ADVERTISEMENT
March 2019 Table of Contents
Original Contributions
Coronary Artery Disease
The Spontaneous Coronary Slow-Flow Phenomenon: Reversal by Intracoronary Nicardipine
Hetal H. Mehta, MD; Mackenzie Morris, MD; David L. Fischman, MD; John J. Finley, IV, MD; Nicholas Ruggiero, MD; Paul Walinsky, MD; Melissa McCarey, MPH; Michael P. Savage, MD
An under-recognized cause of chest pain, the coronary slow-flow (CSF) phenomenon is characterized by delayed coronary opacification during diagnostic angiography in the absence of epicardial coronary artery disease. Given its angiographic resemblance to no-reflow, a condition responsive to calcium-channel blockers, we hypothesized that spontaneous CSF may similarly be reversed by intracoronary (IC) nicardipine; this theory was evaluated in 30 patients.
J INVASIVE CARDIOL 2019;31(3):42-45. Epub 2018 December 15.
Coronary Artery Disease
Shockwave Intravascular Lithotripsy for Calcified Coronary Lesions: First Real-World Experience
Bernard Wong, MBChB; Seif El-Jack, MBBS; Ruth Newcombe; Timothy Glenie, MBChB; Guy Armstrong, MBChB; Ali Khan, MBBS
Calcified coronary lesions often cause suboptimal stent expansion, which is one of the greatest predictors of adverse outcomes such as stent thrombosis and restenosis. Shockwave intravascular lithotripsy (S-IVL; Shockwave Medical, Inc) is a recently approved technique used in the treatment of heavily calcified coronary lesions. We present our early real-world experience with the S-IVL device in 26 patients.
J INVASIVE CARDIOL 2019;31(3):46-48. Epub 2019 February 15.
Coronary Artery Disease
The Embryologic Origin of Vieussens’ Ring
Lloyd W. Klein, MD and Enrique Padilla Campos, MD
In patients with a severe stenosis or total occlusion of the left anterior descending coronary artery or right coronary artery, the conus artery may be the origin of a rich collateral network at the base of the heart circling the great vessels. The course of this collateral pathway appears to partially form a large, ring-shaped structure around the pulmonary outflow tract, termed Vieussens’ ring. This review describes the embryologic basis of Vieussens’ ring as well as its importance clinically.
J INVASIVE CARDIOL 2019;31(3):49-51.
High-Risk PCI
Elective Mechanical Circulatory Support in the Percutaneous Treatment of Patients With Combined Complex Coronary Artery Disease and Severe Aortic Valve Stenosis
Carlo Briguori, MD, PhD; Amelia Focaccio, MD; Carmen D’Amore, MD; Lucio Selvetella, MD; Tommaso Lonobile, MD
One of the procedural concerns during percutaneous treatment of patients with concomitant coronary artery disease and aortic valve stenosis is the risk of hemodynamic instability. In the present study, we assessed the safety and effectiveness of elective hemodynamic support with the Impella 2.5 system in patients undergoing combined high-risk PCI and balloon aortic valvuloplasty, as a bridge to transcatheter aortic valve replacement.
J INVASIVE CARDIOL 2019;31(3):52-56.
Peripheral Vascular Disease
Interim Results of the PROMISE I Trial to Investigate the LimFlow System of Percutaneous Deep Vein Arterialization for the Treatment of Critical Limb Ischemia
J.A. Mustapha, MD; Fadi A. Saab, MD; Daniel Clair, MD; Peter Schneider, MD
Percutaneous deep vein arterialization (pDVA) using the LimFlow stent-graft system is a novel approach for treating patients with critical limb ischemia (CLI) who are ineligible for conventional endovascular or surgical revascularization. LimFlow may reduce amputation in this population for whom it would otherwise be considered inevitable. Our objective was to investigate the efficacy and safety of LimFlow use in these no-option CLI patients.
J INVASIVE CARDIOL 2019;31(3):57-63.
Transcatheter Aortic Valve Replacement
Feasibility and Safety of Adopting Next-Day Discharge as First-Line Option After Transfemoral Transcatheter Aortic Valve Replacement
Yasuhiro Ichibori, MD, PhD; Jun Li, MD; Angela Davis, RN; Toral M. Patel, MD; Jerry Lipinski, BS; Muhammad Panhwar, MD; Petar Saric, MD; Ghazanfar Qureshi, MD; Sandeep M. Patel, MD; Basar Sareyyupoglu, MD; Alan H. Markowitz, MD; Hiram G. Bezerra, MD, PhD; Marco A. Costa, MD, PhD; David A. Zidar, MD, PhD; Ankur Kalra, MD; Guilherme F. Attizzani, MD
Data on next-day discharge (NDD) after transcatheter aortic valve replacement are limited. This study investigated the feasibility and safety of NDD as a first-line option (the very-early discharge strategy) compared with an early-discharge strategy (2-3 days as a first-line option) after transcatheter aortic valve replacement in 611 consecutive patients.
J INVASIVE CARDIOL 2019;31(3):64-72.
