DES Strut Thickness and Clinical Outcomes After CTO Recanalization: Insights From LATAM CTO Registry.

BACKGROUND: Ultra-thin strut drug-eluting stent (UTS-DES) may improve outcomes after percutaneous coronary intervention (PCI) but have received limited study in chronic total occlusion (CTO) PCI. AIMS: To compare of 1-year incidence of major adverse cardiac events (MACE) between patients who underwent CTO PCI with ultrathin (≤ 75 µm) versus thin (>75 µm) strut DES in the LATAM CTO registry. METHODS: Patients were considered for inclusion only if successful CTO PCI was performed and when only one type of stent strut thickness (ultrathin or thin) was used. A propensity score matching (PSM) was computed to produce similar groups in relation to clinical and procedural characteristics. RESULTS: Between January 2015 and January 2020, 2092 patients underwent CTO PCI, of whom 1466 were included in the present analysis (475 in the ultra-thin and 991 in the thin strut DES). In unadjusted analysis the UTS-DES group had lower rate of MACE (HR: 0.63 95 % CI 0.42 to 0.94, p = 0.04) and repeat revascularizations (HR: 0.50 95 % CI 0.31 to 0.81, p = 0.02) at 1-year follow-up. After adjustment for confounding factors in a Cox regression model there was no difference in 1-year incidence of MACE between groups (HR: 1.15 95 % CI 0.41 to 2.97, p = 0.85). On PSM of 686 patients (343 in each group) the 1-year incidence of MACE (HR 0.68 95 % CI 0.37-1.23; P = 0.22) and individual components of MACE did not differ between groups. CONCLUSIONS: One-year clinical outcomes after CTO PCI were similar with ultrathin and thin strut DES.

Pseudoaneurysm After Distal Transradial Coronary Intervention Successfully Managed by Prolonged Pneumatic Compression: Simple Solution for a Rare and Challenging Problem.

A 75-year-old woman with hypertension, hypothyroidism, and diabetes was referred to the catheterization laboratory due to non-ST segment elevation myocardial infarction. Urgent coronary angiography was uneventfully performed via right distal transradial access, despite lusoria subclavian artery. Left anterior descending artery was successfully treated by percutaneous coronary intervention with stenting. A TR band was left in situ for 60 minutes and completely removed after 2 hours, without bleeding. Proximal and distal radial pulses were palpable after hemostasis and at hospital discharge, 24 hours later, uneventfully. Six days after, she noticed subtle and rapidly progressive wrist, hand and fingers swelling, with pain, ecchymosis, and movement limitation.

Distal transradial access for post-CABG coronary and surgical grafts angiography and interventions.

BACKGROUND: Post-CABG coronary and grafts angiography (CGAG) and interventions (PCI) have historically been performed via classic transfemoral approach. Particularly for those with left internal mammary artery (LIMA) grafts, left standard transradial access (lsTRA) represents a feasible alternative, with significant fewer vascular complications, but it has ergonomic disadvantage for the operator because of the need to bend over the patients, especially in obese ones. Distal transradial access (dTRA) may provide important advantages, including shorter hemostasis and greater patient and operator comfort, mainly for left dTRA (ldTRA). We aim to describe the feasibility and safety of right and left dTRA for post-CABG CGAG and PCI. MATERIAL AND METHODS: From February 2019 to April 2021, 111 consecutive post-CABG patients submitted to CGAG and/or PCI via dTRA have been enrolled. RESULTS: Mean patient age was 67.6 years old. Most were male (88.3%) and had chronic coronary syndromes (61.3%). Overall, 35.1% had acute coronary syndromes. Distal RA was successfully punctured in all 111 patients, always without ultrasound guidance. All procedures involving LIMA grafts were done via ipsilateral ldTRA. We had only 5 (4.5%) access site crossovers. Successful dTRA sheath insertion was then achieved in 95.5% of all patients, mostly (74.8%) via ldTRA and with standard 6Fr sheath (99.1%). Distal and proximal RA pulses were palpable in all patients at hospital discharge. No major adverse cardiac and cerebrovascular events and no major complications related to dTRA were recorded. CONCLUSIONS: dTRA for routine post-CABG CGAG and PCI by experienced transradial operators appears to be feasible. Further randomized and larger trials are needed to assure clinical benefits and safety of this new technique.

Bilateral Distal Transradial Access for Ostial Left Anterior Descending Chronic Total Occlusion Recanalization.

The adoption of distal transradial access (dTRA) as default approach for coronary angiography and interventions was recently published. As a refinement of conventional (proximal) TRA, this technique has many advantages in terms of patient and operator comfort, access-site bleeding, faster hemostasis, and risk of radial artery occlusion. Bilateral dTRA for complex chronic total occlusion percutaneous coronary intervention by experienced operators is feasible and safe.

Complex Coronary Intervention Via Right Distal Transradial Access With Lusoria Subclavian Artery Under Refractory Electrical Storm: A Really Challenging Case.

The adoption of distal transradial access (TRA) as default approach for coronary angiography and interventions was recently published. As a refinement of conventional (proximal) TRA, this technique has advantages in terms of patient and operator comfort and risk of radial artery occlusion. We report herein a very challenging case of coronary angiography followed by complex percutaneous coronary intervention via right distal TRA, with aberrant (lusoria) subclavian artery, in the setting of non-ST segment elevation acute myocardial infarction complicated by refractory electrical storm.

Huge Cavity Spilling Coronary Perforation Management: When the Basic Works Well.

Type III cavity-spilling coronary artery perforation is an unusual but dreaded complication which can be conservatively managed with simple prolonged balloon inflation without compromising the final PCI result by anticoagulation reversal.

Distal Transradial Access (dTRA) for Coronary Angiography and Interventions: A Quality Improvement Step Forward?

Distal TRA is a novel access site in the interventional cardiology field, with current data demonstrating high success and infrequent complication rates - global procedural metrics that are comparable with historical proximal TRA. Distal TRA may conversely provide important advantages over proximal TRA, including patient comfort, shorter hemostasis time, and lower radial artery occlusion rates.

Late Diagnosed Left Coronary to the Pulmonary Artery Large Fistulae: An Interesting and Incidental Cath Lab Finding.

Coronary artery anomalies are congenital changes in their origin, course, and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or at autopsies. A coronary artery fistulae involve a communication between a coronary artery and a chamber of the heart or any segment of the systemic or pulmonary circulation. We present herein the case of a 67-year-old man with a recent history of exertional angina and dyspnea to usual daily activities whose coronary angiogram revealed an interesting and incidental coronary-pulmonary artery large fistulae.

Left Main Compression by a Giant Aneurysm of the Left Sinus of Valsalva: An Extremely Rare Reason for Myocardial Infarction and Cardiogenic Shock.

Aneurysms of the sinus of Valsalva are very rare and mostly located in the right coronary sinus. They might course with dyspnea, fatigue, and acute coronary syndromes. We present herein an extremely rare case report of a 61-year-old woman diagnosed with external left main coronary compression by a giant aneurysm of the left sinus of Valsalva, which was successfully managed with percutaneous coronary intervention.