William Rollefson

Percutaneous Implantation of A Parachute Device For Treatment of Ischemic Heart Failure

Congestive heart failure (CHF) secondary to ischemic cardiomyopathy is associated with significant morbidity and mortality despite currently available medical therapy. The Parachute(TM) device is a novel left ventricular partitioning device that is delivered percutaneously in the left ventricle (LV) in patients with anteroapical regional wall motion abnormalities, dilated LV and systolic dysfunction after anterior myocardial infarction with favorable clinical and LV hemodynamic improvements post-implantation. Here, we do review the current literature and present a case of the Parachute device implantation.

Immediate and intermediate-term results of optical coherence tomography guided atherectomy in the treatment of peripheral arterial disease: Initial results from the VISION trial

BACKGROUND Long-term patency rates for percutaneous peripheral arterial interventions are suboptimal. Optical coherence tomography (OCT) guided atherectomy may yield superior patency by optimizing plaque removal while preserving the tunica media and adventitia. METHODS The VISION study is a multicenter prospective study of patients with peripheral arterial disease undergoing OCT guided atherectomy with the Pantheris™ device. In 11 patients enrolled in a single center, we report procedural and clinical outcomes, at 30days and 6months. RESULTS The mean age was 63±11years and 73% (n=8) were men. The target lesion was in the superficial femoral artery in 82% (n=9) of the patients. Mean stenosis severity was 87%±10% and mean lesion length was 39±31mm. Procedural success was observed in all patients with no device related complications. Mean post-atherectomy stenosis was 18%±15%. Almost all excised tissue consisted of intimal plaque (94%). At 30days, significant improvements in Rutherford class, VascuQoL scores and ABI were observed, 0.9±0.8 vs. 3.1±0.7 (p=0.01), 4.9±1.9 vs. 3.6±1.5 (p=0.03) and 1.04±0.19 vs. 0.80±0.19 (p<0.01) respectively. At 6months, there were significant improvements in Rutherford class (1.0±1.0 vs. 3.1±0.7, p=0.01) and ABI (0.93±0.19 versus 0.80±0.19, p=0.02) but not in VascuQoL scores (3.7±1.4 versus 3.6±1.5, p=0.48). Target lesion revascularization occurred in 18% (n=2) of the patients. CONCLUSION OCT guided atherectomy resulted in high procedural success, no device related complications and encouraging results up to 6months. Histological analysis suggested little injury to the media and adventitia. Larger studies are needed to confirm the efficacy of this approach.

Endovascular management of splenic arterial aneurysms

Splenic artery aneurysms are the third most common arterial aneurysms ranging from 0.6 to 30 cm in diameter. They are most commonly found women and in patients with cirrhosis and portal hypertension. The majority of patients are asymptomatic [1]. The causes of splenic artery aneurysm formation remain unknown. Atherosclerosis, focal arterial inflammation, pancreatitis, hypersplenism, portal hypertension, trauma, and hormonal and hemodynamic changes due to pregnancy have been proposed as contributing mechanisms [2]. Ultrasound is the first screening imaging modality, while computed tomography (CT) and magnetic resonance imaging (MRI) angiography allow the accurate description of the morphology and location of the aneurysm along with possible adjacent anatomic pathologies. Overall, the life-time risk of rupture is 2–10% with an associated mortality of up to 25%. The risk of rupture is approximately three times more in men and in smokers [1,3]. Currently, there is no data describing risk factors for splenic artery aneurysm rupture, even in relation to the lesion location or size. Smaller, incidentally identified splenic aneurysms are benign with minimal risk of symptom development, enlargement or rupture. According to the ACC/AHA guidelines open or percutaneous management of such aneurysms is recommended for visceral aneurysms measuring 2.0 cm in diameter or larger [4]. Options include open surgical, laparoscopic and endovascular approach. In the past open laparotomy with aneurysm ligation or splenectomy with potential distal pancreatectomy was the gold standard for the treatment of SAA [5,6]. However, surgical or laparoscopic management may be technically difficult in patients with arterial anomalous variations (especially retro-pancreatic course of the SAA), severe anemia or Jehovah witnesses [5]. Emergent open surgery carries a high peri-operative mortality of 20–40% especially in patients with portal or systemic hypertension, while in elective cases it is approximately 5% [7]. Coil embolization is currently the most common endovascular technique to occlude the aneurysmal sac in SAAs with narrow necks. With optimal patient selection it appears to be simple, safe with low rates of recurrence [5,8]. Need for reintervention or major splenic infarction occurs in less than 10% of the cases in patients with normal hepatosplenic function, while complication increases in patients with portal hypertension [8]. Gelfoam, glue, thrombin or the Amplatzer vascular plug (AVP) embolization have also been successfully tried [9–12]. In larger vessels with complex wide-neck aneurysms, covered stents or stent assisted coil embolization (cage– coil technique: self-expanding stent placement and delivery of the coils to the aneurysmal sac through the stent struts) has been successfully tried [13–16]. When collateral circulation is well developed the “sandwich technique” involves complete occlusion of the splenic artery with coiling of the efferent and the afferent vessel [17,18]. Pappy et al. have described a unique “modified neck remodeling technique” for large wide-neck aneurysms with temporary balloon inflation at the efferent splenic artery during coil embolization, in order to decrease the intra-aneurysm pressure and prevent distal non-target coil embolization [19]. A 65-year-old gentleman with prior history of hypertension, and chronic bronchitis was referred with a 2.7 cm narrow neck splenic artery aneurysm for endovascular management (Figs. 1, 2). The procedure was performed in the catheterization laboratory under conscious sedation. A short 6-French hydrophilic sheath was placed in the left radial artery. A Tiger catheter (Terumo Interventional Systems) was positioned at the origin of the celiac artery where selective angiography was performed (Fig. 3). A 4F Glidecath (Terumo Interventional Systems) was advanced into the aneurysm sac with the assistance of a 0.018-inch guidewire. Angiography was performed through the Glidecath to accurately describe the aneurysm location and morphology. Four AZUR peripheral hydrocoils (Terumo Interventional Systems) were delivered in the aneurysm sac. Post-intervention angiography confirmed optimal