Transcatheter Aortic Valve Replacement
Outcomes Among Patients With Heart Failure With Reduced Ejection Fraction Undergoing Transcatheter Aortic Valve Replacement: Minimally Invasive Strategy Versus Conventional Strategy
Muhammad S. Panhwar, MD; Jun Li, MD; David A. Zidar, MD, PhD; Joshua Clevenger, MD; Jerry Lipinski, BS; Toral R. Patel, MD; Adham Karim, MD; Petar Saric, MD; Sandeep M. Patel, MD; Ankur Kalra, MD; Guilherme Attizzani, MD
Patients with aortic stenosis and concomitant low ejection fraction (EF) may be at risk for adverse hemodynamic effects from general anesthesia utilized in transcatheter aortic valve replacement (TAVR) via the conventional strategy. These patients may be better suited for the minimally invasive strategy, which employs conscious sedation. Our goal was to investigate the effect of TAVR technique on in-hospital and 30-day outcomes in patients with aortic stenosis and reduced EF. In this retrospective study, we identified all patients with low EF (<50%) undergoing transfemoral minimally invasive TAVR vs conventional strategy TAVR between March 2011 and May 2018.
J INVASIVE CARDIOL 2019;31(3):73-78. Epub 2018 December 15.
Clinical Images
Septal Hematoma: A Rare But Potential Serious Complication of Retrograde CTO-PCI
Matthew W.P. Jackson, MB ChB, MRCP; David Lee, MB ChB, MRCP; Mohaned Egred, BSc (Hons), MBChB, MD
The uptake of CTO-PCI and the use of the hybrid approach have increased widely; this has resulted in a new set of complications, some of which are unusual, particularly with the retrograde approach. We present a case of a rare complication of septal collateral perforation resulting in the formation of septal hematoma that fortunately on this occasion did not result in any significant clinical deterioration, and was managed conservatively with a successful outcome. However, on other occasions, the outcome can be more serious.
J INVASIVE CARDIOL 2019;31(3):E47-E48.
Clinical Images
Large Epicardial Hematoma After Percutaneous Coronary Intervention: Multimodality Imaging
Dhaval Desai, MD; Abdur Ahmad, MD; Eric S. Weiss, MD, MPH; Setu Trivedi, DO; Suhail Q. Allaqaband, MD; A. Jamil Tajik, MD; M. Fuad Jan, MBBS, MD
Epicardial hematoma can manifest immediately or within a few minutes to hours after coronary intervention. Review of angiogram after the diagnosis of hematoma, in our case, showed deep distal positioning of a non-polymer jacketed wire, which is the most likely cause of the adverse outcome. Multimodality imaging is critical for diagnosis and management of such cases.
J INVASIVE CARDIOL 2019;31(3):E49-E50.
Clinical Images
Transient Lingual Ischemia Complicating Coronary Angiography
Emmanouil Skalidis, MD, PhD; Evangelos Zacharis, MD, PhD; Michalis Hamilos, MD, PhD; Ioannis Skalidis, MD; Ioannis Anastasiou, MD; Fragiskos Parthenakis, MD, PhD
Arterial embolism is a potential complication of coronary angiography and could theoretically affect the lingual circulation. However, the transient nature of clinical signs and symptoms suggests vasospasm as the most likely underlying mechanism of lingual ischemia in our case.
J INVASIVE CARDIOL 2019;31(3):E51.
Clinical Images
Modified Sleeve Technique for Calcified Coronary Bifurcations
Zaheed Tai, DO
Historically, in calcified coronary lesions, rotational atherectomy can result in side-branch occlusion in up to 10% of the cases. This can potentially result in significant ischemia depending on the territory involved. Our modification of the GuideLiner technique avoids the added risk of guide-catheter dissection from two guides in the left main and can also be used in non-left main bifurcations.
J INVASIVE CARDIOL 2019;31(3):E52-E53.
Clinical Images
Importance of Right Marginal Branch Protection During Primary Angioplasty in Inferior ST-Elevation Myocardial Infarction With Right Ventricular Involvement
Michał Świerczewski; Rajmund Bobrowski; Zuzanna Sala; Łukasz Kalińczuk, MD; Marcin Demkow, MD, PhD
We document the high effectiveness of an extra guidewire insertion aimed at mechanical lumen protection of the right marginal branch from displaced thrombus, which frequently occurs during proximal right coronary artery stenting.
J INVASIVE CARDIOL 2019;31(3):E54.
Clinical Images
Successful Percutaneous Coronary Intervention With Two-Stent Technique for Unprotected True Left Main Bifurcation Lesion Via Left Snuffbox Approach
Yongcheol Kim, MD; Myung Ho Jeong, MD, PhD; Min Chul Kim, MD, PhD; Doo Sun Sim, MD, PhD; Young Joon Hong, MD, PhD; Ju Han Kim, MD, PhD; Youngkeun Ahn, MD, PhD
There are few data regarding complex PCIs, such as interventions for unprotected left main coronary artery and two-stent technique for the bifurcation lesion via snuffbox approach. This case illustrates the potential feasibility of complex PCI and benefits of hemostasis via snuffbox approach.
