Successful Revascularization Research Articles

Manual Microcatheter-tip Modification: A bailout option for difficult "tip-in" technique during chronic total occlusion percutaneous coronary intervention.

The retrograde approach in chronic total occlusion (CTO) interventions often encounters significant challenges, particularly, when aligning the retrograde microcatheter (MC) with the antegrade system is difficult, complicating or even preventing standard externalization. To address these issues, techniques like the "tip-in" have proven to be effective backup strategies. We introduce the "Manual Microcatheter-tip Modification" (MMM) technique as an alternative when the "tip-in" method faces complications. We present a case of a left anterior descending CTO where MMM was successfully employed for the first time, enabling successful revascularization by manually modifying the MC tip to engage the retrograde guidewire. We explore the technical details within the framework of contemporary CTO PCI. This new technique could enhance the management of CTO interventions, offering innovative solutions when traditional externalization methods are problematic.

PREDICTORS OF NO-REFLOW PHENOMENON AFTER PCI IN PAKISTANI PATIENTS

The no-reflow phenomenon is a perplexing complication of PCI. It is marked by poor coronary microvascular perfusion despite successful revascularization. This condition can lead to adverse outcomes such as myocardial infarction and heart failure. Various treatments exist, including pharmacological agents and mechanical interventions, but no flow remains a significant clinical challenge. Objective: This study aims to identify predictors of the no-reflow phenomenon in Pakistani patients undergoing PCI. Methods: Conducted at the National Institute of Cardiovascular Diseases (NICVD) in Karachi from January 2020 to December 2021, this observational study included 256 patients undergoing primary PCI for acute myocardial infarction. Baseline characteristics such as age, sex, BMI, diabetes status, hypertension, smoking status, and left ventricular ejection fraction (LVEF) were recorded. The primary outcome was the incidence of no-reflow, with secondary outcomes including in-hospital mortality and heart failure. Data analysis was performed using SPSS software, with logistic regression pinpointing independent predictors of no-reflow. Results: The patients had a mean age of 58.4 ± 12.3 years, and the median was 59 years. Most patients were male (78.1%). Significant predictors of no-reflow included diabetes mellitus (OR: 2.1, 95% CI: 1.2-3.7, p=0.01), hypertension (OR: 1.8, 95% CI: 1.0-3.2, p=0.04), and reduced LVEF (OR: 1.5 per 5% decrease, 95% CI: 1.2-2.1, p<0.001). Patients experiencing no-reflow had higher in-hospital mortality (11.1% vs. 4.0%, p<0.05) and heart failure rates (24.1% vs. 10.4%, p<0.01) compared to those with normal flow. Conclusion: Diabetes mellitus, hypertension, and reduced LVEF are significant predictors of the no-reflow phenomenon in Pakistani patients undergoing PCI. Identifying high-risk patients allows for targeted preventative strategies to improve clinical outcomes.

Clinical efficacy of endovascular revascularization combined with vacuum-assisted closure for the treatment of diabetic foot.

The diabetic foot is a common cause of disability and death, and comorbid foot infections usually lead to prolonged hospitalization, high healthcare costs, and a significant increase in amputation rates. And most diabetic foot trauma is complicated by lower extremity arteriopathy, which becomes an independent risk factor for major amputation in diabetic foot patients. To establish the efficacy and safety of endovascular revascularization (ER) combined with vacuum-assisted closure (VAC) for the treatment of diabetic foot. Clinical data were collected from 40 patients with diabetic foot admitted to the Second Affiliated Hospital of Soochow University from April 2018 to April 2022. Diabetic foot lesions were graded according to Wagner's classification, and blood flow to the lower extremity was evaluated using the ankle-brachial index test and computerized tomography angiography of the lower extremity arteries. Continuous subcutaneous insulin infusion pumps were used to achieve glycemic control. Lower limb revascularization was facilitated by percutaneous tran-sluminal balloon angioplasty (BA) or stenting. Wounds were cleaned by nibbling debridement. Wound granulation tissue growth was induced by VAC, and wound repair was performed by skin grafting or skin flap transplantation. Of the 35 cases treated with lower limb revascularization, 34 were successful with a revascularization success rate of 97%. Of these, 6 cases underwent stenting after BA of the superficial femoral artery, and 1 received popliteal artery stent implantation. In the 25 cases treated with infrapopliteal artery revascularization, 39 arteries were reconstructed, 7 of which were treated by drug-coated BA and the remaining 32 with plain old BA. VAC was performed in 32 wounds. Twenty-four cases of skin grafting and 2 cases of skin flap transplantation were performed. Two patients underwent major amputations, whereas 17 had minor amputations, accounting for a success limb salvage rate of 95%. ER in combination with VAC is a safe and effective treatment for diabetic foot that can significantly improve limb salvage rates. The use of VAC after ER simplifies and facilitates wound repair.

