Coronary artery perforation(CAP) poses a significant challenge for interventional cardiologists. Management of CAP depends on the location and severity of the perforation. The conventional method for addressing the pe...Coronary artery perforation(CAP) poses a significant challenge for interventional cardiologists. Management of CAP depends on the location and severity of the perforation. The conventional method for addressing the perforation of large vessels involves the placement of a covered stent, while the perforation of distal and collateral vessels is typically managed using coils, autologous skin, subcutaneous fat, microspheres, gelatin sponge, thrombin or other substances. However, the above techniques have certain limitations and are not applicable in all scenarios. Our team has developed a range of innovative strategies for effectively managing CAP. This article provides an insightful review of the various tips and tricks for the treatment of CAP.展开更多
Coronary artery perforation(CAP)remains an infrequent but potentially lifethreatening complication during percutaneous coronary intervention(PCI).Although the prevalence of CAP is about 0.2%−0.9%in relatively low risk...Coronary artery perforation(CAP)remains an infrequent but potentially lifethreatening complication during percutaneous coronary intervention(PCI).Although the prevalence of CAP is about 0.2%−0.9%in relatively low risk PCI,the incidence could up to 9%in complex clinical scenarios such as severe coronary calcification,chronic total occlusions and rotational atherectomy.[1]Despite the new techniques and equipment had lower morbidity and mortality,up to 17%of acute CAP cases would evolve to tamponade and subsequent death.展开更多
In order to improve the success rate of chronic total occlusion (CTO)percutaneous coronary intervention (PCI), retrograde approach has been attracted more attention.Recent study reported the collateral perforation rat...In order to improve the success rate of chronic total occlusion (CTO)percutaneous coronary intervention (PCI), retrograde approach has been attracted more attention.Recent study reported the collateral perforation rate was 6.9% in retrograde CTO PCI.[1,2] Collateral related perforations were higher in patients with the epicardial collateral than that with the septal collateral.[3]Several techniques have been developed to deal with the collateral branch perforation.Here,we described the treatment of epicardial collateral branch perforation by absorbable suture segments embolization through microcatheter during retrograde CTO PCI.展开更多
No-reflow phenomenon is common in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI),and it is strongly associated with adverse clinical prognosis.Previous studies have shown that ...No-reflow phenomenon is common in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI),and it is strongly associated with adverse clinical prognosis.Previous studies have shown that heavy thrombus burden could predict the development of no-reflow in PCI.Manual and mechanical thrombus aspiration catheters are widely used;however,there is still residual refractory thrombus left after the routine use of thrombectomy,especially in patients with subacute myocardial infarction(SMI).In our practice,child catheter aspiration has been used as a safe and effective approach to solve the residual thrombus in SMI patients.We described this technique in detail by a series of cases.展开更多
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side...Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side branch are considered to be strong predictors of reduced technical success.[ 2,3] For such lesions, the antegrade approach may not be feasible or desirable, and the retrograde approach can be used as the initial crossing strategy. However, when treating the blunt CTO with a large side branch proximal to the occlusion, the side branch might be occluded after stent implantation if the retrograde guidewire passed the occluded segment through the subintimal space and re-entered into the true lumen at the opposite side of the side branch.[4] We reported a useful method to solve the above issue which utilizes intravascular ultrasound (IVUS) to guide “extended” reverse controlled antegrade and retrograde subintimal tracking (CART) technique with a cutting balloon.展开更多
Coronary embolism caused by the thrombus from guiding catheters is a rare and challenging complication,which may result in serious and fatal consequences due to the loss of blood flow of the coronary artery during per...Coronary embolism caused by the thrombus from guiding catheters is a rare and challenging complication,which may result in serious and fatal consequences due to the loss of blood flow of the coronary artery during percutaneous coronary intervention(PCI).Current strategies for the reduction of thrombus burden include pharmacological agents(typically glycoprotein IIb/IIIa platelet inhibitors),embolic protection devices(filters and distal balloon occlusion with aspiration),mechanical thrombectomy and manual or aspiration thrombectomy devices.[1]The above strategies are widely used as the first-line treatments,but have limitations for some refractory thrombus.A few techniques have been invented before to address this issue,[2–6]but they are not always effective or unavailable in some medical centers.展开更多
Background: Previous studies revealed that culprit vessels of ST-segment elevation myocardial infarction (STEMI) were often related to mild or moderate stenosis. However, recent studies suggested that severe stenos...Background: Previous studies revealed that culprit vessels of ST-segment elevation myocardial infarction (STEMI) were often related to mild or moderate stenosis. However, recent studies suggested that severe stenosis was primarily found in culprit lesions. The objective of this study was to analyze the stenosis severity of culprit lesions in STEMI patients and to clarity the paradoxical results. Methods: A total of 489 consecutive STEMI patients who underwent primary percutaneous coronary intervention were retrospectively studied from January 2012 to December 2014. The patients were divided into three groups based on stenosis severity using quantitative coronary analysis: Group A, 314 cases, stenosis 〉70%: Group B, 127 cases, stenosis 50-70%: and Group C, 48 cases, stenosis 〈_50%,. The clinical, demographic, and angiographic data of all groups were analyzed. Results: Patients in Group A exhibited a significantly higher prevalence of history of angina pectoris (95.9% vs. 62.5%, P 〈 0.001 ), inultivessel disease (73.2% vs. 54.2%, P = 0.007), and lower cardiac ejection ITaction (53.3 ± 8.6 vs. 56.8 ± 8.4, P = 0.009) than those in Group C. Multivariable analysis revealed that history of angina pectoris (odds ratio [OR]: 13.89, 95% confidence interval [(7]: 6.21-31.11 ) and multivessel disease (OR: 2.32, 95%, CI: 1.25-4.31 ) were correlated with severe stenosis of the culprit lesion in Group A. Conclusions: Most culprit lesions in STEM[ patients were severe stenosis. These patients exhibited a higher prevalence of angina history and multivessel diseases.展开更多
文摘Coronary artery perforation(CAP) poses a significant challenge for interventional cardiologists. Management of CAP depends on the location and severity of the perforation. The conventional method for addressing the perforation of large vessels involves the placement of a covered stent, while the perforation of distal and collateral vessels is typically managed using coils, autologous skin, subcutaneous fat, microspheres, gelatin sponge, thrombin or other substances. However, the above techniques have certain limitations and are not applicable in all scenarios. Our team has developed a range of innovative strategies for effectively managing CAP. This article provides an insightful review of the various tips and tricks for the treatment of CAP.
