Mother-daughter technique for kinked catheter retrieval from radial artery.

Catheter kinking is not an uncommon scenario during cardiac catheterization via transradial access in patients with tortuous vascular anatomy. Several noninvasive and invasive methods have been described to unkink and retrieve the kinked catheter out of the vessel. We present a novel mother-daughter technique to retrieve a kinked radial artery catheter.

[Interventionism in congenital heart disease in Chiapas. The history after thousand cases performed]. / El intervencionismo en cardiopatías congénitas en Chiapas. La historia luego de mil casos realizados.

Background: Congenital heart disease is the most common birth defect and the leading cause of childhood mortality in high-income countries. In these countries, the prognosis for a child born with congenital heart disease is excellent, with over 90% achieving adulthood. However, in the low and lower-middle-income countries, as ours, the outlook is starkly different. In Chiapas, because of the progress of the hemodynamics program, more and more types of congenital heart diseases are susceptible to being treated by cardiac catheterization. Objective: To show the global experience of the interventionism in congenital heart diseases in Chiapas from its inception to recent days. Method: Through a retrospective study from April 2016 to June 2023, we reviewed the electronic files of the total of patients who underwent cardiac catheterism during the same period of time. Results: A total of 1000 procedures were performed, 581 in female patients, with a median age of 4 years (1 day to 77 years). Of the total procedures, 115 (11.5%) were diagnostic catheterizations and 885 (88.5%) were interventional. Conclusions: Cardiac catheterization in pediatrics in Chiapas has displaced cardiac surgery in a large percentage, and the results that have been obtained are undoubtedly encouraging, which already represents a decentralization in the care of congenital heart diseases in our country.

Antecedentes: Las cardiopatías congénitas son el defecto congénito más común y la primera causa de mortalidad infantil en los países de alto ingreso económico. En estos países, el pronóstico de los pacientes nacidos con estos defectos es excelente, llegando el 90% de ellos hasta la edad adulta. Sin embargo, en los países de mediano o bajo ingreso económico, como el nuestro, el pronóstico es completamente distinto. En el Estado de Chiapas, como resultado del avance del programa de hemodinamia, cada vez más tipos de cardiopatías congénitas son susceptibles de ser tratadas por cateterismo cardiaco. Objetivo: Mostrar la experiencia global actual de la hemodinamia en cardiopatías congénitas en Chiapas después de haber alcanzado los primeros 1000 casos realizados desde el inicio de nuestro programa. Método: A través de un estudio retrospectivo que abarcó de abril de 2016 a junio de 2023 revisamos los expedientes electrónicos del total de pacientes que fueron llevados a cateterismo cardiaco durante ese periodo. Resultados: Se realizaron un total de 1000 procedimientos, 581 en pacientes del sexo femenino, con una mediana de edad de 4 años (1 día a 77 años). Del total de los procedimientos, 115 (11.5%) fueron cateterismos diagnósticos y 885 (88.5%) intervencionistas. Conclusiones: El cateterismo cardiaco en cardiopatías congénitas en el Estado de Chiapas ha desplazado a la cirugía cardiaca en un amplio porcentaje, y los resultados obtenidos son sin duda alentadores, lo cual representa ya una descentralización en la atención de las cardiopatías congénitas en nuestro país.

Comparison of Catheterization Versus Echocardiographic-Based Gradients in Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valve Implantation.

OBJECTIVES: In patients with transcatheter aortic valve implantation (TAVI), accurate assessment of gradients is important to assess valve function and durability, which drives clinical decision-making. We sought to evaluate discrepancies in aortic valve mean gradients with balloon-expandable and self-expanding TAVI. METHODS: We retrospectively reviewed 507 patients that underwent TAVI and compared mean gradients by catheterization to transthoracic Doppler echocardiography. RESULTS: Mean gradients by Doppler in balloon-expandable (11.0 ± 5.8 mm Hg) and self-expanding devices (8.7 ± 4.5 mm Hg) were significantly higher than catheterization (3.2 ± 4.0 mm Hg vs 3.5 ± 4.1 mm Hg, respectively; P<.001). In a subgroup analysis of skirted valves, Doppler gradients in balloon-expandable (9.8 ± 4.4 mm Hg) and self-expanding devices (8.6 ± 5.1 mm Hg) were significantly higher than catheterization (3.5 ± 4.1 mm Hg vs 4.2 ± 4.8 mm Hg, respectively; P<.001). When the effect of valve size on gradients was analyzed, Doppler gradients were significantly higher than catheterization for all comparisons. When indexed for valve size, patients with large aortas who received a balloon-expandable TAVI had greater pressure differential than those who received a self-expanding TAVI (8.24 ± 0.46 mm Hg vs 5.16 ± 0.66 mm Hg; P<.001). This trend was not seen in patients with a small aorta-to-valve index. CONCLUSION: Following TAVI, aortic valve mean gradients acquired by Doppler were higher than catheterization and the discrepancy was more pronounced in balloon-expandable than self-expanding prostheses. These differences persist in skirted valves and across valve sizes. These observations may reflect periprocedural hemodynamic changes, differences between prosthetic flow acceleration, and/or pressure recovery.

