scholarly journals Precise Percutaneous Coronary Intervention of LAD Ostial Stenosis by Using Afzal’s Technique: An easy but Innovative Procedure

2016 ◽  
Vol 9 (1) ◽  
pp. 49-54
Author(s):  
Afzalur Rahman ◽  
Farhana Ahmed ◽  
Mohammad Arifur Rahman ◽  
Syed Nasir Uddin ◽  
Md Zillur Rahman ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
De Novo ◽  
Coronary Revascularization ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Special Technique ◽  
Stent Deployment ◽  
Percutaneous Coronary ◽  
Stent Length

Background: The ostial left anterior descending coronary artery (LAD) lesion is an important target for coronary revascularization because its location subtends a large territory of myocardium. Ostial lesions have a reputation of being fibrotic, calcified, and relatively rigid. Greater degraees of rigidity and recoil resulted in lower acute gain and higher rates of target lesion revascularization (TLR) following percutaneous coronary intervention (PCI). In addition, procedural complications such as dissections, vessel closure and myocardial infarction were more frequent. Aim of the study was to evaluate a simple but innovative technique to deal with significant LAD ostial lesion.Methods: This prospective study was conducted between January 2010 and February 2013. Patients with significant angiographic de novo ostial LAD artery stenoses were identified and screened for study eligibility. An ostial stenosis was defined as an angiographic narrowing of e” 70% located within 3 mm of the vessel origin. Study included all consecutive patients with ostial lesions who underwent elective PCI and stent deployment. The study population consisted of 36 patients.Results: Among 36 patients 27 (75%) were male. mean age was 55.75 ± 8.07 years. 21 (58.3%) had diabetes, 15 (41.7%) hypertension, 21 (58.3%) hypercholesterolemia, 24 (66.66%) were smoker and 18 (50%) had F/H of CAD. Among them 6 (16.7%) had STEMI, 9 (25%) had NSTEMI, 12 (33.3%) had UA and 9 (25%) CSA. CAG showed 15 (41.7%) SVD, 15 (41.7%) DVD and 6 (16.7%) were TVD. LAD ostial stenosis were 83.16 ± 10.14%. Considering procedural characteristics, DES were 33 (91.7%) and BMS were 3 (8.3%). DES polymers were Evarolimus 15 (41.7%), Zotarolimus 12 (33.3%) and Biolimus 6 (16.7%). Mean stent length were 21.75 ± 8.07 mm. Mean stent diameter were 2.83 ± 0.28 mm. Minimum follow up time was 9 months and maximum follow up time was 44 months. There were no MACE but Angina (CCS II) were 2 (5.55%) and LVF (NYHA II) were 1(2.77%).Conclusion: Precise placement of LAD ostial stent is always challenging. Several technique applied but results not always satisfactory. Our strategies were precise location of stent implantation at ostium by adopting special technique of simultaneous balloon placement from distal LM to proximal LCX preventing unwanted stent movement during its placement and also properly guiding us for precise stent placement at the ostium. Parked balloon from distal LM to LCX will also be helpful for quick measure for any plaque shifting into LCX.Cardiovasc. j. 2016; 9(1): 49-54

Effect of paclitaxel-coated balloon angioplasty on side branch lesion and cardiovascular outcomes in patients with de novo true coronary bifurcation lesions undergoing percutaneous coronary intervention

2021 ◽  
Author(s):  
Youmei Li ◽  
Qi Mao ◽  
Huanyun Liu ◽  
Denglu Zhou ◽  
Jianhua Zhao
Keyword(s):  
Percutaneous Coronary Intervention ◽  
De Novo ◽  
Coronary Intervention ◽  
Side Branch ◽  
Cardiovascular Outcomes ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Bifurcation ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions

Abstract Purpose To compare the effects of paclitaxal-coated balloon (PCB) versus conventional balloon (CB) on side branch (SB) lesion and cardiovascular outcomes in patients with de novo true bifurcation lesions. Methods In total, 219 patients with de novo true bifurcation lesions were enrolled and divided into PCB group (102 cases) and CB group (117 cases) according to angioplasty strategy in SB. Drug-eluting stent (DES) was implanted in main vessel (MV) for each subject. All subjects underwent a 12-month follow-up for late lumen loss (LLL), restenosis and major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). MACEs included cardiac death, nonfatal myocardial infarction and angina pectoris. Results There were no differences in diameter, minimum lumen diameter (MLD) and stenosis for bifurcation lesions between the two groups before and immediately after PCI (P > 0.05). After 12-month follow-up, no differences occurred in MV-MLD and MV-LLL between the two groups (P > 0.05); SB-MLD in PCB group was higher than that in CB group (1.97 ± 0.36 mm vs. 1.80 ± 0.43 mm, P = 0.007); SB-LLL in PCB group was lower than that in CB group (0.11 ± 0.18 mm vs. 0.19 ± 0.25 mm, P = 0.024). Multivariate COX analyses indicated that PCB group had lower MACE risk than CB group (HR = 0.480, 95%CI 0.244–0.941, P = 0.033). Conclusion PCB could decrease SB-LLL and MACE risk in patients with de novo true coronary bifurcation lesion 12 months after single-DES intervention.

