GuideLiner Mother‐and‐Child Guide Catheter Extension: A Simple Adjunctive Tool in PCI for Balloon Uncrossable Chronic Total Occlusions

Objectives

To investigate the use of the GuideLiner “mother‐and‐child” guide catheter extension system as a simple solution to facilitate initial device delivery in balloon uncrossable chronic total occlusions (CTOs) undergoing percutaneous coronary intervention (PCI).

Background

During PCIs for CTO lesions, an important reason for procedural failure is the inability to deliver a balloon or microcatheter across the lesion.

Methods

We retrospectively accessed our interventional registry for 07/01/2010 to 03/21/2012 and extracted data on all CTO lesions involving GuideLiner catheter use. Cine review was performed to identify cases where a guidewire had crossed the CTO and the use of a GuideLiner catheter facilitated initial device delivery.

Results

We identified 28 patients that underwent PCI for CTO with a GuideLiner catheter used to assist initial balloon or microcatheter advancement across the culprit lesion. Mean overall CTO length was 26.3 ± 18.1 mm. The GuideLiner catheter was successful in delivering a small balloon to the CTO lesion in 85.7% of cases (24/28). A single CTO PCI resulted in a distal guidewire perforation, but there was no hemodynamic compromise or pericardial effusion and the patient was discharged the next day. Overall procedural success in these selected cases (where a guidewire had already crossed the CTO) was 89.3% (25/28).

Conclusions

The GuideLiner mother‐and‐child catheter is a simple, safe and efficacious adjunctive device for difficult CTO PCIs where despite standard measures it is not possible to deliver an initial balloon or microcatheter across the occluded segment.

     

Percutaneous Coronary Intervention of Complex Calcified Lesions With Drug‐Coated Balloon After Rotational Atherectomy

Objectives

We investigated the safety and efficacy of PCI using drug‐coated balloon (DCB) after rotational atherectomy (rotablation) in a retrospective single center study in patients with calcified de novo coronary lesions. The majority of patients had an increased risk for bleeding.

Background

DCB has been effective in the treatment of in‐stent restenosis, small vessels, and bifurcations. DCB enables short one month dual antiplatelet treatment. No published data exist on the use of DCB after rotablation.

Methods

82 PCIs were performed in 65 patients (mean age 72 ± 10 years) using rotablation followed by DCB treatment. The median follow‐up time was 17 months. 82% of the patients had at least one risk factor for bleeding such as oral anticoagulation. 32% had an acute coronary syndrome. Median duration of dual antiplatelet treatment was 1 month.

Results

MACE (the composite of cardiovascular death, ischemia‐driven target‐lesion revascularization [TLR] or non‐fatal myocardial infarction) occurred in 14% and 20% of the patients at 12 and 24 months, respectively. The rate of ischemia‐driven TLR was 1.5% at 12 months and 3.0% at 24 months. No acute closure of the treated vessel occurred. Bailout stenting was needed in 10% of the PCIs. The incidence of significant bleeding was 9% at 12 months.

Conclusions

This is the first study to show that PCI using DCB after preparation of calcified lesions with rotablation is safe and effective. This novel strategy may be considered especially in patients with a bleeding risk such as those using an oral anticoagulant.

     

Complications with Angio‐Seal™ Vascular Closure Devices Compared with Manual Compression after Diagnostic Cardiac Catheterization and Percutaneous Coronary Intervention

Objectives

This study assessed and compared vascular complications in CATHs and PCIs using an Angio‐Seal? vascular closure device (VCD) versus manual compression (MC).

Methods

Secondary data analysis of a population‐based multiyear cohort database was conducted to compare femoral access‐related vascular outcomes in cardiac procedures using VCD and MC between May 1, 2006 and December 31, 2010. The primary outcome was any vascular complication. Propensity score adjusted analysis was conducted to reduce bias associated with covariate imbalance between the groups compared.

