Coronary Angioplasty Research Articles

Hepatic T1 Mapping as a Novel Cardio-Hepatic Axis Imaging Biomarker Early after STEMI.

The hepatic response after ST-elevation myocardial infarction (STEMI) may be associated with mortality and morbidity. We aimed to assess the cardio-hepatic axis post-STEMI using cardiovascular magnetic resonance (CMR). This prospective, observational, single-centre study included consecutive STEMI patients who underwent CMR after primary angioplasty from January 2015 to January 2019. Standard infarct characteristics were analysed, and hepatic T1 and hepatic extracellular volume (ECV) were assessed using pre- and post-contrast T1-mapping sequences. The primary endpoint was the relationship between native hepatic T1-values and ischemic right ventricular (RV) involvement, determined by RV ejection fraction (EF) dysfunction and/or the presence of RV acute myocardial infarction (AMI). The diagnostic performance of hepatic T1 values for detecting RV involvement was assessed using the area under the receiver operating characteristic curve (AUC). Of 177 consecutive STEMI patients undergoing CMR, 142 were included. Patients with RV ischemic involvement, compared to those without, had significantly higher native hepatic T1 (p < 0.001) and hepatic ECV (p = 0.016). Hepatic T1 values demonstrated a good diagnostic performance in detecting RV involvement (AUC 0.826, p < 0.001) and correlated positively with NT-proBNP values (r = 0.754, p < 0.001). Patients with high hepatic T1 values (>605 ms) had significantly higher NT-proBNP levels (<0.001), larger RV end-diastolic volume (p < 0.001), lower RV-EF (p < 0.001), and a higher prevalence of RV AMI (p = 0.022) compared to those with hepatic T1 ≤ 605 ms, while left ventricular EF and infarct size were similar. Multivariable logistic regression analysis identified RV-EF (p = 0.010) and NT-proBNP values (p < 0.001) as independent predictors of increased hepatic T1 values. Patients with increased hepatic T1 values had a higher rate of re-hospitalization for heart failure at 17-month follow-up (12.1% vs 2.0%, p = 0.046). Hepatic T1 mapping has emerged as a possible novel imaging biomarker of the cardio-hepatic axis in STEMI, being associated with RV involvement and increased NT-proBNP values.

Successful nonsurgical therapeutic management in a case of early mechanical aortic prosthetic thrombosis and coronary embolism after a modified Bentall procedure.

Prosthetic valve thrombosis, although rare, is a life-threatening complication of valve replacement surgery. The authors present an atypical case of a modified Bentall procedure with the CarboSeal Valsalva™ conduit complicated by an early mechanical prosthetic aortic valve thrombosis and coronary embolism. The patient was successfully treated with an emergency percutaneous coronary angioplasty and intracoronary thrombus aspiration of the left anterior descending artery, followed by a systemic 10mg bolus of tissue plasminogen activator followed by ultraslow (25 h) infusion of low-dose (25mg), while supported with venoarterial extracorporeal membrane oxygenation.

Assessment of chronical total occlusions management in France: The ENCOCHE Registry, a prospective, multicentric study

BackgroundCoronary chronic total occlusions (CTO) are frequent, and coronary angioplasty has been increasingly used in recent years for lesion revascularisation. However, to date, no dedicated multicentric prospective study is available in France. AimTo describe the characteristics of CTO patients and to assess current treatment strategies in French catheterisation laboratory practice. MethodsPatients presenting with CTOs were included from 16/09/2021 to 13/12/2021 over two consecutive prospective phases. In phase I (one month), data were collected to include all patients presenting CTO at diagnostic angiography. In phase II (two months), data were collected focusing on patients who underwent CTO-PCI. ResultsA total of 1303 patients (1460 CTOs) were included in 68 French centres. The mean age was 67.7±10.7 years and 84.3% of the patients were men. The prevalence of prior PCI (44.6%), and diabetes mellitus (35.6%) was high. In phase I, multivessel coronary artery disease was detected in two-thirds of cases, and most of them (88.5%) had a single CTO. The mean J-CTO score was 1.9±1.2, with a proportion of difficult and very difficult CTO (J CTO score ≥2) of 61.1%. The selected treatment was medical therapy in 57% of cases, coronary angioplasty in 30% and bypass surgery in 13%. In phase II, 528 patients were included with a mean J-CTO score of 1.8±1.2. Successful guidewire crossing through CTO lesion was obtained with an antegrade access in 89% of patients. Procedural success rate of CTO-PCI was 80%, with a rate of major in-hospital complications of 1% (death: 0.4%, MI: 0.2%, stroke: 0.2%, emergency CABG: 0.2%). ConclusionThis prospective study provides a snapshot of CTOs prevalence and CTO treatment strategies in France in 2021.

