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Objectives: This study aims to assess balloon angioplasty (BAP) and stent implantation (SI) procedures early after congenital heart surgery (CHS) in children. Background: These interventions are considered potential high‐risk procedures and often avoided or postponed. Methods: This is a retrospective, single centre study of all BAP and SI procedures within 30 days after CHS (01/2001 until 01/2021). Results: A total of 127 (96 SI, 31 BAP) procedures were performed in 104 patients at median 6.5 days (interquartile range: 1–15) after CHS. Balloon‐to‐stenosis ratio and balloon‐to‐reference vessel ratio were significantly smaller compared to stent‐to‐stenosis ratio and stent‐to‐reference vessel ratio (p <.001 and p =.005). There was a greater rise in absolute vessel diameter, greater rise in vessel diameter in relation to the stenosis and vessel diameter in relation to the reference vessel with SI (p <.001, p =.01, and p <.001). Up to 94% SIs fulfilled both success criteria (increase of vessel diameter ≥50% of minimal vessel diameter or achievement ≥75% of the reference vessel diameter). Major adverse events were more frequent in the BAP group (p =.05). Intraprocedural complications were 5/31 (16%) in the BAP group and 13/96 (13%) in the SI group (p =.77). Conclusion: BAP and SI procedures within 30 days post‐CHS can be performed safely, with a greater stent‐to‐stenosis ratio and a greater rise in vessel diameter with stent implantation. [ABSTRACT FROM AUTHOR]

Abstract Guiding catheter damage and body wire intermingling are uncommon complications of standard operational procedures. Optimal application of this device includes replacing the small guiding catheter upon excessive resistance during stent insertion.

Coaxial trapping of guide extension catheters within a coronary artery allows for maximal support in delivering equipment; however, use of this technique within the left main coronary artery has been avoided due to concerns surrounding hemodynamic instability and vessel injury. We describe our initial experience with impromptu coaxial trapping of guide extension catheters within the left main coronary artery using the dual access rapid trap (DART) technique. Coaxial trapping of guide extension catheters within the left main coronary artery using DART enabled successful equipment delivery across balloon-uncrossable lesions. This case demonstrates that DART is a safe and effective method for equipment delivery across balloon-uncrossable lesions and may aid operators in safely solving complex cases., (© 2024 The Author(s).)

Background: The clinical impact of percutaneous coronary intervention (PCI) and implantation of overlapping stents (OS) using platforms with the same versus different pharmacological characteristics is unknown. Our objective was to compare the outcomes of PCI with OS according to their pharmacological characteristics.Methods: In this observational single-center registry, we included all PCI performed from April 2014 to December 2018 in which overlapping drug-eluting stents were implanted. Two groups were created according to whether the stents release the same drug [homogeneous: (HO)] or different [heterogeneous: (HE)]. The primary endpoint was the need for target lesion revascularization (TLR). Clinical assessment was performed after the procedure, bianually and at the end of follow-up (June 2019).Results: 381 lesions with OS (HO: 209; HE: 172) were included (75.1% male, 66.7 ± 11.6 years). Clinical presentation was stable coronary artery disease in 49.9%. Syntax score was 23.7 ± 13.3. The number of OS implanted was 2.2 ± 0.5 and the total stent length was 59.5 ± 20.1 mm (HE: 61.5 ± 21.6 vs. HO: 57.8 ± 18.8 mm; p < 0.01). After a median follow-up of 21 months, the HE group showed a lower TLR rate than the HO group (HE:2.3% vs HO:7.2%; p = 0.03). The rates of cardiac death (p = 0.44), myocardial infarction (p = 0.36) and stent thrombosis (p = 0.85) were similar between groups. In the multivariate analysis, the OS with homogeneous-drug devices was an independent predictor of a higher rate of TLR.Conclusions: PCI using OS with homogeneous pharmacological characteristics was associated with a higher rate of TLR in comparison with the implantation of OS with heterogeneous pharmacological characteristics. [ABSTRACT FROM AUTHOR]