Current outlook after 4 years since the beginning of interventional cardiology in congenital heart disease in Chiapas State / Panorama actual a 4 años del inicio de la cardiología intervencionista en cardiopatías congénitas en el Estado de Chiapas.

Introduction: As a result of technological advances, more and more types of congenital heart diseases are susceptible to being treated in the hemodynamic laboratory. The sum of more advanced imaging techniques as well as the development of a diversity of devices specially manufactured for use in children has allowed a better selection of patients and therefore that many of them can be corrected through cardiac catheterization or some patients with more complex congenital heart diseases require fewer surgical procedures or, if they do require them, that these may be of less complexity and risk. Objective: We decided to show the global experience of the interventionism in congenital heart diseases in Chiapas from its inception to recent days. Methods: Through a retrospective study from April 2016 to August 2020, we reviewed the electronic files of the total of patients who underwent cardiac catheterism during the same period of time. Results: A total of 510 procedures were performed, 300 in female patients, with a median age of 4 years (8 days - 77 years). Of the total procedures, 67 (13.1%) were diagnostic catheterizations and 443 (86.9%) were interventional. Conclusions: Cardiac catheterization in congenital heart disease in Chiapas has become a very valuable option with encouraging results which represents a possible decentralization in the care of congenital heart diseases in our country.

Introducción: Como resultado de avances tecnológicos, cada vez más tipos de cardiopatías congénitas son susceptibles a ser tratadas en el laboratorio de hemodinamia. La suma de técnicas de imagen más avanzadas, así como el desarrollo de una diversidad de dispositivos especialmente fabricados para su uso en niños ha permitido una mejor selección de pacientes y, por ende, que muchos de ellos pueden ser corregidos en su totalidad por medio de cateterismo cardiaco o bien que algunos pacientes con enfermedades cardiacas más complejas requieran menos procedimientos quirúrgicos o si los requieren, que estos sean de menor complejidad y riesgo. Objetivo: Decidimos mostrar la experiencia global de la hemodinamia en cardiopatías congénitas en Chiapas desde sus inicios hasta últimas fechas. Método: Mediante un estudio retrospectivo que abarcó de abril de 2016 a agosto de 2020 revisamos los expedientes electrónicos del total de pacientes que fueron llevados a cateterismo cardiaco durante ese periodo de tiempo. Resultados: Un total de 510 procedimientos fueron llevados a cabo, 300 en pacientes del sexo femenino, con una mediana de edad de 4 años (8 días - 77 años). Del total de procedimientos, 67 (13.1%) fueron cateterismos diagnósticos y 443 (86.9%) intervencionistas. Conclusión: El cateterismo cardiaco en cardiopatías congénitas en el Estado de Chiapas se ha convertido en una opción muy valiosa con resultados bastante alentadores, lo cual representa ya una posible descentralización en la atención de las cardiopatías congénitas en nuestro país.

Early radial artery occlusion following the use of a transradial 7-French sheath for complex coronary interventions in Chinese patients.