Routine Early Coronary Angioplasty versus Ischaemia-Guided Coronary Angioplasty after Successful Thrombolysis in Patients with Acute Anterior STEMI

Routine Early Coronary Angioplasty versus Ischaemia-Guided Coronary Angioplasty after Successful Thrombolysis in Patients with Acute Anterior STEMI

TCT-938 Identification and Characterization of Microparticles and Microorganisms in Blood Clots of STEMI Patients: A Comparative Study of Rescue and Primary Angioplasty

TCT-938 Identification and Characterization of Microparticles and Microorganisms in Blood Clots of STEMI Patients: A Comparative Study of Rescue and Primary Angioplasty

Comparative Study between Immediate and Mid-Term Results of Coronary Angioplasty Using Two Different Types of Drug-Eluting Stents

Comparative Study between Immediate and Mid-Term Results of Coronary Angioplasty Using Two Different Types of Drug-Eluting Stents

TCT-323 Evaluating the Efficacy of Coronary Sinus Aspiration During Coronary Angioplasty to Attenuate the Risk of Contrast-Induced Acute Kidney Injury in Predisposed Patients

TCT-323 Evaluating the Efficacy of Coronary Sinus Aspiration During Coronary Angioplasty to Attenuate the Risk of Contrast-Induced Acute Kidney Injury in Predisposed Patients

TCT-100 A Novel Traction Balloon Technique With Noncompliant Balloon for Guide Extension Insertion in Complex Coronary Angioplasty: A Solution Based on the Third Law of Motion

TCT-100 A Novel Traction Balloon Technique With Noncompliant Balloon for Guide Extension Insertion in Complex Coronary Angioplasty: A Solution Based on the Third Law of Motion

THE EFFECT OF OVERWEIGHT AND OBESITY ON DYSLIPIDEMIA: CROSS-SECTIONAL STUDY IN HEART CENTER

Background. Obesity has turned into a worldwide epidemic with increasing prevalence that is associated with excess mortality and morbidity. Obesity is a risk factor for many diseases including cardiovascular disease, the leading cause of death worldwide. Aim of the study was conducted to evaluate the association of obesity with dyslipidemia and hypertension among patients with low, medium and high risk of developing cardiovascular diseases Materials and methods. Cross-sectional study was conducted at the tertiary hospital in Astana, Kazakhstan. In total 216 participants included in this study. Results. Student’s t test was performed to elicit association between body mass index and lipid panel analysis such as cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein, where all p values found to be &lt;0.0001. Consequently, there is a statistically significant association, and increased body mass indexis linked with higher lipids in the body.Obesity increases risk of atherosclerosis 2.81 times in comparison those who have a normal body mass index. Obesity increases risk of coronary angioplasty with stenting 1.91 times in comparison those who did not undergo stenting procedure. Conclusion. Atherogenic dyslipidemia is extremely common in obesity, both in the presence and in the absence of severe insulin resistance, and is probably the main factor in the increased risk of cardiovascular diseases in these people

The efficacy of an intracoronary cocktail administration in preventing no-reflow during excimer laser coronary angioplasty in patients with in-stent restenosis: A pilot study. (ELCA- cocktail study)

