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Background--Transradial approach (TRA), when compared with transfemoral, improves the safety of percutaneous coronary procedures. Arterial axis variants are known to hinder the performance of transradial approach percutaneous coronary procedures. Data on the occurrence of arterial axis variants in the right and left arm arterial axes of individual patients are lacking. Methods and Results--From a single-center prospective registry, we selected all patients in whom bilateral upper limb arterial anatomy was assessed based on the performance of left and right radial catheterization obtained during the same or during repeat coronary diagnostic or interventional procedure(s). The occurrence of upper right and left limb arterial axis variants was classified according to the previously described operative ABC classification. A total of 610 patients were identified. An ABC upper limb arterial axis variant was detected in 156 (25.6%) patients. Variants were right-sided only in 65 (11.0%), left-sided only in 40 (6.6%), and bilateral in 46 (7.5%) patients. Thus, arterial axis variants were significantly more common in the right side (P=0.02). Bilateral arterial variants were significantly associated with age, female sex, and valvulopathy. Both A (radial/brachial) and B (axillary/subclavian/innominate) variants exhibited concordance across the 2 sides (odds ratio, 7.2; 95% confidence interval, 4.1-12.7 and 8.0; 95% confidence interval, 2.1-30.9, respectively). Conclusions--The occurrence of an anatomic variant potentially hindering transradial approach coronary diagnostic or interventional procedures is bilateral in <8% of cases and is more common in the right arm. Such information may guide, during the clinical practice, the access selection in the case of repeat procedures or need for additional accesses. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the influence of the amount of myocardium subtended by a stenosis on fractional flow reserve (FFR), especially in relation to quantitative coronary angiography. The study assessed the severity of each lesion and evaluated the amount of jeopardized myocardium using three validates scores. Results revealed concomitant collateralized chronic total occlusion and the correlation of FFR values to minimal lumen diameter, diameter stenosis and the scores.

The article presents a study on the frequency-domain optical coherence tomography (FD-OCT) in assessing predictors of periprocedural myocardial infarction (MI). Fifty patients underwent FD-OCT before and after coronary stenting where only drug-eluting stents were implanted. It was concluded that type IVa MI can be predicted by the presence of thin-cap fibroatheroma at pre-PCI FD-OCT and of intrastent thrombus and intrastent dissection at post-PCI FD-OCT.

Supplemental Digital Content is available in the text. Background: The aim was to assess whether periprocedural myocardial injury (PPMI) predicts outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). PPMI is a strong predictor of outcomes following coronary intervention, but its impact in the context of TAVR remains unclear. We performed a systematic review and meta-analysis to ascertain the association between PPMI and short- or long-term outcomes. Methods and Results: Electronic searches identified studies reporting PPMI following TAVR. Primary end point was 30-day all-cause mortality, with secondary end points, including 1-year all-cause mortality, neurological events, post-TAVR pacemaker implantation, and aortic regurgitation. Analyses were performed using random effects modeling and reported as summary odds ratio (OR) with 95% CI. Nine studies comprising 3442 patients (mean age 81.0±6.6 years, 51.2% female) were included. PPMI occurred in 25.5% of patients following TAVR. The pooled all-cause mortality at 30-days and 1-year was 5.2% and 18.6%, respectively. The occurrence of PPMI following TAVR was associated with significantly increased risk of both 30-day (OR, 4.23; CI, 1.95–9.19; P <0.001) and 1-year all-cause mortality (OR, 1.77; CI, 1.05–2.99; P <0.001). Similarly, PPMI was associated with post-TAVR neurological events (OR, 2.72; CI, 1.69–4.37; P <0.001) and post-TAVR permanent pacing (OR, 1.43; CI, 1.02–2.00; P =0.04) but not with a statistically significant increase in aortic regurgitation post-TAVR (OR, 1.39; CI, 0.93–2.08; P =0.11). Conclusions: PPMI is common following TAVR and is strongly associated with 30-day and 1-year mortality. Detection of PPMI has potential to identify TAVR patients at highest risk of subsequent adverse events. [ABSTRACT FROM AUTHOR]