OBJECTIVES: We aimed to explore the impact of 7-Fr sheaths on the incidence of early radial artery occlusion (RAO) after transradial coronary intervention (TRI) in Chinese patients. BACKGROUND: RAO precludes future use of the vessel for vascular access. Transradial catheterization is usually performed via 5-Fr or 6-Fr catheters; 7-Fr sheath insertion enables complex coronary interventions but may increase the RAO risk. METHODS: We prospectively enrolled 130 consecutive patients undergoing complex TRI using 7-Fr sheaths. Radial artery ultrasound assessment was performed before and after TRI. Early RAO was defined as the absence of flow on ultrasound within 6-24 hr after TRI. Multivariate logistic regression was used to determine the factors related to early RAO after TRI. RESULTS: 7-Fr sheaths were mainly used for chronic total occlusion (44.6%), bifurcation (30.0%), and tortuous calcification (25.4%) lesions. All patients were successfully sheathed. Percutaneous coronary intervention (PCI) procedural success was 96.2%; 119 patients (91.5%) had preserved radial artery patency after TRI. All 11 RAO cases (8.5%) were asymptomatic. The radial artery diameter was significantly larger postoperatively (3.1 ± 0.4 mm) than preoperatively (2.6 ± 0.5 mm) (p < .001). No parameters significantly differed between patients with and without RAO. TRI history was the only independent risk factor of early RAO (odds ratio: 6.047, 95% confidence interval: 1.100-33.253, p = .039). CONCLUSIONS: 7-Fr sheath use after transradial access for complex PCI is feasible and safe. Evaluating the radial artery within 24 hr after TRI allows timely RAO recognition, important for taking measures to maintain radial artery patency and preserve access for future TRIs.

Comparison of pathologist review protocols for cytologic detection of prostatic and urothelial carcinomas in canines: A bi-institutional retrospective study of 298 cases.

Urothelial carcinoma, also known as transitional cell carcinoma, is the most common primary bladder tumour in dogs, and can also involve the prostate gland. Cytology is a common diagnostic tool utilized for dogs with bladder or prostate gland lesions. The objectives of this retrospective study were to compare the sensitivity and specificity of cytologic evaluation for urothelial or prostatic carcinoma between two institutions with different cytology review protocols as well as determine if certain collection methods resulted in higher cytologic accuracy. A total of 298 cases met inclusion criteria. The overall sensitivity and specificity for institution 1 were 91.8% and 50%, respectively, compared to 31.1% and 97.4%, respectively, for institution 2. When the urine sample review protocol at institution 2 was matched to that of institution 1, sensitivity and specificity were more similar to institution 1 (71.2% and 88.9%, respectively). Our results show that the sensitivity and specificity of cytology are affected by screening and review protocols implemented by different institutions. The data also demonstrate that sensitivity and specificity vary by collection method. Diagnostic catheterization had the highest performance: of the 11 cases between two institutions, it had 100% sensitivity and specificity. In contrast, examination of urine sediment not collected via diagnostic catheterization had low sensitivity and specificity that varied greatly by institution. In summary, cytologic interpretation should be undertaken with consideration given to both processing and collection protocols.

Iatrogenic catheter-induced ostial coronary artery dissections: Prevalence, management, and mortality from a cohort of 55,968 patients over 10 years.

OBJECTIVE: We sought to describe the prevalence, management strategies and evaluate the prognosis of patients with iatrogenic catheter-induced ostial coronary artery dissection (ICOCAD). BACKGROUND: ICOCAD is a rare but potentially devastating complication of cardiac catheterisation. The clinical manifestations of ICOCAD vary from asymptomatic angiographic findings to abrupt vessel closure leading to myocardial infarction and death. METHODS: 55,968 patients who underwent coronary angiography over a 10-year period were screened for ICOCAD as defined by the National Heart, Lung, and Blood Institute. The management and all-cause mortality were retrieved from local and national databases. RESULTS: The overall prevalence of ICOCAD was 0.09% (51/55,968 patients). Guide catheters accounted for 75% (n = 37) of cases. Half of the ICOCAD cases involved the right coronary artery while the remaining were related to left main stem (23/51; 45%) and left internal mammary artery (2/51; 4%). Two-thirds of ICOCAD were high grade (type D, E, and F). The majority of cases were type F dissections (n = 18; 66%), of which two third occurred in females in their 60s. The majority of ICOCAD patients (42/51; 82%) were treated with percutaneous coronary intervention while the remaining underwent coronary artery bypass grafting (3/51; 6%) or managed conservatively (6/51; 12%). Three deaths occurred during the index admission while 48/51 patients (94.1%) were safely discharged without further mortality over a median follow-up of 3.6 years. CONCLUSIONS: ICOCAD is a rare but life-threatening complication of coronary angiography. Timely recognition and prompt bailout PCI is a safe option for majority of patients with good clinical outcomes.

Renal insufficiency following contrast media administration trial III: Urine flow rate-guided versus left-ventricular end-diastolic pressure-guided hydration in high-risk patients for contrast-induced acute kidney injury. Rationale and design.