Results

Of the 11,897 procedures, 7,063 (59.4%) used a VCD. Vascular complications occurred in 174/8,796 (2.0%) of CATHs and 82/3,004 (2.7%) of PCIs. In the CATH sample, the odds of vascular complication were 57% lower if a VCD was used (OR = 0.43, 95% CI 0.31–0.60). For the PCI sample, the risk was 49% lower if a VCD was used (OR = 0.51, 95% CI 0.31–0.81).

Conclusions

A low incidence of vascular complications was observed with the use of an Angio‐Seal VCD relative to MC for both procedures.

     

Elective or Emergency Use of Mechanical Circulatory Support Devices During Transcatheter Aortic Valve Replacement

Objective

Evaluate the use of mechanical circulatory support (MCS) devices in high‐risk patients undergoing transcatheter aortic valve replacement (TAVR).

Background

The use of MCS devices in elderly patients with multiple comorbidities undergoing TAVR is underexplored.

Methods

All patients undergoing TAVR at a single tertiary academic center who required MCS during index procedure between 2008 and 2015 were included in a prospective database.

Results

MCS was used in 9.4% (54/577) of all TAVRs (n = 52 Edwards Sapien and n = 2 CoreValves) of which 68.5% (n = 37) were used as part of a planned strategy, and 31.5% (n = 17) were used in emergency “bail‐out” situations. IABP was the most commonly used device (87%) followed by Impella and ECMO (6% each). Among the MCS group, 22% required cardiopulmonary resuscitation during the procedure (n = 4 elective [11%] vs. n = 8 emergent [47%]) and 15% upgrade to a second device (Impella or CPB after IABP; n = 5 elective [14%] vs. n = 3 emergent [18%]). Median duration of support was 1‐day. Device related complications were low (4%). In‐hospital mortality in this extremely high‐risk population was 24% (13/54) (11% [4/37] for elective cases and 53% [9/17] for emergency cases). Cardiogenic shock (50%) was the most common cause of in‐hospital death. Cumulative all‐cause 1‐year mortality was 35% (19/54) (19% 97/370 for elective and 71% [12/17] for emergency cases).

Conclusion

Emergent use of MCS during TAVR in extremely high‐risk population is associated with high short and long‐term mortality rates. Early identification of patients at risk for hemodynamic compromise may rationalize elective utilization of MCS during TAVR.

     

The Impact of Modern Noninvasive Cardiac Imaging on Coronary Intervention Rates

Objectives

It remains still unclear whether the use of modern noninvasive diagnostic modalities for evaluation of coronary artery disease (computed tomography coronary angiography (CTCA), nuclear myocardial perfusion imaging (MPI)) were able to change the “diagnostic yield” of invasive coronary angiography (ICA).

Methods

The total number of ICA in the years 2000–2009 was related to the number of percutaneous interventions (PCIs) and we assessed whether there was a significant trend over time using time series analyses. We compared these data with the number of patients undergoing CTCA and nuclear MPI in the same time period.

Results

During the 10‐year observational period, 23,397 ICA were performed. The proportion of purely diagnostic ICA (without PCI) remained stable over the whole study period (tau = ?0.111, P = 0.721). A CTCA program was initiated in 2005 and 1,407 examinations were performed until 2009. Similarly, the number of nuclear MPI increased from 2,284 in the years 2000–2004 to 5,260 in the years 2005–2009 (P = 0.009).

Conclusion

Despite increasing availability, noninvasive testing modalities did not significantly alter the rate of purely diagnostic ICA, and still are underused as gatekeeper to ICA. Further effort is needed to optimize the use of noninvasive imaging modalities in the work‐up process for coronary artery disease. (J Interven Cardiol 2014;27:50–57)

     

Use and Performance of Premounted Stents Compared to Nonpremounted Stents in Pediatric and Adult Congenital Cardiac Catheterization

Objectives

We sought to characterize the use, efficacy, and performance characteristics of premounted stents relative to nonpremounted stents when used during congenital cardiac catheterization.

