Dual catheter technique for the treatment of severe coronary artery perforations

Objectives : To evaluate the outcome of patients with coronary perforations who were treated with the dual catheter approach. Background : Coronary artery perforation is a grave complication of percutaneous coronary intervention (PCI) with high mortality and morbidity. Treating a coronary artery perforation with two catheters through dual access enables a rapid delivery of covered stent or coils to the vessel, without losing control of the perforation site. Methods : We retrospectively reviewed all patients who had a severe coronary perforation during a PCI in our center, and compared outcomes of patients treated with the dual versus the traditional single guiding catheter approach. Results : Between April 2004 and October 2008, 13,466 PCI's were performed in Columbia University – New York Presbyterian Medical Center. There were 33 documented cases of coronary perforations during that period of time (0.245%), among these, 26 were angiographically severe (Ellis type 2 or 3 perforations). Eleven patients were treated acutely with a dual catheter technique whereas the other fifteen patients were treated using a single guiding catheter. In the dual catheter group one patient expired after emergent CABG (9.1%), and four patients underwent emergent paricardiocentesis (36.4%). In patients treated with single catheter, there were three deaths (20%), two surgical explorations (13.3%), eight emergent pericardiocenthesis (53.3%), and one event of severe anoxic brain damage (6.7%). Conclusion : The dual catheter technique is a relatively safe and reproducible approach to treat a PCI induced severe coronary artery perforation, and may improve outcome compared to historical series. © 2010 Wiley‐Liss, Inc.     

The “double stingray technique” for recanalizing chronic total occlusions with bifurcation at the distal cap

Antegrade dissection re‐entry is often discouraged for chronic total occlusions (CTOs) with a bifurcation at the distal cap due to risk of side branch occlusion that can lead to periprocedural myocardial infarction and incomplete revascularization. Antegrade dissection re‐entry, however, is often needed, especially in complex cases. We present the novel “double Stingray technique” for CTOs involving bifurcations, in which the Stingray system is used twice for re‐entry into both vessel branches, followed by two‐stent bifurcation stenting to maintain the patency of both branches.     

Rotational atherectomy in the subadventitial space to allow safe and successful chronic total occlusion recanalization: Pushing the limit further

Dissection and re‐entry (DR) techniques have played a key role in the increase of success rates of chronic total occlusion (CTO) recanalization. DR usually allows wiring complex occlusions, even in case of important calcification. In extreme cases, such as in balloon failure‐to‐cross, rotational atherectomy (RA) might be decisive. However, according to experts' recommendations, RA should not be performed in dissection planes because of the high risk of perforation and further extending the dissection, so that its use after DR might be limited. Here, we describe a case of successful right coronary artery CTO recanalization in which, after failure of several antegrade and retrograde techniques, RA was safely performed antegradely in the subadventitial space, thus eventually enabling reverse controlled antegrade and retrograde subintimal tracking (CART). Although the feasibility of RA in CTO percutaneous coronary intervention had already been suggested, this case reports on the novel use of RA to allow further manipulation of the subadventitial space (reverse CART) prior to successful recanalization. © 2017 Wiley Periodicals, Inc.     

Impact of complete percutaneous revascularization in elderly patients with chronic total occlusion

Evidence‐based recommendations for clinical practice are intended to help health care providers and patients make decisions, minimize inappropriate practice variation, promote effective resource use, improve clinical outcomes, and direct future research. The Society for Cardiovascular Angiography and Interventions (SCAI) has been engaged in the creation and dissemination of clinical guidance documents since the 1990s. These documents are a cornerstone of the society's education, advocacy, and quality improvement initiatives. The publications committee is charged with oversight of SCAI's clinical documents program and has created this manual of standard operating procedures to ensure consistency, methodological rigor, and transparency in the development and endorsement of the society's documents. The manual is intended for use by the publications committee, document writing groups, external collaborators, SCAI representatives, peer reviewers, and anyone seeking information about the SCAI documents program.     

Conversations in cardiology: Using new media to transmit timely medical knowledge. How do you assess the left main stenosis with FFR and IVUS in a patient with multivessel CAD?

Conversations in Cardiology is a new use of modern email communication to facilitate transfer of medical knowledge. In this Conversation in Cardiology, Dr. Barry Uretsky of Little Rock Arkansas asked a question about a patient with left main narrowing and the assessment by FFR and IVUS and several well known expert interventionalists address the clinical dilemma. Their answers and rebuttals are reflective of areas of agreement and disagreement and demonstrate the educational value of this format from expert opinion on problems not readily addressed by reference books or formal data studies. © 2012 Wiley Periodicals, Inc.     

体外肺膜氧合在急性冠脉综合征介入治疗中的临床应用与分析

目的 总结及分析体外肺膜氧合（Extracorporeal membrane oxygenation，ECMO）在急性冠状动脉综合征（Acute coronary syndrome,ACS）介入治疗中的临床应用及评价预后。方法 回顾性分析2015年8月至2018年8月因ACS入院，并在ECMO辅助下行冠状动脉造影术的20例患者的临床资料。采用SPSS 23.0软件进行统计分析，计量资料以x±s表示，采用COX回归分析相关因素与患者生存时长的关系，并用OR值与相关因素与生存时间长短之间的关系强度，采用寿命表达计算总数的生存率和绘制生存曲线图。结果 20例ECMO支持下行经皮冠状动脉介入治疗（Percutaneous transluminal coronary intervention，PCI）， 患者中16例成功置入冠状动脉支架，其年龄为43~76岁，平均年龄（61.4±9.1）岁，中位年龄为61岁；平均住院天数为（18.0±12.4）d；ECMO平均支持时间为（31.52±27.97）h，术后成功脱机16例（80%），生存出院16 例（80%），术后6个月生存率85.0%，平均住院时间为（18.0±12.4）d，术后并发症（OR=3.486，95%CI 1.266~9.599）、ECMO支持时间（OR=1.05，95%CI 1.010~1.106）、术后CK（OR=1.009，95%CI 1.001~1.017）是急性冠状动脉综合征ECMO辅助行PCI 预后的危险因素，其中死亡终点事件主要分布在术后30 d内，术后5例（71.4%）出现肺部感染，2例（28.6%）出现急性出血，1例（14.3%）出现心房颤动 ，1例（14.3%）出现肾功能不全、呼吸衰竭，给予CRRT及呼吸机辅助治疗，1例（14.3%）出现弥漫性血管内凝血，1例（14.3%）下肢缺血性坏疽。结论 ECMO辅助PCI为ACS提供了有效治疗方式，严格把握ECMO辅助时间对治疗危重症ACS远期预后有着重要的意义。     

非ST段抬高性急性冠状动脉综合征介入治疗的远期随访

目的　探讨非ST段抬高性急性冠状动脉 (冠脉 )综合征介入治疗的远期疗效。方法　对 1991年 1月至 2 0 0 0年 1月 2 2 4例进行冠脉介入治疗的病人进行了随访研究 ,随访时间 10～ 10 8个月 ,平均 ( 32 4± 19 5 )个月。根据临床资料分非ST段抬高性急性冠脉综合征组 (n =12 6 )和稳定型心绞痛组 (n =98)。将全部病例的随访情况进行了对比研究。结果　非ST段抬高性急性冠脉综合征组和稳定型心绞痛组之间的胸痛 ( 0 71± 0 79和 0 36± 0 5 7,P >0 0 5 ) ,气急、气短 ( 0 2 4± 0 4 8和 0 13± 0 34,P >0 0 5 )和心悸症状 ( 0 89± 1 0 3和 0 36± 0 5 7,P >0 0 5 )的积分差异无显著性。两组间超声心动图局部室壁运动异常发生率 ( 6 5 %和 5 9% ,P >0 0 5 )和次极量负荷实验阳性率 ( 19%和 13% ,P>0 0 5 )差异无显著性 ,两组的无心脏事件生存率和死亡率差异无显著性 ( 6 2 %和 91% ,P >0 0 5 ;5 %和 1% ,P >0 0 5 )。两组患者的主观满意率分别是 84 %和 94 % (P >0 0 5 )。结论　非ST段抬高性急性冠脉综合征的介入治疗可获得较好的远期效果 ,并与稳定型心绞痛的介入治疗效果相同。     

冠心病冠状动脉支架置入术住院死亡33例分析

目的探讨分析冠状动脉支架置入术治疗中住院死亡病因。方法1994-012004-03对广东省人民医院的3252例冠心病病人,行冠状动脉支架置入术治疗术中及术后33例住院死亡患者作回顾性分析。结果其中4例死于术中,其余29例患者死于术后,主要死亡原因依次为:心源性休克、室颤、急性左心衰、多器官衰竭、心脏破裂、急性肾衰,住院病死率为1·01%。结论冠心病冠状动脉支架置入术死亡主要原因是心源性休克、室颤、急性左心衰等。通过一些措施,可以进一步降低住院患者病死率。     

Successful percutaneous coronary intervention in a patient with severe haemophilia A using bivalirudin as the sole procedural anticoagulant

This article presents the case of a patient with severe haemophilia A who underwent successful multivessel percutaneous coronary intervention (PCI). Patients with haemophilia who are diagnosed with coronary artery disease (CAD) and require intervention present a challenge to doctors due to the high risks of bleeding. The patient was administered recombinant factor VIII pre- and post-procedure. Anticoagulation during PCI was maintained with bivalirudin, a thrombin-specific anticoagulant. There were no complications and the patient tolerated the procedure well. This case suggests that bivalirudin as the sole procedural anticoagulant can be safely used in patients with a very high risk of bleeding undergoing PCI.     

Pseudo‐Pericardial Tamponade From Right Ventricular Hematoma After Chronic Total Occlusion Percutaneous Coronary Intervention of the Right Coronary Artery

This is the first case reported in the literature of regional tamponade physiology following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the right coronary artery (RCA) with compression of the right sided chambers that was managed percutaneously with computerized tomographic (CT) guided drainage. This case report highlights the heightened index of suspicion needed to make the diagnosis; the often nondiagnostic nature of the surface echocardiogram and the need for cross specialty collaboration to treat this entity successfully. Key words: Coronary Aneurysm/Dissection/Perforation (CORD); Percutaneous Coronary Intervention (PCI); CTO; ICT – Imaging; electron beam CT/multidetector CT © 2016 Wiley Periodicals, Inc.