1,721,309 research outputs found
Procedural Strategies to Reduce the Incidence of Contrast-Induced Acute Kidney Injury During Percutaneous Coronary Intervention
No full textContrast-induced acute kidney injury (CI-AKI) is a potentially serious complication following coronary angiography and percutaneous coronary intervention (PCI). The incidence of CI-AKI is particularly high in patients with advanced chronic kidney disease (defined as an estimated glomerular filtration rate <30 ml/min/1.73 m2). Although much effort has been dedicated to the identification and implementation of preventive measures for this complication at the pre-intervention stage, much less has been investigated on the procedural strategies and techniques to decrease the risk of CI-AKI during PCI. The mainstay of such approaches relies on the minimization of contrast volume by means of specific strategies or dedicated devices. Invasive imaging, such as intravascular ultrasound or non-contrast-based optical coherence tomography, is another pillar of any ultra-low-contrast-volume PCI protocol. Finally, an array of miscellaneous ancillary measures can be implemented to decrease the risk of CI-AKI, which includes the use of radial access, remote ischemic conditioning, and hemodynamic support in high-risk patients. The present review analyzes the technical aspects as well as the scientific evidence supporting these novel techniques, with the goal to improve the outcomes of patients at high risk for CI-AKI undergoing PCI
Manual of chronic total occlusion interventions : a step-by-step approach /
No full text"Manual of Coronary Chronic Total Occlusion Interventions: A Step-by-Step Approach, Second Edition, is an easy to read reference for coronary chronic total occlusion interventions (CTO). Written by recognized national and international experts in the field, this reference compiles the steps necessary to preform, what pitfalls to watch out for, and troubleshooting tactics necessary for coronary chronic total occlusion interventions (CTO). This second edition is updated with new developments in the field. The 2nd edition covers techniques like the Carlino technique, "scratch and go", "BASE", double-blind stick and swap, and subintimal crush, along with tips about how to use the latest complex PCI equipment. It also covers recently published trials, CTO scores and hybrid series"--Publisher's description.Includes bibliographical references.When to perform chronic total occlusion interventions -- Equipment -- The basics : timing, dual injection, studying the lesion, access, anticoagulation, guide support, trapping, pressure and electrocardiogram monitoring -- Antegrade wire escalation : the foundation of chronic total occlusion percutaneous coronary intervention -- Antegrade dissection/reentry -- The retrograde approach -- Putting it all together : the hybrid approach -- "balloon-uncrossable" and "balloon-undilatable" chronic total occlusions -- Complex lesion subsets -- Radiation management during chronic total occlusion percutaneous coronary intervention -- Stenting of chronic total occlusion lesions -- Complications -- How to build a successful coronary chronic total occlusion program -- Equipment commonly utilized in CTO interventions -- Commonly used acronyms in CTO interventions."Manual of Coronary Chronic Total Occlusion Interventions: A Step-by-Step Approach, Second Edition, is an easy to read reference for coronary chronic total occlusion interventions (CTO). Written by recognized national and international experts in the field, this reference compiles the steps necessary to preform, what pitfalls to watch out for, and troubleshooting tactics necessary for coronary chronic total occlusion interventions (CTO). This second edition is updated with new developments in the field. The 2nd edition covers techniques like the Carlino technique, "scratch and go", "BASE", double-blind stick and swap, and subintimal crush, along with tips about how to use the latest complex PCI equipment. It also covers recently published trials, CTO scores and hybrid series"--Publisher's description.Online resource; title from electronic title page (ClinicalKey, viewed December 15, 2017).Elsevie
Intravascular Ultrasonography Analysis of the Everolimus-Eluting Stent in Coronary Chronic Total Occlusions
Full text linkThe 51st Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 22, 2013, 3-6 p.m., D1.602)PURPOSE: Coronary artery disease (CAD) is consistently the number one cause of death for both men and women worldwide. Of the millions of patients diagnosed with CAD, approximately 1 in 5 is found to have a coronary artery that has been 100% blocked for three months or longer, representing the most formidable subset of atherosclerosis: chronic total occlusion (CTO). While drug-eluting stents have demonstrated success in patients with less severe coronary atherosclerosis, little is known about their efficacy in CTOs, which are currently managed by bare metal stents associated with high rates of restenosis. The present study aims to evaluate the effectiveness of the novel Everolimus-Eluting Stent (EES) in CTOs, using intravascular ultrasonography (IVUS) to assess restenosis.