This study compared the 3-year outcomes of intracoronary imaging–guided pre-dilation, stent sizing, and post-dilation (iPSP) for patients with complex coronary artery lesions. The long-term effects of the optimal drug-eluting stent implantation technique in complex coronary artery disease have not been evaluated. From the IRIS-DES (Interventional Cardiology Research In-cooperation Society-Drug-Eluting Stents) registry, the study evaluated 9,525 patients who underwent percutaneous coronary intervention for left main, bifurcation, long or diffuse (>30 mm), or angiographically severely calcified lesions. The primary outcome was a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization. The inverse probability of treatment weighting method was used to adjust for confounding factors. At the index procedure, intravascular ultrasound assessment PSP were performed in 8,522 (89.5%) patients, 5,141 (54.0%) patients, and 5,531 (58.1%) patients, respectively; overall, 3,374 (35.4%) patients underwent stent implantation using all 3 parts of the iPSP strategy and were defined as the iPSP group. At 3 years, the adjusted rate of the primary outcome was significantly lower in iPSP group (5.6% vs 7.9%; adjusted hazard ratio: 0.71; 95% confidence interval: 0.63 to 0.81; p < 0.001). Among patients undergoing drug-eluting stent implantation in complex coronary artery stenosis, iPSP was associated with a lower risk of cardiac events at 3 years. Therefore, physicians should apply iPSP more actively for the treatment of complex coronary artery stenoses, even in the current era. (Evaluation of the First, Second, and New Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133) [ABSTRACT FROM AUTHOR]

Balancing pulmonary and systemic circulations in single ventricle patients with a conduit after Stage 1 palliation is challenging. A transcatheter intervention for excessive pulmonary blood flow would provide benefit. We report a case of a critically ill single ventricle patient with symptoms of excessive pulmonary blood flow after Stage 1 despite maximal medical therapy. The patient underwent percutaneous intraluminal downsizing of the right ventricle to pulmonary artery conduit using a novel application of the Diabolo-covered stent technique, with subsequent clinical improvement. A second catheterization was performed during the interstage period with successful dilation of the stent to achieve appropriate saturations. The Diabolo technique can be successfully employed in this population to restrict pulmonary blood flow and has the advantage of being adjusted during placement and in subsequent interventions., (© 2024 Wiley Periodicals LLC.)

Background: Ureteral stenting is a technique-demanding procedure performed during robot-assisted laparoscopic ureteral reimplantation (RALUR). Many stenting techniques have been reported; however, none of them could be accepted as an ideal way. Objectives: The aim of the study was to report our initial results of a modified stenting technique for RALUR. Methods: Consecutive 4 patients undergoing RALUR were prospectively enrolled into our study. Our ureteral stenting technique included the following steps: catheterize a head-cut Foley catheter at the beginning of the operation, drag out the Foley catheter from the ureterovesical stoma after finishing posterior anatomosis, insert a guide wire through the catheter to the ureter lumen, and place the double-J (DJ) stent over the guide wire with a pusher. Results: All surgeries were successfully performed without severe complications. The mean stenting time was 1.6 min. No submucosa pseudocanal was found during stenting. DJ stent was removed 4 weeks after surgery. During the 3-month follow-up, it was observed that no vesicoureteral reflux or ureter stricture was found. Conclusions: Our ureteral stenting technique is an effective, simple, and safe procedure in RALUR, and could also be performed in laparoscopic ureteral reimplantation. [ABSTRACT FROM AUTHOR]

Guiding catheter damage and body wire intermingling are uncommon complications of standard operational procedures. Optimal application of this device includes replacing the small guiding catheter upon excessive resistance during stent insertion. [ABSTRACT FROM AUTHOR]