BackgroundThe no-reflow phenomenon is a significant complication during excimer laser coronary angioplasty (ELCA) procedures, which can lead to adverse outcomes. This study explores the efficacy of intracoronary administration of a cocktail solution comprising nitroglycerin, heparin, and verapamil on preventing no-reflow during ELCA in patients with in-stent restenosis (ISR). MethodsThis study included patients undergoing ELCA with contrast infusion for ISR. Based on whether receiving the intracoronary cocktail solution during ELCA, participants were divided into two groups: the cocktail (+) group and the cocktail (−) group. The primary endpoint was the incidence of no-reflow, which was defined as the cessation of blood flow into the distal coronary artery in the absence of a clear angiographic explanation for impairment of flow. ResultsA total of 54 lesions in 51 patients were included. The mean age of the study population was 61.8 ± 9.7 years, with 84.3 % male. Baseline clinical characteristics were well-balanced. The incidence of no-reflow was significantly lower in the cocktail (+) group compared to the cocktail (−) group (0 % vs. 17.9 %, P = 0.024). No cases of hypotension, major bleeding or coronary perforation in either group. Major adverse cardiac events (MACE) within 6-month were no significant difference between the groups (4.0 % vs. 3.8 %, P = 0.977). ConclusionsThe pilot study suggests that intracoronary administration of a cocktail comprising heparin, nitroglycerin, and verapamil may reduce the incidence of no-reflow during ELCA in patients with ISR. However, given the limited sample size and the non-randomized design, these findings should be considered hypothesis-generating. Future validation needs to be confirmed through multicenter studies with larger sample sizes.

Cangrelor versus crushed ticagrelor in patients with acute myocardial infarction and cardiogenic shock: rationale and design of the randomised, double-blind DAPT-SHOCK-AMI trial.

Cardiogenic shock (CS) is a devastating and fatal complication of acute myocardial infarction (AMI). CS can affect the pharmacokinetics and pharmacodynamics of medications. The unique properties of cangrelor make it the optimal P2Y12 inhibitor for CS-AMI, in terms of both efficacy and safety. The DAPT-SHOCK-AMI trial (ClinicalTrials.gov: NCT03551964; EudraCT: 2018-002161-19) will assess the benefits of cangrelor in patients with an initial CS-AMI undergoing primary angioplasty. This randomised, multicentre, placebo-controlled trial of approximately 550 patients (with an allowed 10% increase) in 5 countries using a double-blind design will compare initial P2Y12 inhibitor treatment strategies in patients with CS-AMI of (A) intravenous cangrelor and (B) ticagrelor administered as crushed tablets at a loading dose of 180 mg. The primary clinical endpoint is a composite of all-cause death, myocardial infarction (MI), or stroke within 30 days. The main secondary endpoints are (1) the net clinical endpoint, defined as death, MI, urgent revascularisation of the infarct-related artery, stroke, or major bleeding as defined by the Bleeding Academic Research Consortium criteria; (2) cardiovascular-related death, MI, urgent revascularisation, or heart failure; (3) heart failure; and (4) cardiovascular-related death, all (1-4) within 1 year after study enrolment. A platelet reactivity study that tests the laboratory antiplatelet benefits of cangrelor, when given in addition to standard antiplatelet therapy, will be conducted using vasodilator-stimulated phosphoprotein phosphorylation. The primary laboratory endpoints are the periprocedural rate of onset and the proportion of patients who achieve effective P2Y12 inhibition. The DAPT-SHOCK-AMI study is the first randomised trial to evaluate the benefits of cangrelor in patients with CS-AMI.

A comparative study on the effect of coronary angioplasty on left ventricular function in post myocardial infarction among patients with and without type-2 diabetes mellitus