BACKGROUND: Urine flow rate (UFR)-guided and left-ventricular end-diastolic pressure (LVEDP)-guided hydration regimens have been proposed to prevent contrast-induced acute kidney injury (CIAKI). The REnal Insufficiency Following Contrast MEDIA Administration triaL III (REMEDIAL III) is a randomized, multicenter, investigator-sponsored trial aiming to compare these two hydration strategies. METHODS: Patients at high risk for CIAKI (that is, those with estimated glomerular filtration rate ≤ 45 mL/min/1.73 m2 and/or with Mehran's score ≥11 and/or Gurm's score >7) will be enrolled. Patients will be randomly assigned to (a) LVEDP-guided hydration with normal saline (LVEDP-guided group) and (b) UFR-guided hydration carried out by the RenalGuard system (RenalGuard group). Seven-hundred patients (350 in each arm) will be enrolled. In the LVEDP-guided group the fluid infusion rate will be adjusted according to the LVEDP as follows: 5 mL kg-1 hr-1 for LVEDP ≤12 mmHg, 3 mL kg-1 hr-1 for LVEDP 13-18 mmHg, and 1.5 mL kg-1 hr-1 for LVEDP >18 mmHg. In the RenalGuard group hydration with normal saline plus low-dose of furosemide is controlled by the RenalGuard system, in order to reach and maintain a high (>300 mL/hr) UFR. In all cases, iobitridol (a low-osmolar, nonionic contrast agent) will be administered. RESULTS: The primary endpoint is the composite of CIAKI (i.e., serum creatinine increase ≥25% and/or ≥0.5 mg/dL from the baseline to 48 hr after contrast media exposure) and/or acute pulmonary edema. CONCLUSION: The REMEDIAL III will test the hypothesis that the UFR-guided hydration is superior to the LVEDP-guided hydration to prevent the composite of CIAKI and/or acute pulmonary edema.

Pulmonary Hypertension Subtypes and Mortality in CKD.

RATIONALE & OBJECTIVE: Pulmonary hypertension (PH) contributes to cardiovascular disease and mortality in patients with chronic kidney disease (CKD), but the pathophysiology is mostly unknown. This study sought to estimate the prevalence and consequences of PH subtypes in the setting of CKD. STUDY DESIGN: Observational retrospective cohort study. SETTING & PARTICIPANTS: We examined 12,618 patients with a right heart catheterization in the Duke Databank for Cardiovascular Disease from January 1, 2000, to December 31, 2014. EXPOSURES: Baseline kidney function stratified by CKD glomerular filtration rate category and PH subtype. OUTCOMES: All-cause mortality. ANALYTICAL APPROACH: Multivariable Cox proportional hazards analysis. RESULTS: In this cohort, 73.4% of patients with CKD had PH, compared with 56.9% of patients without CKD. Isolated postcapillary PH (39.0%) and combined pre- and postcapillary PH (38.3%) were the most common PH subtypes in CKD. Conversely, precapillary PH was the most common subtype in the non-CKD cohort (35.9%). The relationships between mean pulmonary artery pressure, pulmonary capillary wedge pressure, and right atrial pressure with mortality were similar in both the CKD and non-CKD cohorts. Compared with those without PH, precapillary PH conferred the highest mortality risk among patients without CKD (HR, 2.27; 95% CI, 2.00-2.57). By contrast, in those with CKD, combined pre- and postcapillary PH was associated with the highest risk for mortality in CKD in adjusted analyses (compared with no PH, HRs of 1.89 [95% CI, 1.57-2.28], 1.87 [95% CI, 1.52-2.31], 2.13 [95% CI, 1.52-2.97], and 1.63 [95% CI, 1.12-2.36] for glomerular filtration rate categories G3a, G3b, G4, and G5/G5D). LIMITATIONS: The cohort referred for right heart catheterization may not be generalizable to the general population. Serum creatinine data in the 6 months preceding catheterization may not reflect true baseline CKD. Observational design precludes assumptions of causality. CONCLUSIONS: In patients with CKD referred for right heart catheterization, PH is common and associated with poor survival. Combined pre- and postcapillary PH was common and portended the worst survival for patients with CKD.

Feasibility of single catheter intervention for multivessel coronary artery disease using transradial approach.