Background: The crush and the culotte stenting were both reported to be effective for complex bifurcation lesion treatment. However, their comparative performance remains elusive. Methods: A total of 300 patients with coronary bifurcation lesions were randomly assigned to crush (n = 150) and culotte (n = 150) treatment. The primary endpoint was the occurrence of major adverse cardiac events (MACEs) at 12 months including cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization. Index lesion restenosis at 12 months was a secondary endpoint. The surface integrals of time-averaged wall shear stress at bifurcation sites were also be quantified. Results: There were no significant differences in MACE rates between the two groups at 12-month follow-up: Crush 6.7%, culotte 5.3% (P = 0.48). The rates of index lesion restenosis were 12.7% versus 6.0% (P = 0.047) in the crush and the culotte groups, respectively. At 12-month follow-up, the surface integrals of time-averaged wall shear stress at bifurcation sites in the crush group were significantly lower than the culotte group ([5.01 ± 0.95] × 10−4 Newton and [6.08 ± 1.16] × 10−4 Newton, respectively; P = 0.003). Conclusions: Both the crush and the culotte bifurcation stenting techniques showed satisfying clinical and angiographic results at 12-month follow-up. Bifurcation lesions treated with the culotte technique tended to have lower restenosis rates and more favorable flow patterns.

Percutaneous coronary interventions involving coronary bifurcation lesions are more complex and associated with adverse outcomes (both angiographic and clinical) compared to non-bifurcation lesions. Tryton, a dedicated bifurcation stent, has been introduced with the aim to simplify treatment of bifurcation lesions. Tryton stent in combination with conventional drug eluting stent is safe and associated with reduced stenosis and bail-out stenting of side branch compared to provisional stenting involving a large side. However, little is known regarding safety and efficacy of Tryton stent in left main (LM) bifurcation lesion. We describe two cases of unprotected LM bifurcation stenting using Tryton stent in combination with drug eluting stent. [ABSTRACT FROM AUTHOR]

Stent implantation in coronary bifurcations presents unique challenges and currently there is no universally accepted stent deployment approach. Despite clinical and computational studies, the effect of each stent implantation method on the coronary artery hemodynamics is not well understood. In this study the hemodynamics of stented coronary bifurcations under pulsatile flow conditions were investigated experimentally. Three implantation methods, provisional side branch (PSB), culotte (CUL), and crush (CRU), were investigated using time-resolved particle image velocimetry to measure the velocity fields. Subsequently, hemodynamic parameters including wall shear stress, oscillatory shear index (OSI), and relative residence time (RRT) were calculated. The pressure field through the vessel was non-invasively quantified and pressure wave speeds were computed. The effects of each stented case were evaluated and compared against an un-stented case. CRU provided the lowest compliance mismatch, but demonstrated detrimental stent interactions. PSB, the clinically preferred method, and CUL maintained many normal flow conditions. However, PSB provided about a 300% increase in both OSI and RRT. CUL yielded a 10 and 85% increase in OSI and RRT, respectively. The results of this study support the concept that different bifurcation stenting techniques result in hemodynamic environments that deviate from that of un-stented bifurcations, to varying degrees. [ABSTRACT FROM AUTHOR]

There is currently no consensus regarding the optimum treatment strategy for an isolated side branch lesion. The usefulness of a side branch stenting technique with a balloon crushing the segment protruding into the main vessel has been reported; however, there remain concerns about malapposition of crushed stent struts and a consequent risk of stent thrombosis. We herein report a case with a diagonal branch lesion that was successfully treated with this technique. Follow-up optical coherence tomography clearly revealed that the protruding stent struts in the main vessel were crushed and covered almost completely. Our findings may support the feasibility of this treatment in the mid-term period. < Learning objective: There is currently no consensus regarding the optimum treatment strategy for an isolated side branch lesion. In the present case, we successfully treated an isolated diagonal branch lesion using a side branch stenting technique with a balloon crushing the segment protruding into the main vessel. Good neointimal coverage of a crushed stent segment protruding into the main vessel by follow-up optical coherence tomography may support the feasibility of this treatment in the mid-term period.> [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the mid-term angiographic result of T-stenting with small protrusion (TAP) as the bailout strategy for treating coronary bifurcation lesions. From 2009 to 2012, symptomatic patients who had severe coronary bifurcation stenoses were treated with one-stent strategy using drug-eluting stents, with kissing balloon inflation performed whenever side branch (SB) impingement occurred. TAP was performed if residual diameter stenosis of SB was ≥75 %, presence of ≥type B dissection or flow impairment was observed in the SB. Seventy-one patients (83 % male, mean age of 61 ± 12 years) were recruited into the study. MEDINA classification 1,1,1 lesions were observed in over 60 % of patients. The mean stent size and length in the main vessel (MV) and SB were 2.86 ± 0.43 and 30 ± 12, and 2.45 ± 0.26 and 16 ± 6 mm, respectively. Restudy angiography was performed on 64 (90 %) patients at 9.2 ± 3.9 months. Angiographic restenosis was observed in 8 (12.5 %) patients with late lumen loss in the MV and SB being 0.22 ± 0.19 and 0.34 ± 0.37 mm, respectively. The use of TAP as the bailout technique for treating coronary bifurcation lesions is associated with good angiographic outcomes, in terms of late lumen loss and restenosis, at 9 months. [ABSTRACT FROM AUTHOR]

Background The mother and child technique with a deep-seated 4F Kiwami catheter has been reported to be effective for delivering stents to complex lesions. Objectives To assess the feasibility and efficacy of a novel 4.5F child catheter for deep insertion and stent deployment into the distal coronary artery for the treatment of complex lesions. Method We retrospectively evaluated 51 consecutive patients, who underwent percutaneous coronary intervention between January 2011 and December 2013, using a 4.5F CoKatte catheter after stent delivery failure using the conventional procedures. We evaluated the procedure success, need for an additional anchor balloon technique, and complications related to the deep insertion. Results Stent delivery to the intended lesion was successful in all cases. For advancement and subsequent deep intubation of the catheter, 42 lesions required the additional anchor balloon technique. No complications, including proximal dissection, air embolism, and severe ischemia, were observed in relation to the deep insertion of the catheter. Conclusion Percutaneous coronary intervention with the novel 4.5F catheter is a safe and effective method, which can facilitate stent delivery to a complex coronary lesion. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to evaluate the impact of anatomic and procedural variables on the outcome of the unprotected left main coronary artery (uLMCA) itself after drug-eluting stent (DES) implantation. Background: There is a controversial debate regarding when and how to perform percutaneous coronary intervention (PCI) for an uLMCA stenosis. Methods: This analysis is based on a randomized study of 607 patients undergoing PCI for uLMCA, randomized 1:1 to receive paclitaxel- or sirolimus-eluting stents. We evaluated the impact of the SYNTAX score, uLMCA anatomy, and stenting technique on in-stent restenosis (ISR), target lesion revascularization (TLR), and the 3-year outcomes. Results: The 3-year cardiac mortality rate was 5.8%; 235 (39%) patients had a true bifurcation lesion (TBL), and the median SYNTAX score was 27. TBL was associated with a higher need for multiple stents (72% vs. 37%, p < 0.001). TBL was a significant predictor of ISR (23% vs. 14%, p = 0.008) and for TLR (18% vs. 9%, p < 0.001). The need for multiple stents was a predictor of ISR (22% vs. 13%, p = 0.005) and for TLR (16% vs. 9%, p = 0.005). Culotte stenting showed better results compared with T-stenting for ISR (21% vs. 56%, p = 0.02) and for TLR (15% vs. 56%, p < 0.001). We observed a significant association between uLMCA-TLR and SYNTAX scores (9.2% for scores ≤22, 14.9% for scores 23 to 32, and 13.0% for scores ≥33, p = 0.008). Conclusions: PCI of uLMCA lesions with DES is safe and effective out to 3 years. TBL and multiple stents were independent predictors for ISR. In the multivariate analysis, independent predictors for TLR were TBL, age, and EuroSCORE (European System for Cardiac Operative Risk Evaluation). (Drug-Eluting-Stents for Unprotected Left Main Stem Disease [ISAR-LEFT-MAIN]; NCT00133237) [Copyright &y& Elsevier]

Facilitated antegrade dissection re-entry (F-ADR) is a technique described for treating post coronary artery bypass surgery chronic total occlusions (CTO) when there is flush occlusion of the distal cap of the CTO at the vein graft anastomosis. In this scenario retrograde access is usually impossible and if antegrade wiring fails, F-ADR is then the best option. Following antegrade dissection past the anastomosis, a balloon is delivered via the vein graft and inflated in the native vessel distal to the anastomosis to facilitate re-entry using a Stingray catheter. However, the applicability and outcome of this technique have not been described in cases where the graft to native vessel anastomosis has previously been stented. We report a case series of successful CTO recanalization using F-ADR across stented graft-native vessel anastomoses., (© 2022 Wiley Periodicals LLC.)