scholarly journals Employment status three years after percutaneous coronary intervention and predictors for being employed: A nationwide prospective cohort study

2020 ◽  
Vol 19 (5) ◽  
pp. 433-439
Author(s):  
Siv JS Olsen ◽  
Henrik Schirmer ◽  
Tom Wilsgaard ◽  
Kaare H Bønaa ◽  
Tove A Hanssen
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Employment Status ◽  
Smoking Status ◽  
Coronary Revascularization ◽  
Coronary Intervention ◽  
Self Report ◽  
Percutaneous Coronary ◽  
Working Age ◽  
Vocational Support

Background: Vocational support is recommended for patients in cardiac rehabilitation (CR), as returning to work is important in patients social readjusting after an acute coronary event. Information is lacking on whether CR leads to higher long-term employment after percutaneous coronary intervention (PCI). Aims: The aims of this study were to determine employment status three years after PCI, to compare employment status between CR participants and CR non-participants and to assess predictors for employment. Methods: We included first-time PCI patients from the NorStent trial, who were of working age (<63 years; n = 2488) at a three-year follow-up. Employment status and CR participation were assessed using a self-report questionnaire. Propensity score method was used in comparing employment status of CR participants and CR non-participants. Results: Seventy per cent of participants who were <60 years of age at the index event were employed at follow-up and CR participation had no effect on employment status. Being male, living with a partner and attaining higher levels of education were associated with a higher chance of being employed, while being older, prior cardiovascular morbidity and smoking status were associated with lower chance of being employed at follow-up. Conclusion: Because a significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization, updated incentives should be implemented to promote vocational support. Such programmes should focus on females, patients lacking higher education and patients who are living alone, as they are more likely to remain unemployed.

scholarly journals Percutaneous coronary intervention versus medical therapy for chronic total coronary occlusions: a systematic review and meta-analysis of randomised trials

2020 ◽  
Vol 29 (1) ◽  
pp. 30-41 ◽  
Author(s):  
A. van Veelen ◽  
J. Elias ◽  
I. M. van Dongen ◽  
L. P. C. Hoebers ◽  
B. E. P. M. Claessen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Left Ventricular ◽  
Randomised Trials ◽  
Percutaneous Coronary

Abstract Background The results of chronic total occlusion percutaneous coronary intervention (CTO-PCI) trials are inconclusive. Therefore, we studied whether CTO-PCI leads to improvement of clinical endpoints and patient symptoms when combining all available randomised data. Methods and results This meta-analysis was registered in PROSPERO prior to starting. We performed a literature search and identified all randomised trials comparing CTO-PCI to optimal medical therapy alone (OMT). A total of five trials were included, comprising 1790 CTO patients, of whom 964 were randomised to PCI and 826 to OMT. The all-cause mortality was comparable between groups at 1‑year [risk ratio (RR) 1.70, 95% confidence interval (CI) 0.50–5.80, p = 0.40] and at 4‑year follow-up (RR 1.14, 95% CI 0.38–3.40, p = 0.81). There was no difference in the incidence of major adverse cardiac events (MACE) between groups at 1 year (RR 0.69, 95% CI 0.36–1.33, p = 0.27) and at 4 years (RR 0.85, 95% CI 0.60–1.22, p = 0.38). Left ventricular function and volumes at follow-up were comparable between groups. However, the PCI group had fewer target lesion revascularisations (RR 0.28, 95% CI 0.15–0.52, p < 0.001) and was more frequently free of angina at 1‑year follow-up (RR 0.65, 95% CI 0.50–0.84, p = 0.001), although the scores on the subscales of the Seattle Angina Questionnaire were comparable. Conclusion In conclusion, in this meta-analysis of 1790 CTO patients, CTO-PCI did not lead to an improvement in survival or in MACE as reported at long-term follow-up of up to 4 years, or to improvement of left ventricular function. However, CTO-PCI resulted in less angina and fewer target lesion revascularisations compared to OMT.

