Ahmet Taştan

GuideLiner catheter application in complex coronary lesions: experience of two centers

Objective: GuideLiner catheter provides adequate back-up support and a coaxial guide engagement for stent delivery in complex coronary anatomies. In this study, we aimed to present one of the largest series of experience with GuideLiner catheter utilized for challenging percutaneous coronary interventions in two centers. Methods: We retrospectively collected the coronary angiography records of 64 patients between January 1, 2012 and August 1, 2014 in whom conventional techniques failed for stent delivery and 5-in-6 Fr GuideLiner catheter was used for this purpose. The data were assessed in terms of the lesion characteristics, procedural success, and complications. Descriptive statistics and frequencies were used in statistical analyses. Results: The mean age of the patients was 69.8±10.0 years. Femoral approach was employed in all cases. Lesions were mostly (90.6%) class B2 or C according to the AHA/ACC lesion classification. The GuideLiner catheter was mainly used to increase back-up of the guide catheter (85.9%), and in 95.3% of all cases, the procedure was successful. The mean depth of the GuideLiner catheter intubation was 30.3±21.6 mm. None of the patients had coronary dissection or major complications. Conclusion: In this study, we presented a large registry of two centers used the GuideLiner catheter. The device effectively allowed stent delivery in challenging lesions, where conventional techniques have failed, without major complications.

Procedural and one-year clinical outcomes of bioresorbable vascular scaffolds for the treatment of chronic total occlusions: a single-centre experience

Summary Introduction The bioresorbable vascular scaffold system (BVS) is the latest fully absorbable vascular therapy system that is used to treat coronary artery disease. The BVS has been used in different coronary lesion subsets, such as acute thrombotic lesions, bifurcation lesions, ostial lesions and lesions originating from bypass grafts. However, data about the use of BVS in chronic total occlusions (CTO) are limited. We report our BVS experience for the treatment of CTOs in terms of procedural features and one-year clinical follow-up results. Methods An analysis was made of 41 consecutive patients with CTO lesions who were referred to our clinic between January 2013 and December 2014. A total of 52 BVS were implanted. An analysis was made of patient characteristics, procedural features [target vessel, BVS diameter, BVS length, post-dilatation rate, type of post-dilatation balloon, procedure time, fluoroscopy time, contrast volume, postprocedure reference vessel diameter (RVD), post-procedure minimal lesion diameter (MLD), type of CTO technique and rate of microcatheter use] and one-year clinical follow-up results [death, myocardial infarction, angina, coronary artery bypass graft (CABG), target-lesion revascularisation (TLR) and target-vessel revascularisation (TVR)]. Descriptive and frequency statistics were used for statistical analysis. Results The mean age of the patient group was 61.9 ± 9.7 years, 85.4% were male, and 51.2 % had diabetes. Prior myocardial infarction incidence was 65.9%, 56.1% of the patients had percutaneous coronary intervention and 17.1% had a previous history of CABG. The procedure was performed via the radial route in 24.3% of the patients. The target vessel was the right coronary artery in 48.7% of the patients. Post-dilatation was performed on the implanted BVS in 97.5% of the patients, mainly by non-compliant balloon; 87.8% of the BVS were implanted by the antegrade CTO technique. Mean procedure time was 92 ± 35.6 minutes. Mean contrast volume was 146.6 ± 26.7 ml. At one year, there were no deaths. One patient had lesionrelated myocardial infarction and needed revascularisation because of early cessation of dual anti-platelet therapy. Eleven patients had angina and five of them needed target-vessel revascularisation. Conclusions BVS implantation appeared to be effective and safe in CTO lesions but randomised studies with a larger number of patients and with longer follow-up times are needed

Are all patients with psoriasis at increased risk for coronary artery disease

Associations have been recently recognized between psoriasis and an increased incidence of atherosclerotic diseases. However, there are scarce data on the prevalence of coronary lesions in patients with psoriasis. The aim of this study was to identify the calcified and non‐calcified atherosclerotic coronary lesions in patients with psoriasis compared to controls. Forty patients with psoriasis and 42 control subjects matched for age, sex, and cardiovascular risk profile were included in this case–control study. Coronary lesions were evaluated by a 128‐slice dual source multidetector computed tomography scanner. Coronary calcification scoring was calculated according to the Agatston score. The prevalence of atherosclerotic coronary lesions (psoriasis: 15%, controls: 16.7%; P = 0.83) and the mean coronary calcification scoring (psoriasis: 9.9 ± 35.2 Agatston unit, controls 2.8 ± 12.0 Agatston unit; P = 0.81) did not show a significant difference between the two groups. Multivariate analysis identified age ≥48 years and fasting blood glucose ≥99.0 mg/dl as independent predictors of coronary artery disease in patients with psoriasis (F = 30.9; P = 0.001; adjusted R2 = 0.49). Patients with psoriasis had the same prevalence of calcified and non‐calcified atherosclerotic coronary lesions as compared to controls. Our results demonstrated the necessity of considering the age and fasting blood glucose of patients with psoriasis in a decision for further cardiovascular evaluation.

Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty: which is preferable?

Summary Background Percutaneous balloon mitral valvuloplasty (BMV) is an important option for the treatment of mitral valve stenosis. The crux of this process is choosing the appropriate Inoue balloon size. There are two methods to do this. One is an empirical formula based on the patient’s height, and other is to choose according to the maximal inter-commissural distance of the mitral valve provided by echocardiography. Methods The study, performed between January 2006 and December 2011, included 128 patients who had moderate to severe mitral stenosis and whose valve morphology was suitable for BMV. Patients were randomised into two groups. One group was allocated to conventional height-based balloon reference sizing (the HBRS group) and the other was allocated to balloons sized by the echocardiographic measurement of the diastolic inter-commissural diameter (the EBRS group). Results BMV was assessed as successful in 60 (92.3%) patients in the HBRS group and in 61 (96.8%) in the EBRS group (p = 0.03). The mean of the calculated balloon reference sizes was significantly higher in the HBRS than in the EBRS group [26.3 ± 1.2 mm, 95% confidence interval (CI): 26.1–26.6 vs 25.2 ± 1.1, 95% CI: 25.0–25.4, respectively; p = 0.007). Final mitral valve areas (MVA) were larger and mitral regurgitation (MR) > 2+ was less in the EBRS group (p = 0.02 and p = 0.05, respectively). Conclusions EBRS is a method that is independent of body structure. Choosing Inoue balloon size by measuring maximal diastolic annulus diameter by echocardiography for BMV may be an acceptable method for appropriate final MVA and to avoid risk of significant MR.

Use of guideliner cathater in saphenous vein graft: A case report

Guideliner catheter (Vascular Solutions, Minneapolis, MN) is a novel, rapid exchange system which allows deep intubation and facilitate equipment delivery through the complex coronary lesions. We describe the use of this device in a percutaneous intervention of a native diagonal lesion through tortious and calcific saphenous vein graft.

Role of Autonomic Dysfunction and Relation with Diastolic Dysfunction in Resistant Hypertensives

PP-017nnThere may be a role of autonomic dysfunction and sympathetic overactivity in the development of hypertension. The risks of cardiovascular events and target organ damage are much more in resistant hypertension. In recent years; renal denervation therapies have become more popular for drug-