smaller profile balloons, rapid pacing and vascular closure devices. ABV can safely used as bridging procedure before Surgical AVR or TAVI in high-risk patients

An improved dynamic model and numerical simulation of yarn in the ring spinning system

The nonlinear dynamic behavior of ballooning yarn in the ring spinning system is investigated. An improved dynamic model of ballooning yarn with axial conveying speed is established. Based on Hamilton’s law of variation principle, the three-dimensional dynamic differential equations are derived. Then, the shooting method is employed to solve the two-point boundary value problem of ordinary differential equations. The numerical results of balloon profiles and distribution tension curves of ballooning yarns are discussed. The numerical results imply that with the increase of Ω, the yarn conveying speed increases, the minimum tension at the guide eye increases, and the helical loops of the balloon profile decrease. It is also found that as Ω increases, the spatial area of the guide eye tension [Formula: see text] that forms the dynamic balloon decreases. When the yarn conveying speed is medium or high, under different tensions at the guide eye, the yarn tensions along the height direction of the balloon change in the same trend, and the tensions of the ballooning yarn at the same height are very close. In addition, with the increase of Ω, the distribution tension of the ballooning yarn changes significantly under the same guide eye tension.

C82 PROCEDURES AND DEVICES FOR CALCIUM TREATMENT IN AN INCREASINGLY COMMON SCENARIO: YOUNG ONCOLOGIC PATIENTS

Abstract Background Cardiovascular disease and cancer have a high prevalence in Western countries, sharing many risk factors: obesity, diabetes, cigarette smoking, advanced age, diet and sedentary lifestyle. There is growing evidence that patients with ischemic heart disease (CAD) have a higher risk of developing cancer and, conversely, patients with a history of cancer are exposed to a higher incidence of CAD. In particular, cancer and its related therapies may promote the process of atherosclerosis, often with high calcific burden. Case Report This is a case of a 58 years old gentleman with a past smoking habit. Unfortunately from 2019 he was diagnosed by a stage IV lung adenocarcinoma, actually in 3rd line therapy: Carboplatin–Alimta, Atezolizumab and Paclitaxel weekly; no metastatic localizations was found at follow up CT scan. Last July, the patient complained of breath fatigue during exertion. At a complete cardiologic examination EKG was normal, and severe aortic stenosis was detected with concentric left ventricular hypertrophy, preserved ejection fraction. At CT scan, the aortic valve was confirmed as bicuspid Sievers type 0 (Figure 1, panel A). Vmax was 5.49 cm/s, max gradient was up to 120 mmHg, and medium gradient was 67 mmHg, as shown in Figure 1, panel B. Coronary angiography showed a very severe, focal, concentric calcific lesion of the left anterior descendant branch (Figure 2, Panel A). The patient was then referred to our local Heart Team and due to his oncological condition with prognosis >12 months, we decided to treat him percoutaneously. Aortic stenosis was treated Transcatheter Aortic Valve Implantation (TAVI) a few days later: predilatation, implant of a with a balloon–expandable valve Edwards Sapien 3 n°23 and post–dilatation, by femoral access (Figure 2, four steps of TAVI). Coronary lesion was uncrossable with the lowest profile balloons, so rotatripsy was perfomed: rotational atherectomy followed by 40 pulses of lithotripsy with Shockwave (Figure 2, Panel B and C). Everolimus eluting stent 3.00 x 23 mm was implanted and optimized (Figure 2, Panel D). Conclusion Recent devices and techniques in Invasive Cardiology allow percutaneous therapies for patients with time–dependent diseases, such as patients with advanced lung adenocarcinoma. Lately, oncological therapies for this type of lung cancer are very promising, allowing the combination of interventional procedures capable of further increasing the prognosis of these patients.