Same versus next day discharge after elective transradial PCI: The RAdial SAme Day DischArge after PCI trial. (The RASADDA-PCI trial)

BACKGROUND AND PURPOSE Transradial percutaneous coronary intervention (TR-PCI) has been increasingly popular over the last decade in the US. Previous studies have shown that same-day (SD) discharge after elective PCI is as safe as overnight (ON) observation. Our study was performed to assess the clinical and financial impact of early discharge in patients undergoing TR-PCI. METHODS This is a single center registry of patients undergoing elective TR-PCI. Timing of discharge was determined by the treating physician. (Groups: Same Day Discharge -SD-; Overnight Stay -ON-). Demographic data, procedural characteristics and adverse outcomes were recorded. Outcomes included 30 day-MACE and procedure- related complications, as well as total operative costs in patients from both groups. Propensity score matching for patient demographics, coronary symptoms and procedure indicators was used to compare both groups. RESULTS The entire cohort included 852 patients (429 in SD group and 423 in ON group) and the propensity score matched groups of 245 patients in the SD group and 245 patients in the ON group. The two groups had no significant baseline clinical differences, and had similar clinical outcomes. Specifically, no significant difference was noted in procedural complications (3.7% vs 2.5%, p = 0.43), re-hospitalization (4.1% vs 4.1%, p = 0.92), re-intervention (2.5% vs 2.1%, p = 0.77), myocardial infarction (0% vs 0.08%, p = 0.15), stroke (0% vs 0%, p = 1.0) and all-cause mortality (0% vs 0%, p = 1.0). SD Group patients had a significant lower procedure-related cost compared to overnight stay patients (

SAFETY AND EFFECT ON HEALTHCARE EXPENSES WITH SAME VERSUS NEXT DAY DISCHARGE AFTER ELECTIVE TRANSRADIAL PERCUTANEOUS CORONARY INTERVENTION

3,346.45 vs

Assessing myocardial viability using the coronary flow response to intravenous dobutamine infusion in recent myocardial infarction

4,681.99, p < 0.0001) and lower 30-day post procedure-associated cumulative costs/total operating costs (

Comparison of low-volume versus standard-volume left ventriculography†‡

4,493.22 vs

A poly-N-acetyl glucosamine hemostatic dressing for femoral artery access site hemostasis after percutaneous coronary intervention: a pilot study

7,112.21, p < 0.0001). CONCLUSION In elective patients undergoing low risk TR-PCI, same-day discharge seems to be a safe and feasible clinical practice, with significant potential savings to the US healthcare system.

Aortic annular rupture during TAVR: Mini review.

Background: Transradial (TR) PCIs have been progressively increasing over the last decade in the US. Previous studies have shown that same-day discharge after elective PCI is associated with similar safety compared to overnight observation. This study sought to assess the clinical and financial

TCT-275 Radial hemostasis is facilitated with a potassium ferrate hemostatic patch (Statseal): preliminary results from the randomized controlled Statseal with TR Band Assessment Trial (STAT)

Coronary flow response to low-dose (5 and 10 micrograms/kg/min) dobutamine infusion was used to assess myocardial viability at the time of cardiac catheterization in 13 patients (age, 60 +/- 11 years) with recent myocardial infarction. Echocardiographic improvement in regional wall motion performed 4 to 6 weeks after discharge was used as the marker for viability. Viable patients demonstrated a 2-fold increase in flow from baseline (p < 0.001) during intravenous infusion. In contrast, patients without viability demonstrated no increase in flow. The coronary flow response to dobutamine measured at the time of catheterization shows promise in identifying viable myocardium in postinfarction patients.