catheterization laboratory
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Author(s):  
Gagan Kaur ◽  
Patrick Baghdasaryan ◽  
Balaji Natarajan ◽  
Prabhdeep Sethi ◽  
Ashis Mukherjee ◽  
...  

AbstractCoronary no-reflow phenomenon is a lethal mechanism of ongoing myocardial injury following successful revascularization of an infarct-related coronary artery. Incidence of this phenomenon is high following percutaneous intervention and is associated with adverse in-hospital and long-term outcomes. Several mechanisms such as ischemia-reperfusion injury and distal microthromboembolism in genetically susceptible patients and those with preexisting endothelial dysfunction have been implicated. However, the exact mechanism in humans is still poorly understood. Several investigative and treatment strategies within and outside the cardiac catheterization laboratory have been proposed, but they have not uniformly shown success in reducing mortality or in preventing adverse left ventricular remodeling resulting from this condition. The aim of this article is to provide a brief and concise review of the current understanding of the pathophysiology, clinical predictors, and investigations and management of coronary no-reflow phenomenon.


2022 ◽  
Vol 99 (7-8) ◽  
pp. 440-443
Author(s):  
A. V. Bocharov ◽  
L. V. Popov ◽  
A. K. Mittsiev ◽  
M. D. Lagkuev

Objective. To evaluate the clinical and demographic characteristics of a group of patients under 35 years old admitted with acute coronary syndrome, as well as the features of coronary bed damage and endovascular treatment.Material and methods. A retrospective analysis of the group of patients aged 30 to 35, admitted to the Regional Vascular Center with a diagnosis of acute coronary syndrome in the period from 2019 to June 2021, was carried out. The study included 72 patients with ACS, regardless of the ST segment changes on the electrocardiogram, were admitted to the hospital by the emergency medical service referral. Positive troponins were detected in all the patients by qualitative analysis. Upon admission, they were sent to a catheterization laboratory. An examination was carried out according to the recommendations of medical care, as well as selective coronary angiography and, if indicated, stenting of the coronary arteries was performed.Results. When analyzing the clinical and demographic characteristics of the group, attention has been drawn to the absolute predominance of males — 71 (98.7%), urban residents — 64 (88.9%), low frequency of bad habits: tobacco smoking in 13 (18.1%) and alcohol abuse in 2 (2.8%) patients, the absence of concomitant pathology, a signifi cant time from the onset of symptoms to calling an ambulance (165 [90; 263]). According to the results of angiography, it should be noted the possibility of acute coronary syndrome with intact coronary arteries is 9 (27.3%) among all ACS cases with ST segment elevation and 29 (74.3%) with ACS without ST segment elevation, while in one third of the above episodes (13 (34.2%)) ACS was caused by the presence of a muscle “bridge” in the basin of the anterior descending artery, a concomitant phenomenon of slowed blood fl ow. The attention has been also drawn to the almost equal proportions of acute thrombotic occlusion (19 (55.9%)) and haemodynamically signifi cant hemadostenosis (14 (41.2%)) as the cause of ACS.Conclusion. In patients under 35 years old with a typical clinical. picture, positive troponins, with a qualitative analysis, there is a high probability of pathological changes in the coronary bed, regardless of the ST segment changes, which requires X-ray endovascular methods of diagnosis and treatment. Angiographic features of the coronary artery lesion in young people are the discreteness of the lesion in the proximal or middle sections of the arteries, the high frequency of thrombotic occlusions, the predominant lesion of the anterior descending or right coronary arteries, the low frequency of calcifi cation of the coronary arteries.


2022 ◽  
Vol 14 (1) ◽  
pp. 120
Author(s):  
B. Popovic ◽  
J. Varlot ◽  
B. Girard Bertrand ◽  
P.A. Metzdorf ◽  
E. Camenzind ◽  
...  

Author(s):  
Jennifer Jdaidani ◽  
Antoine Younes ◽  
Dounia Z. Iskandarani ◽  
Abdallah G. Rebeiz ◽  
Houssein Darwish ◽  
...  

2021 ◽  
Vol 10 (24) ◽  
pp. 5974
Author(s):  
Alexandru Achim ◽  
Kornél Kákonyi ◽  
Zoltán Jambrik ◽  
Ferenc Nagy ◽  
Julia Tóth ◽  
...  