Treatment of acute high risk sub-massive pulmonary embolism with balloon angioplasty and thrombolysis simultaneously

Background: Acute sub-massive pulmonary embolism is a common clinical condition, and it is associated with high mortality and morbidity. This condition is commonly associated with various co-morbidities and clinical circumstances. Methods: This is a case report series of 4 patients, wherein the thrombolysis and balloon angioplasty was performed simultaneously using a Cordis 6F diagnostic catheter and later exchanged with a 6F guide catheter in the respective pulmonary artery when a larger balloon was required. Results: All these four patients achieved successful revascularization of the respective pulmonary artery. One patient expired 30 hours after the procedure with a significant reduction in the symptoms suddenly, which was likely a second episode of pulmonary embolism. No bleeding manifestations were observed in any of the patients. The other three patients are on follow-up. Conclusion: Simultaneous coronary balloon dilatation and thrombolysis is a useful method in the treatment of high risk submassive acute pulmonary embolism. If needed, higher caliber balloons can be used for the same technique using guide catheters.

The Effect of Revascularization on Lower Limb Circulation Parameters in Symptomatic Peripheral Arterial Disease.

Background: The prevalence of peripheral arterial disease and the number of revascularization procedures performed in symptomatic patients are steadily increasing. However, uncertainties remain regarding hemodynamic monitoring after revascularization and the prediction of clinical outcomes. This study aimed to investigate hemodynamic parameters with a focus on the microvasculature. Methods: This prospective, single-center study included 29 patients (15 with intermittent claudication [IC] and 14 with chronic limb-threatening ischemia [CLTI]). Before and after the revascularization procedure, in addition to the ankle-brachial index (ABI), microperfusion parameters, including microvascular blood flow, capillary oxygen saturation (SO2), and relative hemoglobin content (rHb), were assessed with lightguide spectrophotometry combined with laser Doppler flowmetry using an oxygen-to-see (O2C) device in the horizontal and elevated leg positions. Results: At baseline, SO2 in the elevated leg position was significantly lower in patients with CLTI than in those with IC (p = 0.0189), whereas the other microcirculatory parameters and ABI values were not significantly different. Patients with diabetes mellitus had a higher flow rate than those without in the horizontal leg position (p = 0.0162) but not in the elevated leg position. After successful revascularization, the flow increased immediately and significantly in both positions, whereas SO2, rHb, and the ABI did not. Conclusions: Elevated leg SO2 was significantly lower in CLTI than in clinically compensated peripheral arterial disease, whereas microvascular flow was a suitable surrogate parameter indicating successful revascularization. In studies using surgical or interventional revascularization procedures, noninvasive hemodynamic monitoring of the microcirculation at the foot level might be beneficial.

Outcomes of Primary Percutaneous Coronary Intervention in Post COVID-19 Patients Presenting with ST Segment Elevation Myocardial Infarction