Background and objectives. Coronary angioplasty is a common intervention for improving cardiac function postmyocardial infarction. However, the impact of this procedure in patients with type-2 diabetes mellitus (T2DM) compared to those without diabetes remains less understood. Material and methods. This study included 50 patients who underwent coronary angioplasty post-myocardial infarction. Patients were divided into two groups based on the presence (Group A) or absence (Group B) of T2DM, with 6 patients in each group. We assessed left ventricular function using echocardiography, focusing on ejection fraction and wall motion score, at baseline, and at 1, 3, and 6 months post-angioplasty. Additional data on clinical outcomes, functional status, cardiac biomarkers, medication use, comorbid condition management, and hemodynamic measurements were also collected. Results. Both groups showed improvement in left ventricular function post-angioplasty, with no significant difference in ejection fraction and wall motion score between the two groups at each follow-up. Clinical outcomes, functional status, and biomarker levels were comparable between groups. Medication compliance was high in both groups. The control of comorbid conditions and hemodynamic stability post-angioplasty were similarly maintained in both diabetic and nondiabetic patients. Conclusion. Coronary angioplasty positively impacts left ventricular function in post-myocardial infarction patients, irrespective of the presence of T2DM. Both diabetic and non-diabetic patients demonstrated similar improvements in cardiac function and overall clinical outcomes, suggesting that angioplasty is an effective intervention for post-myocardial infarction patients regardless of their diabetes status. Further studies with larger sample sizes are recommended to validate these findings.

Management of adult focal nasolacrimal duct stenosis: long-term outcomes of 3D CT-DCG-assisted and endoscopically guided coronary catheter balloon dacryoplasty.

The purpose was to evaluate the use of 3D CT-DCG-assisted and endoscopically guided coronary catheter balloon dacryoplasty (CC-BDCP) in adults with focal stenosis of the nasolacrimal duct (NLD) and report their long-term outcomes. A prospective, non-randomized, single-center clinical study was performed, and the patients underwent endoscopy-guided CC-BDCP using percutaneous transluminal coronary angioplasty (PTCA) balloon catheters. 25 patients were enrolled in the study. The CC-BDCP procedure was performed in 21 of 25 (84%) patients, and the remaining 4 (16%) patients had significant procedural difficulties due to unfavorable anatomical conditions. Of the 21 patients, 10 (47.6%) were procedurally assessed as "easy" (eCC-BDCP) and in 11 (52.4%) as procedurally "difficult" (dCC-BDCP). Values on Munk's epiphora intensity scale changed overall from 4.0 preoperatively to 1.4 ± 1.6 (p = 0.00001) postoperatively overall. FDDT changed overall from 2.9 ± 0.3 to 1.1 ± 1.2 after treatment (p = 0.00008) (from 2.8 ± 0.4 to 0.3 ± 0.6 in the eCC-BDCP group and from 2.9 ± 0.3 to 1.4 ± 1.2 in the dCC-BDCP group (p = 0.01352). The anatomical and functional success rate was 77% overall, 90% in the eCC-BDCP group, and 64% in the dCC-BDCP group. The CC-BDCP led to a statistically significant decrease in epiphora in a particular group of adult patients with demonstrable focal stenosis of the NLD.

Efficacy of virtual reality therapy versus pharmacological sedation for reducing pain and anxiety during coronary catheterisation procedures: A prospective randomised controlled trial.

The use of virtual reality (VR) therapy has grown considerably, as it is effective for reducing pain and anxiety in different clinical areas. However, it has not been well evaluated for coronary angiography and angioplasty. This study aimed to compare VR therapy with pharmacological sedation (Sedation) for reducing pain in patients undergoing a planned coronary angiography or coronary/peripheral angioplasty. In this prospective randomized controlled trial, patients were randomly allocated to one of two groups before catheterization: a Sedation group (injection of midazolam and fentanyl) or a VR group (Deepsen VR headset). The primary outcome measure was the maximum pain during the procedure (visual analogue scale: 0-10). The secondary outcome measures were anxiety following the procedure (Spielberger State Anxiety Inventory: 20-80), the occurrence of arterial spasm, the haemodynamic profile and patient satisfaction. The VR group (n = 63) had a mean pain rating of 2.5; for the Sedation group (n = 59) this was 1.0. This did not meet the criterion for non-inferiority. Anxiety was comparable between the two groups (VR: 25.4; Sedation: 24.7), as was the occurrence of arterial spasm (VR: 7.9%; Sedation: 8.5%; p = 0.91), but blood pressure was higher in the VR group (140.2/71.7 mmHgvs. 121.8/64.7 mmHg). There were no VR-related adverse effects, and patient satisfaction was high for both groups. Virtual reality therapy was not non-inferior to pharmacological sedation for reducing pain during coronary angiography or angioplasty. However, it reduced anxiety to a comparable level. Virtual reality therapy represents an alternative to pharmacological sedation, which is well accepted by patients.

