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Key Points Subintimal guidewire entry during antegrade wiring attempts can be approached with various techniques, such as: ( a ) withdraw and redirect the guidewire; ( b ) parallel wire technique; ( c ) re‐entry using the Stingra...
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Key Points Subintimal guidewire entry during antegrade wiring attempts can be approached with various techniques, such as: ( a ) withdraw and redirect the guidewire; ( b ) parallel wire technique; ( c ) re‐entry using the Stingray system or guidewires; or ( d ) using the retrograde approach Antegrade fenestration and re‐entry is a creative novel technique for antegrade re‐entry that uses balloon angioplasty at the distal cap to create fenestrations between the false lumen and the distal true lumen, followed by advancement of a soft‐polymer jacketed guidewire through the fenestrations to achieve distal true lumen re‐entry Antegrade fenestration and re‐entry is an intuitive, simple, and low‐cost technique, but balloon inflation may cause subintimal hematoma that could hinder re‐entry. Additional study is needed to refine how antegrade fenestration and re‐entry should optimally be performed and to better understand its strengths and shortcomings
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ObjectivesWe sought to analyze the percutaneous coronary intervention (PCI) outcomes of very elderly patients (V. Eld. group, age >80 years) and compare their outcomes to a less elderly cohort (Eld. group, age 75-80 years) traditi...
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ObjectivesWe sought to analyze the percutaneous coronary intervention (PCI) outcomes of very elderly patients (V. Eld. group, age >80 years) and compare their outcomes to a less elderly cohort (Eld. group, age 75-80 years) traditionally reported in the literature.
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BackgroundThe hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly increased procedural success rates, yet some cases still fail. We sought to evaluate the causes of failure i...
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BackgroundThe hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly increased procedural success rates, yet some cases still fail. We sought to evaluate the causes of failure in a contemporary CTO PCI registry.
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BackgroundAlthough the retrograde approach has improved the success rate and procedural efficiency of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), it can still be challenging and time-consuming. We intro...
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BackgroundAlthough the retrograde approach has improved the success rate and procedural efficiency of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), it can still be challenging and time-consuming. We introduce a novel technique that aims to facilitate the critical step of retrograde wire externalization during reverse controlled antegrade and retrograde tracking and dissection (CART), which we named DRAFT (Deflate, Retract and Advance into the Fenestration Technique).
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Это-вторая часть перевода Рекомендаций по коронарным вмешательствам. Настоящие рекомендации по чрескожным коронарным вмеша...
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Это-вторая часть перевода Рекомендаций по коронарным вмешательствам. Настоящие рекомендации по чрескожным коронарным вмешательствам являются обновлением, представленным в ноябре 2005 г. на Ежегодной научной сессии Американской ассоциации сердца. Предыдущие Рекомендации по чрескожным коронарным вмешательствам были подготовлены Американской коллегией кардиологов и Американской ассоциацией сердца в 2001 г. В подготовке настоящей версии, кроме перечисленных обществ, принимали участие эксперты Американского общества сердечно-сосудистой ангиографии и интервенций (5СА1). В настоящей части Рекомендаций рассматриваются факторы, связанные с успехом или осложнениями вмешательств. Кроме того, проводится сравнение чрескожных коронарных вмешательств с открытой операцией коронарного шунтирования и с медикаментозной терапией. Официальное разрешение на перевод Рекомендаций было получено авторами от Директора по лицензиям и партнерству Американской коллегии кардиологов ЕНгаЬегН ), УУНзоп.
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<p class="global-para-14"> <p>The relationship between epicardial adipose tissue volume (EATV) and plaque vulnerability in non-culprit coronary lesions is not clearly understood.</p><p>Fifty-four consecutive patients/158 lesions w...