Abstract Background Coronavirus disease-2019 (COVID-19) is thought to predispose patients to wide variety of thrombotic disease, including Acute Coronary Syndromes (ACS). While such fact is established in literature to occur during the acute infection, data regarding the long term thrombotic effects of COVID-19 are still unclear. Aim and Objectives To determine the special coronary angiographic findings, the procedural and clinical success of revascularization among post COVID-19 patients presenting with STEMI. Patients and Methods This study was performed on a 100 patients who presented to emergency departments of Ain shams university hospitals with ST Segment Elevation Myocardial Infarction and underwent primary PCI, during a period of 6 months: From January to June of 2022. The patients were randomized into two groups: Group (A) the Post COVID-19 group, comprising 50 patients who developed COVID-19 infection in the past 6 months, as diagnosed at the time by RT-PCR or a CT chest of CORADS-IV or more – and group (B) the Control group, comprising 50 patients who deny COVID-19 infection in the past 6 months, endorsed by a negative COVID-19 antibody test. A subgroup analysis was done where patients in group (A) were further divided into two subgroups: the Early Post-COVID subgroup, having developed STEMI within 8 weeks of infection and comprising 16 patients, and the Late Post-COVID subgroup, having developed STEMI >8-24 weeks post infection and comprising 34 patients. The groups were compared as regards clinical, angiographic, laboratory and echocardiographic outcomes of percutaneous intervention. Results Our study demonstrated that patients who developed STEMI within 8 weeks of a COVID-19 infection (the Early Post-COVID subgroup) showed a statistically significant high thrombus burden on angiography, at 81.3% versus 48% of the control group. A high thrombus burden was defined in our study as having a modified thrombus grade of 4 or more. This subsequently resulted in higher use of pre-dilatation (56.2% versus 24%) and thrombus aspiration (43.8% versus 4%) in the Early Post- COVID subgroup, both at a statistically significant level (P-values = 0.015 and 0.001 respectively). Coronary No-Reflow was a much more frequent complication following PCI in the Early post-COVID subgroup (62.5%) compared to the Control group (22%). These patients also suffered a lower Ejection Fraction on Echocardiography (Mean 36% versus 43.4%) and a larger LVIDs (Mean 47mm versus 43.9mm) as compared to the Control group. This data translated clinically into a higher MACE among the Early Post-COVID patients, at 31.3% versus 6% of the control group. Of note that these differences were not as evident upon comparing the whole post COVID group to the control group. Conclusion We concluded that the thrombogenic effect of COVID-19 on the outcomes of STEMI persists even after resolution of the infection but gradually declines overtime. It affects the angiographic, procedural and overall clinical success of revascularization during in-hospital stay. This effect is maximal during the first 8 weeks after infection, but declines thereafter.

First-Line Aspiration Thrombectomy of M2 Occlusions with a Novel Reperfusion Catheter (REDTM 62): Real-World Experience from Two Tertiary Comprehensive Stroke Centers.

The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVOs). We evaluated technical features and initial results of a novel reperfusion catheter (REDTM 62) used for frontline aspiration thrombectomy of M2 occlusions in acute ischemic stroke patients. Appropriate aspiration catheters are crucial for a successful ADAPT maneuver; however, the selection of catheters suitable for smaller-sized vessels is scarce compared to the ones for large vessel occlusions. All patients treated with ADAPT using REDTM 62 as the frontline treatment approach for acute M2 occlusions between December 2022 and February 2024 were retrospectively enrolled. Demographic data, procedural timings and safety, recanalization rates, and outcome data were recorded. Twenty patients with a median admission National Institutes of Health Stroke Scale (NIHSS) score of 8 were identified. Successful revascularization (DMVO-thrombolysis in cerebral infarction [TICI]≥2b) with REDTM 62 aspiration thrombectomy was obtained in 65.0% (13/20) of cases. The first pass effect was 45.0% (9/20). In 2 cases, the REDTM 62 did not reach the clot due to marked distal vessel tortuosity. Stent retrievers were additionally used in 9 cases and led to an overall DMVO-TICI 2c/3 of 90.0% (18/20). Mean procedural time was 48 minutes. No complications directly related to ADAPT occurred. In-hospital mortality rate was 20.0% (4/20). The median discharge NIHSS score was 2.5. A good functional outcome at discharge (modified Rankin scale 0-2) was achieved in 55.0% (11/20) of cases. Our initial experiences with the novel REDTM 62 reperfusion catheter for treatment of M2 occlusions is in line with published data. ADAPT using this catheter may be considered as a safe and effective first-line treatment option. Further studies are warranted to validate the initial results.

Right ventricular–pulmonary arterial coupling in patients with first acute myocardial infarction: an emerging post-revascularization triage tool

