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Chronic total occlusion (CTO) remains a technical challenge for the interventional cardiologists. The application of the retrograde approach has dramatically improved success rates of CTO PCI. However, retrograde wire externalization could be very difficult especially when the antegrade guiding catheter cannot sit into the coronary ostium stably. We report a novel technique to facilitate retrograde wire externalization in aorto-ostial chronic total occlusion intervention without using snare.

Objective With the evolution of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) technique and equipment, the success rate of CTO PCI has improved over the years. We examined the failed cases in this expert registry and looked at the mode of failure. Methods In 2016, consecutive CTO PCI performed by eight high volume CTO with an agreed CTO algorithm were examined in a registry. Results There was a total of 485 patients with 497 CTOs were treated with technical and procedural success rates of 93.8% and 89.9%, respectively. The mean J-CTO score was 2.9 ± 1.2. The main mode of failure in cases with only antegrade attempt was inability to wire to true lumen despite advanced antegrade wiring technique for example, parallel wiring or IVUS guided wiring (10 out of 11 cases). The mode of failure in retrograde attempt was: 30% was due to inability to wire the collateral channel; 30% was due to failed reverse controlled antegrade and retrograde subintimal tracking (CART); 30% was due to inability to cross CTO by retrograde microcatheter. Four cases were terminated prematurely due to procedure complications. Conclusion Similar to previous reported studies, primary failure mode of only antegrade attempt was inability to wire to true lumen. However, contrary to other registries where failure to cross the retrograde channel with wire was the predominant failure mode, the retrograde failure mode was equally divided between failure to cross the channel with wire, failure to do reverse CART, and failure to cross the CTO with the microcatheter.

The Micra transcatheter pacing system (Medtronic, Minneapolis, MN) is a safe and effective alternative to transvenous pacemaker in selected patients.1, 2, 3 The device was designed with full recapture capability. In 40% of cases, initial deployment of device may result in unsatisfactory electrical parameters, necessitating recapture.4 The tether in the delivery system serves as an important connection between the device and the delivery catheter, allowing multiple recaptures to be performed. This report describes an unexpected event of tether breakage during a difficult recapture attempt, leading to device embolization. Small body build of the patient and apical deployment of the device are postulated as possible contributory factors to this complication.

Our case illustrates the feasibility of high-risk PCI to salvage LMCA stenosis, possibly caused by coronary injury during direct coronary cardioplegia for a recent triple-valve operation.

To the best of our knowledge, this is the first report of optical coherence tomography evaluation of superficial femoral artery atherectomy in a patient from the Asia-Pacific region. We demonstrate the feasibility of this technique in Chinese populations.

A 61-year-old woman presented to a rural hospital with inferior ST-elevation myocardial infarction 13 months after uncomplicated elective percutaneous coronary intervention with implantation of a 3.5 × 28-mm Absorb bioresorbable vascular scaffold (BVS; Abbott Vascular, Abbott Park, Illinois) in

We present a patient with non-obstructive intraluminal clot protrusion treated with medical therapy. Follow-up OCT scan showed layered neointimal changes similar to images observed in stent failure.

Optimal GuideLiner positioning for OCT acquisition in tortuous vessels requires special attention to avoid iatrogenic dissection.

A reliable stenting strategy for treating isolated side branch (SB) ostium stenosis is not well established. The purpose of this study was to examine the 6-month angiographic outcome of a novel technique, called the shoulder technique, on this lesion subtype. Symptomatic patients with isolated SB ostium stenosis, defined as ≥75% diameter stenosis at SB ostium and

Patient Initials or Identifier Number CYD ### Relevant Clinical History and Physical Exam A 54-year-old man, a non-smoker or non-drinker, with good past health, presented severe retrosternal chest pain with a diagnosis of non-ST-elevation myocardial infarction. He is hemodynamically stable

Cardiac contractility modulation (CCM) is a new device-based therapy for advanced systolic heart failure with normal QRS duration and therefore not suitable for cardiac resynchronization therapy (CRT). Left ventricular (LV) reverse remodeling was reported in patients treated with CCM or CRT, however, the extent of response was not compared.This observational study consisted of three groups of patients with symptomatic heart failure and LV ejection fraction35% despite optimal medical therapy. Group 1 included those received CCM with a QRS duration120 ms (n=33), Group 2 included those received CRT with a QRS duration of 120-150 ms (n=43), and Group 3 included those received CRT with a QRS duration150 ms (n=56). LV end-systolic volume (LVESV) was measured at baseline and 3 months later.Age, gender, etiology of heart failure and baseline ejection fraction were comparable. A significant LV reverse remodeling was observed in each group. The degree of LVESV reduction was similar between Group 1 and Group 2 (-11.3 ± 1 1.8 vs. -13.6 ± 18.3%, p=0.833), however, it was greater in Group 3 (-25.0 ± 18.0%, both p0.01). By using the reduction ≥ 15%, the responder rate was not different between Group 1 (39%) and Group 2 (42%), but significantly higher in Group 3 (68%) (χ(2)=9.514, p=0.009).CCM exhibited a similar LV reverse remodeling response to CRT for patients with a mildly prolonged QRS, though the effect was less strong when compared to CRT for patients with a very wide QRS.