Atherosclerotic renal artery stenosis (ARAS) is the most common cause of renal artery stenosis in the adult population. ARAS may result in progressive renal impairment, renovascular hypertension, and/or cardiac disturbance syndromes. Because medical therapy does not affect the progressive nature of this disease process, more aggressive treatments are needed to definitively treat ARAS. When performed correctly, renal artery stenting has been shown to stabilize or improve renal function and/or renovascular hypertension in 65-70% of carefully selected patients with ARAS. Therefore, percutaneous renal artery stenting should be considered the primary treatment for patients with symptomatic ARAS. [Copyright &y& Elsevier]

Background: Ostial left anterior descending (LAD) artery lesions are a critical area for coronary stenting, given that the location subtends a large area of the myocardium and can also be more technically challenging. It remains controversial whether crossover stenting of ostial LAD back into the left-main (LM) is advantageous over stenting the ostium alone., Methods: To evaluate the long-term clinical outcomes of stenting ostial LAD lesions, we retrospectively reviewed all ostial LAD lesions cases at QEII Health Science Centre between 2008 and 2018. Specifically, we compared the outcomes in those patients that had left main stent crossover vs. ostial stenting (OS) alone., Results: The total number of patients included in the study was 175, with 25 patients (14%) having a crossover to the LM and 150 (86%) having OS. There were more patients with previous CABG (24%) in the crossover group compared to the OS group (9.2%) (P = 0.042). The one-year MACE was not significantly different between CO vs. OS (13.3% (10.5-16.1) vs. 12% (5.5-18.5)). The five-year MACE was numerically higher, although statistically not significant, in CO vs. OS (19.3 (15.9-22.7) vs. 25.9 (16.6-35.2))., Conclusion: This study shows that percutaneous intervention provides reasonable long-term outcomes and low rates of repeat revascularization for isolated ostial LAD lesions, with no noticeable difference in outcomes with crossover stenting into the LM vs. OS alone. A larger, prospective study may be required to determine the optimal strategy for treating ostial LAD lesions., Competing Interests: None., (AJCD Copyright © 2022.)

Coronary bifurcation lesions (CBLs) account for 15%-20% of all percutaneous coronary interventions. The complex nature of these lesions is responsible for poorer procedural, early and late outcomes. This complex lesion subset has received great attention in the interventional cardiac community, and multiple stenting techniques have been developed. Of these, the provisional stenting technique is most often the default strategy; however, the elective double stenting (EDS) technique is preferred in certain subsets of complex CBLs. The double kissing crush technique may be the preferred EDS technique because of its efficacy and safety in comparative trials; however, this technique consists of many steps and requires training. Many new methods have recently been added to the EDS techniques to provide better stent scaffolding and to reduce early and late adverse outcomes. Intravascular imaging is necessary to determine the interventional strategy and postinterventional results. This review discusses the basic concepts, contemporary percutaneous interventional technical approaches, new methods, and controversial treatment issues of CBLs., Competing Interests: Conflict-of-interest statement: Author declares no conflict of interests for this article., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

The Palmaz Genesis XD stents (Cordis®, Cardinal Health, Dublin, OH) are an ideal option for stenting vessels in pediatric patients due to their ability to be re-dilated to large diameters to accompany children's somatic growth. Unfortunately, their length limits their utility for pulmonary vein stenting in small children, due to the risk of protrusion into the left atrium or into distal pulmonary vein branches. We describe a stent shortening technique by longitudinally compressing them prior to deployment, which may enhance their applicability in pediatric pulmonary vein stenosis., (© 2021 Wiley Periodicals LLC.)

Delayed coronary obstruction is a rare but often fatal complication of transcatheter aortic valve replacement that can present within 24 hr after the transcatheter aortic valve replacement procedure. We present a case of a 77-year-old woman whose distal left main coronary artery bifurcation became obstructed by an embolized piece of native valve leaflet material 16 hours after the uncomplicated transfemoral implantation of an Edwards Sapien Ultra 23 mm aortic valve, which was successfully treated with the simultaneous kissing stent technique., (© 2021 Wiley Periodicals LLC.)