BackgroundThe tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is a non-invasive surrogate for right ventricular–pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocardial infarction (AMI), which may cause acute RV pressure overload, remains unexplored. ObjectiveThis study aimed to determine predictors of RV-PA uncoupling in patients with first AMI and examine whether it could improve risk stratification for cardiovascular in-hospital mortality after revascularization. MethodsThree-hundred consecutive patients with first AMI were prospectively studied (age 61.2 ± 11.8, 24% females). Echocardiography was performed 24 h after successful revascularization, and TAPSE/PASP was evaluated. Cardiovascular in-hospital mortality was recorded. ResultsThe optimal cutoff value of TAPSE/PASP to determine cardiovascular in-hospital mortality was 0.49 mm/mmHg. RV-PA uncoupling was considered for patients with TAPSE/PASP ≤0.49 mm/mmHg. Left ventricular ejection fraction (LVEF) was independently associated with RV-PA uncoupling. A total of 23 (7.7%) patients died in hospital despite successful revascularization. TAPSE/PASP was independently associated with in-hospital mortality after adjustment for Global Registry of Acute Coronary Events (GRACE) risk score and LVEF (odds ratio 0.14 [95% confidence interval 0.03–0.56], P = 0.007). The prognostic value of a baseline model including the GRACE risk score and NT-pro-BNP (χ2 26.55) was significantly improved by adding LVEF ≤40% (χ2 44.71, P < 0.001), TAPSE ≤ 17 mm (χ2 75.42, P < 0.001) and TAPSE/PASP ≤ 0.49 mm/mmHg (χ2 101.74, P < 0.001) for predicting cardiovascular in-hospital mortality. ConclusionRV-PA uncoupling, assessed by echocardiographic TAPSE/PASP ≤ 0.49 mm/mmHg 24 h after revascularization, may improve risk stratification for cardiovascular in-hospital mortality after first AMI.

Impact of Infrapopliteal Revascularisation Establishing In Line Flow to the Wound in Patients with Chronic Limb Threatening Ischaemia

This study aimed to determine the impact of infrapopliteal (IP) revascularisation establishing in line flow to the wound (IFW) on wound healing in chronic limb threatening ischaemia (CLTI), using a core laboratory assessment for wounds and in line flow. The Wound-directed Angiosome RevasculaRIzation apprOach to patients with cRitical limb iSchaemia (WARRIORS) multicentre observational study enrolled patients with CLTI with tissue loss undergoing IP revascularisation in Japan, with scheduled two year follow up. The primary outcome measure was complete wound healing, defined as achievement of complete epithelialisation of all wounds without major amputation. IP revascularisation establishing IFW was defined as revascularisation after which a tibiopedal artery that actually fed an injured pedal unit was patent. The incidence of wound healing was compared between the IFW and non-IFW groups using inverse probability of treatment weighting based on the propensity score. A total of 440 patients with CLTI (median age, 75 years; male, 64.1%; diabetes mellitus, 72.0%; dialysis, 57.7%) with tissue loss (Wound, Ischemia, and foot Infection stage 4, 66.4%) who underwent IP revascularisation (endovascular procedure, n = 304; bypass grafting, n = 136) between October 2017 and June 2020 were registered. During a median follow up of 23.6 months, 51.1% achieved wound healing. Successful IP revascularisation with IFW was achieved in 68.2%. After analysis, the IFW group had a higher incidence of wound healing than the non-IFW group (34.5 vs. 16.1 per 100 person years; p = .030). The association of IFW with wound healing was not statistically different between patients undergoing bypass grafting and those undergoing an endovascular procedure (p for interaction = .38). There was no statistically significant interaction effect between IFW and direct revascularisation for wound healing (p for interaction = .51). IP revascularisation establishing IFW was statistically significantly associated with a higher wound healing rate in patients with CLTI.

SOFIA Aspiration System as first-line Technique (SOFAST): a prospective, multicenter study to assess the efficacy and safety of the 6 French SOFIA Flow Plus aspiration catheter for endovascular stroke thrombectomy

BackgroundMechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). The SOFAST study collected clinical evidence on the safety and efficacy...

A Long-Term Outcome of Symptomatic Middle Cerebral Artery Undergoing Intracranial Angioplasty or Stenting

PurposeFor symptomatic stenosis in the middle cerebral artery (MCA), intracranial angioplasty and stenting are frequently employed. However, limited data exist regarding their long-term impact. Our study demonstrates the long-term advantages in preventing ischemic events through a 5-year follow-up period. MethodsA set of 41 individuals with symptomatic stenosis in the central cerebral artery (MCA) who underwent angioplasty or stenting procedures between October 2004 and April 2018 at various hospitals in Southwest China were prospectively enrolled in the study. The rates of successful revascularization, complications, imaging observations, and clinical outcomes were systematically assessed. ResultsA total of 41 individuals successfully underwent stenting , respectively. After stenting, the extent of stenosis was decreased from 71.8 percent (56 -87.8%) to 24.9 percent (0-45 percent). The mean of follow period is 36.9 ± 13.68 months (range , 11-67 months). There was no deterioration of neurological function or a new ischemic event. A DSA or CTA was conducted after the procedure and demonstrated no in-stent restenosis. No patient experienced restenosis below 50% during the mean follow-up period. The morbidity and mortality rates of the case series were 7.3% and 2.4%, respectively. ConclusionIn the treatment of symptomatic MCA atherosclerotic stenoses, intracranial angioplasty & stenting are demonstrated to be technically feasible and safe. Its early & long-term efficacy on ischemic event prevention is acceptable, with a reduced level of restenosis, although the representative sample is tiny.

