Key Points
Vascular complications plague patients treated with mechanical circulatory support.
These complications are associated with significant morbidity and risk erasing the benefits of the ...technology.
Standardized care with across the spectrum of indication, access, care, and ultimate removal of mechanical support is a promising concept to reduce complications in this high‐risk patient group.
Key Points
Use of bare metal stents (BMS) saw a significant decline between 2013 and 2017 across 18 medical centers in Italy.
Indications for BMS most frequently included perceived risk of thrombosis ...during STEMI therapy or bleeding in the elderly or others from prolonged antiplatelet therapy despite information that was available to the contrary.
Persistent use of BMS represents an example of the problem of unlearning old information so that new and better practice patterns can be incorporated into practice.
Key Points
Published data on distal radial access has increased since its introduction via the Internet several years ago.
Based on reports of over 4,000 procedures the success with the distal radial ...approach appears to be similar to that of tradition radial when good pulses are available.
The distal radial approach may have advantages with preservation of radial artery function after catheterization.
Key Points
Publications concerning the dorsal radial approach have proliferated providing an opportunity to evaluate the present state of knowledge with meta‐analysis.
Advantage to the dorsal radial ...compared to conventional radial access include less radial artery occlusion, quicker hemostasis time and less bleeding.
Disadvantages to dorsal radial continue to be an increased access time and greater risk of cross‐over, both characteristics that may be attenuated by experience.
Key Points
Patients undergoing percutaneous coronary intervention (PCI) in the state of Michigan have more comorbidities compared to patients undergoing PCI in the United Kingdom.
While the adoption ...of radial artery access for PCI has increased steadily over time in both Michigan and the United Kingdom, the use of radial access was significantly greater in the UK at all time points compared to Michigan for all PCI indications.
The use of mechanical support during PCI has increased over time in Michigan but decreased over time in the United Kingdom.
Key Points
Limb dysfunction is common after radial access although many show dysfunction at baseline.
Thrombosis may be present in the radial artery but is not necessary to manifest limb dysfunction.
...The role of periarterial nerve damage to this syndrome remains uncertain.
Key Points
Paravalvular leak closure may have a therapeutic effect on the extent of hemolysis that some patients experience after valve surgery.
Reduction of hemolysis is most likely in a patient ...with a mechanical valve and is not necessarily correlated with the volume of regurgitative flow or its subsequent reduction.
Hemolysis associated with biological valves are less likely to respond to perivalvular leak closure suggesting that mechanisms other than net volume of regurgitation or micro‐jets are present and should be considered.
Key Points
The incidence of gastrointestinal (GI) bleeding after percutaneous coronary interventional has remained stable recently although those undergoing treatment for ST‐elevation myocardial ...infarction appear to be doing better.
Short‐term prognosis is worsened after a GI bleed and this adverse outcome persists out to at least 1 year.
Poor outcomes late after a GI bleed suggest persistence patient factors that require further study to understand who is at risk, whether short‐term measures can prevent bleeding, and whether interventions after bleeding can improve long‐term outcomes.
