What is the most appropriate method for coronary sinus cannulation? The telescopic method or the electrophysiologic method?

Objectives

The most challenging stage of cardiac resynchronization therapy (CRT) is coronary sinus cannulation (CS). The aim of this study was to compare coronary sinus cannulation techniques using electrophysiology catheters and coronary angiography catheters.

Methods

In this observational, retrospective and non-randomized study, 87 patients who were eligible for CRT device implantation were screened at Kahramanmaras Sutcu Imam University Hospital between March 2014 and March 2018. Seventy-two patients who met the inclusion criteria were enrolled in the study. The study population was divided into 2 groups: the first group consisted of 36 patients whose coronary sinuses were cannulated via electrophysiology (EP) catheters and the second group included 36 patients who received coronary angiography catheters for coronary sinus cannulation.

Results

The two groups were similar in terms of the baseline characteristics of the patients. The total fluoroscopy time was less with cannulation using coronary angiography catheters. There were no differences between the two groups in terms of the amount of contrast material and the success of the operations.

Conclusions

Coronary sinus catheterization using coronary angiography catheters significantly reduces fluoroscopy time in patients undergoing CRT.

Complications of Cardiac Catheterization: A Single-Center Study

In Turkey as well as in the whole world, cardiac catheterization is an invasive intervention that is being increasingly used both for diagnosis and treatment. With technological and pharmacologic development and experience, the indications for this intervention are ever increasing. This invasive intervention brings, of course, some complications with it. These may range from local ones to death. In this study the authors analyzed the local cardiac complications and those related to other systems that they encountered in 10,445 catheterizations conducted for diagnosis and treatment in their clinic over a 26-month period. They found the rate of all complications to be 3.54% (2.05% diagnostic, 9.1% therapeutic). Of these complications, 1.89% (0.80% diagnostic, 6.02% therapeutic) were cardiac, 1.27% (0.97% diagnostic, 2.4% therapeutic) local. They found that the ratios of death were 0.09% for diagnostic interventions, 1.13% for therapeutic interventions, and 0.31% altogether. In the diagnostic group 0.02% required urgent coronary bypass surgery, and 0.41% needed urgent coronary bypass surgery in the therapeutic group. In conclusion, despite the noticeable changes in patient profile and application, the ratios for cardiac catheterization have changed little over the years.

Current Role of Laser Angioplasty of Restenotic Coronary Stents

Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1 ±9.9 vs 13.6 ±9.1 mm; p=0.034), more complex (36.5% type C stenoses vs 14.3%; p=0.006), and more frequently had reduced distal blood flow (TIMI <3: 18.9% vs 4.8%; p=0.025) compared to lesions in the PTCA group. Immediate angiographic results of PTCA and ELCA + PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA + PTCA, in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group vs 8.6% in PTCA group). The 1-year follow-up showed that the rates of major adverse cardiac events (MACE) were comparable in the 2 groups (37.3% in ELCA group vs 46.6% in PTCA group). The rates of target vessel revascularization (TVR) within 1 year after the intervention were also similar in the 2 groups (32.8% vs 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in the ELCA group, no increase in the rate of complications was registered.

Increased platelet distribution width is associated with ST-segment elevation myocardial infarction and thrombolysis failure

We investigated 2 hypotheses: (1) a relationship between platelet indices and stable coronary artery disease (CAD) and acute ST-segment elevation myocardial infarction (STEMI) and (2) a relationship between platelet indices on admission and thrombolysis outcomes in patients with STEMI. A total of 260 patients were enrolled. The white blood cell (WBC) and platelet distribution width (PDW) were found to be increased in patients with STEMI (P for both < .001). White blood cell and PDW were independent predictors of acute STEMI. Mean platelet volume (MPV) and PDW were significantly higher in the thrombolysis failure group than in the thrombolysis success group (9.9 ± 1.8 vs 9.2 ± 1.5 fL, P = .021 and 17.7 ± 1.0 vs 16.4 ± 2.1 fL, P < .001, respectively). Mean platelet volume and PDW were independent predictors of thrombolysis failure. Patients with acute STEMI had higher PDW than did patients with stable CAD. In addition, higher PDW and MPV seem to correlate with thrombolysis failure in patients with STEMI.

[Two years experience of the use of a penetration catheter (Tornus) recanalization during percutaneous coronary interventions on chronic total occlusions]

We included in this study 43 patients chronic total occlusions (CTO) subjected percutaneous coronary interventions (PCI) with the use of penetration catheter (Tornus) in 2009-2010. Penetration catheter was applied only in those cases when it was not possible to introduce low profile coronary dilatation catheter into the site of occlusion. After penetration of CTO by a guide wire a channel was formed by a manually rotated penetration catheter. The Tornus catheter was successfully passed into distal part of an artery in 81.4% of cases. In other.