文摘Coronary artery perforation(CAP)remains an infrequent but potentially lifethreatening complication during percutaneous coronary intervention(PCI).Although the prevalence of CAP is about 0.2%−0.9%in relatively low risk PCI,the incidence could up to 9%in complex clinical scenarios such as severe coronary calcification,chronic total occlusions and rotational atherectomy.[1]Despite the new techniques and equipment had lower morbidity and mortality,up to 17%of acute CAP cases would evolve to tamponade and subsequent death.
文摘In order to improve the success rate of chronic total occlusion (CTO)percutaneous coronary intervention (PCI), retrograde approach has been attracted more attention.Recent study reported the collateral perforation rate was 6.9% in retrograde CTO PCI.[1,2] Collateral related perforations were higher in patients with the epicardial collateral than that with the septal collateral.[3]Several techniques have been developed to deal with the collateral branch perforation.Here,we described the treatment of epicardial collateral branch perforation by absorbable suture segments embolization through microcatheter during retrograde CTO PCI.
文摘No-reflow phenomenon is common in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI),and it is strongly associated with adverse clinical prognosis.Previous studies have shown that heavy thrombus burden could predict the development of no-reflow in PCI.Manual and mechanical thrombus aspiration catheters are widely used;however,there is still residual refractory thrombus left after the routine use of thrombectomy,especially in patients with subacute myocardial infarction(SMI).In our practice,child catheter aspiration has been used as a safe and effective approach to solve the residual thrombus in SMI patients.We described this technique in detail by a series of cases.
文摘Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side branch are considered to be strong predictors of reduced technical success.[ 2,3] For such lesions, the antegrade approach may not be feasible or desirable, and the retrograde approach can be used as the initial crossing strategy. However, when treating the blunt CTO with a large side branch proximal to the occlusion, the side branch might be occluded after stent implantation if the retrograde guidewire passed the occluded segment through the subintimal space and re-entered into the true lumen at the opposite side of the side branch.[4] We reported a useful method to solve the above issue which utilizes intravascular ultrasound (IVUS) to guide “extended” reverse controlled antegrade and retrograde subintimal tracking (CART) technique with a cutting balloon.
文摘Coronary embolism caused by the thrombus from guiding catheters is a rare and challenging complication,which may result in serious and fatal consequences due to the loss of blood flow of the coronary artery during percutaneous coronary intervention(PCI).Current strategies for the reduction of thrombus burden include pharmacological agents(typically glycoprotein IIb/IIIa platelet inhibitors),embolic protection devices(filters and distal balloon occlusion with aspiration),mechanical thrombectomy and manual or aspiration thrombectomy devices.[1]The above strategies are widely used as the first-line treatments,but have limitations for some refractory thrombus.A few techniques have been invented before to address this issue,[2–6]but they are not always effective or unavailable in some medical centers.
文摘Background: Previous studies revealed that culprit vessels of ST-segment elevation myocardial infarction (STEMI) were often related to mild or moderate stenosis. However, recent studies suggested that severe stenosis was primarily found in culprit lesions. The objective of this study was to analyze the stenosis severity of culprit lesions in STEMI patients and to clarity the paradoxical results. Methods: A total of 489 consecutive STEMI patients who underwent primary percutaneous coronary intervention were retrospectively studied from January 2012 to December 2014. The patients were divided into three groups based on stenosis severity using quantitative coronary analysis: Group A, 314 cases, stenosis 〉70%: Group B, 127 cases, stenosis 50-70%: and Group C, 48 cases, stenosis 〈_50%,. The clinical, demographic, and angiographic data of all groups were analyzed. Results: Patients in Group A exhibited a significantly higher prevalence of history of angina pectoris (95.9% vs. 62.5%, P 〈 0.001 ), inultivessel disease (73.2% vs. 54.2%, P = 0.007), and lower cardiac ejection ITaction (53.3 ± 8.6 vs. 56.8 ± 8.4, P = 0.009) than those in Group C. Multivariable analysis revealed that history of angina pectoris (odds ratio [OR]: 13.89, 95% confidence interval [(7]: 6.21-31.11 ) and multivessel disease (OR: 2.32, 95%, CI: 1.25-4.31 ) were correlated with severe stenosis of the culprit lesion in Group A. Conclusions: Most culprit lesions in STEM[ patients were severe stenosis. These patients exhibited a higher prevalence of angina history and multivessel diseases.