Effect of coarctation of aorta anatomy and balloon profile on the outcome of balloon angioplasty in infantile coarctation

ObjectiveCoarctation of the Aorta (CoA) is a relatively common cardiovascular disorder. The present study aimed to evaluate the effect of COA anatomy and high versus low-pressure balloons on the outcome of balloon angioplasty among neonates and infants.MethodsIn this retrospective study, the neonates and infants undergoing balloon angioplasty at Namazi hospital were enrolled. After balloon angioplasty, immediate data results were promptly recorded.Moreover, midterm echocardiographic information was collected via electronic cardiac records of pediatric wards and clinical and echocardiographic data at least 12 months after balloon angioplasty. Finally, data were analyzed using SPSS-20.ResultsIn this study, 42 infants were included. The median age at the time of balloon angioplasty was 1.55 (range 0.1–12) months and 66.7% of the patients were male. The mean pressure gradient of coarctation was 38.49 ± 24.97 mmHg, which decreased to 7.61 ± 8.00 mmHg (P < 0.001). A high-pressure balloon was used in 27, and a low-pressure balloon was used in 15 patients. COA's pressure gradient changed 30.89 ± 18.06 in the high-pressure group and 24.53 ± 20.79 in the low-pressure balloon group (P = 0.282). In the high-pressure balloon group, 14.81% and in the low-pressure group, 33.33% had recoarctation and need second balloon angioplasty (p < 0.021). The infant with discrete coarctation had a higher decrease in gradient and lower recoarctation.ConclusionRecoarctation rate was lower in the high-pressure balloon. The infant with discrete COA had a better response to the balloon with more decrease in gradient and lower recoarctation rate. Therefore, the stenotic segment anatomy needs to be considered in the selection of treatment methods.

Retrospective comparison of percutaneous balloon pericardiotomy with pericardiocentesis versus pericardiocentesis alone for management of symptomatic pericardial effusions

Abstract Background Cardiac tamponade is a potentially life-threatening complication of pericardial effusion. Pericardiocentesis with drainage is the mainstay of treatment for patients with pericardial effusion and cardiac tamponade. Percutaneous balloon pericardiotomy (PBP) is an adjunct to pericardiocentesis that may alleviate the risk for recurrent effusion and repeat procedures. However, the efficacy of PBP plus pericardiocentesis compared to pericardiocentesis alone is not clear. Purpose We sought to determine whether PBP plus pericardiocentesis was associated with less recurrence of pericardial effusion than pericardiocentesis alone. Methods We conducted a single-centre retrospective analysis of patients ≥18 years old with non-iatrogenic pericardial effusion undergoing either pericardiocentesis alone or PBP plus pericardiocentesis for the first time. For PBP, a balloon was advanced over a guidewire until it crossed the pericardium and was then inflated until the balloon profile was fully expanded. Type of balloon used, and single or double balloon technique were left up to the operator. Recurrent pericardial effusion was defined as a large pericardial effusion on echocardiogram, pericardial effusion that caused hemodynamic compromise, or pericardial effusion that necessitated another intervention to drain at any time after initial procedure. Risk factors for recurrent pericardial effusion were also assessed. Results There were 208 patients who underwent pericardiocentesis, with 33 patients receiving PBP plus pericardiocentesis. In all patients, the rate of recurrent pericardial effusion was 15.9% and 15.2%, respectively (p=0.92). In patients with a cancer diagnosis at time of procedure, the rate of recurrent pericardial effusion was 17.8% and 16.7%, respectively (p=0.89). In patients with malignant pericardial effusion as confirmed by cytology, the rate of recurrent pericardial effusion was 20.4% and 13.3%, respectively (p=0.72). Patients with a connective tissue disease (CTD) had an increased odds ratio (OR) of recurrent pericardial effusion when compared to patients without a CTD (OR 3.19, 95% CI 1.31–7.77). Conclusions The results of this study suggest that PBP plus pericardiocentesis offers no significant benefit over pericardiocentesis alone at preventing recurrent pericardial effusion. This finding was true in all sub-groups, including patients with cancer and patients with malignant pericardial effusion. Patients with a CTD were three times more likely than patients without a CTD of having a recurrent pericardial effusion, independent of treatment strategy. Funding Acknowledgement Type of funding sources: None.

Saving lives and limbs: Challenges for the REBOA aficionado

Although the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) has expanded the management options among patients with noncompressible torso hemorrhage, the risk of procedural complications continues to elicit caution. Although this life-saving adjunct has proven effective in carefully select patients, limb loss remains a dreaded complication that demands proper training, technique, and experience. Lower profile balloons have simplified the management of the arterial puncture and possibly the rate of iatrogenic vascular injury sustaining the desire for an alternative to resuscitative thoracotomy.

Influence of balloon design, plaque material composition, and balloon sizing on acute post angioplasty outcomes: An implicit finite element analysis.

In this work we propose a generic modeling approach for simulating percutaneous transluminal angioplasty (PTA) endovascular treatment, and evaluating the influence of balloon design, plaque composition, and balloon sizing on acute post-procedural outcomes right after PTA, without stent implantation. Clinically-used PTA balloons were classified into two categories according to their compliance characteristics, and were modeled correspondingly. Self-defined elastoplastic constitutive laws were implemented within the plaque and artery models, after calibration based on experimental and clinical data. Finite element method (FEM) implicit solver was used to simulate balloon inflation and deflation. Besides balloon profile at max inflation, results are mainly assessed in terms of the elastic recoil ratio (ERR) and lumen gain ratio (LGR) obtained immediately after PTA. No variations in ERR nor LGR values were detected when the balloon design changed, despite the differences observed in their profile at max inflation. Moreover, LGR and ERR inversely varied with the augmentation of calcification level within the plaque (-11% vs. +4% respectively, from fully lipidic to fully calcified plaque). Furthermore, results showed a direct correlation between balloon sizing and LGR and ERR, with noticeably higher rates of change for LGR (+18% and +2% for LGR and ERR respectively for a calcified plaque and a balloon pressure increasing from 10 to 14 atm). However a larger LGR comes with a higher risk of arterial rupture. This proposed methodology opens the way for evaluation of angioplasty balloon selections towards clinical procedure optimization.

Intraoperative infrarenal aortic balloon occlusion in pregnancies with placenta accreta spectrum disorder

Background: The objective of this study was to evaluate the efficacy of intraoperative aortic balloon occlusion (IABO) during caesarean section for placenta accreta, increta or percreta and explore the relationship between different profile balloon catheters and catheter-related complications. Methods: This retrospective case control study included 295 patients with pathologically confirmed placenta accreta spectrum (PAS) disorder at the Sichuan Academy of Medical Sciences &amp; Sichuan Provincial People’s Hospital between 2013 and 2019. The characteristics of 162 patients who had aortic balloon occlusion (balloon group) were compared with those of 133 patients who had no catheterization (control group). Results: There were significant differences between the two groups in estimated blood loss, calculated blood loss, number of transfusions, transfused packed red blood cells (PRBCs), haemoglobin reduction, operation time and caesarean hysterectomy (P &lt; 0.05). Regarding different PAS disorders, the estimated blood loss among women with placenta accreta and placenta increta was lower in the balloon group (n = 32 and 102, respectively) than in the non-balloon group (n = 33 and 85; P = 0.04 and P &lt; 0.01, respectively). Only the placenta increta group showed a significant difference (P &lt; 0.01) in transfused PRBCs. In patients who used the low-profile balloon catheters, we found a significant reduction in catheter-related complications compared with the high-profile group (n = 52 vs. 110, P = 0.04). Conclusions: Our study demonstrated that intraoperative infrarenal aortic balloon occlusion was effective in both reducing intraoperative haemorrhage and blood transfusion, and in preventing hysterectomy during caesarean section for pathologically diagnosed placenta accreta and increta. Low-profile balloon catheters can reduce catheter-related complications.

Double kissing crush: aspectos técnicos e considerações atuais

Percutaneous treatment of coronary bifurcation lesions remains a challenge, even with all advances in technique and materials available, such as hydrophilic guidewires, lower profile balloons and drug-eluting stents with new materials, thinner struts and less thrombogenic polymers. Despite these advances, little progress has been made in dedicated bifurcation stenting. The degree of technical difficulty and the lack of dedicated material result in higher rates of restenosis and stent thrombosis, especially in true bifurcation lesions, in which the therapeutic strategy [...]

Mathematical modeling and numerical simulation of nonlinearly elastic yarn in ring spinning

In this paper, yarn dynamic behavior in the ring spinning system has been studied. A new model has been proposed by considering nonlinear elastic yarn. Equations of motion were derived by Newton’s second law and resolved by the finite difference method. Some results were given and relationships among models of inextensible yarn, linear elastic yarn, and nonlinearly elastic yarn were discussed. Experiments were conducted to evaluate the accuracy of the proposed model in terms of yarn tension and balloon profile and a good agreement has been made between the predicted data and experimental results.