Background: Percutaneous coronary intervention (PCI) is well established for the treatment of obstructive coronary artery disease. This study was performed to assess the impact of in-hospital mortality and 30-day readmission with intracoronary imaging as an adjunct to baseline coronary angiography., Methods: The study was derived from the Healthcare Cost and Utilization Project's National Readmission Database (NRD) of 2016, sponsored by the Agency for Healthcare Research and Quality. Patients who underwent PCI were identified using appropriate ICD-10 codes. Study population was further subcategorized into 2 PCI arms: intravascular imaging (''imaging'' group) and fluoroscopy guided (''angiography'' group). Primary endpoints were 30-day readmissions and in-hospital mortality. Secondary endpoints were length of stay, cost of care, predictors of 30-day readmission and in-hospital mortality in PCI related hospitalizations., Results: We identified in total 188,368 index admissions, with 12,379 patients in the "imaging-guided" group and 175,989 in the "angiography-alone" group. There were no differences in 30-day readmissions between both groups (~10.8% in both arms, p = .788). However, in-hospital mortality carried a statistically significant reduction with use of imaging-guided PCI (1.72% vs 2.24%, p = .004). The median length of stay was longer in the imaging-guided arm (3 vs. 2 days, p < .001), associated with larger median total hospital costs ($32,123 USD vs. $25,162 USD, p < .001). The strongest predictor of in-hospital mortality in both univariate and multivariate analysis was having an existing coagulopathy., Conclusion: The results of this study did not confer benefit with regards to 30-day hospital readmission rates when utilizing intracoronary imaging versus angiography-alone in percutaneous coronary intervention, but did suggest there may be an association between the use of intracoronary imaging and improved in-hospital mortality. In addition, resource utilization was higher in the intra-coronary imaging arm of the study., (© 2020 Wiley Periodicals LLC.)

SUMMARY It is occasionally necessary to cross a sharp venous occlusion (a thin web of tissue without a lumen) and sometimes it is not possible to cross the stricture with a wire, so puncturing it with a sheathed needle is then required to enable stenting. Other methods have been reviewed; however, we think this balloon technique makes it a safer procedure. [ABSTRACT FROM AUTHOR]

Proximal to distal Y stenting technique is a modified bifurcation technique based on the original Y stenting technique described over 20 years ago. We use a bench top model to illustrate the steps of the technique, which can provide both provisional and full coverage options, using radial artery access. This technique may be applied in clinical settings on a wide range of bifurcation anatomies with a number of unique advantages., (© 2020 Wiley Periodicals LLC.)

Objective: The purpose of this experimental bench test was to compare stent deformation, obstruction of stent struts at a jailed side branch (SB) ostium, and stent strut malapposition between SB inflation using proximal balloon edge dilation (PBED) technique and SB inflation using conventional balloon dilation in repetitive-proximal optimizing technique (re-POT) sequence., Background: The second proximal optimizing technique (POT) procedure in the re-POT sequence might increase obstruction of stent struts at a jailed SB ostium, because deformation of stent cells at the main branch (MB) occurred during SB inflation for opening the SB ostium., Methods: A fractal coronary bifurcation bench model made of flexible urethane was used, and crossover single-stent implantation (Xience Sierra, Abbott Vascular, Santa Clara, CA, n = 12) was performed from the MB with the re-POT sequence. During the re-POT sequence, the jailing rate at the SB ostium assessed by videoscopy was compared between SB inflation using PBED technique (PBED group, n = 6) and SB inflation using conventional balloon dilation (conventional group, n = 6)., Results: The jailing rate after the second POT procedure tended to be lower in the PBED group than in the conventional group (26 ± 12% vs. 34 ± 8%, p = .211), and the change in the jailing rate during the second POT procedure was significantly smaller in the PBED group than in the conventional group (4.8 ± 5.3% vs. 11.6 ± 3.5%, p = .026)., Conclusions: In the re-POT sequence, the PBED technique with a short balloon for SB inflation might minimize worsening of the jailing rate at the SB ostium during the second POT procedure., (© 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals, Inc.)

