Cardiovascular revascularization medicine : including molecular interventions
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Cardiovasc Revasc Med · Sep 2017
Case ReportsTranscatheter closure of a complex atrial septal defect after occluder device embolization.
Percutaneous closure is nowadays considered the treatment of choice of ostium secundum atrial septal defects (ASD). However, transcatheter closure can be highly challenging when we face an ASD with complex morphological features. The combination of different imaging modalities can be very helpful. This case shows the great value of using both intracardiac and real time 3D transesophageal echocardiography for the percutaneous closure of a complex iatrogenic ASD after device embolization.
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Cardiovasc Revasc Med · Jul 2017
ReviewTranscatheter versus surgical aortic valve replacement in patients with non-high surgical risk severe aortic stenosis: A systematic review.
Transcatether aortic valve replacement (TAVR) has emerged as an acceptable alternative to surgical aortic valve replacement (SAVR) in patients with high-risk surgical profile. In this analysis, we compare both approaches in non-high surgical risk severe aortic stenosis. ⋯ In severe AS patients with non-high surgical risk, TAVR has lower risk of MI at one month, but both TAVR and SAVR yielded similar outcomes at one month in terms of mortality and CVA and at 12months in terms of mortality, CVA and MI. In regard to secondary outcomes at one month, TAVR has lower rates of bleeding and acute kidney injury, and higher rates of need for new permanent pacemakers and high rate of vascular access site complications.
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Cardiovasc Revasc Med · May 2017
Hybrid metal/scaffold-jacket versus full-metal jackets in left anterior descending coronary artery diffuse disease: Differences in radiation exposure and fluoroscopic/procedural times.
Bioabsorbable vascular scaffolds (BVS) are made from a radiolucent material. Their multiple implantations on a single long diffused segment requires a specific technique with imaging magnification, which could cause an increase in dose delivered during percutaneous coronary intervention (PCI) procedure. We aimed to identify differences in radiation dose, fluoroscopy and procedural times in Hybrid DES+ multiple BVS (Absorb, Abbott Inc., USA) implantation (hybrid metal/scaffold jacket) versus multiple III generation Drug-eluting stents (DES) (full-metal jacket) in patients with long and diffuse coronary artery disease of the left anterior descending (LAD) coronary artery. ⋯ The use of hybrid metal/scaffold jacket for the treatment of long and diffuse disease of LAD is associated with a higher fluoroscopy time and radiation exposure compared to full-metal jacket, quantifiable in approximately 35%.
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Cardiovasc Revasc Med · Apr 2017
Current practice of transradial approach for coronary procedures: A survey by the Italian Society of Interventional Cardiology (SICI-GISE) and the Italian Radial Club.
Transradial approach (TRA) for percutaneous coronary procedures is associated with improved patient outcome and is being increasingly adopted worldwide. We surveyed Italian interventional cardiologists in order to take a snapshot of the current practice of TRA. ⋯ This survey provides contemporary data about the adoption of TRA in Italy and gives interesting insights about several technical and clinical issues related to the practice of this vascular approach for coronary procedures.
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Cardiovasc Revasc Med · Mar 2017
Meta Analysis Comparative StudyA comparison of cangrelor, prasugrel, ticagrelor, and clopidogrel in patients undergoing percutaneous coronary intervention: A network meta-analysis.
Newer P2Y12 inhibitors have more rapid onset of platelet inhibition compared with clopidogrel, especially the intravenous P2Y12 inhibitor cangrelor. Direct comparisons between cangrelor and oral P2Y12 inhibitors ticagrelor and prasugrel do not exist. Thus, we performed a network meta-analysis to directly and indirectly compare different P2Y12 inhibitors in patients undergoing percutaneous coronary intervention (PCI). ⋯ Despite rapid platelet inhibition provided by cangrelor, newer oral P2Y12 inhibitors such as ticagrelor and prasugrel have comparable clinical outcomes.