Very delayed coronary stent fracture: A case report

AbstractA stent fracture is an emerging complication of the coronary stents. There are numerous risk factors for stent fractures; which include forceful exaggerated motion in the atrioventricular groove seen in right coronary artery, long stent, an ostial lesion at the point of maximum curvature in a tortuous vessel, stent over-expansion, stent overlapping with different size stents, complex lesion after stenting of a totally occluded vessel, Cypher stent and a highly mobile segment causing high mechanical stress. Furthermore, chronic stretch at specific vessel sites as bends may lead to late occurrence of fracture.Here we report a case of 40-year-old male who had two overlapping Cypher stents (3.0×13mm and 2.75×18mm) deployed at mid left anterior descending artery 2 years earlier presented with progressive chest pain

Predictors of radial artery size in patients undergoing cardiac catheterization: Insights from the good radial artery size prediction (GRASP) study

Background: Radial artery occlusion occurs after transradial cardiac catheterization or percutaneous coronary intervention. Although use of a sheath larger than the artery is a risk factor for radial artery occlusion, radial artery size is not routinely measured. We aimed to identify bedside predictors of radial artery diameter. Methods: Using ultrasound, we prospectively measured radial, ulnar, and brachial artery diameters of 130 patients who presented for elective percutaneous coronary intervention or diagnostic angiography. Using prespecified candidate variables we used multivariable linear regression to identify predictors of radial artery diameter. Results: Mean internal diameters of the right radial, ulnar, and brachial arteries were 2.44 ± 0.60, 2.14 ± 0.53, and 4.50 ± 0.88 mm, respectively. Results for the left arm were similar. The right radial artery was larger in men than in women (2.59 vs 1.91 mm; P \u3c 0.001) and smaller in patients of South Asian descent (2.00 vs 2.52 mm; P \u3c 0.001). Radial artery diameter correlated with wrist circumference (r2 = 0.26; P \u3c 0.001) and shoe size (r2 = 0.25; P \u3c 0.001) and weakly correlated with height (r2 = 0.14; P \u3c 0.001), weight (r2 = 0.18; P \u3c 0.001), body mass index (r2 = 0.07; P = 0.002), and body surface area (r2 = 0.22; P \u3c 0.001). The independent predictors of a larger radial artery were wrist circumference (r2 = 0.26; P \u3c 0.001), male sex (r2 = 0.06; P \u3c 0.001), and non-South Asian ancestry (r2 = 0.05; P = 0.006; final model r2 = 0.37; P \u3c 0.001). A risk score using these variables predicted radial artery diameter (c-statistic, 0.71). Conclusions: Wrist circumference, male sex, and non-South Asian ancestry are independent predictors of increased radial artery diameter. A risk score using these variables can identify patients with small radial arteries. © 2014 Canadian Cardiovascular Society

One-year real-world outcomes for patients undergoing transcatheter mitral valve repair: the Gulf MTEER registry (GULF Mitral Transcatheter Edge to Edge Repair)

Background Severe mitral regurgitation (MR) with left ventricular dysfunction portends worse outcomes. Over the course of the last two decades, transcatheter repair of the mitral valve offered an alternative therapeutic modality for those deemed inoperable or high risk. Landmark studies such as the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation and Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation trials have shown conflicting results with respect to all-cause death and heart failure rehospitalisations. The Gulf Mitral Transcatheter Edge to Edge Repair registry (Gulf MTEER registry) is a regional registry that captured outcomes in those undergoing transcatheter repair of the mitral valve. The objectives of this study were to describe the baseline characteristics of patients undergoing transcatheter mitral valve repair in the Gulf region and estimate the cardiovascular effects of the mitral transcatheter therapies in routine practice.Methods The Gulf MTEER registry is an observational, multicentre, retrospective registry that enrolled all patients undergoing transcatheter repair of the mitral valve from four of the Gulf countries (Saudi Arabia, Kuwait, Bahrain, Oman) between 1 January 2017 and 31 December 2019. Baseline characteristics, echocardiographic parameters and immediate procedural success were reported. The primary outcome was a composite of death and rehospitalisations at 1 year. The secondary outcomes were the individual components of the composite endpoint; that is, death and rehospitalisations at 1 year as well as residual or recurrent MR or worsening New York Heart Association class and a need for repeat repair.Results A total of 176 patients were enrolled. Men constituted 56.3% of the total. At 1 year the primary outcome occurred in 21.1% (95% CI 15.6, 27.9). The secondary outcomes of death occurred in 5.4% (CI 2.9, 10.0) and rehospitalisations occurred in 16.9% (CI 11.9, 23.3). Univariate analysis revealed that the odds of having death or re-hospitalisation was two times higher if the effective regurgitant orifice (ERO) >40 mm2 irrespective of the therapy.Conclusions The Gulf MTEER registry is the first registry in the Gulf region defining the patient population receiving MTEER therapies and evaluating 1-year outcomes. This is a low risk cohort with a high rate of immediate procedural success and low rate of all-cause death and rehospitalisations at 1 year. The odds of an event was two times higher if the ERO ≥40 mm2 with only a signal to higher odds for low left ventricular ejection fraction and larger end systolic dimension