Objectives: Aim of this study was to evaluate feasibility and benefit of self-designed, radiopaque markers as a novel technique in neonates and infants with shunt- or duct-dependent lesions., Background: Surgically placed radiopaque markers have the potential to facilitate postoperative percutaneous interventions., Methods: All consecutive children with surgically placed radiopaque markers involving systemic-to-pulmonary artery connections or arterial ducts in the context of hybrid palliation and subsequent cardiac catheterization between January 2013 and March 2019 were included in this analysis. Our primary endpoint was our concept's feasibility, which we defined as a combination of surgical feasibility and the percutaneous intervention's success. Secondary endpoint was the rate of complications resulting from the surgical procedure or during catheterization., Results: Radiopaque markers that reveal the proximal entry of a surgical shunt or the arterial duct proved to be a feasible and beneficial approach in 25 postoperative catheterizations. The markers' high accuracy enabled easy probing and proper stent positioning in 13 neonates with a median age and weight of 121 days (range 9-356) and 4.7 kg (1.6-9.4) at the intervention. No procedural complications or unanticipated events associated with the radiopaque marker occurred. The markers were never lost, never migrated, and caused no local obstructive lesion. Surgical removal was straightforward in all patients., Conclusions: Radiopaque markers are a promising and refined technique to substantially facilitate target vessel access and enabling the accurate positioning of stents during postoperative percutaneous procedures., (© 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals, Inc.)

Background: Patients with symptomatic carotid stenosis recently treated with percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS) are always classified as at high risk for surgery, given that they are required uninterrupted dual antiplatelet therapy. In this regard, carotid artery stenting (CAS) may represent a valid alternative., Objective: The purpose of this study is to overview CAS outcomes in symptomatic patients with and without ACS., Methods: One hundred fifty-one consecutive symptomatic patients who underwent CAS between 2010 and 2017 in a single institution were included in this study, of which 66 (43.7%) were identified as having ACS. All patients were followed-up with carotid duplex ultrasound scan and a neurological assessment of symptoms status at 30-day postprocedure and at 3, 6, and 12 months, with annual follow-up after that for 3 years., Results: Among symptomatic ACS patients, common risks factors were active smoking, metabolic syndrome, diabetes, and hypertension. In the short-term follow-up, no significant differences were observed among rates of death, stroke, myocardial infarction (MI), and restenosis, between patients with and without ACS. Mean clinical follow-up was 28.2 (12.3) months. In the long-term follow-up, higher rates of death and MI were recorded in patients with ACS (death: 11.4% vs. 5.4%, p = .04; MI: 11.4% vs. 3.6%, p = .02), owing to the complexity of these patients., Conclusions: This single-center study suggested that CAS is a safe and effective treatment for patients with symptomatic carotid artery stenosis, who recently underwent PTCA for ACS, requiring uninterrupted dual antiplatelet therapy., (© 2019 Wiley Periodicals, Inc.)

Aim: Achieving the optimal apposition of coronary stents during percutaneous coronary intervention is not always feasible. The risks and benefits of stent postdilation in primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) have remained controversial. We sought to evaluate the immediate angiographic and long-term outcomes in patients with and without stent postdilation., Methods: A cohort of patients (n = 1,224) with STEMI, treated with PPCI (n = 500 postdilated; n = 724 controls), were studied. The flow grade, the myocardial blush grade, and the frame count were considered angiographic outcomes. The clinical outcomes were major adverse cardiovascular events (MACE)-comprising cardiac death, nonfatal MI, and repeat revascularization-and the device-oriented composite endpoint (DOCE)-consisting of cardiac death, target lesion revascularization, and target vessel revascularization., Results: The flow and myocardial blush grades were not different between the two groups, and the frame count was significantly lower in the postdilation group (15.7 ± 8.4 vs. 17 ± 10.4; p < .05). The patients were followed up for 348 ± 399 days. DOCE (2.2% vs. 5.8%) and cardiac mortality (1.2% vs. 3.2%) were lower in the postdilation group. In the fully adjusted propensity score-matched analysis, postdilation was associated with decreased DOCE (HR = 0.40 [0.18-0.87], p = .021)., Conclusions: Selective postdilation improved some angiographic and clinical outcomes and could not be discouraged in PPCI on patients with STEMI., (© 2019 Wiley Periodicals, Inc.)