Background

Endovascular stent implantation is an effective means of relieving vascular obstruction in patients with congenital heart disease. However, stent implantation is technically challenging and important complications occur. Premounted stents appear to offer many advantages relative to their nonpremounted counterparts, and it has been suggested that the use of premounted stents is associated with fewer complications. However, translation of these potential benefits into procedural or clinical success has been poorly examined and the data are conflicting.

Methods

All stent placements performed between January 1, 1999 and December 31, 2009 were reviewed. Analysis of technical success, hemodynamic success and complications was performed.

Results

416 stents were placed over the 10 year period. 158 (38%) were premounted. There was no apparent trend in the frequency of use of premounted stents over the study period. Implanted premounted stents were smaller in diameter than nonpremounted stents 4.9 mm +/? 1.8 versus 13.9 mm +/? 3.7, and the site of stent placement differed significantly. Unadjusted and adjusted analysis of technical success with respect to the precision of stent placement, hemodynamic success, and complications showed no difference between premounted and non‐premounted stents.

Conclusions

We found no difference between premounted and nonpremounted stents with respect to procedural and hemodynamic success or complications. Nevertheless, there remain practical advantages to the use of premounted stents that may justify their expanding role in congenital cardiac catheterization. (J Interven Cardiol 2013;26:58–61)

     

Real‐life data regarding acute procedural success and 1‐year clinical outcome of desolve bioresorbable scaffolds

Objectives

We aimed to evaluate the peri‐procedural success of DESolve bio‐resorbable scaffolds (BRSs) and analyzed real‐life data about major cardiac events during 1‐year follow‐up.

Background

There is little information about real‐life data of DESolve BRS which is a novel stent technology offering various advantages over drug eluting stents and commonly used in daily cardiology practice.

Methods

We conducted this single‐center and non‐randomized cross‐sectional study from June 2015 through August 2016 in Medipol University Department of Cardiology and included 117 patients undergoing single or multivessel percutaneous coronary interventions (PCI) with novolimus‐eluting BRS devices (152 scaffolds) (Elixir Medical Corporation). Study end points were acute device and procedural success, scaffold thrombosis and major adverse cardiac event (MACE) rates of DESolve BRS.

Results

Device success was 96.7% and procedural success was 99.3%. We detected MACE rate as 0.9% while clinical‐driven target lesion revascularization was performed in one patient. None of the patients experienced scaffold thrombosis or death. Peri‐procedural complications were reported in three patients.

Conclusions

High rates of successful scaffold implantations, low rates of peri‐procedural complications, and major cardiac events in long‐term suggest that DESolve scaffolds can safely and effectively be used in daily intervention practice by particularly experienced operators.

     

A Novel‐Modified Provisional Bifurcation Stenting Technique: Jailed Semi‐Inflated Balloon Technique

Objective

We proposed a new technique for the treatment of coronary bifurcation lesions, called jailed semi‐inflated balloon technique (JSBT).

Background

Currently, provisional approach is recommended to treat most of coronary bifurcation lesions. However, it is associated with the risk of side branch (SB) occlusion after main vessel (MV) stenting due to plaque or carina shift into the SB. The SB occlusion may cause peri‐procedural myonecrosis or hemodynamic compromise. Therefore, strategies are needed to reduce the SB occlusion during provisional approach.

Methods

Between September 2014 and April 2015, we selected 137 patients (104 male, 33 female; mean age 63.6 ± 11.7 years) with 148 distinct coronary bifurcation lesions underwent percutaneous coronary intervention using JSBT. All patients were followed with hospital visits or telephone contact up to 1 month.

Results

The majority of the patients had acute coronary syndrome (64.2%) and Medina 1.1.1. bifurcation lesions (62.8%). The lesion localization was distal left main (LM) coronary artery in 28 patients. After the MV stenting, thrombolysis in myocardial infarction (TIMI) 3 flow was established in 100% of both MV and SB. There was no SB occlusion in any patient. There was no major adverse cardiac event during in‐hospital stay and 1 month follow‐up.

