Revascularization Of Right Coronary Artery Research Articles

RIGHT CORONARY ARTERY PERCUTANEOUS CORONARY INTERVENTION IN A PATIENT WITH ANOMALOUS ORIGIN OF LEFT MAIN FROM RIGHT CORONARY SINUS – CASE REPORT”

A 63-year-old male is hospitalized during an episode of NSTEMI and therefore he underwent Coronary Angiography which revealed Two-Vessel coronary artery disease and anomalous origin of Left Main Artery. Left Main Artery and Right Coronary Artery did both originate from right coronary sinus, but with separate ostia. The patient underwent revascularization of Right Coronary Artery with balloon angioplasty and drug eluting stents. The case report is made at the University Hospital Center “Mother Tereza”, Tirana Albania.

Impact of percutaneous coronary intervention in right coronary artery on right ventricular function in patients with acute myocardial infarction.

Background: Right ventricular (RV) dysfunction is a potent predictor of mortality and morbidity following acute myocardial infarction (AMI). Despite the fact that elective percutaneous coronary intervention (PCI) has significantly decreased myocardial damage to the left ventricle, there is a lack of information regarding the effect of PCI on RV function. Aim: This study aimed to examine the effect of right coronary artery (RCA) revascularization on the systolic and diastolic functions of the right ventricle following acute inferior wall myocardial infarction. Methods: Fifty-nine patients diagnosed with acute inferior wall myocardial infarction after RCA revascularization were prospectively investigated between April 2018 and January 2020. The patients underwent 2D echocardiography. RV systolic and diastolic functions were reported before and after the PCI procedure and compared using echocardiographic RV systolic and diastolic parameters. Results: After PCI, echocardiographic RV systolic and diastolic functions significantly improved in the proximal and mid RCA in terms of TAPSE, RVFAC, and E/A. Significant improvement was found in the mid RCA in terms of S' velocity (p=0.008) and in the proximal RCA in terms of E/e' (p=0.021). Overall echocardiographic systolic and diastolic parameters in patients with RV dysfunction following PCI were improved [TAPSE (37.29% vs. 81.82%), S' velocity (37.29% vs. 68.18%), RVFAC (33.90% vs. 90.00%), and E/A (33.90% vs. 75.00%)]. Conclusion: Our findings revealed that patients with RV dysfunction showed remarkable improvement after RCA revascularization. Hence, in future cases, RCA revascularization may become an appropriate treatment alternative for the recovery of patients with RV dysfunction.

Correlation between Right Ventricular Function with Revascularization Time and 30-day Mortality in ST-Elevation Myocardial Infarction Patients Underwent Right Coronary Artery Intervention

Abstracts: Right ventricular (RV) function provides strong prognostic information in patients treated with primary percutaneous coronary intervention (PCI) due to myocardial infarction. Longitudinal RV systolic function can be assessed by the measurement of the tricuspid annular plane systolic excursion (TAPSE). This study aimed to evaluate the correlation between TAPSE and revascularization time with 30-day mortality using TIMI risk score in patients presenting STEMI who underwent revascularization of right coronary artery (RCA). This was a descriptive amd analytical study. Data were collected from iSTEMI Registry database which consisted of 49 STEMI patients undergoing PCI in RCA and TAPSE measurement at Prof. Dr. R. D. Kandou General Hospital from October 3rd, 2018 to July 28th, 2019. Echocardiographic examination was done within 48 hours of hospitalization. A descriptive analysis and bivariate correlation with Spearman’s rho were applied between given variables. P-value of <0.05 was considered to be statistically significant. The results showed that the mean age of the patients was 57.92 10.345 years old and 79.2% were male. The mean TAPSE measurement was 18.51 mm +/- 3.63 mm. The median revascularization time was 357.5 minutes while median TIMI score was 4. Shorter treatment time (p=0.708) and lower TIMI score (p=0.923) were not associated with better right ventricular function measured with TAPSE in patients undergoing RCA intervention. In conclusion, right ventricular function is not associated with revascularization time and thirty days mortality in patients presenting with ST-elevation acute myocardial infarction involving right coronary artery.Keywords: tricuspid annular plane systolic excursion; revascularization time; right coronary artery; ST-elevation myocardial infarction