The Usefulness of Intravascular Ultrasound and Optical Coherence Tomography in Patients Treated with Rotational Atherectomy: An Analysis Based on a Large National Registry.

Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve the clinical outcomes of percutaneous coronary interventions (PCIs) in selected subsets of patients. The aim was to investigate whether the use of OCT or IVUS during a PCI with rotational atherectomy (RA-PCI) will increase the odds for successful revascularization, defined as thrombolysis in myocardial infarction (TIMI) 3 flow. Data were obtained from the national registry of PCIs (ORPKI) maintained by the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The dataset includes PCIs spanning from January 2014 to December 2021. A total of 6522 RA-PCIs were analyzed, out of which 708 (10.9%) were guided by IVUS and 86 (1.3%) by OCT. The postprocedural TIMI 3 flow was achieved significantly more often in RA-PCIs guided by intravascular imaging (98.7% vs. 96.6%, p < 0.0001). Multivariable analysis revealed that using IVUS and OCT was independently associated with an increased chance of achieving postprocedural TIMI 3 flow by 67% (odds ratio (OR), 1.67; 95% confidence interval (CI): 1.40-1.99; p < 0.0001) and 66% (OR, 1.66; 95% CI: 1.09-2.54; p = 0.02), respectively. Other factors associated with successful revascularization were as follows: previous PCI (OR, 1.72; p < 0.0001) and coronary artery bypass grafting (OR, 1.09; p = 0.002), hypertension (OR, 1.14; p < 0.0001), fractional flow reserve assessment during angiogram (OR, 1.47; p < 0.0001), bifurcation PCI (OR, 3.06; p < 0.0001), and stent implantation (OR, 19.6, p < 0.0001). PCIs with rotational atherectomy guided by intravascular imaging modalities (IVUS or OCT) are associated with a higher procedural success rate compared to angio-guided procedures.

The role of body mass index in high- and low-velocity trauma causing knee injury associated with popliteal artery lesions

BackgroundAmong arterial traumas, osteoarticular traumas are particularly dangerous, and those involving the popliteal artery are associated with a high amputation rate. Despite representing a minority of arterial traumas, with an incidence that varies considerably by population and geographic location, traumatic lesions of the popliteal artery are challenging. This study aimed to verify the impact of body mass index (BMI) on arterial trauma damage and patient outcomes.MethodsData were retrospectively collected from the electronic medical reports of all patients with osteoarticular and vascular associated lesions treated in the emergency operating room at our institution between 1 January 2005 and 1 May 2022. Forty-one patients presented with lower limb arterial trauma (43.2%); popliteal artery lesions occurred in 11 of these patients (26.8%), who were eligible for inclusion in the study. The lesion mechanism was dislocation by high-velocity trauma in 9 patients and dislocation by low-velocity trauma in 3 patients. All 7 males (63.6%) experienced high-velocity trauma, and 2 of the 3 females experienced low-velocity trauma. Only one patient had an isolated popliteal artery lesion associated with fractures in the leg or the contralateral limb. Patients with low-velocity trauma were older than 54 years, while those with high-velocity trauma were aged 22 to 71 years.ResultsIn 10/11 patients (90.9%), revascularization was performed after osteoarticular stabilization and reduction of the dislocation or fracture. Intraoperative angiography was selectively used. Two patients required above-the-knee amputation after the procedure: one due to infection of the surgical access point and the other due to severe soft tissue injury. One patient died during hospitalization due to trauma-related complications and comorbidities.ConclusionsHigh-velocity trauma and low-velocity trauma in patients with a body mass index > 35 kg/m2 and knee lesions are associated with popliteal artery lesions. Revascularization success is not associated with high- or low-velocity trauma.

