The role of preoperative venography in predicting the difficulty of a transvenous lead extraction procedure

Introduction: We hypothesized that an accurate assessment of preoperative venography could be useful in predicting transvenous lead extraction (TLE) difficulty. Methods and Results: A dedicated preoperative venogram was performed in consecutive patients with cardiac implantable electronic device who underwent TLE. The level of stenosis was classified as without significant stenosis, moderate, severe, and occlusion. The presence of extensive lead-venous wall adherence (≥50 mm) was also assessed. A total of 105 patients (median age: 71 years; 72% male) with a median of 2 (1–2) leads to extract were enrolled. Preoperative venography showed moderate to severe stenosis in 31 (30%), complete occlusion in 15 (14%), and extensive lead-venous wall adherence in 50 (48%) patients. Complete TLE success was achieved in 103 (98%) patients. A total of 55 (52%) were advanced extractions as they required a powered mechanical and/or laser sheath. They were more prevalent in the group with extensive lead-venous wall adherence (72% vs. 34%, p <.001), while no differences were found between patients with and without venous occlusion. In multivariate analysis, the presence of adherence was a predictor of advanced extraction (odds ratio: 2.89 [1.14–7.32], p =.025). The fluoroscopy time was also significantly longer (14.0 [8.2–18.7] vs. 5.1 [2.1–10.0] min, p <.001). The rate of complications did not differ based on the presence of venous lesions. Conclusion: Although procedural success and complication rates were similar, patients with extensive lead-venous wall adherence required a longer fluoroscopy time and were three times more likely to need advanced extraction tools. Conversely, the presence of total venous occlusion had no impact on the procedure complexity

Radial artery anomalies in patients undergoing transradial coronary procedures – An Egyptian multicenter experience

Objectives: We investigated the incidence of radial anomalies (RA) in patients undergoing transradial (TR) coronary procedure and their impact on procedural outcome in the Egyptian population. Background: Radial anomalies (RA) are considered an important factor for procedural failure. Information about anatomical variation is limited in our Egyptian population. Methods: We performed a multicentre prospective study in Egypt. A total of 650 consecutive patients undergoing their first TR coronary procedure were recruited from January 2013 till January 2015. By retrograde radial arteriography we assessed the frequency of RA and their impact on procedural outcome. Results: 650 consecutive patients were studied, 74% male, mean (SD) age 55 (10) years. The overall incidence of radial artery anomaly was 12.6% (n = 82). 40 (6.2%) patients had a high-bifurcating radial origin, 8 (1.2%) had a full radial loop, 14 (2.1%) had extreme radial artery tortuosity and 20 (3%) had other anomalies such as persistent left subclavian artery and extreme subclavian tortuosity. Overall transradial procedural success was 95%. Procedural failure was more common in patients with anomalous anatomy (39%) than in patients with normal anatomy (0.2%). Procedural failure was highest in patients with radial loop (87.5%), followed by those with subclavian tortuosity (45%), then high radial bifurcation (30%), and severe radial tortuosity (28.5%). 14 (2.1%) vascular complications occurred, all of which were treated conservatively. Conclusion: There is a relatively significant presence of radial anomalies, with different degrees of impact on procedural failure rate, in our Egyptian population. Further collaborative studies are recommended to increase our success rates

Study of MRI brain findings and carotid US features in systemic sclerosis patients, relationship with disease parameters

Abstract Background/objectives Systemic sclerosis (SSc) is an autoimmune disease associated with immune abnormalities and widespread vascular lesions, including increased intimal and medial thickness. These changes may be reflected in early atherosclerosis and cardiovascular risks. We aimed in this study to examine the carotid artery intima-media thickness and MRI brain findings in SSc patients and compared them to a group of normal controls. A relationship between these parameters and clinical measures in SSc was also sought. Methods Seventy-two SSc patients with no central nervous system (CNS) symptoms and 42 healthy controls were included. Clinical and laboratory measures, Medsger’s severity scale, and Doppler ultrasound common carotid artery intima-media thickness (CCA-IMT) were measured. Brain fluid-attenuated inversion recovery (FLAIR)-MRI and diffusion-weighted MRI (DWI) were also done. Results SSc patients had more CCA-IMT, higher CRP, and more brain MRI hyperintense lesions than controls (P < 0.05). Significant positive correlations existed between CCA-IMT and Medsger vascular (r = 0.7, P = 0.02). The FLAIR-MRI showed multiple hyperintense lesions in 24 patients (33%), ranging 0–36 lesions. SSc patients with more lesions (positive MRI) had longer disease duration (P = 0.001) and left and right carotid artery atheromata (P = 0.001, and 0.013, respectively) than SSc patients with negative MRIs; Medsger vascular score did not separate the SSc groups (P = 0.08). Conclusions In systemic sclerosis patients without central nervous system symptoms, MRI lesion numbers correlated with CCA-IMT. MRI abnormalities were found more frequently if CRP was elevated, if the Medsger SSc Severity Scale was increased, or if there was thickened carotid IMT

Dual antiplatelet therapy duration after coronary stenting in clinical practice: results of an EAPCI survey

Aims: Our aim was to report on a survey initiated by the EuropeanAssociation of Percutaneous Cardiovascular Interventions (EAPCI) concerning opinion on the evidence relating to dual antiplatelet therapy (DAPT) duration after coronary stenting.Methods and results: Results from three randomised clinical trials were scheduled to be presented at the American Heart Association Scientific Sessions 2014 (ARIA 2014). A web-based survey was distributed to all individuals registered in the EuroIntervention mailing list (n=15,200) both before and after ARIA 2014. A total of 1,134 physicians responded to the first (i.e., before AHA 2014) and 542 to the second (i.e., after ARIA 2014) survey. The majority of respondents interpreted trial results consistent with a substantial equipoise regarding the benefits and risks of an extended versus a standard DAPT strategy. Two respondents out of ten believed extended DAFT should be implemented in selected patients. After ARIA 2014, 46.1% of participants expressed uncertainty about the available evidence on DAFT duration, and 40.0% the need for clinical guidance.Conclusions: This EAPCI survey highlights considerable uncertainty within the medical community with regard to the optimal duration of DAFT after coronary stenting in the light of recent reported trial results. Updated recommendations for practising physicians to guide treatment decisions in routine clinical practice should be provided by international societies