Background: Elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with acute coronary syndrome (ACS). However, the prognostic value of diabetic control (ie, hemoglobin A1c levels) in patients with ACS is still undefined. Hypothesis: Hemoglobin A1c level may predict short-term outcome in patients with ACS. Methods: We conducted a retrospective study with prospective follow-up in 317 diabetic patients with ACS. Patients were stratified into 2 groups based on HbA1c level, checked within 8 weeks of the index admission (optimal control group, HbA1c ≤7%; suboptimal control group, HbA1c >7%). All patients were followed up prospectively for major adverse cardiovascular events (MACE) and mortality for 6 months. Short-term clinical outcomes were also compared between the 2 study groups. Results: In our cohort, 27.4%, 46.4%, and 26.2% patients had unstable angina, non–ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, respectively. In-hospital mortality was similar in both HbA1c groups (3.37% vs 2.88%, P = 0.803). Six-month MACE was also similar (26.40% vs 26.47%, P = 0.919). All-cause mortality, cardiovascular mortality, symptom-driven revascularization, rehospitalization for angina, and hospitalization for heart failure were also similar in both groups. The hazard ratios for 6-month MACE and individual endpoints were also similar in both groups. Conclusions: This study suggests that HbA1c levels before admission are not associated with short-term cardiovascular outcome in diabetic patients subsequently admitted with ACS. © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.

A 48-year-old man underwent elective percutaneous coronary intervention of a mid–left anterior descending (LAD) artery bifurcation lesion. A dedicated bifurcation self-expanding biolimus-eluting stent (3.0 × 14 mm AXXESS, Biosensors International, Morges, Switzerland) was implanted in the mid

The Combo drug-eluting stent (OrbusNeich Medical, Inc, Fort Lauderdale, FL) has an abluminal sirolimus-eluting bioabsorbable polymer and a luminal CD34+ antibody designed to capture endothelial progenitor cells to promote early re-endothelialization. This is the first prospective study to evaluate

Myanmar often baffles political scientists throughout the world for the resilience of its military regime and its resistance to attempts at democratization. Although Eastern Europe provides a plethora of examples reaffirming the rosy picture that Western democracy will gradually prevail as the universal political system, Myanmar seems to offer an exception. Paradoxically, most of the factors conducive to the introduction of democratization — such as increasing costs for military maintenance, a long-term economic fiasco, widespread local mobilization, sweeping electoral defeats for the military-backed government, international boycotts and condemnation — exist in Myanmar. In August 2007, a new spate of uprisings, later to become known as the “Saffron Revolution” or the “Saffron Uprising,” was suppressed by the Myanmar junta, leaving the junta to continue in power to mishandle the disastrous cyclone of May 2008. Why does the transitologist assumption for democratization record consistent failure in this cou...

Long-term health-related-quality-of-life (HRQoL) benefits of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) are not well established. Consecutive patients undergoing PCI at our institution from September 2009 to January 2011 were evaluated. EuroQoL-5D (EQ-5D) health

Objectives This study sought to evaluate the safety and effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) for patients with large coronary vessels. Background Randomized trials have demonstrated that DES reduce the risk of target vessel revascularization (TVR) compared to BMS. This benefit is less pronounced as artery diameter increases. Whether DES are superior to BMS for larger coronary arteries in the setting of routine clinical practice is unknown. Methods We analyzed data from 869 patients undergoing de novo lesion PCI with reference vessel diameter greater than or equal to 3.5 mm in the NHLBI Dynamic Registry according to whether they were treated with DES or BMS. Patients were followed for 3 years for the occurrence of cardiovascular events. Results At 3-year follow-up, rates of TVR at 3 years were similar and low in both groups (4.4% vs. 3.7%, P = 0.62). After adjustment for differences in baseline characteristics, the adjusted hazard ratio for 3-year MI for DES was 1.85 (95% CI 0.93–3.7, P = 0.08), for TVR at 3 years 1.14 (95% CI 0.52–2.49, P = 0.75) and for mortality 0.89 (95%CI 0.49–1.62, P = 0.71). Conclusions In our study of the unrestricted use of DES for patients with lesions in larger diameter coronary arteries, first generation DES did not reduce 3-year risk of TVR. Our findings do not support the preferred use of DES over BMS for patients with lesions located in arteries >3.5 mm. It is unknown whether secondary generation DES can offer better outcome compared to BMS in large coronary vessels. Further study on this issue is warranted. © 2013 Wiley Periodicals, Inc.

A 73-year-old woman presented to our institution with an abnormal shadow on chest radiography. The patient was a nonsmoker and enjoyed good past health. There were no constitutional symptoms. She was completely asymptomatic during exercise and at rest. An ECG (Figure 1) showed normal sinus rhythm. A posteroanterior view of the chest radiograph (Figure 2) showed a well-circumscribed roundish mass at the left heart border. A lateral chest radiograph (Figure 3) suggested a more anterior-located abnormality. Figure 1. ECG showing normal sinus rhythm with normal cardiac axis. Figure 2. Posteroanterior view of chest radiograph showing a mass at the left heart border. Figure 3. Lateral chest radiograph showing an anteriorly located mass. An echocardiogram was performed to delineate the relationship of the mass and the adjacent cardiac structure. It showed a large vascular structure anterior to the main pulmonary artery and continuous …