[Comparative assessment of risk factors and hospital results in male and female patients underwent to coronary artery bypass surgery]

There are controversial data on relatively unfavorable effect of female gender on postoperative mortality of patients underwent to coronary artery bypass grafting (CABG). In order to assess risk factors and hospital outcomes after elective CABG we studied retrospectively data on patients who had undergone CABG in Sani Konuogly medical center (Gasiatep, Turkey) during the period from March 2002 to March 2010. For elimination of unfavorable effect of old age we included into analysis data from patients younger than 65 years. In accordance with study aim all patients (n=2692) were divided into two gender groups 1966 men (mean age 54,01 years) and 726 women (mean age 54.35 years). Diabetes (48.3 and 26.9%; p=0.0001), arterial hypertension (76.6 and 28.4%; p=0.00001), and obesity (50 42%; p=0.03) were more frequent among women while smoking (44.5 and 10.3%; p=0.0001), hyperlipidemia (37.6 and 21.5%; p=0.0002), and history of myocardial infarction (31.3 and 17.3%; p=0.06) were more often registered among men. Mortality was insignificantly higher in women (1.6 and 0.9%; p=0.06). Perioperative Q-wave myocardial infarction was more frequent among men than among women (1.5 and 0.4% respectively; p=0.04). It is necessary to conduct prospective well controlled study for exclusion of gender influences on perioperative outcomes in patients subjected to CABG .

[Clinical and angiographical results of the use of the EPHESOS stent in patients with coronary artery atherosclerosis]

The Ephesos is a new balloon-expandable, stainless steel, tubular stent with multicellular design. This open nonrandomized study assesses the immediate and long-term clinical and angiographic outcomes after Ephesos implantation in patients with native coronary artery disease. The Ephesos was implanted in 168 patients with 198 de novo lesions. Most patients (56%) had unstable angina, and 38% of lesions were type B2-C. The mean lesion length was 12.5-/+7.2 mm, and 29% of lesions were >15 mm in length. No stent deployment failure occurred, as well as acute or subacute stent thrombosis. In-hospital non-Q-wave myocardial infarction occurred in 2 patients. The 6-month event-free survival was 83.9%. Two patients with no restenosis in the target vessel died of fatal infarction due to abrupt closure of a nontarget vessel. The 6-month angiographic follow-up was obtained in 164 patients (98%) (192 lesions). The loss index was 0.27-/+0.25. Angiographic restenosis rate was 12%. Twenty patients with restenosis had repeat target lesion revascularization. The results of this study indicate a potential benefit of EPHESOS for the prevention of stent thrombosis and restenosis in these relatively high-risk patients.

[Rheolytic thrombectomy with AngioJet catheter during transluminal coronary revascularization in patients with acute myocardial infarction]

BACKGROUND

Although balloon angioplasty and stenting are effective in the treatment of acute myocardial infarction (M1), reduced coronary flow and distal embolization frequently complicate interventions when thrombus is present. Adjunctive treatment with mechanical thrombectomy devices was suggested to reduce these complications.

METHODS

We evaluated immediate angiographic, in-hospital and 30-day follow-up clinical outcomes of 185 patients with acute MI and angiographically evident thrombus who were treated with AngioJet rheolytic thrombectomy followed by immediate definitive treatment.

RESULTS

Procedural success (residual diameter stenosis <50% and thrombolysis in myocardial infarction [TIMI] flow >2 after final treatment) was 97%. Rheolytic thrombectomy success was achieved in 7% of patients. Subsequent definitive treatment included stenting in 67% and balloon angioplasty alone in 26% of patients. Final TIMI 3 flow was achieved in 89%. AngioJet treatment resulted in mean thrombus area reduction from 69.6 mm(2) at baseline to 17.3 mm(2) post-thrombectomy (p<0.001). Procedural complications included distal embolization (7.6%) and perforation (1.1%). Clinical success (procedure success without major in-hospital cardiac events) rate was 88%, in-hospital mortality - 7.0%. There were no further major adverse events during 30-day follow-up.

CONCLUSION

Rheolytic thrombectomy can be performed safely and effectively in patients with acute MI, allowing for immediate definitive treatment of thrombus-containing lesions.

[Immediate and long-term results of implantation of the coronary stent "BioDiamond"]

AIM

To assess immediate and long-term outcomes after BioDiamond-stent implantation in patients with native coronary artery disease.

MATERIALS AND METHODS

The BioDiamond stent was implanted in 112 patients with 132 de novo lesions. Most patients (54%) had unstable angina, 33% of the lesions were of type B2-C.

RESULTS

No stent deployment failure occurred as well as acute or subacute stent thrombosis. The 6-month angiographic follow-up was obtained in 108 patients (98%) (125 lesions). The loss index was 0.40 +/- 0.27. Angiographic restenosis rate occurred in 14%. Repeat target lesion revascularization was successful in 16 patients with restenosis.

CONCLUSION

The results of this study indicate a potential benefit of BioDiamond for prevention of stent thrombosis and restenosis in these relatively high-risk patients.

A pilot study of the utilisation and outcome of community orders: client, carer, case manager and Mental Health Review Tribunal perspective

Mental health problems are a major public health concern due to their prevalence and impact at a personal, family, social and economic level. Compulsory community treatment is being utilised as a health care approach, despite much disagreement and lack of Australian research demonstrating its effectiveness. This pilot study investigated the utilisation and outcomes of community orders from the perspective of a client, carer, case manager and Mental Health Review Tribunal member. The findings indicate that compulsory community treatment had a positive impact upon hospital readmission rates and medication usage. All groups of respondents rated community orders as being of benefit in a number of areas. Further controlled studies are required.