Acute myocardial infarction with left main coronary artery ostial negative remodelling as the first manifestation of Takayasu arteritis: a case report

BackgroundTakayasu arteritis is a chronic inflammatory disease involving the aorta and its major branches. Acute myocardial infarction rarely but not so much presents in patients with Takayasu arteritis, and the preferable revascularization strategy is still under debate.Case presentationA 22-year-old female with Takayasu arteritis presented with acute myocardial infarction. Coronary angiography and intravenous ultrasound (IVUS) showed that the right coronary artery (RCA) was occluded and that there was severe negative remodelling at the ostium of the left main coronary artery (LMCA). The patient was treated by primary percutaneous transluminal coronary angioplasty (PTCA) with a scoring balloon in the LMCA, without stent implantation. After 3 months of immunosuppressive medication, the patient received RCA revascularization by stenting. There was progressive external elastic membrane (EEM) enlargement of the LMCA ostium demonstrated by IVUS at 3 and 15 months post-initial PTCA.ConclusionHere, we report a case of Takayasu arteritis with involvement of the coronary artery ostium. Through PTCA and long-term immunosuppressive medication, we found that coronary negative remodelling might be reversible in patients with Takayasu arteritis.

Over Ten Years' Follow-Up of Chronic Total Coronary Occlusion Angioplasty

ObjectivesIt has been reported that successful percutaneous coronary intervention for chronic total occlusion (CTO-PCI) might be associated with symptom relief, a lower rate of subsequent myocardial infarction and coronary artery bypass graft surgery, and improved long-term survival, compared with unsuccessful PCI for CTO. However, the long-term benefit of percutaneous recanalization of CTO remains unclear. Therefore, we aimed to evaluate the long-term benefit of percutaneous recanalization of CTO. MethodsWe analyzed consecutive cases of CTO-PCI performed between January 2000 and December 2006. The health status of all patients on September 2017 was obtained via letter or from medical records. We collected relevant patient information as well as angiographic and procedural characteristics. ResultsA total of 477 patients (82.8% men, mean age, 65.7 years) underwent CTO-PCI. The procedural was successful in 382 cases (80.3%). Reference vessel diameter, occlusion length and angiographic stump of CTO site were associated with the success of CTO intervention. During the mean follow-up period of 139.8 months, successful CTO-PCI was associated with a higher survival rate when compared with failed CTO-PCI (Log-rank test: P = 0.0147). When categorized by target vessel, successful revascularization of left anterior descending (LAD) -CTO improved long-term survival (Log-rank test: P = 0.0041). On the other hand, successful revascularization of right coronary artery or left circumflex -CTO was not associated with improved long-term survival [Log-rank test: P = 0.5631 (RCA), P = 0.2774 (LCX)]. ConclusionsSuccessful CTO-PCI, especially the successful revascularization of LAD-CTO, improved long-term survival of patients.

Residual Right Coronary Artery Stenosis after Left Main Coronary Artery Intervention Increased the 30-Day Cardiovascular Death and 3-Year Right Coronary Artery Revascularization Rate.

