Cardiovascular Intervention and Therapeutics

The advantages of sheathless guiding catheters over the conventional approach using sheaths in percutaneous coronary intervention (PCI) regarding access-site complications, particularly ultrasound-diagnosed radial artery occlusion (RAO), remain unknown. The present study investigated the incidence of access-site complications of transradial primary PCI using sheathless guiding catheters in acute coronary syndrome (ACS). This prospective study evaluated access-site complications in 500 patients with ACS undergoing sheathless transradial primary PCI. Doppler ultrasound evaluation of the radial arteries was performed 2 and 30 days after the procedure. Sheathless guiding catheters (7.5-Fr) were used in 91.0% of the patients. The procedural success rate was 98.4%. Ultrasound-diagnosed RAO rates were 2.0% and 3.8% at 2- and 30-day follow-ups, respectively. Logistic regression analysis identified that the sheath-to-artery ratio (per 0.1) (odds ratio [OR] 5.71; 95% confidence interval [CI] 1.18–27.71; p = 0.001) was associated with more frequent RAO and that hypertension (OR 0.22; 95% CI 0.06–0.81; p = 0.023) was associated with less frequent RAO. Receiver operating characteristic curve analysis revealed that a sheath-to-artery ratio of 1.47 was the cutoff for 30-day post-procedural RAO (sensitivity 72%, specificity 81%). Sheathless transradial primary PCI for ACS was associated with a low incidence of access-site complications and a higher sheath-to-artery ratio cutoff for RAO than that expected from conventional PCI using sheaths based on historical data, demonstrating the access-site safety of sheathless guiding catheters and their benefit in PCI for ACS (University Hospital Medical Information Network-Clinical Trial Registry Number UMIN000019931).

We report a case of chronic total occlusion (CTO) of the left anterior descending artery, which was treated by percutaneous coronary intervention using a retrograde approach via an extremely tortuous right ventricular branch of the right coronary artery. New concept guidewires and a channel dilator were advanced by delicate manipulation into the distal site of the CTO and a successful percutaneous recanalization was performed. These new concept guidewires may facilitate the retrograde approach for CTOs via tortuous collateral channels.

Functional outcome of venous stent placement for the management of acute iliofemoral deep vein thrombosis (DVT) following catheter-directed thrombolysis (CDT), remain undefined. The purpose of this study was to assess immediate and intermediate term outcomes among patients treated with venous stenting following CDT in patients with proximal lower limb DVT. Thirty consecutive patients aged between 20–70 years with proximal lower limb DVT formed the study group. The mean duration of CDT done with streptokinase was 4.5 ± 1.3 days. Patients with residual venous obstruction and/or large clot burden were treated further with venous angioplasty and/or stenting. Primary endpoint was to evaluate the safety, efficacy and patency of venous stenting in the management of incomplete result following CDT. After 12 months, post-thrombotic syndrome (PTS) was assessed clinically using Villalta scale and deep venous patency was assessed through duplex ultrasound. We studied 8 (5 female and 3 male) patients with 9 (3 left and 6 right) limb involvement and 13 stent (4 balloon expandable and 9 self expandable) placement. All patients improved clinically immediately following venous stenting. Technical success was achieved in all patients. One patient developed pulmonary embolism during course of hospital stay. One patient had stent thrombosis and PTS and another patient died due to carcinoma breast during follow-up. Deep venous stenting is an effective mode of treatment in proximal acute lower limb DVT with high late patency rate up to 1-year.

Cor triatriatum is an uncommon congenital anomaly and its coexistence with rheumatic mitral stenosis is rare. We report two patients with rheumatic mitral stenosis with associated cor triatriatum. Percutaneous mitral valvuloplasty was successfully performed in both cases. We describe the clinical presentation and discuss the technical issues related to balloon mitral valvotomy in these cases.

Complications related to hardware malfunction during balloon mitral valvuloplasty (BMV) are rarely met in catheterization laboratory. However, the consequences can be grave including death. We report an extremely rare complication of fracture of BMV coiled tip guidewire, which was successfully retrieved percutaneously with a relatively simple technique. Finally the procedure was completed without any complication.

Drug-eluting stents (DES) have demonstrated safety and efficacy in clinical outcomes, especially reduced rate of revascularization. However, it remains unknown whether clinical outcomes related to mortality improved after the introduction of DES. We sought to examine clinical outcomes including all-cause mortality, cardiovascular and non-cardiovascular death in pre-DES and DES eras. This was a single-center retrospective study including patients who underwent percutaneous coronary intervention (PCI) from August 1997 and June 2011. Study population was divided into two groups according to the time period of PCI (August 1997 to July 2004; pre-DES era, August 2004 to June 2011; DES era). The primary endpoint was all-cause mortality and secondary endpoints were cardiovascular and non-cardiovascular mortality. These endpoints were evaluated 3 years after PCI. A total of consecutive 3361 patients from our PCI cohort were analyzed. Patients in DES era were more likely to have traditional risk factors and angiographic disadvantages. The incidence of the primary endpoint was comparable between the two groups (p = 0.053). Cardiovascular and non-cardiovascular mortality were also similar between the groups (p = 0.1 and p = 0.2, respectively). Importantly, non-cardiovascular mortality accounted for over 60 % of all-cause mortality in both eras. DES era was not associated with 3-year all-cause mortality, whereas DES use was associated with a reduction in 3-year cardiovascular mortality (HR 0.16, 95 % CI 0.010–0.9, p = 0.035). All-cause mortality, cardiovascular and non-cardiovascular mortality at three years were comparable between pre-DES and DES era, despite the higher risk profiles of patients in DES era.