01 marzo 2013

JACC CARDIOVASCULAR INTERVENTIONS. Edge Vascular Response After Percutaneous Coronary Intervention. An Intracoronary Ultrasound and Optical Coherence Tomography Appraisal

Bill D. Gogas, MD; Hector M. Garcia-Garcia, MD, MSc, PhD; Yoshinobu Onuma, MD; Takashi Muramatsu, MD, PhD; Vasim Farooq, MBChB; Christos V. Bourantas, MD, PhD; Patrick W. Serruys, MD, PhD

The concept of edge vascular response (EVR) was first introduced with bare-metal stents and later with radioactive stents of various activity levels. Although radioactive stents reduced intra-stent neointimal hyperplasia and thereby the incidence of in-stent restenosis in a dose-dependent manner, tissue proliferation at the non-irradiated proximal and distal stent edges resulted in the failure of this invasive treatment. The advent of first- and second-generation drug-eluting stents (DES) reduced in-stent restenosis to approximately 5% to 10%, depending on the lesion subset and DES type. When in-segment restenosis (stent and 5-mm proximal and distal margins) occurred, it was most commonly focal and located at the proximal edge. In addition, stent thrombosis, the other main contributing factor for DES failure, seemed in part to be associated with residual plaque presence and underlying tissue composition at the landing zone of the implanted device, particularly if landed in a necrotic core rich milieu. More recently, the introduction of bioresorbable scaffolds for the treatment of coronary artery disease has prompted the re-evaluation of the EVR. This has recently been assessed up to 2-years after implantation of the Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, California). In general, the EVR consists of a focal but significant proximal lumen loss that in a few instances necessitates target lesion revascularization of a flow-limiting edge stenosis. Herein, we provide an overview of the in vivo evaluation of the EVR with intravascular ultrasound, virtual histology intravascular ultrasound, and the more recently developed optical coherence tomography. Our objective is to highlight the clinical importance of the EVR as a predisposing and contributing factor to device failure with either bare-metal stents, DES, or bioresorbable scaffolds.

01 marzo 2013

AMERICAN HEART JOURNAL. TransRadial Education And Therapeutics (TREAT): Shifting the balance of safety and efficacy of antithrombotic agents in percutaneous coronary intervention:

Connie N. Hess, MD , Sunil V. Rao, MD , David F. Kong, MD , Julie M. Miller, MD , Kevin J. Anstrom, PhD , Olivier F. Bertrand, MD , Jean-Philippe Collet, MD , Mark B. Effron, MD , Benjamin C. Eloff, PhD , Emmanuel O. Fadiran, PhD , Andrew Farb, MD , Ian C. Gilchrist, MD , David R. Holmes, MD , Alice K. Jacobs, MD , Prashant Kaul, MD , L. Kristin Newby, MD, MHS , David R. Rutledge, PharmD , Dale R. Tavris, MD, MPH , Thomas T. Tsai, MD, MSc , Roseann M. White, MA , Eric D. Peterson, MD, MPH , Mitchell W. Krucoff, MD, FACC, FCCP

Percutaneous coronary intervention (PCI) is an integral part of the treatment of coronary artery disease. The most common complication of PCI, bleeding, typically occurs at the vascular access site and is associated with short-term and long-term morbidity and mortality. Periprocedural bleeding also represents the primary safety concern of concomitant antithrombotic therapies essential for PCI success. Use of radial access for PCI reduces procedural bleeding and hence may change the risk profile and net clinical benefit of these drugs. This new drug-device safety interaction creates opportunities to advance the safe and effective use of antithrombotic agents during PCI. In June 2010 and March 2011, leaders from government, academia, professional societies, device manufacturing, and pharmaceutical industries convened for 2 think tank meetings. Titled TREAT I and II, these forums examined approaches to improve the overall safety of PCI by optimizing strategies for antithrombotic drug use and radial artery access. This article summarizes the content and proceedings of these sessions.

01 abril 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Impact of Drug-Eluting Stents on Distal Vessels

Kohei Wakabayashi, MD, PhD, Gary S. Mintz, MD, Neil J. Weissman, MD, Gregg W. Stone, MD, Stephen G. Ellis, MD, Eberhard Grube, MD, John A. Ormiston, MBChB, Mark A. Turco, MD, Rajbabu Pakala, PhD, Zhenyi Xue, MS, Sameer Desale, MS, Ana Laynez-Carnicero, MD, Rafael Romaguera, MD, Gabriel Sardi, MD, Augusto D. Pichard, MD and Ron Waksman, MD

Background—Previous studies have not addressed vessel response >5 mm distal to the stent edge. Therefore, we investigated the impact of paclitaxel-eluting stents (PES) versus bare metal stents (BMS) on distal vessels in the serial intravascular ultrasound substudies of TAXUS IV, V, and VI.