METHODS: One hundred consecutive CTO patients who were successfully treated using EES at the Dallas VAMC between 2009-2012 were enrolled in the AngiographiC Evaluation of the Everolimus-Eluting Stent in Chronic Total Occlusions (ACE-CTO trial: NCT01012869). Patients underwent follow-up angiography and IVUS imaging at 8 months and clinical follow-up for up to 12 months. The primary endpoint of this study, binary angiographic restenosis, was defined as >50% minimum lumen diameter stenosis, as assessed by 8-month follow-up quantitative coronary angiography in the treated coronary segment. The primary endpoint of the IVUS analysis was 8-month in-stent neointimal hyperplasia (NIH) volume, defined as the difference between stent and lumen volume.
RESULTS: Of the 226 patients who underwent CTO percutaneous coronary intervention (PCI) during the enrollment period, 129 were eligible and 100 agreed to participate. Mean age was 64±7 years, and 99% of the patients were men. Patients had high prevalence of hypertension (91%), hyperlipidemia (90%), diabetes (47%), prior myocardial infarction (51%), and prior PCI (21%). The CTO target vessel was the right coronary artery (70%), left anterior descending artery (16%), circumflex (13%), or left main (1%). The mean number of implanted stents was 3.3±1.3, mean stent diameter was 2.8±1.1 mm, mean stent length was 85±34 mm, and 94 patients had overlapping stents. Binary angiographic restenosis was 45%. Follow-up IVUS analysis of 55 patients revealed low median minimum lumen area (3.3 mm2) and high NIH volume (103.6 mm3).
CONCLUSIONS: Everolimus-eluting stent implantation in CTOs is associated with high rates of angiographic restenosis and high NIH volume, suggesting the need for novel therapeutic strategies to improve outcomes in this complex and challenging lesion subgroup.Southwestern Medical Foundatio
Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of “vessel architecture”
No full textDespite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely. A modern approach to CTO PCI involves understanding the concept of "vessel architecture," which is based on the distinction between coronary structures (occlusive plaque, comprising the disrupted intima and media, and the outer adventitia) and extravascular space. The vessel architecture represents a safe work environment for guidewire and device manipulation. This review provides an anatomy-based description of the concept of vessel architecture, along with a historical perspective of subadventitial techniques for CTO PCI, and outcome data of CTO PCI utilizing the subadventitial space
Functional Assessment of Intravascular Lithotripsy for Stent Underexpansion
No full textBackground: Stent underexpansion from severe calcification leads to adverse outcomes. While intravascular lithotripsy (IVL) is effective pre-stenting, its role in treating stent underexpansion remains unclear. Methods: We conducted a multicenter, retrospective study of patients undergoing percutaneous coronary intervention (PCI) with IVL from January 2019 to 2025. Patients were categorized into two groups based on IVL use: the upfront group (IVL before stent placement) and the intrastent group (IVL for treating stent underexpansion). The outcomes included a quantitative flow ratio-based trans-stent gradient (QFR-TSG) > 0 post-PCI, target vessel failure, and major adverse cardiovascular events (MACE). Statistical analyses employed inverse probability of treatment weighting with logistic and Cox regression models and Kaplan−Meier survival curves. Results: A total of 166 consecutive patients were included, with 79 (47.6%) in the intrastent IVL group and 87 (52.4%) in the upfront IVL group. Compared to the upfront IVL group, patients treated with intrastent IVL had a higher prevalence of diabetes mellitus (49.4% vs. 19.5%, p < 0.001). QFR-TSG > 0 was significantly more frequent in the intrastent IVL group (77.2% vs. 60.9%, p = 0.036). After IPTW adjustment, intrastent IVL was not significantly associated with increased MACE risk (OR 1.11; 95% CI 0.55–2.61; p = 0.240). Kaplan−Meier analysis similarly showed no difference in MACE-free survival between groups over a mean follow-up of 3.7 years (log-rank p = 0.299). Conclusions: Intrastent IVL yields inferior functional results versus upfront IVL but appears safe and may serve as a useful rescue option for stent underexpansion
Coronary stents and surgery: a dangerous combination
Full text linkDetailed formal protocol with illustrations and extensive bibliography.UT Southwestern--Internal Medicin
If a stent is good enough for a President...
Full text linkDetailed formal protocol with illustrations and extensive bibliography.UT Southwestern--Internal Medicin
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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