Timothy Shapiro

A randomized trial comparing compression, perclose proglide™ and Angio‐Seal VIP™ for arterial closure following percutaneous coronary intervention: The cap trial

Objective: This prospective randomized trial compared the Angio‐Seal VIP™ with Perclose Proglide™ and to manual compression with respect to time to hemostasis and ambulation, patient satisfaction, and vascular complications following percutaneous coronary intervention (PCI). Background: The use of arterial closure devices for the reduction of vascular complications following PCI remains controversial. There have been no head to head trials comparing these most commonly used arterial closure devices following PCI. Methods: Two hundred patients undergoing PCI were randomized to manual compression, Perclose Proglide™ or Angio‐Seal VIP™. Ambulation was allowed 3 hr after Perclose Proglide™ or Angio‐Seal VIP™ and 6 hr after compression. Results: There were 10 failures to deploy Perclose Proglide™ and none for Angio‐Seal™ (P < 0.01). Time to hemostasis was significantly shorter with Angio‐Seal VIP™ compared with Perclose Proglide™ (5.3 vs. 46.8 min, P < 0.01). Time to ambulation was shorter with Angio‐Seal VIP™ than with Perclose Proglide™ (261 vs. 334 min, P < 0.05) and the time to ambulation, as expected, was longest with compression (943 min, P < 0.01 vs. Angio‐Seal VIP™ and Perclose Proglide™). Delay in ambulation was higher with Perclose Proglide™ than with Angio‐Seal VIP™ (18 vs. 9, P < 0.01). There was no significant difference in major vascular complications between groups. Compared with compression, patient discomfort was significantly improved with Angio‐Seal™ (1.5 vs. 2.0, P < 0.01), but not with Perclose Proglide™. Conclusion: The Angio‐Seal VIP™ device has a high rate of deployment success, which is significantly better than that of Perclose Proglide™. Angio‐Seal VIP™ allows for earlier hemostasis and ambulation compared with both compression and Perclose Proglide™ and is associated with greater patient satisfaction compared with compression.

The relationship of obesity to ischemic outcomes following coronary stent placement in contemporary practice.

We analyzed the relationship of obesity, determined by body mass index (BMI), to short‐ and long‐term outcomes in the TARGET trial.

Incredibly late thromboses in first generation drug eluting stents: a case series.

BackgroundThe drug-eluting stents have decreased the incidence of instent restenosis compared to bare metal stents. But, the incidence of late and very late stent thrombosis has increased with the drug-eluting stents.Case presentationWe are here, reporting three cases of incredibly late instent thrombosis, each one occurring after more than 50 months of drug-eluting stent placement.ConclusionThe occurrence of stent thrombosis as late as 5 years has been reported in literature. This highlights the importance that there may be no limit to the time duration to the occurrence of very late stent thrombosis and dual antiplatelet therapy with aspirin and clopidogrel may have to be continued indefinitely in patients with drug-eluting stents.

Adoption of the transradial approach for percutaneous coronary intervention and rates of vascular complications following transfemoral procedures: Insights from NCDR

This study was designed to examine the association between adopting the transradial approach for percutaneous coronary intervention (PCI) and rates of vascular complications following transfemoral PCI.

THE ANGIO-SEAL EVOLUTION MULTICENTER REGISTRY: THE LEARNING CURVE ASSOCIATED WITH A NEW CLOSURE DEVICE

Methods: The Angio-Seal Evolution closure device (EVCD) was placed in 1,004 patients by 44 investigators at 10 sites undergoing cardiac catheterization (CATH) or intervention (PCI) from retrograde femoral artery access. Prior VCD and registry EVCD experience were assessed for each investigator. In-hospital and 30-day clinical follow-up including device deployment success, and major and minor vascular complications (VC) were obtained in all patients. The registry was approved by the Institutional Review Board of each site.