01 febrero 2012

CIRCULATION. Incidence and Prognosis of Resistant Hypertension in Hypertensive Patients

Stacie L. Daugherty, MD, MSPH; J. David Powers, MS; David J. Magid, MD, MPH; Heather M. Tavel, BS; Frederick A. Masoudi, MD, MSPH; Karen L. Margolis, MD, MPH; Patrick J. O Connor, MD, MPH; Joe V. Selby, MD, MPH; P. Michael Ho, MD, PhD

Background—Despite a recent American Heart Association (AHA) consensus statement emphasizing the importance of resistant hypertension, the incidence and prognosis of this condition are largely unknown.

01 marzo 2013

JACC CARDIOVASCULAR INTERVENTIONS. Fractional Flow Reserve–Guided Revascularization. Practical Implications of a Diagnostic Gray Zone and Measurement Variability on Clinical Decisions

Ricardo Petraco, MD; Sayan Sen, MBBS; Sukhjinder Nijjer, MBChB; Mauro Echavarria-Pinto, MD; Javier Escaned, MD, PhD; Darrel P. Francis, MB, BChir, MA, MD; Justin E. Davies, MBBS, PhD

Objectives: This study sought to evaluate the effects of fractional flow reserve (FFR) measurement variability on FFR-guided treatment strategy.

01 abril 2013

AMERICAN HEART JOURNAL. Rationale and design of the EMBRACE STEMI Study

Anjan K. Chakrabarti, MD , Kristin Feeney, BS , Cassandra Abueg, MPH , David A. Brown, PhD , Ewa Czyz, MD , Michal Tendera, MD , Andras Janosi, MD , Robert P. Giugliano, MD , Robert A. Kloner, MD, PhD , W. Douglas Weaver, MD , Christoph Bode, MD , Jacek Godlewski, MD , Bela Merkely, PhD, DSc , C. Michael Gibson, MS, MD

Background: Although significant efforts have been made to improve ST-segment elevation myocardial infarction (STEMI) outcomes by reducing symptom-onset-to-reperfusion times, strategies to decrease the clinical impact of ischemic reperfusion injury have demonstrated limited success. Bendavia, an intravenously administered mitochondrial targeting peptide, has been shown to reduce myocardial infarct size and attenuate coronary no-reflow in experimental modelswhen given before reperfusion.

40 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Outcomes After Coronary Stent Implantation in Patients With Metal Allergy

Santiago Romero-Brufau, Patricia J.M. Best, MD, David R. Holmes Jr, MD, Verghese Mathew, MD, Mark D.P. Davis, MD, Gurpreet S. Sandhu, MD, PhD, Ryan J. Lennon, MS, Charanjit S. Rihal, MD, MBA and Rajiv Gulati, MD, PhD

Background—Clinical outcomes after stent placement in patients with a history of metal allergy remain incompletely understood. We performed a single-center retrospective study to evaluate such outcomes.

01 marzo 2013

JACC. Transluminal Attenuation Gradient in Coronary Computed Tomography Angiography Is a Novel Noninvasive Approach to the Identification of Functionally Significant Coronary Artery Stenosis

Dennis T.L. Wong, MBBS (Hons); Brian S. Ko, MBBS (Hons); James D. Cameron, MBBS, MD; Nitesh Nerlekar, MBBS; Michael C.H. Leung, MBBS (Hons), PhD; Yuvaraj Malaiapan, MBBS; Marcus Crossett, Ba App Sc; Darryl P. Leong, MBBS (Hons), MPH, PhD; Stephen G. Worthley, MBBS, PhD; John Troupis, MBBS; Ian T. Meredith, MBBS (Hons), PhD; Sujith K. Seneviratne, MBBS

Objective: The purpose of this study was to assess the diagnostic accuracy of TAG320 in predicting functional stenosis severity evaluated by fractional flow reserve (FFR).