Implementation of Global Longitudinal Strain (GLS) in NON-ST Segment Elevation Myocardial Infarction in AL-Yarmook Teaching Hospital

Background: It would be advantageous to develop a noninvasive diagnostic tool that could more reliably distinguish between persons who would benefit from early coronary angioplasty and revascularization and those who would not in non-ST-segment elevation acute coronary syndrome. The LVGLS assessment is painless and may be completed quickly without putting patients through intense activities. Aim of study: To evaluate wall motion abnormality by (GLS) method in comparison with 2D echo and ECG changes. Material and method: A cross sectional study that included 60 patients who admitted to Al-Yarmouk teaching hospital due to new onset of acute coronary syndrome. Result: Mean GLS of patients was -13.61 ± 1.67, and the largest proportion of them were aged 56-60 yrs. regarding echo finding, 80% show hypokinetic motion wall abnormality. Patients with abnormal ECG changes, hypokenisia and low EF had significantly lower mean of GLS (p-value 0.0001, 0.0001, 0.004, respectively). The prediction value of GLS over EF was higher when comparing them according to presence of ECG changes and MWA. Conclusion: GLS is a powerful predictor of left ventricular function and appears to be a better metric than ejection fraction in NSTEMI patients.

Successful coronary angioplasty of a spontaneous occlusion of the conus artery causing a ST-segment elevation myocardial infarction and electrical storm

BackgroundConus artery occlusion is a rare life-threatening event, typically secondary to iatrogenic etiology, and is treated mainly with conservative therapy and/or balloon angioplasty without stenting. However, treatment remains challenging.Case presentationWe report the case of a 60-year-old man with a known history of coronary artery disease presenting with multiple internal defibrillator cardioversions due to an electrical storm (recurrent ventricular fibrillation). The coronary angiography showed an acute occlusion of the conus artery arising from the proximal segment of the right coronary artery, treated by percutaneous transluminal coronary angioplasty with stenting (drug-eluting stent) without any serious complications.ConclusionsTo our knowledge, this is the first case in the literature where a non-iatrogenic occlusion of the conus artery causing a ST-segment elevation myocardial infarction and electrical storm was treated with percutaneous coronary intervention with drug-eluting stenting.Graphical abstract

Outcome of Saphenous Vein Graft Percutaneous Coronary Intervention Using Contemporary Drug-Eluting Stents: A SCAAR Report

BackgroundPercutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) is associated with poor outcomes and is often regarded as inferior to native vessel PCI. We investigated clinical outcomes of SVG-PCI using contemporary drug-eluting stents (DES), in a complete, nationwide population. MethodsThe complete Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to identify all patients in Sweden who underwent SVG-PCI with a contemporary DES between 2013 and 2020. Baseline characteristics, procedures, and outcomes were described. ResultsA total of 2198 SVG-PCI procedures with 3106 contemporary DES were included. Patients had a high incidence of comorbidities such as diabetes (40%), prior myocardial infarction (MI) (69%), and acute coronary syndrome (74%) at presentation. SVG-PCI procedures commonly involved multiple DES (41%). Native vessel PCI, in addition to SVG-PCI, was performed in only 13% of procedures. At 1 year, adverse clinical outcomes were frequent as exemplified by any death (9.2%), MI (9.1%), or revascularization (21.1%), whereas stent and lesion-related outcomes on a patient level were less common: stent thrombosis (1.2%), in-stent restenosis (4.3%) and target lesion revascularization (4.3%). Similarly, at 3 years, clinical outcomes were frequent: death (19.8%), MI (21.1%), revascularization (32.8%); and stent-related outcomes were less common: stent thrombosis (2.9%), restenosis (10.8), and target lesion revascularization (13.6%). ConclusionsIn this nationwide cohort of patients who underwent SVG-PCI with contemporary DES, patients were characterized by a high-risk profile and high rates of adverse clinical events. However, the incidence of stent and lesion-related events was low.

