Erdem Özel

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

Medical treatment of an adult with uncorrected isolated interrupted aorta resulted in no complications after 4 years of follow-up.

Patient: Female, 56 Final Diagnosis: Isolated adult interrupted aortic arch Symptoms: Headache • hypertension • left ventricular hypertrophy Medication: — Clinical Procedure: — Specialty: Surgery Objective: Congenital defects/diseases Background: Interrupted aorta is a rare congenital malformation defined as the lack of continuity between the ascending and descending parts of the aorta. Case Report: This malformation was first described by Steidele in 1778. To date a few isolated adult interrupted aortic arch patients have been reported and most of them were treated surgically. However, there is not data about outcome of patients who decline surgery or who are not good candidates for surgery because of excessive risks, and there is not a data about how to follow these patients. Conclusions: Herein we present a case of adult type A isolated interrupted aorta followed-up for 4 years by medical therapy without complications.

Percutaneous right atrial pacemaker lead repositioning using a regular deflectable ablation catheter

Lead dislocation is one of the most undesired complications of permanent pacemaker implantation. The rate of dislodgement of atrial pacing leads is nearly 3% [1]. Reopening the pacemaker pocket and repositioning the lead is the most commonly used technique for correcting dislocations which occur in the early period after implantation. However, this increases the risk of pocket infection and increases lead insulation problems. Snare systems and urological baskets have also been used for repositioning atrial leads [2, 3]. We report a patient who experienced dislodgement of the atrial pacemaker lead of a cardiac resynchronization therapy (CRT) device, which was corrected using a regular deflectable ablation catheter by the transfemoral route. n nA 77-year-old female patient with severe ischemic left ventricular dysfunction and wide QRS had received a CRT device. At the follow-up 1 week after the procedure, atrial sensing and pacing dysfunctions were detected. Fluoroscopy revealed dislodgement of a passive fixation J-shaped atrial lead. Lead repositioning via a percutaneous transfemoral approach was planned to avoid surgical revision. A regular deflectable ablation catheter (steerable 4-mm-tip ablation catheter, Mariner, Medtronic, Minneapolis, USA) was advanced to the right atrium through a 7 Fr introducer from the right femoral vein. We propagated the ablation catheter above the level of the atrial lead and made an anteflexion to the distal portion of the catheter. We captured the distal loop of the atrial lead, then with a slight counterclockwise rotation and pull back we oriented the atrial lead towards the right atrial appendage (Figure 1). The lead functions were normal after the intervention. The patient was discharged the next morning and had normal pacemaker functions at follow-up. n n n nFigure 1 n nSuccessful atrial lead reposition by deflectable ablation catheter n n n nEarly lead displacements after pacemaker implantations are the most frequent cause of reintervention in the majority of patients. We performed successful atrial lead repositioning with a deflectable ablation catheter by the percutaneous approach without the need for a surgical operation. However, this technique has a number of contraindications. Percutaneous lead repositioning can only be performed on patients who have passive fixation electrodes and leads with suitable loop anatomy. Conditions which necessitate the removal of the dislocated lead such as serious insulation problems are another contraindication for percutaneous lead repositioning. Repositioning of active fixation leads should be performed surgically. Since our case had a passive fixation atrial lead and a suitable loop anatomy, it was possible to perform the procedure safely. However, operators need to be cautious about dislodgement of other stable leads while performing the procedure, especially in patients with an implanted CRT. Favale et al. reported successful percutaneous atrial lead repositioning in 2 patients with permanent pacemakers and in 1 patient with an implantable cardioverter defibrillator [4]. We believe that our paper is the first one to report percutaneous atrial lead repositioning with a regular deflection ablation catheter in a patient with a CRT device. n nAlthough it needs some experience, percutaneous transfemoral lead repositioning is a much less invasive technique and may be preferred as a first-step approach if the patient has acceptable loop anatomy of the atrial lead.

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.

An Extremely Rare Reason for Failure of Left Sided Pacemaker Implantation

We reported a case of isolated anomaly of the left brachiocephalic vein which is diagnosed during a permanent pacemaker implantation. It is a very rare anomaly and makes the left sided pacemaker implantation impossible.