01 marzo 2013

JACC CARDIOVASCULAR INTERVENTIONS. Optical Coherence Tomography Versus Intravascular Ultrasound to Evaluate Coronary Artery Disease and Percutaneous Coronary Intervention

Hiram G. Bezerra, MD, PhD; Guilherme F. Attizzani, MD; Vasile Sirbu, MD; Giuseppe Musumeci, MD; Nikoloz Lortkipanidze, MD; Yusuke Fujino, MD; Wei Wang, MS; Sunao Nakamura, MD, PhD; Andrej Erglis, MD; Giulio Guagliumi, MD; Marco A. Costa, MD, PhD

Objectives: We compared intravascular ultrasound (IVUS) and 2 different generations of optical coherence tomography (OCT)—time-domain OCT (TD-OCT) and frequency-domain OCT (FD-OCT)—for the assessment of coronary disease and percutaneous coronary intervention (PCI) using stents.

28 septiembre 2012

WORLD JOURNAL OF RADIOLOGY. Usefulness of the Guglielmi detachable coil for embolization of a systemic venous collateral after Fontan operation: A case report

Tetsuo Sonomura, Akira Ikoma, Nobuyuki Kawai, Tomohiro Suenaga, Takashi Takeuchi, Hiroyuki Suzuki, Shunji Uchita, Motoki Nakai, Hiroki Minamiguchi, Kazushi Kishi and Morio Sato.

Embolization of collateral veins is often treated with rigid coils (Gianturco and interlocking detachable coils type). However, when dealing with tortuous and dilated collateral veins, there is a high risk for technical failure and coil migration due to inflexibility of the coils. To safely and successfully solve this problem, Guglielmi detachable coils (GDC) can be used for embolization. Their flexibility allows for easy navigation in tortuous veins, low risk of unintended coil release or coil migration, and safe deployment. A 12-year-old girl with a single ventricle had severe cyanosis and a low exercise tolerance 5 years after Fontan procedure. The symptoms were caused by a tortuous and dilated collateral from the left phrenic vein into the left pulmonary vein, forming a right-to-left shunt. The collateral, which had a large diameter and high flow, and therefore a high risk of coil migration, was successfully embolized with 8 GDC. There were no complications such as coil migration or cerebral infarction. Transcatheter embolization increased her systemic oxygen saturation from 81%-84% to 94%-95%, and increased her ability to exercise. The embolization procedure using flexible GDC was low risk compared with other rigid coil embolization techniques when performing embolization of tortuous and dilated collateral veins.

01 abril 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Incidence and Outcome of Surgical Procedures After Coronary Bare-Metal and Drug-Eluting Stent Implantation. A Report From the CREDO-Kyoto PCI/CABG Registry Cohort-2

Akihiro Tokushige, MD*, Hiroki Shiomi, MD*, Takeshi Morimoto, MD, Yutaka Furukawa, MD, Yoshihisa Nakagawa, MD, Kazushige Kadota, MD, Masashi Iwabuchi, MD, Satoshi Shizuta, MD, Tomohisa Tada, MD, Junichi Tazaki, MD, Yoshihiro Kato, MD, Mamoru Hayano, MD, Mitsuru Abe, MD, Natsuhiko Ehara, MD, Tsukasa Inada, MD, Satoshi Kaburagi, MD, Shuichi Hamasaki, MD, Chuwa Tei, MD, Hitoshi Nakashima, MD, Hisao Ogawa, MD, Ryozo Tatami, MD, Satoru Suwa, MD, Akinori Takizawa, MD, Ryuji Nohara, MD, Hisayoshi Fujiwara, MD, Kazuaki Mitsudo, MD, Masakiyo Nobuyoshi, MD, Toru Kita, MD and Takeshi Kimura, MD on behalf of the CREDO-Kyoto PCI/CABG registry cohort-2 investigators

Background—There still remain safety concerns on surgical procedures after coronary drug-eluting stents (DES) implantation, and optimal management of perioperative antiplatelet therapy (APT) has not been yet established.

01 marzo 2012

CIRCULATION. Spontaneous Intrastent Dissection. Late Neointimal Separation Within a Bare Metal Stent Causing Acute Coronary Syndrome

John Conleth Murphy, MD; Ravinay Bhindi, MD, PhD

A 50-year-old man presented to his local emergency department with acute-onset retrosternal chest pain associated with nausea. Five years previously, he had undergone primary percutaneous coronary intervention for the management of ST-segment myocardial infarction and received a 3.0×18 MultiLink Vision bare metal stent to an occluded proximal circumflex. On arrival in the emergency department, his pain was relieved with sublingual nitrate and did not recur. His ECG was normal, but his high-sensitivity troponin was elevated at 12 hours (237 ng/L), in keeping with an acute coronary syndrome. Routine hematologic testing also revealed a previously undiagnosed profound microcytic, hypochromic anemia (hemoglobin, 88 g/L; mean cell volume, 57 fL; mean cell hemoglobin, 16 pg), and on further questioning, the patient admitted to a recent change in bowel habits.