Conclusions

The JSBT technique can be successfully performed in both LM and non‐LM bifurcation lesion. This technique provides high rate of procedural success, excellent SB protection during MV stenting and excellent immediate clinical outcome. (J Interven Cardiol 2015;28:420–429)

     

Benefits of Balloon‐Dilatable Bilateral Pulmonary Artery Banding in Patients With Hypoplastic Left Heart Syndrome and Other Complex Cardiac Anomalies

Objectives

The purpose of this study was to evaluate the potential of balloon‐dilatable bilateral pulmonary artery banding (b‐PAB) and its impact on the configuration of the pulmonary artery (PA).

Background

We have previously used balloon‐dilatable b‐PAB as first‐stage palliation for patients with hypoplastic left heart syndrome (HLHS) and other complex cardiac anomalies.

Methods

Two pliable tapes were placed around each branch of the PA and tightened with 7–0 polypropylene sutures in a manner that allowed for the subsequent adjustment of PA diameters. We retrospectively examined the adjustability of PA diameters by balloon dilation and the need for surgical PA angioplasty at later stages.

Results

From January 2010 to October 2013, we performed b‐PAB in 8 patients, including 3 borderline cases between biventricular repair (BVR) and univentricular repair (UVR). The b‐PAB procedures were performed at a median age of 6.5 days (range, 2–10 days). Balloon dilations were performed in 10 lesions in 4 patients. All of the procedures were performed safely. Two patients reached definite BVR. The remaining 6 patients underwent open palliative procedures with univentricular physiologies that resulted in 2 deaths unrelated to the initial b‐PAB. In all but 1 of the patients, the PA configuration was properly maintained and did not require surgical pulmonary angioplasty.

Conclusions

Balloon‐dilatable b‐PAB can be performed safely and prevents PA distortion at later stages. This technique should be considered for patients with complex cardiac anomalies if uncertainty exists regarding the optimal surgical strategy (BVR or UVR) in early infancy. (J Interven Cardiol 2015;28:594–599)

     

Long‐term clinical results of bioresorbable absorb scaffolds using the PSP‐technique in patients with and without diabetes

Objectives

We evaluated clinical results up to 36 months after implantation of Absorb BVS using PSP‐technique and compared the outcome of patients with and without diabetes mellitus.

Background

Absorb II demonstrated that interventional treatment of coronary artery disease with bioresorbable vascular scaffolds (BVS) without proper PSP‐technique (pre‐dilation, proper sizing, and post‐dilation) is associated with an increased thrombotic risk, even in simple lesions.

Methods

In this prospective study 319 patients with 420 lesions were enrolled and treated with the Absorb BVS. Pre‐dilation was mandatory and post‐dilation with a high‐pressure balloon was performed in patients with a scaffold length >12 mm. Patients were clinically followed up to 3 years. Primary outcome measure was the device‐oriented endpoint (DoCE) defined as cardiac death, myocardial infarction not clearly related to a non‐target vessel and target lesion revascularization.

Results

DoCE was 5.0%, 7.1%, and 10.0% after 12, 24, and 36 months for the total population. Rate of scaffold thrombosis was 0.5%, 0.8%, and 1.4% after 12, 24, and 36 months. Rate of DoCE was higher in the diabetic subgroup with 9.1%, 12.6%, and 12.9% after 12, 24, and 36 months compared with 4.0% (P = 0.13), 5.6% (P = 0.05), and 9.9% (P = 0.20) in patients without diabetes mellitus.

Conclusions

Patients treated with the Absorb BVS using the PSP‐technique show good results up to 3 years with a low rate of scaffold thrombosis. Patients suffering from diabetes mellitus have an increased rate of DoCE compared with non‐diabetic patients.

Clinical Trial Registration

clinicaltrials.gov_NCT02162056 .