We report on two patients who received a transcatheter cavopulmonary connection by a needle puncture under deep conscious sedation. In both patients, the vessel-to-vessel connection was achieved by a venous access into the superior caval vein and direct needle puncture of the pulmonary artery. The two cavopulmonary anastomoses were held open by a covered stent and a bare-metal stent, respectively., (© 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals, Inc.)

Femoropopliteal in-stent chronic total occlusions (CTOs) remain one of the most challenging subsets of peripheral arterial disease to treat percutaneously. Advances in available CTO crossing technology and operator experience have increased percutaneous intervention success rates. We report a case of critical limb ischemia in a patient with chronically occluded femoropopliteal nonoverlapping stents treated with a novel percutaneous approach of subintimal retrograde angioplasty using high compression resistant nitinol stents to crush the occluded previous stents to create a neo-lumen., (© 2019 Wiley Periodicals, Inc.)

Objectives: We aimed to assess the experience using a percutaneous axillary artery approach for insertion of arterial ductal stents in patients with critical right ventricular outflow tract lesions at two tertiary pediatric cardiology centers., Background: Patent ductus arteriosus stenting is an accepted palliative alternative to BT shunts for neonates with critical right heart lesions. Access to tortuous ductus' may be challenging via the femoral artery, whereas the carotid artery presents a low risk of stroke. Recently, the axillary artery has been utilized for access in these patients., Methods: We performed a retrospective review of neonates who underwent stent placement or angioplasty using percutaneous axillary artery approach at two tertiary care centers from October 2016 to November 2018. Medical records were reviewed to ascertain demographic, clinical, and outcome data., Results: Axillary artery access was performed in 20 patients (16 primary ductal stents and 4 re-interventions) at a median (IQR) procedural weight of 3.4 (3-3.9) kg. Median (IQR) procedural time was 110 (75-150) min. The median (IQR) ICU stay and intubation times were 14 (0-94) hr and 5 (0-40) hr, respectively. There were three access-related vascular complications which were managed conservatively with no long-term effects. Two patients subsequently died due to non-procedure related causes., Conclusions: Ductal stenting via a percutaneous axillary artery approach is a viable option in neonates with critical right ventricular outflow tract lesions. This approach provides an additional access site for PDA stenting which may be utilized in patients with vertical duct morphology., (© 2019 Wiley Periodicals, Inc.)

Advances in percutaneous coronary intervention (PCI) techniques in chronic total occlusion (CTO) procedures have improved the success of this procedure. CTO PCI via the retrograde approach are facilitated most frequently by reverse controlled antegrade/retrograde tracking (R-CART). This aims to create a communication between the proximal and distal lumens, which may be achieved between intimal and subintimal spaces. In patients with calcified coronary vessels, creating sufficient disruptions to connect these spaces can be challenging. Intravascular lithotripsy (IVL) has become a useful tool to modify intracoronary calcification for stent deployment and expansion. This case demonstrates the utility of IVL in facilitating connection in R-CART to complete the CTO PCI where heavy calcification was present at the site of chronic occlusion., (© 2019 Wiley Periodicals, Inc.)

Clinically significant unilateral pulmonary arteriovenous malformations (PAVM) can develop in patients with a Fontan circulation when there is unbalanced distribution of hepatic venous (HV) blood flow to the lungs. There are reported surgical and transcatheter techniques to treat PAVMs by rerouting HV return, with promising short-term results. We report a case of a novel, technically simple transcatheter approach to redirect HV blood flow in an adult Fontan patient with polysplenia syndrome and severe unilateral PAVMs. Our patient had a two-stage procedure, the first to redirect all HV blood flow to the affected lung with a single covered stent, and a second to confirm resolution of PAVMs and to reintroduce HV effluent to the unaffected lung. At 10-month follow-up, her oxygen saturations had increased from 75% to 93% with a marked improvement in her functional status., (© 2019 Wiley Periodicals, Inc.)