Objective: The objective of the study was to describe the feasibility of single catheter intervention using the transradial approach for percutaneous coronary intervention (PCI). Background: The transradial approach for PCIs has fewer vascular events and complications and lower mortality rate. However, complications can result from forearm artery tortuosity, a longer learning curve and artery spasm that can complicate, delay and impede coronary artery interventions. The latter is usually exacerbated by the changing and manipulation of catheters. Methods: We performed a study using a single catheter on patients undergoing coronary assessment and treatment. Procedural outcomes including success, procedural time, bleeding, access site complications, and contrast used were all analyzed. Results: We included 327 patients, of whom 70% were male. The mean age was 63.3 ± 11.1 years, mean height was 165.9 ± 7.7 cm, mean weight was 73.3 ± 11.3 kg, and mean body index was 26.5 ± 3.5 kg/m2. Contrast use averaged 158.5 ± 60.5 ml. Three vessels were treated in 3% of all cases, two vessels in 32%, and one vessel in 65%. Procedural success was achieved in 94.5% of the cases. A second catheter was required in 9 cases (2.7%), and crossover to the femoral approach was performed in 9 cases (2.7%) due to a lack of support, artery spasm, difficult anatomy, or the need for a larger catheter. Three complications were related to access, including a Class 2 hematoma that was treated conservatively with no further complications. Conclusions: Our study showed that using a single catheter to perform both diagnostic and therapeutic procedures has a higher success rate, lower spasm incidence, and fewer complications than reported in literature.

Objetivo: Describir la factibilidad del uso de un solo catéter en el intervencionismo coronario percutáneo por vía transradial. Antecedentes: El abordaje transradial en las intervenciones coronarias ha mostrado menores eventos cardiovasculares y complicaciones, y menor mortalidad. Sin embargo, algunos eventos adversos pueden resultar por trotuosidad de las arterias del brazo, curva de aprendizaje más larga o espasmo arterial que puede complicar, retardar o impedir la intervención coronaria. Ésta última es usualmente exacerbada por el intercambio de catéterres o la manipulación de los mismos. Métodos: Realizamos un studio utilizando un solo catéter en pacientes sometidos a coronariografía e intervención coronaria. Los desenlaces del procedimiento incluyendo éxito, tiempo de procedimiento, sangrado, complicaciones en el sitio de acceso y uso de medio de contraste fueron analizados. Resultados: Incluimos 327 pacientes, 70% de los cuales fueron varones. La edad promedio fue de 63.3 ± 11.1 años, la estatura promedio fue de 165.9 ± 7.7 cm, peso promedio de 73.3 ± 11.3 kg y el índice de masa corporal promedio de 26.5 ± 3.5 kg/m2. El contraste utilizado promedio fue 158.5 ± 60.5 ml. El total de vasos tratados fue de tres en 3% de los casos, dos en 32% de los casos y uno en 65%. El éxito del procedimiento fue logrado en 94.5% de los pacientes No obstante, un Segundo catéter fue requerido en 9 intervenciones (2.7%), y cambio en la vía de acceso fue realizado en 9 casos (2.7%) por falta de apoyo, espasmo arterial, anatomía dificil o necesidad de un catéter de mayor lumen. Tres complicaciones asociadas al sitio de acceso incluyendo un hematoma clase 2 fueron registradas el cual se trató conservadoramente. Conclusiones: Nuestro estudio mostró que el uso de un catéter único para realizar tanto procedimientos diagnósticos como terapéuticos tiene una tasa de éxito mayor, con menor incidencia de espasmo y complicaciones reportadas en la literatura.

Feasibility of single catheter intervention for multivessel coronary artery disease using transradial approach.

Objective: The objective of the study was to describe the feasibility of single catheter intervention using the transradial approach for percutaneous coronary intervention (PCI). Background: The transradial approach for PCIs has fewer vascular events and complications and lower mortality rate. However, complications can result from forearm artery tortuosity, a longer learning curve and artery spasm that can complicate, delay and impede coronary artery interventions. The latter is usually exacerbated by the changing and manipulation of catheters. Methods: We performed a study using a single catheter on patients undergoing coronary assessment and treatment. Procedural outcomes including success, procedural time, bleeding, access site complications, and contrast used were all analyzed. Results: We included 327 patients, of whom 70% were male. The mean age was 63.3 ± 11.1 years, mean height was 165.9 ± 7.7 cm, mean weight was 73.3 ± 11.3 kg, and mean body index was 26.5 ± 3.5 kg/m2. Contrast use averaged 158.5 ± 60.5 ml. Three vessels were treated in 3% of all cases, two vessels in 32%, and one vessel in 65%. Procedural success was achieved in 94.5% of the cases. A second catheter was required in 9 cases (2.7%), and crossover to the femoral approach was performed in 9 cases (2.7%) due to a lack of support, artery spasm, difficult anatomy, or the need for a larger catheter. Three complications were related to access, including a Class 2 hematoma that was treated conservatively with no further complications. Conclusions: Our study showed that using a single catheter to perform both diagnostic and therapeutic procedures has a higher success rate, lower spasm incidence, and fewer complications than reported in literature.