     

Endovascular Repair of Traumatic Aortic Injury: A Novel Arena in Interventional Cardiology

Objective

To assess the feasibility of endovascular repair of traumatic aortic injuries performed by interventional cardiologists in collaboration with cardiothoracic surgeons.

Background

Traumatic aortic injury (TAI) represents a significant cause of mortality in trauma patients. Endovascular techniques have recently come into play for the management of TAI and are usually performed by a multidisciplinary team consisting of a thoracic or vascular surgeon and/or interventional radiology. With extensive expertise in catheter‐based interventions, interventional cardiologists may have a pivotal role in this important procedure.

Methods

From January 2009 to July 2011, we reviewed the TAI endovascular repair outcomes performed by a team of interventional cardiologists in collaboration with cardiothoracic surgery at our institution. The charts of these patients were reviewed to collect desired data, which included preoperative, procedural, and follow‐up details.

Results

Twenty patients were identified in our series. Most of these patients developed TAI from motor vehicle accidents. Technical success for endovascular repair of TAI was achieved in all patients. Two patients developed endoleak, of which one patient required subsequent open repair. Two patients expired in the hospital from coexistent injuries.

Conclusions

Our series of endovascular repair for TAI performed by interventional cardiologists with the collaboration of cardiothoracic surgeons showed excellent outcomes. Our experience may give further insight in the collaborative role of interventional cardiology and cardiothoracic surgery for endovascular repair of TAI. (J Interven Cardiol 2013;26:77–83)

     

Balloon‐Expandable Transcatheter Aortic Valves Can Be Successfully and Safely Implanted Transfemorally Without Balloon Valvuloplasty

Objectives

To assess the necessity for balloon aortic valvuloplasty (BAV) during transfemoral transcatheter aortic valve implantation (TAVI) when using balloon‐expandable valves.

Background

BAV is a usual part of TAVI procedures, prior to valve implantation. However, the benefits and necessity of this are unknown and recent evidence in self‐expanding valves suggests it may not be necessary.

Methods

Retrospective single‐center study of 154 patients undergoing first‐time, transfemoral TAVI for native aortic valve stenosis, with (N = 76), and without (N = 78), BAV as part of the procedure. Data collected included demographic, procedural, and outcome data.

Results

BAV did not alter VARC‐2 defined procedural success or early safety compared to not performing a BAV, including mortality, degree of aortic regurgitation, or need for post‐TAVI balloon dilatation, although there was a strong trend to reduced stroke when not performing a BAV. There was a significantly reduced procedural time (P = 0.01) and fluoroscopic time (P < 0.001) without performing a BAV. There were no differences in cerebral embolization (solid, gaseous, or total emboli) noted between the 2 groups, as measured on transcranial doppler (TCD).

Conclusions

TAVI can be effectively and safely performed without a BAV and this results in reduced procedural and fluoroscopic times, although embolization to the brain is not reduced. There is a trend toward reduced stroke risk. (J Interven Cardiol 2016;29:319–324)

     

Cryoplasty for the Treatment of Coronary Bifurcation Stenoses Following Main Vessel Stenting

Objectives

This retrospective study sought to assess the safety and clinical efficacy of cryoplasty for treatment of side‐branch stenoses following main vessel stenting in coronary bifurcation lesions.

Background

Cryoplasty prevents restenosis by reducing smooth muscle proliferation and extracellular matrix synthesis. Clinical effectiveness has been demonstrated in the peripheral circulation. Treatment of coronary bifurcation lesions remains a challenge. We used a novel strategy of main vessel stenting combined with side‐branch cryoplasty to treat high‐grade stenoses following main vessel stenting.

Methods

Eighteen patients with bifurcation lesions had significant plaque shift into a side branch after main vessel intervention. Drug‐eluting stents were placed in the main vessel and cryoplasty was performed on the side‐branch vessel. Quantitative coronary analysis was performed on all side‐branch vessels both pre– and post–main vessel stenting. All patients had clinical follow‐up 3 months or more after cryoplasty including either nuclear stress testing or diagnostic coronary angiogram.