P5623Plaque characteristics, slow flow during percutaneous coronary intervention, and clinical outcomes of irregular protrusion by optical coherence tomography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Amano ◽  
R Noike ◽  
D Saito ◽  
T Yabe ◽  
I Watanabe ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Stent Implantation ◽  
Coronary Intervention ◽  
Vessel Diameter ◽  
Target Lesion ◽  
Slow Flow ◽  
Percutaneous Coronary ◽  
Stent Length ◽  
One Year

Abstract Introduction In pathological studies, penetration of the lipid core into the stent strut is associated with neointimal growth and stent thrombosis. Irregular protrusion on optical coherence tomography (OCT) is associated with clinical events and target lesion revascularization. However, there are few reports about the relationship among irregular protrusion, plaque characteristics, and slow flow during percutaneous coronary intervention. We investigated clinical and procedure characteristics, plaque characteristics, slow flow after stent implantation, and clinical outcomes with irregular protrusion by using OCT. Methods Eighty-four lesions in 76 patients undergoing OCT before percutaneous coronary intervention were evaluated. Irregular protrusion was defined as protrusion of material with an irregular surface into the lumen between stent struts with a maximum height of ≥100 μm. Major adverse clinical outcomes were defined as death, acute myocardial infarction, acute coronary syndrome, or target lesion revascularization. Results Lesions with irregular protrusion were found in 56% (47/84). Compared with lesions without irregular protrusion, those with irregular protrusion had significantly higher low-density lipoprotein cholesterol (LDL-C) levels (108±31 mg/dL vs. 95±25 mg/dL, P=0.044); a tendency toward decreased use of statins (44% [19/43] vs. 67% [22/33], P=0.065); significantly larger reference vessel diameter (3.12±0.53 mm vs. 2.74±0.63 mm, P=0.004); significantly larger stent diameter (3.23±0.43 mm vs. 3.00±0.49 mm, P=0.025); a tendency toward longer total stent length (29.3±14.2 mm vs. 23.7±11.4 mm, P=0.056); significantly larger maximum balloon diameter (3.56±0.55 mm vs. 3.22±0.63 mm, P=0.010); significantly higher incidence of slow flow after stent implantation (38% [18/47] vs. 11% [4/37], P=0.006); significantly higher ΔTIMI flow from pre-stenting to post-stenting (0.4±0.6 vs. 0.1±0.3, P=0.009); significantly higher incidence of lipid-rich plaque (70% [33/47] vs. 35% [13/37], P=0.002); thin-cap fibroatheromas (TCFAs: 49% [23/47] vs. 5% [2/37], P<0.001); plaque rupture (40% [19/47] vs. 16% [6/37], P=0.018); macrophage accumulation (51% [24/47] vs. 24% [9/37], P=0.015); internal running vasa vasorum (51% [24/47] vs. 11% [4/37], P<0.001); thrombus (32% [15/47] vs. 3% [1/37], P<0.001); and a tendency higher incidence of one-year adverse clinical outcomes (12% [5/43] vs. 0% [0/33], P=0.075: log rank). The multivariable analysis showed that TCFA was an independent predictor of irregular protrusion (odds ratio 9.00, 95% CI 1.32–61.36, P=0.025). Conclusions Irregular protrusion on OCT was associated with high plaque vulnerability, higher LDL-C, less frequent use of statin, larger vessel diameter, longer total stent length, slow flow after stent implantation, and one-year adverse clinical outcomes.

scholarly journals Employment status three years after percutaneous coronary intervention – a nationwide prospective cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S J S Olsen ◽  
H Schirmer ◽  
K H Boenaa ◽  
T A Hanssen
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Return To Work ◽  
Employment Status ◽  
Coronary Revascularization ◽  
Coronary Intervention ◽  
Coronary Event ◽  
Self Report ◽  
Percutaneous Coronary ◽  
Working Age

Abstract Background Return to work plays an important part in social readjustment after an acute coronary event, and has important implications for both the individual and the society. Updated knowledge is lacking regarding losng-term employment after percutaneous coronary intervention (PCI). Aims The aims of this study were to determine employment status three years after PCI and to assess predictors for return to work stratified by gender. Methods We included first-time PCI patients from the NorStent Trial, who were of working age (&lt;60 years; n=2488) at a three-year follow-up. Employment status were assessed using self-report. Results Fifty-seven percent of females and 73% of males who were &lt;60 years of age at the index event were employed at follow-up (p&lt;0.001). Living with a partner, higher levels of education, and living in the western part of Norway were associated with a higher chance of being employed in males, while higher levels of education were associated with a higher chance of being employed in females. Prior cardiovascular morbidity and former smoking were associated with lower chance of being employed in males, while being older was associated with lower chance of being employed in females. Conclusion A significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization. Our findings indicate a need for revised and gender specific initiatives to promote vocational support. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): The Northern Norway Regional Health Authority

scholarly journals Long-Term Outcomes of Extent of Revascularization in Complex High Risk and Indicated Patients Undergoing Impella-Protected Percutaneous Coronary Intervention: Report from the Roma-Verona Registry

