Дистальный лучевой доступ: есть ли клиническая выгода?

For decades, the femoral artery has been the most common access for diagnostic and therapeutic endovascular operations. However, over the past 20 years, radial access has been gaining popularity as being safer and more practical with more significant benefits. Recently, the new distal radial access has proven to be equal or perhaps even safer than the vascular access for diagnostic and therapeutic coronary and non-coronary interventions. Today, this access should be in the arsenal of every interventional surgeon.На протяжении десятилетий бедренная артерия была наиболее частым доступом при проведении диагностических и лечебных эндоваскулярных операций. Однако последние 20 лет радиальный доступ набирает популярность как более безопасный и практичный со значительным количеством преимуществ. В последнее время новый дистальный радиальный доступ оказался равным или возможно даже более безопасным сосудистым доступом для диагностических и лечебных коронарных и некоронарных вмешательств. На сегодняшний день этот доступ должен быть в арсенале каждого интервенционного хирурга

EFFICACY OF SIROLIMUS ELUTING STENTS IMPLANTATION IN DIFFUSE (LONG AND EXTREMELY LONG) CORONARY ATHEROSCLEROTIC LESIONS

Aim. Comparison of efficacy of stents coated with sirolimus (group I — 116 patients), and bare metallic stents (group II — 117 patients) in treatment of diffuse (long) atherosclerotic lesions in coronary arteries.Material and methods. The groups were comparable by main parameters. Diabetes was found in 19% and 13,7%, respectively; multivessel lesion in 87,1% and 80,4%; vessel caliber less than 2,75 mm — 46,5% and 23,9%, respectively. Length of the lesion was 25,9±6,6 mm (28-93 mm) in group I and 22,1±7,8 mm (26-102 mm) in group II. Totally, 473 stents implanted into 232 arteries (2,1 per artery): group I — 184 stents in 116 arteries (overlap of 2> stents in 87,9% cases) and 289 in 117 in group II (superposition of stents in 87,1%).Results. The direct success at short term was noted in 113 patients in group I (97,4%) and in 116 in group II (99,1%) (p=0,74). In both groups there were no cases of acute thrombosis of stents. Subacute thrombosis (in 1-3 weeks) was noted in 2 patients (1,7%) in group I and in 1 (0,85%) in group II (p=0,47). Long term angiographic restenosis was noted in 12 patients from group I (10,6%) and in 66 in group II (56,9%) (p<0,0025). Also, in group II 47 patients from 66 had diffuse restenosis (71,2%), as in group I there was no diffuse restenosis. Survival rate with no MACE or angina in 12 months was 79,8% in group I, and 31% in group II

Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention.

Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI.  1. Ischemic symptom improvement is the primary indication for CTO-PCI.  2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI.  3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges.  4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs.  5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use.  6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation.  7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks