Percutaneous Coronary Intervention Experience Research Articles

Malaysia's early experience of percutaneous coronary intervention using new synergy megatron drug-eluting system

Malaysia's early experience of percutaneous coronary intervention using new synergy megatron drug-eluting system

Clinical Experience of Percutaneous Coronary Intervention for Severely Calcified Coronary Artery Lesions with Orbital Atherectomy System.

Clinical Experience of Percutaneous Coronary Intervention for Severely Calcified Coronary Artery Lesions with Orbital Atherectomy System.

Impact of Coronary Revascularization Strategy on Outcomes of Transcatheter Aortic Valve Implantation

Although the effect of coronary revascularization on clinical outcomes before and after transcatheter valve implantation (TAVI) is debatable, there is currently insufficient data to determine the most appropriate revascularization strategy. In this study, we present our single-center experience of percutaneous coronary intervention (PCI) and its effect on clinical outcomes and mortality in patients undergoing TAVI.We performed a retrospective analysis of 526 consecutive patients at our center, and 127 patients with obstructive coronary artery disease were included in the study. Patients were divided into two groups: the revascularization group (group 1) and the non-revascularization group (group 2). Procedural complications and long-term all-cause mortality rates were compared between the two groups.Of the 526 patients, group 1 comprised 65 patients (12.3%) who underwent PCI, and group 2 comprised 62 patients (11.7%) who did not undergo revascularization. According to Valve Academic Research Consortium 2 criteria, post-procedural complications, including pericardial effusion, stroke, major vascular complications, major bleeding, and emerging arrhythmias, were similar between the groups. A Kaplan-Meier survival curve analysis showed no significant difference between the revascularization and non-revascularization groups (Overall: 40.0±2.8 month; 95% CI 34.4-45.6 month, p=0.959). After adjustment for basal SYNTAX score, chronic kidney disease stage, previous myocardial infarction, and baseline troponin levels, the long-term survival of group 1 was significantly longer when compared with group 2 (p=0.036). In 75.4% of cases, PCI was performed within 11.0±14.7 days before or after TAVI as a staged procedure. In 13.8% of cases, PCI was performed simultaneously with TAVI. While there was no significant difference in in-hospital, 6-month, and 1-year mortality rates between the simultaneous and staged PCI groups, there was a significant difference in 30-day mortality (11.1% vs. 0%, respectively; p=0.016).Peri-procedural and long-term safety outcomes and mortality rates are not significantly different between revascularized and non-revascularized patients, and neither staged nor simultaneous PCI have adverse outcomes in patients undergoing TAVI.

TCTAP A-049 Clinical Experience of Percutaneous Coronary Intervention for Severely Calcified Coronary Artery Lesion with Diamondback 360 Coronary Orbital Atherectomy System

Percutaneous coronary intervention (PCI) of severely calcified coronary artery lesions are associated with lower procedure success rates and higher rates of target lesion failure compared with non-calcified lesions even in the DES era. Scoring balloon and Rotational atherectomy are applied to modify

Initial experience of percutaneous coronary intervention in bifurcations with bioresorbable vascular scaffolds using different techniques — Insights from optical coherence tomography

Percutaneous coronary intervention (PCI) of coronary artery bifurcations (CABs) is associated with increased risk of drug-eluting stent (DES) failure when compared with non-CAB PCI [1,2]. Although still a controversial topic, the risk of adverse events seems particularly increased when two – rather than one – DESs are implanted [3]. Indeed, the preferred strategy recommended by the current guidelines, when feasible, is one stent technique [4]. Nevertheless, the necessity of stenting both branches is frequent (~1/3 of the cases) in “real-world” clinical practice, most likely in cases of large side branches, true bifurcations (i.e., Medina 1,1,1), long lesions extending distal to side branch ostium, and when the likelihood of re-crossing the side branch after main branch stenting is low [5].

“Short” thrombelastography as a test of platelet reactivity in response to antiplatelet therapy: Validation and reproducibility

Background: A significant proportion of patients receiving dual antiplatelet therapy following percutaneous coronary intervention experience recurrent ischaemic events despite standard doses of treatment. Although clinical studies show significant heterogeneity in antiplatelet therapy responses, routine testing is not undertaken due to (i) lack of a standardized test, and (ii) poor clarity with regards to definition of abnormal responses. Short Thrombelastography (s-TEG) is a validated test that allows rapid measurement of clotting responses to antiplatelet therapy.Objectives: This study sought to determine the reproducibility of s-TEG and to compare s-TEG with VerifyNow in assessment of responses to antiplatelet therapy.Methods: (i) intra-individual variability was assessed using s-TEG Area Under the Curve (AUC15) and maximum amplitude (MA) in one volunteer at 20 time-points on no medication and at 10 time-points pre and post 300 mg aspirin treatment (ii) inter-individual variability was determined from a retrospective analysis of data on MA and AUC15 obtained from 56 volunteers on no medication, 25 volunteers pre and post 300 mg aspirin treatment and 28 patients pre and post 600 mg clopidogrel treatment (iii) a comparison between AUC15 arachidonic-acid (AA) channel and VerifyNow aspirin response units (VN ARU) and between AUC15 adenosine diphosphate (ADP) channel and VerifyNow P2Y12 reactivity units (VN PRU) was obtained from retrospective analysis of data at 370 and 296 time-points respectively.Results: There was minimal intra-and inter-individual variability in MA and AUC15 in the AA, ADP and thrombin channels. There was a good correlation between AA AUC15 and VN ARU (r = 0.701, p < 0.001) and between ADP AUC15 and VN PRU (r = 0.609, p < 0.001).Conclusions: s-TEG is a reproducible and reliable near-patient test that correlates well with VerifyNow. Large scale studies are needed to determine its potential role in individually tailored antiplatelet therapy.