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<p class="global-para-14"> <p>The relationship between epicardial adipose tissue volume (EATV) and plaque vulnerability in non-culprit coronary lesions is not clearly understood.</p><p>Fifty-four consecutive patients/158 lesions with suspected coronary artery disease underwent computed tomography (CT) and 40 MHz intravascular ultrasound imaging (iMap-IVUS) in cardiac catheterization. Cross-sectional CT slices were semiautomatically traced from base to apex of the heart. Using a 3D workstation, EATV was measured as the sum of fat areas (?190 to ?30 Hounsfield units [HU]). All coronary vessels were imaged using iMap-IVUS before stenting to analyze coronary plaques as fibrotic, lipidic, necrotic, or calcified tissue.</p><p>Mean EATV was 73.7 ± 24.6 (range: 30.2 to 131.8) mL. Patients were divided into two groups by mean EATV (group H: n = 27, EATV ≥ 73.7 mL; group L: n = 27, EATV < 73.7 mL). Total luminal volume, total vessel volume, and total plaque volume were significantly larger in group H. Fibrotic plaque and lipidic plaque volumes were also significantly larger in group H. There was a significant negative correlation between EATV and fibrous tissue ( r = -0.31, P = 0.02) and a significant positive correlation between EATV and necrotic tissue ( r = 0.37, P = 0.007). EATV was related to plaque with vulnerability in the right coronary artery (RCA) ( r = 0.57, P = 0.04) and the left anterior descending artery (LAD) ( r = 0.53, P = 0.02). In conclusion, increased EATV was associated with the total coronary plaque burden and composition, particularly in the RCA and LAD.</p> </p>
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Chronic Total Occlusion (CTO) intervention is a challenging area in interventional cardiology. Presently about 70% of CTO interventions are successful. Materials and methods: This was a single center prospective study of a cohort ...
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Chronic Total Occlusion (CTO) intervention is a challenging area in interventional cardiology. Presently about 70% of CTO interventions are successful. Materials and methods: This was a single center prospective study of a cohort of all patients undergoing percutaneous coronary intervention (PCI) as elective or adhoc procedure for CTO from August 2014 to June 2015. Only antegrade CTO interventions were included. In all patients the following data were recorded. Results: A total of 210 (8.9% of total PCI (2353) during the study period) CTO patients were followed up. The mean age was 56.54 ±8.9. In the study sixty nine patients (32.9%) presented with chronic stable angina and rest of the patients had history of acute coronary syndrome of which 22.9% (n = 48) had unstable angina (UA) or non ST elevation myocardial infarction (NSTEMI) and 44.2% (n = 93) had ST Elevation Myocardial Infarction (STEMI). In those with history of ACS, 64.78% (n = 92) had ACS during the previous year and remaining 35.22% (n = 49) had ACS prior to that. Single vessel CTO was seen in 89.5% (n = 188) and two vessel CTO in 10.5% (n = 22). LAD was involved in 36.7% (n = 77), RCA in 48.1% (n = 101), and LCX in 15.2% (n = 32). Procedural success in the first attempt was 68.1% (n = 143), which increased to 71.42% (n = 150) after the second attempt. CTO interventions were more frequently successful when the calcium was absent or minimal (p-0.05), CTO length was <10 mm (p < 0.01) and good distal reformation (p<0.01).
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hi rotational atherectomy (RA), several burr sizes are available, such as 1.25 mm, 1.5 mm, 1.75 mm, or >= 2.0 mm. It is important to select an appropriate bun size for each lesion because rotational atherectomy has several unique ...
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hi rotational atherectomy (RA), several burr sizes are available, such as 1.25 mm, 1.5 mm, 1.75 mm, or >= 2.0 mm. It is important to select an appropriate bun size for each lesion because rotational atherectomy has several unique complications regarding burrs such as entrapment or perforation. When a burr cannot penetrate the lesion, downsizing of the burr is generally recommended. Also, if the smallest burr (1.25 mm) cannot penetrate the lesion, a change to a more supportive or larger French guiding catheter has been recommended. We describe the case of a 68 year-old female who was referred to our department for percutaneous coronary intervention to the calcified stenosis in the middle of the left anterior descending coronary artery. We used the smallest burr (1.25 mm) and a supportive 7 Fr guiding catheter to penetrate the lesion. However, the smallest burr could not pass the lesion even after 14 sessions (total ablation time: 339 seconds). We intentionally increased the burr size from 1.25 mm to 1.5 mm. The 1.5 mm burr successfully passed the lesion without any perforation or burr entrapment. In this manuscript, we discuss why increasing the burr size was successful for this severely calcified lesion that was not penetrated by the smallest burr.
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