Influence of the Adopted Balloon Modeling Strategies in the Stent Deployment Procedure: An In-Silico Analysis

As the promoter of the stent expansion, the balloon plays a very important role, offering a strong influence on the deployment process. Balloon-artery interaction is pointed as a probable cause of restenosis, stressing the relevance of balloon modeling when simulating the stenting procedure. In this work, an in-silico study of the balloon modeling strategies is performed. Ultrasonic-microcasting is a novel technology that allows obtaining stents manufactured in magnesium alloys, being suggested as a promising solution. However, this technique demands superior stent strut thickness, which may have an impact on the stent deployment procedure. The influence of the balloon modeling is studied through the simulation of different balloon geometries (open- or taper-ended) and material constitutive model (linear elastic or hyperelastic) on the expanded configuration of a stent manufactured through ultrasonic-microcasting. The results obtained suggest that the choice of balloon type has small impact in terms of demanded pressure to inflate the balloon and in the stent final radius achieved at fully-expanded configuration. Additionally, it was proved that the balloon-type influences the stent expanded profile along its length and diameter as a result of the different deformation behavior exhibited by the balloon. The hyperelastic taper-ended balloon suggests being the model that better correlates with both experimental and clinical results regarding the expanded balloon profile during the procedure.

3:00 PM Abstract No. 42 Analysis of microchannel recanalization with orbital atherectomy in failed standard recanalization of TASC-II D aortoiliac occlusive disease

Endovascular treatment of TASC II D aorto-iliac lesions now an accepted form of revascularization. We sought to analyze the technical and clinical outcomes of microchannel recanalization and orbital atherectomy (MCOA) in TASC II D aorto-iliac lesions refractory to standard recanalization techniques. Nineteen patients from 2016-2018 with symptomatic TASC-II D aortoiliac occlusive disease (AIOD) prohibitive for open bypass underwent traditional or MCOA recanalization. In four patients, native microchannels were probed and traversed with a 0.014 wire. The atherectomy crown was tracked over wire and orbital atherectomy was initiated with the 1.25 crown starting at the lowest revolution and continued until the microchannel is sufficiently large to track a 1.2 mm balloon for angioplasty. Serial microchannel angioplasty with exchange for stiffer and/or larger profile wires and balloons was achieved until a covered stent could be safely deployed across the target lesion. Technical and clinical outcomes including lesion characteristics, survival, limb salvage, patency, and change in clinical symptoms were analyzed. Both groups had similar Rutherford scores, ABI, and presence of outflow lesions. All MCOA patients presented with long segment unilateral CIA occlusion with contralateral CIA stenosis. In MCOA cases, there were no intraoperative ruptures or dissections. There were many similar metrics and outcomes between traditional recanalization versus MOCA: procedure time (150.3 min vs. 183.0 min, P = 0.41), primary patency rate (86.7% vs. 75.0%, P = 0.53), long-term (2.5 years) clinical symptoms improvement (86.7% vs. 75.0%, P = 0.53), and median all outcome progression free survival (1919 days vs. 1928 days, P = 0.62). Short-term (30 day) clinical symptoms improvement and limb salvage rate was equal between traditional recanalization versus MCOA (100% vs. 100%, P = >0.999). Native microchannel recanalization with subsequent orbital atherectomy is an option in high-risk patients with TASC II D aorto-iliac disease who have failed traditional prodding recanalization. Further work in proper patient selection and safe utilization of atherectomy devices in the CIA is needed.

Abstract No. 455 Customized patient-specific three-dimensional printed pediatric renovascular phantom for complex renal artery stenosis preprocedural planning: “plug and play”