01 marzo 2013

JACC. Appropriate Use of Cardiovascular Technology

Robert C. Hendel, MD, FACC, FAHA, FASNC; Manesh R. Patel, MD, FACC; Joseph M. Allen, MA; James K. Min, MD, FACC; Leslee J. Shaw, PhD, FACC, FASNC, FAHA; Michael J. Wolk, MD, MACC; Pamela S. Douglas, MD, MACC, FAHA, FASE; Christopher M. Kramer, MD, FACC, FAHA; Raymond F. Stainback, MD, FACC, FASE; Steven R. Bailey, MD, FACC, FSCAI, FAHA; John U. Doherty, MD, FACC, FAHA; Ralph G. Brindis, MD, MPH, MACC, FSCAI, ex officio

The past several decades have seen rapid and extensive changes in the practice of cardiology, especially in the innovation and utilization practices of imaging, interventional, and electrophysiology procedures. Enhanced radionuclide imaging techniques, evolution of echocardiography, development of cardiac magnetic resonance (MR), and coronary computed tomography (CT) angiography techniques, as a well as drug-eluting stents and cardiovascular implantable electronic devices, have revolutionized how patients are diagnosed and treated. Although these developments have resulted in direct patient benefits including improved survival and enhanced quality of life, there has been an accompanying increase in resource utilization and healthcare costs. Although declines in utilization of many cardiovascular procedures have been observed as of late, during the years preceding 2005, the growth rates were at times substantial as these technologies were adopted. The perceived high rate of growth of expenditures related to cardiovascular procedures has precipitated payers to initiate utilization constraints to markedly reduce spending and reimbursement. Various payer initiatives have created an onerous burden leading to costly administrative requirements, including physician profiling and prior authorization (1). These general programs are also, in part, driven by marked geographic variability in utilization, which underscore the need for further guidance regarding optimal patient selection for procedures ((2),3). Professional efforts to better define quality have identified the importance of matching procedures and patients (4).

01 marzo 2013

JACC CARDIOVASCULAR INTERVENTIONS. Effect of Radial Versus Femoral Access on Radiation Dose and the Importance of Procedural Volume. A Substudy of the Multicenter Randomized RIVAL Trial

Sanjit S. Jolly, MD, MSc; John Cairns, MD; Kari Niemela, MD, PhD; Philippe Gabriel Steg, MD; Madhu K. Natarajan, MD, MSc; Asim N. Cheema, MD, PhD; Sunil V. Rao, MD; Warren J. Cantor, MD; Vladimír Džavík, MD; Andrzej Budaj, MD, PhD; Tej Sheth, MD; Vicent Valentin, MD; Anthony Fung, MBBS; Petr Widimsky, MD; Emile Ferrari, MD; Peggy Gao, MSc; Barbara Jedrzejowski, MEng; Shamir R. Mehta, MD, MSc

Objectives: The authors sought to compare the radiation dose between radial and femoral access.

01 abril 2013

AMERICAN HEART JOURNAL. Rationale and design of the ATTRACT Study: A multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis

Suresh Vedantham, MD , Samuel Z. Goldhaber, MD , Susan R. Kahn, MD, MSc , Jim Julian, MMath , Elizabeth Magnuson, ScD , Michael R. Jaff, DO , Timothy P. Murphy, MD , David J. Cohen, MD, MSc , Anthony J. Comerota, MD , Heather L. Gornik, MD , Mahmood K. Razavi, MD , Lawrence Lewis, MD , Clive Kearon, MB, PhD

Background: Current standard therapy for patients with acute proximal deep vein thrombosis (DVT) consists of anticoagulant therapy and graduated elastic compression stockings. Despite use of this strategy, the postthrombotic syndrome (PTS) develops frequently, causes substantial patient disability, and impairs quality of life. Pharmacomechanical catheter-directed thrombolysis (PCDT), which rapidly removes acute venous thrombus, may reduce the frequency of PTS. However, this hypothesis has not been tested in a large multicenter randomized trial.