Objetivo: Describir la factibilidad del uso de un solo catéter en el intervencionismo coronario percutáneo por vía transradial. Antecedentes: El abordaje transradial en las intervenciones coronarias ha mostrado menores eventos cardiovasculares y complicaciones, y menor mortalidad. Sin embargo, algunos eventos adversos pueden resultar por trotuosidad de las arterias del brazo, curva de aprendizaje más larga o espasmo arterial que puede complicar, retardar o impedir la intervención coronaria. Ésta última es usualmente exacerbada por el intercambio de catéterres o la manipulación de los mismos. Métodos: Realizamos un studio utilizando un solo catéter en pacientes sometidos a coronariografía e intervención coronaria. Los desenlaces del procedimiento incluyendo éxito, tiempo de procedimiento, sangrado, complicaciones en el sitio de acceso y uso de medio de contraste fueron analizados. Resultados: Incluimos 327 pacientes, 70% de los cuales fueron varones. La edad promedio fue de 63.3 ± 11.1 años, la estatura promedio fue de 165.9 ± 7.7 cm, peso promedio de 73.3 ± 11.3 kg y el índice de masa corporal promedio de 26.5 ± 3.5 kg/m2. El contraste utilizado promedio fue 158.5 ± 60.5 ml. El total de vasos tratados fue de tres en 3% de los casos, dos en 32% de los casos y uno en 65%. El éxito del procedimiento fue logrado en 94.5% de los pacientes No obstante, un Segundo catéter fue requerido en 9 intervenciones (2.7%), y cambio en la vía de acceso fue realizado en 9 casos (2.7%) por falta de apoyo, espasmo arterial, anatomía dificil o necesidad de un catéter de mayor lumen. Tres complicaciones asociadas al sitio de acceso incluyendo un hematoma clase 2 fueron registradas el cual se trató conservadoramente. Conclusiones: Nuestro estudio mostró que el uso de un catéter único para realizar tanto procedimientos diagnósticos como terapéuticos tiene una tasa de éxito mayor, con menor incidencia de espasmo y complicaciones reportadas en la literatura.

Feasibility of single catheter intervention for multivessel coronary artery disease using transradial approach / Viabilidad de la intervención con un solo catéter para la enfermedad de la arteria coronaria con múltiples vasos mediante abordaje transradial

Abstract Objective: The objective of the study was to describe the feasibility of single catheter intervention using the transradial approach for percutaneous coronary intervention (PCI). Background: The transradial approach for PCIs has fewer vascular events and complications and lower mortality rate. However, complications can result from forearm artery tortuosity, a longer learning curve and artery spasm that can complicate, delay and impede coronary artery interventions. The latter is usually exacerbated by the changing and manipulation of catheters. Methods: We performed a study using a single catheter on patients undergoing coronary assessment and treatment. Procedural outcomes including success, procedural time, bleeding, access site complications, and contrast used were all analyzed. Results: We included 327 patients, of whom 70% were male. The mean age was 63.3 ± 11.1 years, mean height was 165.9 ± 7.7 cm, mean weight was 73.3 ± 11.3 kg, and mean body index was 26.5 ± 3.5 kg/m2. Contrast use averaged 158.5 ± 60.5 ml. Three vessels were treated in 3% of all cases, two vessels in 32%, and one vessel in 65%. Procedural success was achieved in 94.5% of the cases. A second catheter was required in 9 cases (2.7%), and crossover to the femoral approach was performed in 9 cases (2.7%) due to a lack of support, artery spasm, difficult anatomy, or the need for a larger catheter. Three complications were related to access, including a Class 2 hematoma that was treated conservatively with no further complications. Conclusions: Our study showed that using a single catheter to perform both diagnostic and therapeutic procedures has a higher success rate, lower spasm incidence, and fewer complications than reported in literature.