Introduction: Distal radial access (dRA) has recently gained global popularity as an alternative access route for vascular procedures. Among the benefits of dRA are the low risk of entry site bleeding complications, the low rate of radial artery occlusion, and improved patient and operator comfort. The aim of this large multicenter registry was to demonstrate the feasibility and safety of dRA in a wide variety of routine procedures in the catheterization laboratory, ranging from coronary angiography and percutaneous coronary intervention to peripheral procedures. Methods: The study comprised 1240 patients who underwent coronary angiography, PCI or noncoronary procedures through dRA in two Hungarian centers from January 2019 to April 2021. Baseline patient characteristics, number and duration of arterial punctures, procedural success rate, crossover rate, postoperative compression time, complications, hospitalization duration, and different learning curves were analyzed. Results: The average patient age was 66.4 years, with 66.8% of patients being male. The majority of patients (74.04%) underwent a coronary procedure, whereas 25.96% were involved in noncoronary interventions. dRA was successfully punctured in 97% of all patients, in all cases with ultrasound guidance. Access site crossover was performed in 2.58% of the patients, mainly via the contralateral dRA. After experiencing 150 cases, the dRA success rate plateaued at >96%. Our dedicated dRA step-by step protocol resulted in high open radial artery (RA) rates: distal and proximal RA pulses were palpable in 99.68% of all patients at hospital discharge. The rate of minor vascular complications was low (1.5%). A threshold of 50 cases was sufficient for already skilled radial operators to establish a reliable procedural method of dRA access. Conclusion: The implementation of distal radial artery access in the everyday routine of a catheterization laboratory for coronary and noncoronary interventions is feasible and safe with an acceptable learning curve.


Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1138
Author(s):  
Mathilde Méot ◽  
Raymond N. Haddad ◽  
Juliana Patkai ◽  
Ibrahim Abu Zahira ◽  
Anna Di Marzio ◽  
...  

(1) Background: Transcatheter closure of the patent arterial duct (TCPDA) in preterm infants is an emerging procedure. Patent arterial duct (PDA) spontaneous closure after failed TCPDA attempts is seen but reasons and outcomes are not reported; (2) Methods: We retrospectively included all premature infants <2 kg with abandoned TCPDA procedures from our institutional database between September 2017 and August 2021. Patients’ data and outcomes were reviewed; (3) Results: The procedure was aborted in 14/130 patients referred for TCPDA. Two patients had spasmed PDA upon arrival in the catheterization laboratory and had no intervention. One patient had ductal spasm after guidewire cross. Four patients had unsuitable PDA size/shape for closure. In seven patients, device closure was not possible without causing obstruction on adjacent vessels. Among the 12 patients with attempted TCPDA, five had surgery on a median of 3 days after TCPDA and seven had a spontaneous PDA closure within a median of 3 days after the procedure. Only the shape of the PDA differed between the surgical ligation group (short and conical) and spontaneous closure group (F-type); (4) Conclusions: In the case of TCPDA failure, mechanically induced spontaneous closure may occur early after the procedure. Surgical ligation should be postponed when clinically tolerated.


Biomedicines ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1813
Author(s):  
Karol Kaziród-Wolski ◽  
Janusz Sielski ◽  
Jacek Sidło ◽  
Rafał Januszek ◽  
Zbigniew Siudak

Background: The COVID-19 pandemic is significantly affecting the functioning of the entire healthcare system. The disease itself may be associated with thromboembolic complications. The purpose of this study is to compare patients with acute coronary syndrome (ACS) and patients with ACS who were diagnosed with COVID-19 in terms of their clinical profile, management, treatment complications, and prognosis. Methods: We analyzed 47,940 cases of patients treated for ACS in 2020, including 44,952 patients (93.8%) who were not diagnosed with COVID-19 and 2988 patients (6.2%) who tested positive for COVID-19. Results: Patients with COVID-19 were significantly more likely to experience out-of-hospital sudden cardiac arrest (7.9 vs. 1.1%; p < 0.0001) and be transported directly to a catheterization laboratory (21.3% vs. 8.1%; p < 0.0001). Mortality was significantly higher in this group (0.9% vs. 0.4%; p < 0.0001). The risk of perioperative death was increased by age over 65 years, use of glycoprotein IIb/IIIa inhibitors (GPI IIb/IIIa), femoral access, critical left main stem coronary artery (LMCA) vascular lesions, ST elevation myocardial infarction (STEMI), and no-reflow phenomenon. Conclusions: Despite the pandemic, patients with COVID-19 were treated equally to healthy patients. Efficient organization of the healthcare system allowed the prompt transportation of patients to catheterization laboratories. The study group was characterized by a worse prognosis that was affected by multiple factors.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesca Romana Prandi ◽  
Marialucia Milite ◽  
Roberto Celotto ◽  
Dalgisio Lecis ◽  
Massimo Marchei ◽  
...  

