Tuning and amplification strategies for intravascular imaging coils

The manufacturing of intravascular imaging coils poses several challenges. Due to their size, it can be difficult to incorporate local matching networks and signal amplifiers. The goal of this study is to investigate tuning and amplification strategies for intravascular coils and to assess the signal‐to‐noise benefits of incorporating a matching network and/or miniature amplifier into catheter‐based intravascular imaging devices at various locations in the signal chain. The results suggest that the use of a low‐noise amplifier close to the receiving coil enables the use of miniature coaxial cables to be used despite being noisy. Moreover, an improvement in the signal‐to‐noise ratio of over 75% is presented over conventional intravascular coil configurations where the matching circuit and low‐noise amplifier are placed at the proximal end. Therefore, designing devices for intravascular applications capable of generating high signal‐to‐noise ratio images becomes more feasible, also allowing for significant reductions in scan time. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.     

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.     

Vascular Access Site and Outcomes in 58,870 Patients Undergoing Percutaneous Coronary Intervention With a Previous History of Coronary Bypass Surgery: Results From the British Cardiovascular Interventions Society National Database

Objectives

Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, access site choice and outcomes of patients undergoing PCI with previous coronary artery bypass grafting (CABG) were studied.

Defining Staged Procedures for Percutaneous Coronary Intervention Trials: A Guidance Document

Patients in coronary intervention trials may require more than 1 procedure to complete the intended revascularization strategy. However, these staged interventions are not consistently defined. Standardized definitions are needed to allow meaningful comparisons of this outcome among trials. This document provides guidance on relevant parameters involving staged procedures, including minimum data collection and consistent classification of coronary procedures initially identified as staged; the aim is to achieve consistency among clinical trialists, sponsors, health authorities, and regulators. Definitions were developed jointly among representatives of academic institutions and clinical research organizations based on clinical trial experience and published literature. Reasons for staged procedures were identified and include baseline kidney function, contrast load and radiation exposure, lesion complexity, and patient or operator fatigue. Moreover, nonclinical reasons include procedure scheduling and reimbursement. Management of staged procedures should be a standalone section in clinical trial protocols and clinical events committee charters. These documents should clearly define a time window for staged procedures that allows latitude for local policies, while respecting accepted clinical guidelines, and consistency with study objectives. Investigators should document in the case report form the intent to stage a procedure, the lesions to be treated, and the reasons for staging, preferably before randomization. Ideally, all reinterventions, or at least all procedures performed after the recommended time window, those in which data suggest an anticipated procedure due to a worsening condition and those where a revascularization is attempted in the target vessel, should be reviewed by an independent clinical events committee.     

A Randomized Trial to Assess Regional Left Ventricular Function After Stent Implantation in Chronic Total Occlusion: The REVASC Trial

Objectives

The aim of this study was to investigate whether percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) improves left ventricular function.

Ostial right coronary chronic total occlusion: Transesophageal echocardiographic guidance for retrograde aortic re‐entry

As antegrade options are limited, intervention upon the ostial right coronary artery (RCA) chronic total occlusion (CTO) warrants a retrograde approach. Landmarks for an aggressive approach are concerning as passage of stiff guidewires or electrocautery near the RCA ostium may result in wire passage into structures other than the aorta. We report the first use of transesophageal echocardiography (TEE) to assist retrograde passage of a guidewire into the aorta. For the ostial RCA CTO, TEE guidance may be considered to assist retrograde passage of aggressive guidewires into the aorta.     

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.     

Randomized Comparison Between Radial and Femoral Large-Bore Access for Complex Percutaneous Coronary Intervention

ObjectivesThe aim of this study was to investigate whether transradial (TR) percutaneous coronary intervention (PCI) is superior to transfemoral (TF) PCI in complex coronary lesions with large-bore guiding catheters with respect to clinically relevant access site–related bleeding or vascular complications.BackgroundThe femoral artery is currently the most applied access site for PCI of complex coronary lesions, especially when large-bore guiding catheters are required. With downsizing of TR equipment, TR PCI may be increasingly applied in these patients and might be a safer alternative compared with the TF approach.MethodsAn international prospective multicenter trial was conducted, randomizing 388 patients with planned PCI for complex coronary lesions, including chronic total occlusion, left main, heavy calcification, or complex bifurcation, to either 7-F TR access (TRA) or 7-F TF access (TFA). The primary endpoint was defined as access site–related clinically significant bleeding or vascular complications requiring intervention at discharge. The secondary endpoint was procedural success.ResultsThe primary endpoint event rate was 3.6% for TRA and 19.1% for TFA (p < 0.001). The crossover rate from radial to femoral access was 3.6% and from femoral to radial access was 2.6% (p = 0.558). The procedural success rate was 89.2% for TFA and 86.0% for TRA (p = 0.285). There was no difference between TFA and TRA with regard to procedural duration, contrast volume, or radiation dose.ConclusionsIn patients undergoing PCI of complex coronary lesions with large-bore access, radial compared with femoral access is associated with a significant reduction in clinically relevant access-site bleeding or vascular complications, without affecting procedural success. (Complex Large-Bore Radial Percutaneous Coronary Intervention [PCI] Trial [Color]; NCT03846752)