Background The outcomes of patients with concomitant left main coronary artery (LMCA) and right coronary artery (RCA) diseases are reportedly worse than those with only LMCA disease. To date, only few studies have investigated the clinical impact of percutaneous coronary intervention (PCI) on RCA stenosis during the same hospitalization, in which LMCA disease was treated. This study was aimed at comparing the outcomes between patients with and without right coronary artery intervention during the same hospital course for LMCA intervention. Methods and Results From a total of 776 patients who were undergoing PCI to treat LMCA disease, 235 patients with concomitant RCA significant stenosis (more than 70% stenosis) were enrolled. The patients were divided into two groups: 174 patients received concomitant PCI for RCA stenosis during the same hospitalization, in which LMCA disease was treated, and 61 patients did not receive PCI for RCA stenosis. Patients without intervention to the right coronary artery had higher 30-day cardiovascular mortality rates and 3-year RCA revascularization rates compared to those with right coronary artery intervention. Patients without RCA intervention at the same hospitalization did not increase the 30-day total death, 3-year myocardial infarction rate, 3-year cardiovascular death, and 3-year total death. Conclusions In patients with LM disease and concomitant above or equal to 70% RCA stenosis, PCI for RCA lesion during the same hospitalization is recommended to reduce the 30-day cardiovascular death and 3-year RCA revascularization rate.

Features of coronary artery patterns and percutaneous coronary intervention in patients with acute coronary syndrome and stable angina in patients aged below 40 years

Aim. To study the features of risk profile, coronary artery patterns, and percutaneous coronary intervention in patients aged below 40 years with acute coronary syndrome and stable angina.
 Methods. 208 patients with coronary artery disease aged below 40 years were examined: 51 (24.5%) patients aged 35 years and younger and 157 (75.5%) aged 3640 years. 98 (47.1%) patients were admitted with acute coronary syndrome; 110 (52.9%) patients with stable angina. In groups of acute coronary syndrome and stable angina, myocardial infarction in past medical history was revealed in 23.5% and 36.4%, respectively. 165 patients underwent percutaneous coronary intervention: 84 (50.9%) with acute coronary syndrome; 81 (40.1%) with stable angina.
 Results. Patients with stable angina differed by prevalence of myocardial infarction in past medical history, overweight, and family history of coronary artery disease. In group of acute coronary syndrome urban cohort prevailed as well as consumption of energy drinks among patients below 35 years; high prevalence of left ventricular dysfunction. Patients with acute coronary syndrome were characterized by involvement of one and three coronary arteries, and patients with stable angina by pathology of two and three coronary arteries. Involvement of three coronary arteries was equal in both groups. In both groups, anterior interventricular artery was target coronary artery. Patients with stable angina had the same rate of right coronary artery and left circumflex artery involvement. In patients with stable angina, right coronary artery involvement was rarer, and left main coronary artery involvement was two times more frequent than in patients with acute coronary syndrome. The group with acute coronary syndrome was characterized by predominance of discrete lesions and coronary occlusions over diffuse lesions; and the group of stable angina by diffuse lesions, and two-times less frequent coronary occlusions.
 Conclusion. Among patients with acute coronary syndrome aged below 36 years, revascularization of right coronary artery was predominant, and among patients aged 3640 years with acute coronary syndrome revascularization of left circumflex artery.

Impella RP support in refractory right ventricular failure complicating acute myocardial infarction with unsuccessful right coronary artery revascularization

BackgroundImpella RP has been used to treat right ventricular failure (RVF) developing in various clinical settings that underlay different pathological mechanisms and lead to distinct prognostic implications. MethodsThis is a single-centre retrospective study including all consecutive patients, from January 2015 to December 2018, with inferior STEMI due to acute thrombotic occlusion of right coronary artery (RCA) and unsuccessful primary percutaneous coronary intervention (PCI) complicated by refractory RVF managed with an Impella RP device. ResultsA total of 5 patients have been treated. The mean age was 73 ± 9 years, 80% were males. All patients, except one, were hemodynamically stable at hospital admission. In all patients, PCI resulted unsuccessful (final TIMI flow < 3), with subsequent development of refractory RVF and cardiogenic shock in the catheterization laboratory, despite the use of inotropes and intra-aortic balloon pump (IABP). In 80% of the cases, Impella RP was placed immediately after PCI. Hemodynamics improved immediately after initiation of Impella RP support, with an increase in systolic blood pressure from 91 ± 17 to 136 ± 13 mmHg, a decrease in central venous pressure from 16 ± 2.5 to 12 ± 4 mmHg and a resolution in lactates from 4.5 ± 2.5 to 1.6 ± 0.7 mg/dL. Mean duration of IABP and Impella RP support were 4 and 7 days, respectively. RV recovery occurred in 80% of the cases. All patients survived at 30-day. ConclusionsIn patients with AMI complicated by unsuccessful revascularization of RCA and refractory RVF, the use of Impella RP device resulted in immediate hemodynamic benefit with reversal of shock and favourable survival at 30-day.

