Thomas W. Smith

Renal Frame Count and Renal Blush Grade: Quantitative Measures That Predict the Success of Renal Stenting in Hypertensive Patients With Renal Artery Stenosis

OBJECTIVESnThis study sought to identify angiographic parameters of favorable clinical response to renal artery stenting.nnnBACKGROUNDnStenting improves blood pressure (BP) control in patients with renal artery stenosis (RAS), but markers predicting a favorable clinical response are limited.nnnMETHODSnRenal perfusion was quantified in hypertensive patients (BP >or=140/90 mm Hg) without RAS by determining renal frame count (RFC) (angiographic frames [30 frames/s] for contrast to reach distal renal parenchyma after initial renal artery opacification) and renal blush grade (RBG) (0: none, 1: minimal, 2: normal, 3: hyperemic parenchymal blush). It was hypothesized that stenting unilateral RAS in hypertensive patients would result in decreased RFC and increased RBG, which might predict BP reduction.nnnRESULTSnThe RFC in 17 consecutive hypertensive patients without RAS (control group) (64.4 +/- 14.2 years, 12 male, 22 kidneys) was 20.1 +/- 5.4, whereas RBG was 2.33 +/- 0.66. In 24 consecutive hypertensive patients with unilateral RAS (study group) (72.7 +/- 11.3 years, 8 male), reduced RFC (26.6 +/- 9.1 to 21.4 +/- 6.7, p < 0.001) and increased RBG (1.63 +/- 0.71 to 2.13 +/- 0.85, p = 0.03) were observed after renal stenting. At 6 months, reduced BP (systolic BP 150.6 +/- 15.6 mm Hg to 128.6 +/- 15.5 mm Hg, p < 0.001; diastolic BP 77.2 +/- 15.6 mm Hg to 68.3 +/- 10.4 mm Hg, p = 0.022) without change in number of hypertensive medications was observed. Clinical responders (systolic BP reduction >15 mm Hg) had a greater decrease in RFC (7.7 +/- 4.6 vs. 1.7 +/- 5.1, p = 0.009) and 78.6% of patients with >4 RFC decrease were responders (p = 0.024).nnnCONCLUSIONSnThis study shows that quantitative indices of renal perfusion (RFC and RBG) are impaired in patients with RAS and improve after stenting, and that RFC reduction is associated with BP reduction.

Combined MitraClip Edge-to-Edge Repair With Millipede IRIS Mitral Annuloplasty

Because multiple mechanistic etiologies of mitral regurgitation (MR) frequently coexist, there has been interest in combining or sequentially staging transcatheter approaches to eliminate MR. Combined therapies can be performed together at the time of initial treatment, or they can be staged for the

Usable implantation depth for watchman left atrial appendage occlusion is greater with appendage angiography than transesophageal echocardiography

To compare left atrial appendage (LAA) angiography to transesophageal echocardiography (TEE) for assessing usable LAA depth.

Initial clinical experience with the FlexPoint Steerable Transseptal Needle in left-sided structural heart procedures

The purpose of this study is to describe the initial clinical experience with a steerable transseptal needle (STSN) for left‐sided structural heart procedures.