Resumen Objetivo: Describir la factibilidad del uso de un solo catéter en el intervencionismo coronario percutáneo por vía transradial. Antecedentes: El abordaje transradial en las intervenciones coronarias ha mostrado menores eventos cardiovasculares y complicaciones, y menor mortalidad. Sin embargo, algunos eventos adversos pueden resultar por trotuosidad de las arterias del brazo, curva de aprendizaje más larga o espasmo arterial que puede complicar, retardar o impedir la intervención coronaria. Ésta última es usualmente exacerbada por el intercambio de catéteres o la manipulación de los mismos. Métodos: Realizamos un studio utilizando un solo catéter en pacientes sometidos a coronariografía e intervención coronaria. Los desenlaces del procedimiento incluyendo éxito, tiempo de procedimiento, sangrado, complicaciones en el sitio de acceso y uso de medio de contraste fueron analizados. Resultados: Incluimos 327 pacientes, 70% de los cuales fueron varones. La edad promedio fue de 63.3 ± 11.1 años, la estatura promedio fue de 165.9 ± 7.7 cm, peso promedio de 73.3 ± 11.3 kg y el índice de masa corporal promedio de 26.5 ± 3.5 kg/m2. El contraste utilizado promedio fue 158.5 ± 60.5 ml. El total de vasos tratados fue de tres en 3% de los casos, dos en 32% de los casos y uno en 65%. El éxito del procedimiento fue logrado en 94.5% de los pacientes No obstante, un Segundo catéter fue requerido en 9 intervenciones (2.7%), y cambio en la vía de acceso fue realizado en 9 casos (2.7%) por falta de apoyo, espasmo arterial, anatomía dificil o necesidad de un catéter de mayor lumen. Tres complicaciones asociadas al sitio de acceso incluyendo un hematoma clase 2 fueron registradas el cual se trató conservadoramente. Conclusiones: Nuestro estudio mostró que el uso de un catéter único para realizar tanto procedimientos diagnósticos como terapéuticos tiene una tasa de éxito mayor, con menor incidencia de espasmo y complicaciones reportadas en la literatura.

Distal radial access for coronary angiography and percutaneous coronary intervention: A state-of-the-art review.

Since its introduction by Lucien Campeau three decades ago, percutaneous radial artery approach at the forearm has been shown to provide advantages over the femoral approach and has become the standard approach for coronary angiography and intervention. Though infrequent, vascular complications still remain, mainly radial artery occlusion. Therefore, a more distal radial approach at the snuffbox or at the dorsum of hand has been suggested, initially by anethesiologists for perioperative patient monitoring, and more recently by Babunashvili et al. for retrograde radial artery recanalization of radial artery occlusion and then for coronary angiography and intervention. This distal radial approach has been advocated to reduce the risk of radial artery occlusion at the forearm (which precludes reintervention through the same access site) and bleeding and vascular access site complications, as well as to improve operator and patient comfort, especially when using left radial approach. This review describes in detail the anatomy of the radial artery at the wrist and the hand, the history of distal radial access, the rationale underlying use of this technique, the results published by experienced operators, the technique, the limitations, and potential role of this approach. This journey from the very proximal to the very distal part of the radial artery was indeed initiated and conceptualized by Lucien Campeau himself.

Internal mammary artery injury during percutaneous coronary intervention: a case report.

BACKGROUND: Percutaneous coronary intervention (PCI) is widely used to treat coronary artery disease (CAD). However, complications of PCI are inevitable. Internal mammary artery (IMA) injury is an infrequent but potentially lethal complication of PCI. CASE PRESENTATION: A 78-year-old man was diagnosed with multivessel lesions by coronary angiography. The IMA was injured during PCI, then cured by early identification and active rescue. CONCLUSIONS: This is the first reported case, to our knowledge, of injury to the IMA during PCI. We we report this case to discuss how to treat this injury effectively and avoid this complication during clinical therapy.

Iatrogenic right coronary artery dissection caused by diagnostic transradial cardiac catheterization.

We are presenting rare, but life-threatening complication of diagnostic coronary catheterization. To overcome the problem requires operator's experience and appropriate actions. We want to share our experience to interventionalists to be aware and ready to recognize and overcome such complication.

Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory: Results from a survey of Society of Cardiovascular Angiography and Intervention (SCAI) cardiologists.