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Francesco Burzotta ◽  
Giulio Russo ◽  
Flavio Ribichini ◽  
Anna Piccoli ◽  
Domenico D’Amario ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Revascularization ◽  
High Volume ◽  
Coronary Intervention ◽  
Complete Revascularization ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
The Impact

Objective. To investigate the effect of extent of revascularization in complex high-risk indicated patients (CHIP) undergoing Impella-protected percutaneous coronary intervention (PCI). Background. Complete revascularization has been shown to be associated with improved outcomes. However, the impact of more complete revascularization during Impella-protected PCI in CHIP has not been reported. Methods. A total of 86 CHIP undergoing elective PCI with Impella 2.5 or Impella CP between April 2007 and December 2016 from 2 high volume Italian centers were included. Baseline, procedural, and clinical outcomes data were collected retrospectively. Completeness of coronary revascularization was assessed using the British Cardiovascular Intervention Society myocardial jeopardy score (BCIS-JS) derived revascularization index (RI). The primary end-point was all-cause mortality. A multivariate regression model was used to identify independent predictors of mortality. Results. All patients had multivessel disease and were considered unsuitable for surgery. At baseline, 44% had left main disease, 78% had LVEF ≤ 35%, and mean BCIS-JS score was 10±2. The mean BCIS-JS derived RI was 0.7±0.2 and procedural complications were uncommon. At 14-month follow-up, all-cause mortality was 10.5%. At follow-up, 67.4% of CHIP had LVEF ≥ 35% compared to 22.1% before Impella protected-PCI. Higher BCIS-JS RI was significantly associated with LVEF improvement (p=0.002). BCIS-JS RI of ≤ 0.8 (HR 0.11, 95% CI 0.01- 0.92, and p = 0.042) was an independent predictor of mortality. Conclusions. These results support the practice of percutaneous Impella use for protected PCI in CHIP. A more complete revascularization was associated with significant LVEF improvement and survival.

scholarly journals TCT-410 Results Of Percutaneous Coronary Intervention Of “De Novo” Lesions With Sequent Please® Paclitaxel Eluting Balloon Catheter At A Very Long-Term Follow-Up

2015 ◽  
Vol 66 (15) ◽  
pp. B166-B167
Author(s):  
Ignacio Sanchez-Perez ◽  
Alfonso Jurado-Roman ◽  
Fernando Lozano ◽  
Natalia Pinilla-Echeverri ◽  
Maria T. Lopez-Lluva ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
De Novo ◽  
Balloon Catheter ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Long Term Follow Up

Combined Coronary Revascularization: Single-Center 10-Year Experience

2016 ◽  
Vol 11 (1) ◽  
pp. 40-45
Author(s):  
Marie Aymami ◽  
Vito Giovanni Ruggieri ◽  
Simon Rouzé ◽  
Erwan Flécher ◽  
Julien Guihaire ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Revascularization ◽  
Coronary Intervention ◽  
Arterial Grafts ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective This study aimed to assess the long-term outcome of combined coronary revascularization. Methods Between January 2000 and September 2010, 106 consecutive patients underwent combined coronary revascularization, either the same day or staged within 90 days. Percutaneous coronary intervention was always performed before coronary artery bypass grafting. We identified three groups as follows: one-stop combined coronary revascularization (n = 20), percutaneous coronary intervention for acute coronary syndrome before subsequent surgery (n = 39), and percutaneous coronary intervention for stable coronary artery disease before subsequent surgery (n = 47). Off-pump technique was used in all cases. Results A total of 107 angioplasties were realized (drug-eluting stents, 21; bare metal stents, 114; balloon angioplasty, 4). Percutaneous coronary intervention was mostly performed in the right coronary artery or branches (85%). The mean (SD) number of grafts was 1.9 (0.6), among them 1.8 (0.7) with arterial grafts. A total of 87.7% of the patients underwent exclusive arterial revascularization. There was one reexploration for bleeding and no in-hospital death. Eleven patients died in the follow-up. Repeat percutaneous coronary intervention was necessary for six patients and repeat surgery for one patient. The mean (SD) follow-up was 6.1 (2.7) years. Complete follow-up was obtained in 96.2% of the patients. Freedom from ischemic events (all-cause deaths, angina, acute coronary syndrome, myocardial infarction) was 86.3% (3.7%) at 5 years and 79.7% (5.2%) at 8 years (no difference between groups). Freedom from major adverse cardiac or cerebrovascular events was 88.8% (3.4%) at 5 years and 75.7% (5.2%) at 8 years (no difference between groups). Conclusions Combined coronary revascularization increases the use of arterial grafts, with good long-term outcome.

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