Robotic totally endoscopic beating-heart bypass to the right coronary artery: first worldwide experience.

Left coronary vessels are the usual targets in totally endoscopic coronary artery bypass (TECAB). Grafting of the right coronary artery (RCA) has been limited using this approach because of anatomic and technical difficulties. We report a first series of robotic beating-heart TECAB to the RCA via a right-chest approach. From July 2013 to April 2019, patients who underwent robotic beating-heart TECAB with the right internal mammary artery to the RCA were reviewed. Port placement in the right chest mirrored standard left-sided ports. Indications for right internal mammary artery to RCA bypass were RCA disease not amenable to percutaneous intervention and anomalous origin of the RCA. Right internal mammary artery-RCA bypass was performed in 16 patients (mean age 60.6 ± 13.5, 75% male). All cases were completed without conversion to sternotomy or mini-thoracotomy. Cardiopulmonary bypass was required in 1 patient to expose the posterior descending artery. Mean procedure time was 223 ± 49 min, with half of the patients extubated in the operating room (50%). Mean intraoperative transit-time graft flow was 87.0 ± 19.3 ml/min, and a pulsatility index of 1.2 ± 0.2. Mean length of stay was 2.3 ± 1.2 days. No mortality was observed at mean follow-up time of 20.6 months. One patient required repeat RCA revascularization for progression of native disease 43.7 months after the surgery. Robotic beating-heart TECAB for isolated RCA disease is a feasible operation in selected patients. This technique is possible even for the posterior descending artery.

Effect of Intracoronary Shunt on Right Ventricular Function During Off-pump Grafting of Dominant Right Coronary Artery with Poor Collateral

Although numerous studies have validated the efficacy of intracoronary shunt on reducing left ventricular dysfunction during off-pump coronary artery bypass surgery (OPCAB), there is lack of evidence supporting its role on right ventricular (RV) function during right coronary artery (RCA) revascularization. Therefore, we studied the effect of intracoronary shunt during grafting of dominant RCA without visible collateral supply on global RV function using thermodilution method. Forty patients scheduled for multivessel OPCAB with right dominant coronary circulation without collateral supply confirmed by angiography were randomized to RCA revascularization either with a shunt (n=20) or soft snare occlusion (n=20). RV ejection fraction (RVEF) was recorded at baseline, during RCA grafting, and 15 min after reperfusion. Corresponding RV stroke work index (RVSWI) was calculated. RVEF and RVSWI decreased significantly during RCA grafting and returned to baseline values after reperfusion in both groups without any significant differences between the groups. Intracoronary shunt did not exert any beneficial effect on global RV function during RCA grafting, even in the absence of visible collateral supply. Regarding the possibility of graft failure by intracoronary shunt-induced endothelial damage, routine use of intracoronary shunt during RCA grafting is not recommended in patients with preserved biventricular function.

Revascularization of the Right Coronary Artery: Grafting or Percutaneous Coronary Intervention?