A rare case of large femoral hematoma after femoral artery cannulation

Femoral vessel cannulation is a commonly performed procedure in clinical practice. However, hematomas are a frequent complication of this procedure. Notably, hematoma formation is more likely to occur with femoral arterial cannulation compared to venous cannulation. If a hematoma does form, management can range from external compression to surgical intervention. In this report, we present a rare case of a large femoral hematoma without external skin cover, which is an unusual presentation of a common complication associated with femoral vessel cannulation. An elderly female presented with complaints of a raw area, pain, and blackening at the site of femoral artery cannulation for 10 days. She underwent coronary angioplasty and stenting 20 days prior. On examination, she exhibited a large hematoma over the right groin at the cannulation site without external skin covering. She underwent hematoma debridement with a gracilis muscle flap covering of the exposed femoral vessels. Early recognition and prompt evacuation of hematoma, assessment of femoral vessel breach and its management, as well as plastic reconstruction of exposed vessels, are vital for favorable outcomes.

The association of the basal TIMI flow, post-PCI TIMI flow and thrombus grade with HbA1c levels in non-diabetic patients with acute ST segment elevation myocardial infarction undergoing primary PCI

Abstract Objectives The acute phase of ST-segment elevation myocardial infarction (STEMI), as determined by TIMI angiographic criteria, is influenced by various factors that impact the patient’s clinical outcome. However, the modifiable risk factors of impaired TIMI flow (TIMI&lt;3) and its effective treatment are not fully understood. Hyperglycemia may induce a pro thrombotic state and thus affect TIMI flow before or after PCI. This study investigates the correlation between hemoglobin A1c levels, TIMI flow grade, and thrombus grade in infarct-related arteries, assessing its predictive value in non-diabetic patients with STEMI. Methods The 265 patients selected based on the hemoglobin A1c level lower than 6.5 % and were divided into three groups based on HbA1c level. Comparison between three groups in terms of risk factors, troponin level, blood glucose level, lipid profile, kidney function, number of involved vessels, type of MI, left ventricular ejection fraction, TIMI flow before and after primary angioplasty, thrombus burden, complications and hospital mortality was made. Results With the increase in HbA1c level, the prevalence of TIMI 3 flow after primary PCI decreased. The prevalence of TIMI flow 2–3 before angioplasty also decreased with the increase in HbA1c level. Increased hemoglobin A1c was also significantly related to large thrombus burden (p=0.021). Morover, hemoglobin A1c remained an independent predictor of post-PCI TIMI flow and thrombus burden. Conclusions Elevated hemoglobin A1c is a predictor of TIMI flow less than 3 after primary PCI and high thrombus burden, in STEMI patients without a history of diabetes mellitus.

Increased coronary artery disease severity in patients undergoing invasive diagnostics during the COVID-19 pandemic.

This study aimed to compare the stage of coronary heart disease in patients who underwent invasive cardiac diagnostics during the COVID-19 pandemic and before, based on the number of medical devices used and the number of complex coronary angioplasty procedures performed. A retrospective, single-center study was conducted, which included 187 successive patients with diagnosed coronary heart disease, who were divided into 2 groups: group I (N = 92, pre-COVID-19 pandemic) and group II (N = 95, during COVID-19 pandemic). Despite a comparable number of invasive procedures in both groups, stent length and contrast use per procedure were significantly higher during the COVID-19 pandemic. Similarly, a higher number of stents was used per patient in 2021, however, the difference was not statistically significant (p = 0.0817). Similarly, fluoroscopy time per procedure and procedure duration were significantly longer in the 2021 group. Among patients treated during the COVID-19 pandemic, higher glucose concentration, blood pressure parameters, low-density lipoprotein and total cholesterol were observed; however, these differences were not statistically significant. During the COVID-19 pandemic, coronary atherosclerosis progression were found, requiring a higher number of complex coronary angioplasty procedures, which contributed to a statistically significant increase in the number of medical devices used (angioplasty guidewires, angioplasty balloons) and procedures duration. Med Pr Work Health Saf. 2024;75(4):333-342.