Association of Total Ischemic Times and In-Hospital Outcomes of Acute STEMI Patients who Underwent Primary Angioplasty at a Tertiary Cardiac Care Facility

Aims: To determine the association between total ischemic time and in-hospital outcome of acute ST elevation myocardial infarction (STEMI) patients who underwent primary angioplasty. Study Design: Prospective observational study. Place & Duration of Study: Department of Cardiology, Dow university of health sciences Karachi between October 2017 till March 2021. Methodology: Data for total ischemic time analysis were collected from 366 STEMI patients who consecutively underwent primary angioplasty. Total ischemic time was measured from the onset of chest pain to o the first balloon inflation during primary angioplasty and in hospital outcome was measured. Results: Total ischemic times were available in 366 STEMI patients which was ≥ 30 minutes and < 24 hours: ≤ 2 hours in 15.5%, >2-3 hours in 11.4%, >3-5 hours in 25.4%, and >5 hours in 47.5% of STEMI patients. In addition, STEMI patients with total ischemic times <5 hours demonstrated complete ST-segment resolution and reduced death rate than those with total ischemic times >5 hours. Conclusion: This study showed that shorter ischemic times are significantly related to improved myocardial reperfusion and decreased mortality.

Use of a disposable vascular pressure device to guide balloon inflation of resuscitative endovascular balloon occlusion of the aorta: a bench study

Resuscitative endovascular balloon occlusion of the aorta (REBOA) for rapid hemorrhage control is increasingly being used in trauma management. Its beneficial hemodynamic effects on unstable patients beyond temporal hemostasis has led to growing interest in its use in other patient populations, such as during cardiac arrest from nontraumatic causes. The ability to insert the catheters without fluoroscopic guidance makes the technique available in the prehospital setting. However, in addition to correct positioning, challenges include reliably achieving aortic occlusion while minimizing the risk of balloon rupture. Without fluoroscopic control, inflation of the balloon relies on estimated aortic diameters and on the disappearing pulse in the contralateral femoral artery. In the case of cardiac arrest or absent palpable pulses, balloon inflation is associated with excess risk of overinflation and adverse events (vessel damage, balloon rupture). In this bench study, we examined how the pressure in the balloon is related to the surrounding blood pressure and the balloon's contact with the vessel wall in two sets of experiments, including a pulsatile circulation model. With this data, we developed a rule of thumb to guide balloon inflation of the ER-REBOA catheter with a simple disposable pressure-reading device (COMPASS). We recommend slowly filling the balloon with saline until the measured balloon pressure is 160 mmHg, or 16 mL of saline have been used. If after 16 mL the balloon pressure is still below 160 mmHg, saline should be added in 1-mL increments, which increases the pressure target about 10 mmHg at each step, until the maximum balloon pressure is reached at 240 mmHg (= 24 mL inflation volume). A balloon pressure greater than 250 mmHg indicates overinflation. With this rule and a disposable pressure-reading device (COMPASS), ER-REBOA balloons can be safely filled in austere environments where fluoroscopy is unavailable. Pressure monitoring of the balloon allows for recognition of unintended deflation or rupture of the balloon.

Prospective Study of Serration Angioplasty in the Infrapopliteal Arteries Using the Serranator Device: PRELUDE BTK Study

Purpose: The purpose was to evaluate the safety and efficacy of the Serranator percutaneous transluminal angioplasty serration balloon catheter in patients with infrapopliteal peripheral artery disease. Materials and Methods: A prospective, multicenter, single-arm feasibility study in 46 patients with claudication or chronic limb-threatening ischemia, Rutherford Clinical Category (RCC) 3 to 5, that required treatment of the infrapopliteal arteries above the tibiotalar joint. The primary efficacy outcome was device success—successful insertion, balloon inflation and deflation, and removal of the device(s) with a final diameter stenosis of <50%. The primary safety endpoint was a composite of major adverse limb events (MALE) and perioperative death (POD) through 30 day postprocedure. Other outcomes were change in RCC and ankle-brachial index, wound healing, and clinically-driven target lesion revascularization (CD-TLR). A subset of 9 patients were further evaluated by optical coherence tomography (OCT) or intravascular ultrasound (IVUS) for the presence of serrations in treated lesions. Patient follow-up occurred at 30 days and 6 months. Results: Forty-six patients received treatment with the Serranator device and 55 lesions were treated. Fifty-three lesions were deemed analyzable by the core lab with data and reported hereafter. Device success was 91.7% and freedom from MALE + POD through 30 days was 95.7%. Pretreatment stenosis of 82% was reduced to 21.8% and only 1 lesion (1.9%) required a bailout stent for a grade D dissection. The average maximum balloon inflation pressure was 6 atmospheres. Serrations were present in all treated lesions (n=10) in 9 patients imaged with OCT/IVUS as reviewed by the core laboratory. The RCC score improved by 1 or more level in 70% of patients at 6 months with 42% having a score of 0. The 6 month freedom from CD-TLR was 97.7%. Conclusion: Serranator treatment of infrapopliteal lesions showed excellent lumen gain with minimal evidence of arterial injury and low 6 month CD-TLR. Imaging by IVUS and OCT showed serrations without significant dissection, supporting the device’s proposed mechanism of action.

The Risk Factors Anesthesiologists should Pay Attention for Massive Bleeding in Placenta Accreta Spectrum Patients with Placenta Previa During Surgery: A Retrospective Study

Objectives: PAS combined with placenta previa exists as a high-risk factor for postpartum hemorrhage. The risk factors for predicting a certain disease may be different from the risk factors for massive bleeding during surgery for the disease. To explore whether the risk factors of massive bleeding in patients with Placenta accreta spectrum (PAS) with placenta previa underwent Cesarean section under the background of abdominal aortic balloon occlusion will be changed.Methods: We reviewed 267 singleton pregnancies with PAS and placenta previa. Maternal history, antenatal ultrasound findings of the placenta, placement of the abdominal aortic balloon were reviewed retrospectively, and their association with massive bleeding during Cesarean section was analyzed.Results: Multivariate Logistic regression analysis revealed that the number of pregnancies (odds ratio (OR), 2.680; 95% CI, 1.244–5.774), placenta location (anterior position) (OR, 3.172; 95% CI, 1.349–7.458) and cervical length (OR, 0.918; 95% CI, 0.854–0.987), implant area (OR, 1.018; 95% CI, 1.009–1.027)，abdominal aorta balloon inflation (OR, 0.278; 95% CI, 0.095–0.813) were associated with massive bleeding (>1000 mL).Conclusions: Abdominal aorta balloon inflation may change the known risk factors for hemorrhage. The number of pregnancies, placenta location (anterior position), cervical length, implant area, abdominal aorta balloon inflation are risk factors for massive bleeding during Cesarean section in cases of PAS and placenta previa. Balloon occlusion of the abdominal aorta can indeed reduce the risk of massive bleeding.