Results

Mean percent stenosis decreased from 80.6% post main vessel stenting to 24.8% following cryoplasty (P < 0.0001). Of the 17 patients who had pre‐cryoplasty nuclear stress testing 1 patient had ischemia identified in the distribution of the treated vessel at follow‐up. Five patients had follow up angiography. One patient had restenosis, the other 2 were unchanged. There was a low incidence of MACE.

Conclusions

In this first report of its use in the coronary circulation, cryoplasty for bifurcation side‐branch disease was safe and associated with a low rate of clinical recurrence in carefully selected patients. (J Interven Cardiol 2013;26:239–244)

     

The Learning Curve for Transcatheter Mitral Valve Repair With MitraClip

Objectives

This study sought to assess the learning curve for TMVR for treatment of primary mitral regurgitation (MR).

Background

Data are lacking regarding the technical experience required to achieve optimal clinical outcomes with transcatheter mitral valve repair (TMVR) using the edge‐to‐edge MitraClip technique.

Methods

We examined the sequential experience of the first 75 patients (age 80 ± 9 years; 77% male) who underwent TMVR at our institution. A sequence number of each patient was assigned as a continuous variable and in tertiles for analysis.

Results

TMVR with MitraClip was successful in 97% with an average procedural time of 106 ± 39 minutes. The 30‐day rate of major adverse cardiovascular events was 7%. With increased case experience, there were decreases in procedural time, fluoroscopy time, length of hospital stay, and major adverse cardiovascular events. Procedural success, residual mitral regurgitation and NYHA functional classification at 30‐day follow‐up remained unchanged throughout the experience.

Conclusions

The learning curve for TMVR with MitraClip for treatment of primary MR is characterized by a sequential reduction in procedure time, fluoroscopy time, procedural complications, and hospital length of stay at a tertiary academic medical center. Thirty‐day procedural results are favorable and similar during the initial learning period.

     

The Medtronic Micro Vascular Plug™ for Vascular Embolization in Children With Congenital Heart Diseases

Objectives

To describe the early multi‐center, clinical experience with the Medtronic Micro Vascular Plug? (MVP) in children with congenital heart disease (CHD) undergoing vascular embolization.

Background

The MVP is a large diameter vascular occlusion device that can be delivered through a microcatheter for embolization of abnormal blood vessels.

Methods

A retrospective review of embolization procedures using the MVP in children with CHD was performed in 3‐centers. Occlusion of patent ductus arteriosus using the MVP was not included.

Results

Ten children underwent attempted occlusion using the MVP. The most common indication to use the MVP was failed attempted occlusion using other embolic devices. Five, single ventricle patients (median age 3‐years, median weight 14.9 kg) underwent occlusion of veno‐venous collaterals following bidirectional Glenn operation. Three patients (Median age 8 years) underwent occlusion of coronary artery fistulae (CAF). Two patients (age 7 months and 1 year) underwent occlusion of large aorto‐pulmonary collaterals. A 7‐day‐old child with a large CAF required 2 MVPs and an Amplatzer Vascular Plug (AVP‐II) for complete occlusion. Occlusion of all other blood vessels was achieved using a single MVP. One MVP embolized distally in an 8‐years‐old child with a large CAF. There were no other procedural complications or during follow‐up (median 9 months).

Conclusions

The MVP is a new, large‐diameter vascular embolization device that can be delivered through a microcatheter. It may play an important role in providing highly effective occlusion of abnormal vessels in children.

     

A “Jail Escape Technique” (JET) for distal side branch wiring during provisional stenting: Feasibility and first‐in‐man study

Objective

To evaluate the feasibility of a novel technique for achieving distal SB access and improve strut apposition during provisional stenting.

