[Challenges of coronary catheterization after TAVR]

PURPOSE

Coronary catheterization after transcatheter aortic valve implantation (TAVR) may be challenging. The main objective of the study is to assess the feasibility of coronary catheterization and angioplasty according to each type of valve.

PATIENTS AND METHOD

We retrospectively studied coronary angiography or percutaneous angioplasty procedures after TAVR in two different centers. The catheterization success of coronary artery was evaluated according to the quality of engagement in ostium and opacification of the artery. Other indicators were collected including catheters used, fluoroscopy and angiography times, DAP and the volume of the contrast agent.

RESULTS

Among 1512 TAVR procedures, 33 patients were included. The Sapien 3® valve was implanted in 22 patients and the Evolut® in 11 patients (7 Evolut-R® and 4 Evolut Pro®). Coronary angiography with selective or partially selective catheterization has been successfully performed in all patients with a Sapien 3® valve. In the Evolut® group we identified 3 cases of non-selective catheterization for the right coronary and 1 case for the left coronary. Standard Judkins catheters seem to be the most suitable for both types of valve with very good efficiency.

CONCLUSION

The results of our study is promising for the future of TAVR with a coronary catheterization success rate close to 100% with some difficulties for the Evolut® supra-annular valves. Special attention should be paid to the technique of implantation and orientation of cups in the aortic sinus.

Distal microcatheter placement using the Asahi Chikai TM 0.008-inch micro-guidewire for liquid embolic material delivery: A technical note

INTRODUCTION

Management of vascular malformations requires microcatheter manipulation through distal tortuous arterial feeders less than a millimetre in diameter, to permit safe and effective embolization at the fistula or nidus location. The Asahi Chikai^TM 0.008 inch micro-guidewire recently introduced in the United States was used to evaluate microcatheter torque, support and safety in distal microcatheter navigation.

METHODS

The use of the Asahi Chikai 0.008 inch micro-guidewire in conjunction with flow-guided, and over the wire microcatheters was evaluated in 25 neuroendovascular cases over a 1 year period. It involved single operator usage for endovascular microcatheter embolization of intracranial vascular malformations listed below. The study evaluated angiographic evidence of distal microcatheter positioning, subsequent obliteration of the fistula at the location and complications if any.

RESULTS

The micro-guidewire was used in microcatheter embolization of 10 vein of Galen malformations, 11 brain and head & neck arteriovenous malformations, 2 spinal and 2 cranial dural arteriovenous fistula. Good flow directed and over the wire microcatheter placement using the Asahi Chikai^TM 0.008 inch micro-guidewire was possible across the spectrum of cases achieving optimum catheterization and safe embolization in all. There were no micro-guidewire or microcatheter related vessel spasm, dissection, or perforation during their combined or individual manipulation, contrast or embolic extravasation on fluoroscopy or post- embolization angiograms CONCLUSION: The Asahi Chikai^TM 0.008 inch micro-guidewire is a safe, sturdy micro-guidewire which provides good torque in distal arterial anatomy while providing microcatheter support and maintaining tip configuration on repeated use.

Liquid embolization of brain arteriovenous malformation using novel detachable tip micro catheter: a technical report

BACKGROUND AND IMPORTANCE

Liquid embolization using Onyx® of brain arteriovenous malformations (AVMs) is sometimes limited by micro catheter retention by Onyx® cast during the disengagement process. Use of the new detachable tip micro catheter is presented in this report.

CLINICAL PRESENTATION

Two feeding arteries of a previously ruptured brain AVM in a 62-year-old man were embolized by Onyx 18 prior to surgery using the new Apollo™ micro catheter with the detachable-tip (30 mm) was utilized. The arterial feeders were accessed without difficulty by micro catheter, guided by 0.010" microwire. Onyx reflux around the distal end of the micro catheter was necessary for effective embolization of arteriovenous fistulous components of brain AVM. The micro catheter was successfully retracted after embolization in both feeding arteries, with distal end detachment seen in one but not the other arterial embolization. No arterial thrombosis, vasospasm, dissection, or rupture was seen at respective sites of disengagement.

CONCLUSION

Use of the new micro catheters with detachable-tip design allowed prolonged Onyx® injection times, safe micro catheter disengagement, without any limitations in accessing target arterial feeders.