Clinical characteristics and imaging patterns of cerebral infarction with outcomes of carotid artery stenting in symptomatic carotid stenosis: An eight-year journey

Objectives: Carotid artery stenting (CAS) for symptomatic carotid stenosis (SCS) has emerged as an attractive option in recent times. CAS and topographical patterns of stroke in symptomatic stenosis have been inadequately addressed. With this objective, we conducted a study to analyze infarct patterns and complications of carotid stenting and determine outcome predictors after stenting. Materials and Methods: A single-center retrospective study from January 01, 2015, to December 31, 2022, on patients with SCS, who underwent carotid stenting with at least six months of follow-up was conducted. Infarct patterns, angiographic findings, procedural complications, and outcomes (favorable [modified Rankin scale (mRS) ≤2] or unfavorable [mRS &gt;2]) were recorded. Chi-square, analysis of variance for qualitative and quantitative variables was employed. Significant variables on univariate analysis were entered into regression and outcome predictors were determined. Results: Ninety-six records were included in the study. Forty-six (47.91%), 12 (12.50%), and 38 (39.58%) patients had territorial infarcts (TIs), border-zone infarcts (BZIs), and mixed infarcts (MIs). National Institutes of Health Stroke Scale (NIHSS) &lt;5 and transient ischemic attack (TIA) were significant (P &lt; 0.05) while the circle of Willis anomalies were comparable in TI versus BZI versus MI. Bradycardia (54.16%) and vessel spasm (19.79%) were noted during stenting. Successful revascularization (residual stenosis &lt;20%) was achieved in 97.87%. Procedural complications were comparable in TI versus BZI versus MI. Minor cerebral hyperperfusion syndrome (CHS) with headache (9.57%), seizure (2.12%) peaking between 6 and 12 h, and severe with basal ganglia hemorrhage and death occurred. There were no major strokes. 64.13% and 75.28% achieved a favorable mRS at one and six months, respectively. NIHSS ≤10, early intervention (≤ 2 weeks), absence of diabetes, hypertension, or ischemic heart disease were significant (P &lt; 0.05) for a favorable outcome. NIHSS ≤10, absence of hypertension at one month and NIHSS ≤10, absence of diabetes at six months were predictors of a favorable outcome. Conclusion: Severe carotid disease predisposed to CHS. Overall, CAS was a safe and effective procedure with 74.15% achieving favorable outcomes at six months.

Successful Percutaneous Revascularization for Femoral Artery Occlusion After Catheter Intervention: Serial Case Report

Successful Percutaneous Revascularization for Femoral Artery Occlusion After Catheter Intervention: Serial Case Report

Long-Term Prognostic Impact of Stress Hyperglycemia in Non-Diabetic Patients Treated with Successful Primary Percutaneous Coronary Intervention.

stress hyperglicemia (SH) is common in patients with ST-elevation myocardial infraction (STEMI). The aims of this study were to analyze the impact of SH on the incidence of all-cause mortality and major adverse cardiovascular events (MACE-cardiovascular death, nonfatal reinfarction, target vessel revascularization, and stroke) in STEMI patients without diabetes mellitus (DM) who have been treated successfully with primary PCI (pPCI). we analyzed 2362 STEMI patients treated with successful pPCI (post-procedural flow TIMI = 3) and without DM and cardiogenic shock at admission. Stress hyperglycemia was defined as plasma glucose level above 7.8 mmol/L at admission. The follow-up period was 8 years. incidence of SH was 26.9%. Eight-year all-cause mortality and MACE rates were significantly higher in patients with SH, as compared to patients without SH (9.7% vs. 4.2%, p < 0.001, and 15.7% vs. 9.4%, p < 0.001). SH was an independent predictor of short- and long-term all-cause mortality (HR 2.19, 95%CI 1.16-4.18, and HR 1.99, 95%CI 1.03-3.85) and MACE (HR 1.49, 95%CI 1.03-2.03, and HR 1.35, 95%CI 1.03-1.89). despite successful revascularization, SH at admission was an independent predictor of short-term and long-term (up to eight years) all-cause mortality and MACE, but its negative prognostic impact was stronger in short-term follow-up.

Deciphering the Enigma of Intramyocardial Hemorrhage Following Reperfusion Therapy in Acute ST-Segment Elevation Myocardial Infarction: A Comprehensive Exploration from Mechanisms to Therapeutic Strategies.