The choice of myocardial revascularization strategy for the right coronary artery (RCA) in patients with multivessel disease and chronic stable angina remains controversial. Our aim was to determine the better strategy-hybrid, combining bypass of the left coronary network and percutaneous coronary intervention of the RCA, or exclusively surgical-and if the latter, the best conduit. We used decision analysis, a modeling technique, to compare two RCA revascularization strategies: surgical grafting and percutaneous coronary intervention. A review of the English language literature determined the variables for each strategy. All possible outcomes of each strategy were analyzed to determine the baseline strategy yielding the highest expected effectiveness. Sensitivity analysis determined the most relevant elements in the model and indicated threshold values. Arterial grafting of the RCA led to the highest expected effectiveness, respectively 6% and 7% higher than that of percutaneous coronary intervention and the saphenous graft procedure. Of the arteries available-the radial, right gastroepiploic, and right internal thoracic artery-the most effective was the right internal thoracic artery, pedicled for the proximal part of the RCA and free connected as a Y or a T to the pedicled left internal thoracic artery for the distal part of the RCA. Sensitivity analysis showed surgery to be the appropriate strategy when the expected 1-year patency rate of the arterial graft exceeded 80%. This analysis shows arterial grafting of the RCA to have better outcomes than percutaneous coronary intervention, and the right internal thoracic artery to be the best conduit.

Revascularization of the Right Coronary Artery in Bilateral Internal Thoracic Artery Grafting

Bilateral internal thoracic artery (BITA) grafting with a composite T-graft enables right coronary artery (RCA) system revascularization with the distal end of the free right internal thoracic artery (RITA). This study compares this grafting technique to left-sided BITA grafting and RCA revascularization with the right gastroepiploic artery (RGEA) and saphenous vein grafts (SVG). From April 1996 to July 1999, 1000 consecutive patients underwent left-sided revascularization with BITA. In 231 patients RCA grafting was performed with free RITA, in 246 with RGEA, in 142 with SVG, and 381 did not receive any graft to the RCA (no-graft group). Female gender, old age (> 70), emergency, and congestive heart failure were less prevalent in the RGEA group, and prior percutaneous transluminal coronary angioplasty was more prevalent in the no-graft group. Thirty-day mortality (3.6%, 4.9%, 2%, and 3.4% in the RITA, SVG, RGEA, and no-graft groups, respectively) and occurrence of perioperative complications (sternal infection, myocardial infarction, cerebrovascular accident, and bleeding) were similar. Overall, however, the trend was toward a higher complication rate in the RITA group (10.3%, 4.9%, 5.6%, and 7.3% respectively, p = 0.06). Midterm follow-up (40 to 78 months) showed similar 6-year survival (Kaplan-Meier) (88%, 87%, 89.5%, and 85.5%, respectively) and similar return of angina (10.8%, 6.3%, 10.6%, and 9.5%, respectively) in the four groups. Early and midterm results in patients undergoing left-sided BITA grafting are not affected by the conduit used for RCA grafting.

Revascularization of the right coronary artery: Influence thermodilution right ventricular ejection fraction

This study was designed in order to evaluate the influence of right coronary artery (RCA) disease and its revascularization on right heart performance monitored by measuring thermodilution right ventricular ejection fraction (RVEF). Forty patients undergoing elective aortocoronary bypass surgery were divided into two groups: group 1, with RCA revascularization, n = 20; and group 2, without RCA disease or revascularization, n = 20. RVEF was measured using a pulmonary arterial catheter mounted with a fast-response thermistor and a bedside microprocessor ejection fraction computer. The major finding of the study was that myocardial revascularization with extracorporeal circulation was followed by a decrease in RVEF which was significantly more pronounced in group 1 (−13.1%) in comparison to group 2 (−5.0%). RVEF gradually increased after bypass, but did not reach baseline values. By the first postoperative day, RVEF had reached baseline values again in group 1 and had increased beyond baseline values in group 2. Traditionally measured hemodynamic parameters could not be correlated with the course of RVEF, except for cardiac index. The present study further suggests that right-sided events may have clinical effects on left-sided function. Inadequate protection of the right heart, especially in patients with RCA stenosis, may result in depression of right ventricular myocardial performance, which can be monitored serially by measuring RVEF.