Background

While distal rewiring and stent expansion toward the side branch (SB) are associated with better results during provisional stenting of coronary artery bifurcation lesions, these techniques are technically challenging and often leave unopposed struts near the carina.

Methods

The “Jail Escape Technique” (JET) is performed by passing the proximal tip of the SB wire between the main vessel (MV) stent struts and balloon before implantation, allowing the MV stent to push the SB wire against the distal part of the carina. The MV stent can then be deployed without jailing the SB wire. Distal SB access and strut distribution at the carina were tested in phantom and swine models. Stent distortion, dislodgement forces, and material damage were evaluated with tensile testing. Human feasibility was then tested on 32 patients.

Results

Preclinical testing demonstrated that the SB wire was located at the most distal part of the carina and no strut malapposition at the carina was present after balloon inflation. Stent distortion, dislodgement forces, or material damage were not affected. JET was successfully performed in 30 of 32 patients. No major adverse cardiovascular events occurred in any patient at 6‐month follow‐up.

Conclusion

The “JET” enables distal SB access and eliminates strut malapposition at the carina. Further studies with larger numbers of patients are needed to further investigate this technique.

     

Recurrent Myocardial Infarction After Primary Percutaneous Coronary Intervention in Multivessel Coronary Disease Is Primarily Related to Stent Failure

Objectives

Our aim was to investigate the risk of events related to non‐culprit lesions after primary percutaneous coronary intervention (PCI) in patients with multivessel coronary disease (MVD).

Background

In patients undergoing primary PCI for ST‐elevation myocardial infarction (STEMI) who are diagnosed with MVD, the optimal treatment strategy is currently under debate. Although observational data exposed an increased risk of multivessel PCI in the acute phase of STEMI, 2 recently published randomized controlled trials showed a reduction of death or recurrent myocardial infarction (MI) after preventive PCI of non‐culprit lesions when compared with culprit‐lesion PCI only.

Methods

We performed a post‐hoc analysis of 279 patients with MVD included in the Paclitaxel‐Eluting Stent versus Conventional Stent in Myocardial Infarction with ST‐Segment Elevation (PASSION) trial. We analyzed the incidence and cause of recurrent MI. Recurrent MI due to stent failure was assumed in the event of definite or probable stent thrombosis.

Results

After 5 years, 14 patients (5.7%) with MVD had a recurrent MI versus 17 (5.4%) patients with 1‐vessel disease (HR 1.06, 95%CI 0.52–2.15, P = 0.87). The majority of events was attributable to stent failure, while of the remaining 6 events, only 1 was proven to originate from a lesion that was judged significant at enrolment.

Conclusions

In this post‐hoc analysis of the PASSION trial, recurrent MI in patients with MVD was mainly related to stent failure rather than a new event originating from a significant stenosis in a non‐culprit coronary artery. (J Interven Cardiol 2015;28:523–530)

     

Practical Usefulness of Dual Lumen Catheter‐Facilitated Reverse Wire Technique for Markedly Angulated Bifurcated Lesions

Objectives

This study aimed to investigate the practical usefulness of dual lumen catheter‐facilitated reverse wire technique.

Background

We sometimes encounter difficulty in introducing a guidewire to the highly angulated side branch. In those cases, the reverse wire technique is considered as a last resort to overcome the situation.

Methods

Between January 2013 and June 2015, we performed the reverse wire technique for guidewire crossing into an extremely angulated side branch in consecutive seven cases with true bifurcated lesions. We retrospectively evaluated patients’ backgrounds, lesion characteristics, and details of the percutaneous coronary intervention (PCI) procedures.

Results

Three interventional cardiologists with various levels of experience in coronary intervention performed this technique. A polymer‐jacket hydrophilic‐coated guidewire was used for the reverse wire system excluding in one case, and we adopted a sharp curve for the tip shape in all cases. After crossing the reverse wire into a highly angulated side branch, we usually deliver a flexible micro catheter over the guidewire for the purpose of guidewire exchange. We deployed a stent in the side branch in three cases. We successfully performed all PCI procedures without any complications and no major adverse cardiac event was observed during hospitalization.