The First New Zealand Experience of Percutaneous Coronary Intervention Without Onsite Cardiac Surgery

The First New Zealand Experience of Percutaneous Coronary Intervention Without Onsite Cardiac Surgery

The first New Zealand experience of Percutaneous Coronary Intervention without onsite cardiac surgery

Background: Percutaneous Coronary Intervention (PCI) is a well-recognised treatment for stable angina and in the setting of an acute coronary syndrome (ACS) has morbidity and mortality benefit if performed within 72 h. Time delays often mean that these benefits are not afforded to patients in provincial hospitals who are transferred at considerable expense. The increased safety of PCI has allowed these issues to be addressed internationally by providing local PCI in non-surgical centres. Nelson Hospital recently became the first non-surgical centre to offer PCI in New Zealand. We report on our first year of operation.

Real-world percutaneous coronary intervention experience comparing Taxus paclitaxel-eluting with Cypher sirolimus-eluting stent platforms

Real-world percutaneous coronary intervention experience comparing Taxus paclitaxel-eluting with Cypher sirolimus-eluting stent platforms

A randomised controlled study comparing conventional and magnetic guidewires in a two‐dimensional branching tortuous phantom simulating angulated coronary vessels

To directly compare the magnetic navigation system (MNS) guidewires with conventional guidewires in branching tortuous phantoms with operators of varying MNS and percutaneous coronary intervention experience. Vessel tortuosity, angulation, and side branches remain limiting factors in coronary interventions. The MNS addresses these limitations by precisely directing the tip of a magnetised guidewire in vivo aided by two permanent adjustable external magnets. Crossing and fluoroscopy times of six operators were evaluated in five tortuous Perspex(R) phantom vessels in three consecutive attempts. Standard guidewire (SG) usage was unrestricted. Two 2nd generation magnetic guidewires (MG) were used. Failure was noted if the cross was unsuccessful within 5 min. The magnetic navigation was vastly superior to SG techniques with increasingly tortuous phantoms. It dramatically decreased both the crossing and fluoroscopy times with maximal reduction from 201.7 +/- 111 to 36.4 +/- 13 sec, P < 0.001 and 204.7 +/- 24 to 47.2 +/- 19 sec, P < 0.001, respectively. The MNS had a 98.8% procedural success rate compared to 68% with SG techniques. Moreover it considerably limited the amount of wire usage from 5.5 to 1.3. Operators with prior MG experience performed significantly better than those without, except in the simplest phantom where the difference was nonsignificant (33.8 +/- 13 sec vs. 41.7 +/- 17 sec, P = 0.2). MNS significantly reduces both the crossing and fluoroscopy times in tortuous coronary phantom models achieving excellent success rates with dramatic reductions in guidewire usage. Operators with prior MNS experience had an advantage over the inexperienced.

Implications of Pre-Procedural Anaemia in Patients Undergoing Percutaneous Coronary Intervention—Experience from a Regional Cardiac Centre

Implications of Pre-Procedural Anaemia in Patients Undergoing Percutaneous Coronary Intervention—Experience from a Regional Cardiac Centre

Experience of Percutaneous Coronary Intervention in the Management of Pediatric Cardiac Allograft Vasculopathy

In a retrospective study, we examined the procedural success rate and the short-, intermediate-, and long-term outcomes of coronary interventional procedures in children with cardiac allograft vasculopathy. Seven patients underwent 13 interventional procedures: balloon angioplasty alone (n = 3), angioplasty with stenting (n = 9), or angioplasty with brachytherapy (n = 1), with procedural success in all. Two major complications (cardiac arrest) and a single death occurred in the immediate postprocedural period. Five (83%) of the remaining 6 patients developed moderate to severe restenosis, diffuse disease, or progressive vasculopathy; 3 have been retransplanted, 1 died from progressive cardiac allograft vasculopathy, and 1 is awaiting retransplantation, 40 months after the procedure.

Percutaneous coronary interventions with stents in cardiac transplant recipients

Allograft coronary vasculopathy is the most common cause of death after the first year of cardiac transplantation. Different management strategies have been attempted. The aim of this study was to evaluate our experience of percutaneous coronary intervention (PCI) with stents in cardiac transplant recipients.