Atherosclerosis has been shown to develop preferentially at sites of coronary bifurcation, yet culprit lesions resulting in ST-elevation myocardial infarction do not occur more frequently at these ...sites. We hypothesized that these findings can be explained by similarities in intracoronary lipid and that lipid and lipid core plaque would be found with similar frequency in coronary bifurcation and nonbifurcation segments. One hundred seventy bifurcations were identified, 156 of which had comparative nonbifurcation segments proximal and/or distal to the bifurcation. We compared lipid deposition at bifurcation and nonbifurcation segments in coronary arteries using near-infrared spectroscopy (NIRS), a novel method for the in vivo detection of coronary lipid. Any NIRS signal for the presence of lipid was found with similar frequency in bifurcation and nonbifurcation segments (79% vs 74%, p = NS). Lipid core burden index, a measure of total lipid quantity indexed to segment length, was similar across bifurcation segments as well as their proximal and distal controls (lipid core burden index 66.3 ± 106, 67.1 ± 116, and 66.6 ± 104, p = NS). Lipid core plaque, identified as a high-intensity focal NIRS signal, was found in 21% of bifurcation segments, and 20% of distal nonbifurcation segments (p = NS). In conclusion, coronary bifurcations do not appear to have higher levels of intracoronary lipid or lipid core plaque than their comparative nonbifurcation regions.
...just as was done with FFR, there will be numerous clinical conditions, such as assessment of diffuse disease, serial lesions, severe left ventricular hypertrophy, and acute coronary syndromes, ...that will require study of the iFR behavior. FFR cannot assess individual lesions in the series without hyperemia and a distal coronary occlusion pressure, a highly impractical approach. Because it does not require hyperemia, iFR may be useful to examine individual serial lesions including those involving the left main coronary artery, a clinical scenario yet to be tested.
•Understanding the mechanics of the visual representation of cardiac pressures is fundamental to assessment of cardiovascular hemodynamics.•Without that understanding, one can neither adequately ...assess waveforms, nor problem-solve potential pitfalls of interpretation.•Acquiring an appropriate pressure waveform is critical to accurate interpretation for patient care and justifies the risk to the patient of the invasive procedure.
Objectives The aim of this study was to compare the procedural and clinical outcomes of femoral arterial access with ultrasound (US) guidance with standard fluoroscopic guidance. Background Real-time ...US guidance reduces time to access, number of attempts, and complications in central venous access but has not been adequately assessed in femoral artery cannulation. Methods Patients (n = 1,004) undergoing retrograde femoral arterial access were randomized 1:1 to either fluoroscopic or US guidance. The primary end point was successful common femoral artery (CFA) cannulation by femoral angiography. Secondary end points included time to sheath insertion, number of forward needle advancements, first pass success, accidental venipunctures, and vascular access complications at 30 days. Results Compared with fluoroscopic guidance, US guidance produced no difference in CFA cannulation rates (86.4% vs. 83.3%, p = 0.17), except in the subgroup of patients with CFA bifurcations occurring over the femoral head (82.6% vs. 69.8%, p < 0.01). US guidance resulted in an improved first-pass success rate (83% vs. 46%, p < 0.0001), reduced number of attempts (1.3 vs. 3.0, p < 0.0001), reduced risk of venipuncture (2.4% vs. 15.8%, p < 0.0001), and reduced median time to access (136 s vs. 148 s, p = 0.003). Vascular complications occurred in 7 of 503 and 17 of 501 in the US and fluoroscopy groups, respectively (1.4% vs. 3.4% p = 0.04). Conclusions In this multicenter randomized controlled trial, routine real-time US guidance improved CFA cannulation only in patients with high CFA bifurcations but reduced the number of attempts, time to access, risk of venipunctures, and vascular complications in femoral arterial access. (Femoral Arterial Access With Ultrasound Trial FAUST; NCT00667381 )
Abstract Objectives This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access. Background US guidance has been demonstrated to facilitate vascular access, ...but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization. Methods We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization. Patients were randomized to needle insertion with either palpation or real-time US guidance (351 palpation, 347 US). Primary endpoints were the number of forward attempts required for access, first-pass success rate, and time to access. Results The number of attempts was reduced with US guidance mean: 1.65 ± 1.2 vs. 3.05 ± 3.4, p < 0.0001; median: 1 (interquartile range IQR: 1 to 2) vs. 2 (1 to 3), p < 0.0001 and the first-pass success rate improved (64.8% vs. 43.9%, p < 0.0001). The time to access was reduced (88 ± 78 s vs. 108 ± 112 s, p = 0.006; median: 64 IQR: 45 to 94 s vs. 74 IQR: 49 to 120 s, p = 0.01). Ten patients in the control group required crossover to US guidance after 5 min of failed palpation attempts with 8 of 10 (80%) having successful sheath insertion with US. The number of difficult access procedures was decreased with US guidance (2.4% vs. 18.6% for ≥5 attempts, p < 0.001; 3.7% vs. 6.8% for ≥5min, p = 0.07). No significant differences were observed in the rate of operator-reported spasm, patient pain scores following the procedure, or bleeding complications. Conclusions Ultrasound guidance improves the success and efficiency of radial artery cannulation in patients presenting for transradial catheterization. (Radial Artery Access With Ultrasound Trial RAUST; NCT01605292 )
The patency of the gastroepiploic artery (GEA) had a significant association with minimal luminal diameter (MLD) and percent diameter stenosis, angiographic features that did not affect saphenous ...vein graft patency rates as much. ...recent data by Sant'Anna et al.
The adoption of invasive coronary physiologic lesion assessment before percutaneous coronary intervention has become routine in many catheterization laboratories. In the last decade, numerous studies ...have demonstrated favorable outcomes for revascularization decisions based on in-lab coronary physiology in many patients. The use of coronary physiology in the laboratory has been identified as a class IIa recommendation for patients in whom the clinical presentation and supporting data are too inconclusive to make an objective decision regarding treatment. This article reviews pertinent concepts and studies of the more complex applications of translesional pressure measurements for optimal patient outcomes.
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