Abstract Coronary bifurcations are frequent and account for approximately 20% of all percutaneous coronary interventions. Nonetheless, they remain one of the most challenging lesion subsets in ...interventional cardiology in terms of a lower procedural success rate and increased rates of long-term adverse cardiac events. Provisional side branch stenting should be the default approach in the majority of cases and we propose easily applicable and reproducible stepwise techniques associated with low risk of failure and complications.
Abstract Contemporary clinical trials, registries, and meta-analyses, supported by recent results from the EXCEL (Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease) ...and NOBLE (Percutaneous Coronary Angioplasty Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis) trials, have established percutaneous coronary intervention of left main coronary stenosis as a safe alternative to coronary artery bypass grafting in patients with low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) scores. As left main percutaneous coronary intervention gains acceptance, it is imperative to increase awareness for patient selection, risk scoring, intracoronary imaging, vessel preparation, and choice of stenting techniques that will optimize procedural and patient outcomes.
Contemporary Clinical Applications of Coronary Intravascular Ultrasound Michael C. McDaniel, Parham Eshtehardi, Fadi J. Sawaya, John S. Douglas, Jr, Habib Samady The major utility of intravascular ...ultrasound (IVUS) relates to optimizing stent deployment. In percutaneous coronary intervention with bare-metal stents, IVUS guidance reduces restenosis. In percutaneous coronary intervention with drugeluting stents, IVUS guidance may reduce stent thrombosis. The benefit of IVUS is most important in complex lesions such as left mains and bifurcations. While IVUS luminal area measurements have been used to assess intermediate lesion severity, recent studies have demonstrated that IVUS accurately identifies nonischemic lesions, but cannot accurately predict hemodynamically significant lesions. In the current review, the authors focus on clinical applications of IVUS in interventional cardiology.
Abstract Transcatheter aortic valve replacement (TAVR) has evolved from a novel technology to an established therapy for high/intermediate risk patients with severe symptomatic aortic stenosis (AS). ...Although TAVR is used to treat bicuspid severe AS, the large randomized trials typically excluded bicuspid AS due to its unique anatomical features. This case report describes an acute aortic perforation during delivery of a transcatheter heart valve to treat a severe bicuspid AS with a “gothic aortic arch” – more careful evaluation of the pre-procedural MSCT would have unveiled a sharply angulated aortic arch. This life-threatening complication was successfully treated by thoracic endovascular aortic repair.
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