Conclusions

We could safely and effectively perform the reverse wire technique for guidewire crossing into a markedly angulated side branch. We recommend a polymer‐jacket hydrophilic‐coated guidewire with a sharp curve in the tip shape for this technique. All interventional cardiologists should acquire knowledge and skills regarding this guidewire manipulation technique. (J Interven Cardiol 2015;28:544–550)

     

The Impact of Right Ventricular Stroke Work on B‐Type Natriuretic Peptide Levels in Patients With Mitral Stenosis Undergoing Percutaneous Mitral Valvuloplasty

Objectives

We aimed to explore the relationship between brain natriuretic peptide (BNP) levels and right ventricular (RV) function in patients with mitral stenosis (MS), and to investigate the hemodynamic parameters that predict reduction of BNP levels after percutaneous mitral valvuloplasty (PMV).

Background

Few studies have evaluated BNP in the context of MS, specifically the impact of the RV stroke work (RVSW) on serum BNP levels has not been defined.

Methods

Thirty patients with symptomatic rheumatic MS in sinus rhythm who were referred for a PMV were enrolled. Right and left heart pressures were obtained before and after valvuloplasty. RVSW index (RVSWI) was calculated by cardiac catheterization.

Results

Basal BNP levels were elevated in MS patients and correlated with several hemodynamic parameters including pulmonary pressure, pulmonary vascular resistance index, cardiac index (CI), and RVSWI. In multivariate analysis, CI and RVSWI were independent predictors of raised basal BNP levels. PMV resulted in a significant decrease in the RVSWI with a concurrent increase in CI (2.4 ± 0.43 to 2.9 ± 0.8 L/min/m², P = 0.010). Overall, plasma BNP levels significantly decreased from 124 (63/234) to 73 (48/148) pg/ml postvalvuloplasty. Multivariate analysis revealed that the reduction of left atrial (LA) pressure post‐PMV was an independent predictor of change in BNP levels.

Conclusions

Elevated baseline BNP level in MS patients was independently associated with CI and RVSWI. Plasma BNP levels were reduced after successful PMV, which was associated with the reduction of the LA pressure. (J Interven Cardiol 2013;26:501‐508)

     

Percutaneous Closure of Post‐Infarction Ventricular Septal Defects—An Over Decade‐long Experience

Objectives

To report an over decade‐long experience with percutaneous post‐infarction ventricular septal defect (PIVSD) closure.

Background

PIVSDs remains a major clinical challenge with extremely high mortality. Data concerning interventional closure of PIVSD is scarce.

Methods

All percutaneous PIVSD closures performed between 2003 and 2016 in 8 participating centres were identified. Data concerning patients and procedures was acquired. Patients were divided into two groups, based on the time interval between VSD diagnosis and closure (≤14 days—acute phase, >14 days—non‐acute phase).

Results

Twenty‐one percutaneous PIVSD closures were performed on 20 patients (9 females, mean age: 70 years). Mean interval between the diagnosis and the procedure was 182.6 ± 500 days (range: 7–2228). Defects were mostly located in apical (55%) segments of the septum. In 7 cases (33%) the procedure was performed in the acute phase. The closure was technically successful in 17 cases (81%). Four patients died within 48 hours after the procedure. 30‐days survival rate of the entire cohort was 70%. Univariate analysis revealed impact of technical success of the procedure (HR 0.13, CI 0.03–0.68 P = 0.016) and white blood cell count (HR 1.36 per unit increase, CI 1.1–1.69, P = 0.005) on 30‐day mortality.

Conclusions

In a selected population of patients percutaneous PIVSD closure is feasible and provides satisfactory survival rate. Procedural success has a protective impact on survival. Timing of the closure remains controversial. Procedure in the non‐acute phase carries lower mortality, but at the same time introduces a selection bias. Larger registry‐based studies are required.