The renal artery ostial anatomy, balloon profile and stent deployment are all elements of complex procedural RAS planning in children. This study aims to establish the feasibility of performing simulated renovascular intervention on a 3D printed pediatric RAS endovascular phantom. The first iteration of this phantom contained a normal nonremovable renovascular system. This iteration is upgraded to a removable patient tailored specific RAS “plug and play” module facilitating pre procedure planning. Silicone poured in 3D printed molds were created from the patient’s CT. An additional upper extremity vascular access point was added and a pump was installed to simulate circulatory flow. Models: patient- specific left inferior branch high-grade RAS (80%) and bilateral RAS (63% and 45%) with steep ostial angle Simulation steps: catheter and balloon entry via upper and lower extremity, selective renal angiography, stenosis identification and transgression, cutting balloon angioplasty and balloon expandable stent simulation. Operators completed a 10 point questionnaire, rating their experience using a 5-point Likert scale (1-Strongly disagree to 5-Strongly agree). Upper extremity approach was deemed necessary for selective renal catheterization due to the steep renal artery ostial angulation. Case 1: Left proximal RAS stenting was performed using 5 x 8 mm and 5 x 15 mm Viabahn balloon-expandable stents. Case 2: Right RAS (45%) 3x10 mm cutting balloon angioplasty followed by placement of a 3 x 8 mm balloon-expandable stent. Significant angiographic improvement was noted post procedure in both cases. Three operators had good agreement (k = 0.46) that the 3D printed phantom is helpful in procedure planning, skill development and provides a realistic experience from catheterization to stenting. The simulation resulted in a planned live patient brachial access. To our knowledge this is the first pediatric renovascular phantom using a patient-specific removable model. This platform can provide patient focused simulation for renal arterial approach, balloon stricture negotiation, stent sizing and deployment, all complex elements of this procedure in children.

Native Microchannel Recanalization with Orbital Atherectomy as a Viable Alternative to Failed Standard Recanalization of TASC II D Aortoiliac Occlusive Disease

Endovascular treatment of Trans-Atlantic Inter-Society Consensus (TASC) II D aortoiliac lesions is now an accepted form of revascularization. We sought to demonstrate that native microchannel recanalization and orbital atherectomy is a successful recanalization method of TASC II D aortoiliac lesions refractory to standard recanalization techniques. Four consecutive patients from 2016 to 2018 with symptomatic TASC II D aortoiliac occlusive disease prohibitive for open bypass and failed traditional prodding guidewire or device recanalization technique were identified and underwent advanced native microchannel selection and subsequent orbital atherectomy (Cardiovascular Systems, Inc, St Paul, MN). Native microchannels of the calcified lesions were probed and traversed with a 0.014″ wire. The atherectomy crown was tracked over the wire, and orbital atherectomy was initiated with a 1.25mm crown starting at the lowest revolution and continued until the microchannel is sufficiently large to track a 1.2mm-balloon for angioplasty. Serial microchannel angioplasty with exchange for stiffer and/or larger profile wires and balloons was achieved until a covered stent could be safely deployed across the target lesion. The kissing stent technique was then used to recreate the aortic bifurcation. A ViperSlide lubricant solution was used in all cases per indication for use. Patients were all heparinized to maintain an activated clotting time of 250. Lesion characteristics, survival, limb salvage, patency, and change in clinical symptoms were also analyzed. All 4 patients underwent successful native microchannel recanalization and orbital atherectomy of the common iliac artery (CIA). There were no intraoperative ruptures, embolizations, or dissections. All 4 patients presented with unilateral CIA occlusion with contralateral CIA stenosis. The average occlusion lesion length of the CIA was 6.0cm. The average contralateral stenosis length was 2.3cm. The kissing stent technique was used in all patients for reconstruction of the aortic bifurcation. At 30days, all patients had improvement in pain and primary patency of 100%. Long-term follow-up at 21.6months noted continued improvement in symptoms and primary patency of 75%. The fourth patient died at 4months from lung cancer with occluded iliac stents by imaging at that time. Native microchannel recanalization with subsequent orbital atherectomy is an option in high-risk patients with TASC II D aortoiliac disease who have failed traditional recanalization techniques. Further work in proper patient selection and safe utilization of atherectomy devices in the CIA is needed.

POST PARTUM HEMORRHAGE;