OBJECTIVES: The goal of the present study was to survey the Society of Cardiovascular Angiography and Intervention (SCAI) member cardiologists to evaluate contemporary practice patterns with regards to contrast use, acute kidney injury (AKI) risk assessment, and prevention in patients undergoing invasive angiography. We sought to compare the physician responses against guideline statements and evidence-based data from clinical studies. METHODS: A 20-question online survey based on a modified Likert scale was sent out via email to the Society of Cardiovascular Angiography and Intervention (SCAI) member cardiologists. The survey questions focused on prophylaxis methods, medication management, risk assessment, contrast agent use, and postprocedure care. A scoring system was developed which examined the individual responses to analyze the 10 questions with the greatest strength of evidence in the literature and guidelines. RESULTS: The survey was completed by 506 individuals. Selected responses of note included the use of standardized volume expansion protocols: 64.8%, use of iso-osmolar contrast (iodixanol) in the majority of patients at risk of AKI: 55%, and 27% of individuals reported diluting contrast with saline for patients at risk of AKI during coronary angiography. For questions with support from guideline documents, 56.9% of the responses were scored as concordant with evidence-based data. Individuals who reported that the risk of AKI was often or always important in planning angiography for "at risk patients" were more likely to closely monitor renal function (76.7% vs. 40.0%, P = 0.003), obtain nephrology consultation (45.2% vs. 13.3%, P = 0.016) and use iso-osmolar contrast agents (56.0% vs. 26.7%, P = 0.033). CONCLUSIONS: The majority of cardiologists participating in this survey, reported practice patterns consistent with guideline and evidence-based recommendations. However, over 40% of responses to questions were inconsistent with these recommendations, suggesting continued opportunities for education and quality improvement concerning AKI prevention. © 2016 Wiley Periodicals, Inc.

Acute kidney injury following peripheral angiography and endovascular therapy: A systematic review of the literature.

INTRODUCTION: Radiographic contrast administration is a major cause of acute kidney injury (AKI), worldwide. Currently, contrast induced acute kidney injury (CI-AKI) is the third leading cause of hospital acquired renal failure in the United States. Over 50% of these cases are the result of contrast exposure during cardiac catheterization. The predictive risk factors for and clinical impact of AKI following coronary procedures have been extensively studied and documented in the literature. Similar data, however, are lacking for AKI following angiography or endovascular interventions for lower extremity peripheral artery disease (PAD). METHODS: The present review examined the published data available for AKI in patients undergoing peripheral procedures using MEDLINE searches. Specific data on number of peripheral cases, subject characteristics, hydration strategies, and AKI incidence rates was recorded. RESULTS: The systematic review resulted in 50 potentially relevant studies and ultimately 15 studies were selected for detailed analysis that included AKI incidence data on patients undergoing peripheral angiography or interventions. The summated studies included 11,311 patients and 10,316 peripheral procedures. The median incidence of AKI in the studies was 10%. The retrieved publications demonstrated significant variations in patient risk factors, definitions of AKI, and specificity of description of endovascular therapies. CONCLUSIONS: The incidence, risk factors, and outcomes related to AKI in the context of peripheral angiography or endovascular therapy remain poorly described in the literature and warrant further study in a prospective, systematic fashion. © 2016 Wiley Periodicals, Inc.

Fate of fenestration in children treated with fontan operation.

OBJECTIVE: To review the operative history and clinical and catheterization data on patients treated with total cavopulmonary connection (TCPC) with baffle fenestration and to study whether it is possible to predict the fate of fenestration. BACKGROUND: A baffle fenestration may improve postoperative outcomes after Fontan operation but is later associated with cyanosis and thromboembolic risk. Fenestration may close spontaneously or it can be closed percutaneously in patients with favorable hemodynamics. METHODS: Patients were divided into three groups: those with spontaneous closure of fenestration (group S, n = 34) and those with patent fenestration and favorable (group F, n = 36) or unfavorable (group U, n = 20) response to fenestration test occlusion. Clinical records were reviewed for demographic and anatomical characteristics, previous surgeries, and catheterizations. RESULTS: Predominant ventricular morphology was right ventricle (RV)/left ventricle (LV)/undeterminate in 19/14/1 patients in group S, 14/22/0 in group F, and 14/6/0 in group U. No differences were detected between groups in pre-TCPC catheterization data. Type of baffle fenestration was window/tube in 20/14 in group S, 28/8 in group F, and 20/0 in group U. All tube fenestrations either closed spontaneously or could be closed percutaneously. Twenty-nine percent of patients with window-type fenestrations failed the test occlusion. CONCLUSIONS: Spontaneous closure and favorable result in test occlusion are more common in tube than in window fenestrations. Since most preoperative anatomic and hemodynamic factors were similar in all patient groups, we find it difficult to predict the fate of a window-type fenestration and the result of test occlusion. © 2015 Wiley Periodicals, Inc.

Valve-in-valve-in-valve: Treating endocarditis of a transcatheter heart valve.

Transcatheter heart valve endocarditis is a rare, but life threatening complication. We describe the case of a patient who was successfully treated by transcatheter aortic valve-in-valve-in-valve replacement with a favorable 1-year outcome, despite severe early complications.