Acute ST-segment elevation myocardial infarction (STEMI) is a formidable challenge in cardiovascular medicine, demanding advanced reperfusion strategies such as emergency percutaneous coronary intervention. While successful revascularization is pivotal, the persistent "no-reflow" phenomenon remains a clinical hurdle, often intertwined with microvascular dysfunction. Within this intricate scenario, the emergence of intramyocardial hemorrhage (IMH) has garnered attention as a significant contributor. This review offers a detailed exploration of the multifaceted relationship between IMH and the "no-reflow" phenomenon, delving into the mechanisms governing IMH occurrence, state-of-the-art diagnostic modalities, predictive factors, clinical implications, and the evolving landscape of preventive and therapeutic strategies. The nuanced examination aims to deepen our comprehension of IMH, providing a foundation for the identification of innovative therapeutic avenues and enhanced clinical outcomes for STEMI patients.

Revascularisation patterns and characteristics after erythropoietin pretreatment and multiple burr holes in patients who had acute stroke with perfusion impairment

BackgroundTransdural collaterals, originating mainly from the extracalvarial superficial temporal artery and intracalvarial middle meningeal artery via the external carotid artery (ECA), have been observed after revascularisation surgery. However, the origin...

Case report: Deep vein arterialization for limb salvage in a patient with subacute limb ischemia.

Successful revascularization of the lower extremity is key to avoiding amputation in patients with subacute limb ischemia. Percutaneous deep vein arterialization (DVA) is a novel endovascular technique which allows the shunting of blood through an arteriovenous fistula and native vein into the lower limb, typically employed in no-option chronic limb-threatening ischemia. We present a case illustrating the unconventional use of DVA for limb salvage in a patient presenting with subacute limb ischemia refractive to surgical treatment, endovascular revascularization, and medical therapy. The arteriovenous anastomosis allowed for the reconstitution of arterial inflow to the patient's foot, thereby avoiding major limb amputation. The conventional knowledge that DVA neo-conduits require maturation limiting its role in the treatment of subacute limb ischemia is challenged. However, further research is needed to establish its role and effectiveness for subacute limb ischemia.

X-ray endovascular surgery for in-hospital acute ischemic stroke

The OBJECTIVE was to determine the efficacy of endovascular surgery for in-hospital acute ischemic stroke (AIS) and to identify predictors of unfavorable AIS outcome.METHODS AND MATERIALS. We performed 42 endovascular thrombectomies for in-hospital AIS in patients treated in the hospital for another pathology. Neurological defiCIT was determined by NIHSS scale, thrombectomy efficacy was evaluated by the degree of cerebral revascularization by mTICI scale, functional outcome was determined by Rankin scale (mRS). Multivariate analysis with evaluation of clinical and laboratory, neuroimaging data, and analysis of surgical technique was performed to identify factors contributing to adverse stroke outcome.RESULTS. The mean age of patients was 73.8±11.8 years old. Neurological defiCIT before surgery was 12.8±6.7 points by to NIHSS. Thrombolytic therapy was used in one third of cases, thrombectomy in 92.9 %, and carotid artery stent ing in 2 cases. Successful revascularization (mTICI2b-3) was achieved in 83.3 % of cases. The significant reduction in neurological defiCIT after surgery was achieved to NIHSS 6.0±5.9 points, mRS 2.7±2.1. The mortality rate amounted to 16.7 % of cases. Poor functional outcome (mRS3-5) was significantly associated with: female gender, older age, presence of cardiovascular pathology, recurrent stroke, postoperative tachycardia, low renal tubular filtration rate, hypocoagulation, low cardiac ejection fraction, low aortic valve opening amplitude, high pulmonary hypertension, large left atrial volume, initial severe neurological defiCIT, poor collaterals in the area of cerebral ischemia, proximal internal carotid artery occlusion, hemorrhagic saturation, increased operation time, low degree of revascularization (mTICI0-2a).CONCLUSION. Endovascular surgery has demonstrated its safety and high efficacy in the treatment of in-hospital AIS in surgical hospitalized patients. Endovascular thrombectomies allow to significantly reduce neurological defiCIT and decrease mortality in the severe category of patients with cardioembolic AIS. clinical, laboratory, hemodynamic and neuroimaging factors influencing on poor functional outcome of in-hospital AIS have been determined.