Abstract Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disorder characterized by venous and arterial thromboembolic (TE) disease, and/or pregnancy morbidity, associated with persistent elevated antiphospholipid antibodies (lupus anticoagulant, LA, anticardiolipin, aCL, and anti-beta2-glycoprotein I, anti-β2GPI). A 51 year-old man, smoker, presented to our ER with chest pain. EKG showed Q waves and STE in the anterior leads, with increased troponin levels. A diagnosis of anterior STEMI was made and he was taken into our catheterization laboratory, where a high burden thrombotic plaque determining LM and ostial LAD subocclusion was treated with PPCI and a DES implantation; in addition, multiple failed PCI attempts were performed on a distal LAD occlusion, and an integrilin bolus was administered. The patient was admitted to our CICU and a DAPT with ASA and Ticagrelor was started. TTE showed LVEF 40%, apical akinesis, septal and anterior hypokinesis, and no significant valve disease. An aPTT abnormal value (100.5 s; reference range 25–38.5 s) was detected, not corrected by aPTT mixing study. Given suspected autoimmune prothrombotic state, normal Hb and PLT values and low bleeding risk, LMWH 100 IU/kg every 12 h was started, in addition to DAPT with switch from Ticagrelor to Clopidogrel. LA and aCL and anti-β2GPI IgG were positive, with negativity of others rheumatologic tests, confirming primary APS diagnosis. Repeat TTE showed EF 50%. The patient was discharged in ‘triple therapy’ (DAPT plus LMWH), and referred to the rheumatology clinic. LA, aCL, and anti-β2GPI tests 12 weeks later were positive, confirming a triple positive APS and satisfying revised Sapporo criteria. The rheumatologist switched therapy to Clopidogrel plus Warfarin. At 3 months follow-up, the patient, former smoker, was asymptomatic and TTE confirmed EF 50%, so he was recommended to continue with his medical therapy. APS is rarely associated with AMI (∼5.5%) and in only 2.8% cases AMI represents the onset of the disease. AMI pathogenesis in APS is considered to be acute thrombosis of coronary arteries, in contrast with atherosclerotic plaque rupture in typical AMI. Key discriminators to identify APS as potential underlying cause of AMI include young age, previous unprovoked thromboses, low platelets count (they are consumed in the thrombotic process), high aPTT value (LA may interfere with assembly of the prothrombinase complex on phospholipids), coronary artery thromboses in the setting of otherwise normal otherwise appearing coronary arteries. APS antibodies have also pro-inflammatory activity on vascular endothelial cells, leading to accelerated atherosclerosis. aGAPSS score (high risk ≥10) is useful for risk stratification of recurrent thrombosis and AMI in young patients with APS. The treatment of AMI in APS is therefore a clinical challenge. Strict management of additional CV risk factors is crucial. VKA (INR &gt;3 with Warfarin, INR2–3 with Warfarin and ASA) should be provided for life, because of the very high risk of recurrent TE. DOACs are less effective and less safe than VKAs for TE prevention in APS. The role of coronary stents, considering higher rates of stent thrombosis after PCI in APS patients triple therapy concomitant risks, requires further studies. Due to lack of large, randomized, prospective studies, there is no clear experts consensus about optimal antithrombotic therapy in secondary prevention after arterial TE. APS patients with STEMI should undergo PCI, usually associated with thrombus aspiration, and in selected cases DES implantation in culprit lesion followed by triple antithrombotic therapy with short-term DAPT and long-term VKA.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Aurelio De Filippis ◽  
Edoardo Nobile ◽  
Luca Paolucci ◽  
Luka Vitez ◽  
Maria Caterina Bono ◽  
...  

Abstract Aims The natural history of tricuspid valve (TV) regurgitation is characterized by dismal prognosis and high in-hospital mortality when treated with isolated TV surgery. Although the anatomy and the imaging of the TV are very challenging, the edge-to-edge repair with the TriClip (Abbott Vascular, Santa Clara, CA) showed promising results. We report preliminary results of our experience with the TriClip System in a cohort of ‘real life’ patients with functional tricuspid regurgitation (TR). Methods and results From January to September 2021, 30 consecutive patients with severe TR has been screened, 8 underwent transcatheter TriClip repair. The anatomical feasibility was established according to a complete transesophageal echocardiogram (TEE) and a dedicated CT scan for the right cardiac chambers. All the echocardiographic projections focused on right ventricle were used during the procedure, with the aim of optimizing the visualization of the catheters and device with respect to the anatomical structures of the tricuspid valve complex. The procedure was conducted under general anesthesia, guided by TEE and fluoroscopy. In-hospital and 30-day clinical and echocardiographic outcomes were recorded. The annulus septo-lateral diameter was enlarged in all cases, and functional TR was present in all patients. In two patients, the pacemaker lead interfered with leaflets coaptation. TR jet was predominantly central. The implant and procedural success were achieved in all cases, implanting one device in five patients and two in three patients. The final TR grade was 2+ in four patients and and 1+ in the others. All patients were extubated in the catheterization laboratory. There were no procedural or in-hospital adverse events. At 30-day follow-up, we observed significant improvement in clinical and echocardiographic outcomes. Conclusions In our experience, 26% of screened patients were selected for the procedure. Favourable anatomical findings for the TV edge-to-edge repair were the following: moderate leaflet tethering (coaptation depth &lt;10 mm); large annulus but with small coaptation gap (&lt;7 mm); antero-septal or postero-septal jet location; commissural jet; small right ventricular dimensions; pacemaker lead with no leaflet tethering. The best transcatheter approach consists of obliterating the antero-septal coaptation rim for a more favourable angle between the inferior vena cava and valvular plane. High-quality TEE imaging during the procedure is required for obtaining procedural success. Patient selection and tricuspid valve anatomy characterization with TEE and cardiac CT scan is critical for procedural success and clinical improvements.


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