Hooman Madyoon

Unprotected carotid artery stenting compared to carotid endarterectomy in a community setting.

Purpose: To evaluate the feasibility and safety of carotid artery stenting (CAS) performed by a dedicated multidisciplinary team in a community hospital. Methods: Forty-nine patients (30 men; mean age 74.3 ± 7.4 years, range 51–88) with 14 symptomatic and 35 asymptomatic >50% carotid stenoses were enrolled into the study and treated with self-expanding stents without cerebral protection. The patients were evaluated at 30 days for death, neurological sequelae, and length of stay. A contemporaneous group of 140 patients (80 men; mean age 72.3 ± 7.7 years, range 43–89) undergoing carotid endarterectomy (CEA) was used for comparison of the outcome measures. Owing to crossover of failed CAS patients to the CEA group, the data were analyzed according to intention-to-treat and treatment-received. Results: The only difference in baseline characteristics between the treatment and control groups was the greater frequency of bilateral disease in the CEA group (p=0.009). The CAS procedures were successful in 47 (96.0%) patients; 2 access failures were converted to endarterectomy, and 1 access-site pseudoaneurysm was treated surgically. There were no deaths or myocardial infarctions in either group. In the CAS group, there were no major and only 2 (4.1%) minor strokes compared to 4 (2.9%) major and 4 (2.9%) minor strokes in the CEA group (p>0.05). Median LOS was significantly lower in the CAS group (p<0.0001). Conclusions: Careful case selection and multidisciplinary collaboration facilitate the safe performance of carotid stenting in a community setting with acceptable early results.

Clot Extraction With the FlowTriever Device in Acute Massive Pulmonary Embolism

Clinical guidelines support the use of systemic thrombolytic therapy for acute massive pulmonary embolism (PE). When anticoagulation and thrombolysis fail or are contraindicated, options become limited. We report an acute PE case in which treatment options were limited, and a novel device, the FlowTriever (Inari Medical, Irvine, California), was successfully used. This is the first case report of the use of this device that we are aware of.

TCT-772 High prevalence of pelvic venous compression syndrome among patients with chronic venous insufficiency and effective treatment with venous stenting

May-Thurner Syndrome is the pathologic compression of the L common iliac vein by the R common iliac artery and has an incidence of 22%, in a cadaver study. Venous compression syndrome (VCS) can also occur in the external iliac, common femoral vein and R sided veins as well. VCS prevalence ranges

TCT-784 An Innovative MRA Technique for Simultaneous Imaging of Artery and Vein for Diagnosis of Venous Compression Syndrome

METHODS From January 2008 to May 2015, a total of 226 consecutive patients with 250 wounds underwent complete angiosome-targeted PTA for only ischemic foot wound and multi-vessel BTK artery disease. We evaluated the clinical outcome of angiosome-targeted single-vessel versus multi-vessel PTA. The primary endpoint was defined as the complete wound healing within 12 months without death before wound healing, unexpected amputation or flap or target vessel revascularization, or death. The secondary endpoint of the study was the major adverse limb event (MALE) at 1 year.

Impact of ranolazine on myocardial metabolic ischemia detected by phosphorus-31 magnetic resonance spectroscopy

Background Ranolazine (RAN) is a novel late sodium current inhibitor, effective in treating angina pectoris in patients with chronic stable CAD. Its therapeutic effectiveness is not well understood. It is thought to reduce myocardial energy utilization by enhancing diastolic relaxation and by increasing myocardial blood flow. The purpose of the present study is to define the mechanism for the effectiveness of RAN. We applied myocardial phosphorus-31 magnetic resonance spectroscopy (P-31 MRS) at rest and during handgrip stress to demonstrate the relationship between RAN treatment and stress-induced energy utilization with myocardial ischemia.

TCT-312 Coronary Plaque Regression by 64-Slice Computed Tomography Coronary Angiography (CTCA): Pipe Dream or Real Possibility

Background: Fractional flow reserve (FFR) is a “golden standard” in determining hemodynamic significance of ambiguous lesions and provides guidance on appropriateness of revascularization. The cut-off values for intravascular ultrasound (IVUS) parameters corresponding to FFR of 0.75 or 0.80 are still under investigation. The aim of this study was to determine best IVUS criteria for predicting physiological significance of left main coronary artery (LMCA) stenosis with FFR as the standard. Methods: FFR values during adenosine infusion (at the rate of 140 g/kg/min femoral vein) were calculated in 99 patients aged 58 10 years with an angiographically ambiguous LMCA stenosis. Subsequently, all patients underwent IVUS with automatic pullback at a constant speed of 0.5 mm/sec., from the middle segment of left descending artery (LAD) to the aorto-ostial junction of LMCA. The following IVUS parameters were analyzed: minimum lumen area (MLA, mm), minimum lumen diameter (MLD, mm), the maximum plaque burden (PB, %), and percent area stenosis (%AS, %). Results: The averaged FFR was 0.77 0.10 (range 0.51-0.99). FFR 0.75 was observed in 42 patients (42.4%). Linear regression analysis revealed a strong correlation between the values of FFR and MLA (AUC 0.86, p 0.001), PB (AUC 0.64, p 0.03), %AS (AUC 0.72, p 0.0002) and the MLD (AUC 0.75, p 0.0001). Cut off points for the value of FFR 0.75 were: 5.9 mm for MLA (sensitivity 0.69 and specificity 0.85), 59.7% for PB (sensitivity 0.77 and specificity 0.48), 36% for %AS (sensitivity 0.94 and specificity 0.44) and 2.9 mm for MLD (sensitivity 0.97 and specificity 0.50), respectively. Conclusions: Strong correlation between FFR and LMCA lesion critical IVUS parameters was found in our patient group. MLA value of 5.9 mm in IVUS seems to be a useful criterion for predicting FFR 0.75.