Primary postpartum hemorrhagic, rightly called as obstetrician’s nightmare,refers to excessive blood loss of more than 500ml during the third stage of labour or in the first24 hours after delivery. It continues to be one of the leading causes of maternal mortality andmorbidity all over the world including Pakistan where it is responsible for 21-31% of maternalmortality and morbidity. Objectives: Objective of study was to determine the efficacy of balloontamponade in the management of primary PPH, so that a low cast, easy to use technology isavailable for conserving future fertility by treating postpartum hemorrhage. Settings: Departmentof Gynae &amp; Obs, Allied Hospital, Faisalabad. Study Design: Descriptive cross sectional study.Study Period: 6 months from 1st Oct, 2015 to 31st March, 2016. Material &amp; Methods: All patientsdelivered vaginally at term (after 37 completed weeks of gestation) who developed PPH due touterine atony after failure of conventional medical therapy were included in this study. Patientselection was based on inclusion and exclusion criteria. Their demographic profile and efficacyof balloon tamponade was checked in terms of time required to control hemorrahage andneed of laparotomy. Results: During study period total no. Of vaginal deliveries were 3000.Out of these 298 developed PPH, 220 had PPH due to uterine atony and did not respond toconventional medical therapy. The age of patients ranged between 22 and 40 years with meanage of 30 year (±4.88SD). The parity of the patients ranged between 1 and 14 with the meanparity of 4 (±2.26SD). The condom catheter was introduced in all the selected 80 patients andwas successful in 73 patients. Conclusions: In developing countries such as Pakistan wherethe maternal death rate from PPH is very high, this safe, in expensive and easy procedure (itdoes not require any expertise) can be applied in any situation to save a life and to save theuterus in young patients to conserve reproductive capacity and prevent them from surgery andits morbidity. This will protect the patients from irreversible shock and even death with a successrate of 85-95%.

The Glider registry

BackgroundProvisional stenting of the side‐branch (SB) is the universally accepted gold standard while there is still controversy on the usefulness of routine dilatation of the SB ostium. Recrossing the struts of a previously deployed stent with a wire and a balloon can prove challenging and is occasionally unsuccessful, mainly because the balloon tip hits a stent strut. This prospective multicenter international registry tested the crossing ability procedural results of a new‐dedicated ultrashort balloon specifically designed for side branch dilatation (Glider, TriReme Medical, Pleasanton, CA, USA).MethodsOne hundred and twenty five patients (for a total of 131 bifurcation lesions) were enrolled in the registry between January 2009 and May 2012. The Glider was used as first choice in alternative to conventional balloon (group I, 72%) or as bail‐out after unsuccessful previous attempt at crossing with small conventional low‐profile balloons (group II, 28%). Postprocedural coronary artery dissections and in‐hospital MACE (death, myocardial infarction and repeat revascularization) were assessed. Technical success was defined as the ability of the Glider to recross the struts of a previously deployed stent while procedural success was defined as less of residual 50% diameter stenosis at the origin of the SB with a final TIMI 3 and/or freedom from in‐hospital MACE.ResultsTechnical success was achieved, respectively, in 92% (group I), and 83% (group II). Clinical and angiographic procedural success was achieved in 98% of the lesions. In Group II, no other balloon of the same size could cross in cases where Glider could not. A total of 13 complications were observed, including nine ostial SB dissection four of which needed a second stent on the SB, one stent loss, two severe coronary spasms, and two by thrombus formation.ConclusionThe unique possibility offered by this short dedicated balloon to orientate its beveled tip provides an effective strategy for recrossing stent struts when conventional low profile balloons fail achieving greater SB ostial expansion thus reducing the incidence of strut malapposition during provisional treatment of bifurcational lesions. © 2016 Wiley Periodicals, Inc.

Sa1555 A Retrospective Analysis of the Short Term Outcomes of a One Step Procedure for Endoscopic Placement of Low Profile Balloon Gastrostomy Tubes in a Pediatric Population

From 1991-2008, our department used the minimally invasive technique PEG for placing gastrostomies in children. We then averaged about 50 initial placement procedures with the same quantity of secondary gastroscopy procedures required for changing the PEG-tube (Freka) to a low profile balloon gastrostomy (MIC-Key or Mini-one). In 2008, Kimberly-Clark introduced the MIC-Key Introducer Kit which allows for placement of a low profile balloon gastrostomy tube in a one-step procedure, thus removing the need for a second procedure under general anaesthesia.

Balloon aortic valvuloplasty in elderly patients: a review and update

Calcific aortic stenosis is the most common valvular disease in the western world, with the prevalence increasing with age. Medical management of critical aortic stenosis is associated with high mortality and cost. While surgical valve replacement is ideal, high early morbidity and mortality limit its usefulness among patients with comorbid illness or advanced age. Balloon aortic valvuloplasty can be an important option that can be used as a bridge to definitive replacement or as palliative therapy. Fewer complications and easier recovery may make balloon aortic valvuloplasty a particularly attractive option for very elderly patients. Reducing the balloon profile reduces complications. A case series using a low-profile balloon with rapid inflation to achieve more effective force on calcified valves resulted in good short- and long-term outcomes. Future studies should seek longer-term data and investigate pathological changes following valvuloplasty.