Transradial approach to lower extremity interventions

Percutaneous interventions of the coronary and peripheral vessels have historically been performed using a femoral artery approach. There has been increasing recognition of post-procedural bleeding complications and its impact on short- and long-term mortality. Because of its now recognized safety, the transradial approach has recently emerged as a preferred method compared to the transfemoral approach. The limitations associated with the distance from the puncture site to the lesion location are being addressed as new tools are developed for the endovascular treatment of peripheral arterial disease. In this review, we discuss the many facets of the transradial approach to lower extremity endovascular interventions, highlighting its safety and efficacy. Approaches to special populations including individuals with prior surgical bypass, Leriche’s syndrome, and those committed to chronic anticoagulation are also reviewed

Omega-3 fatty acids plus rosuvastatin improves endothelial function in South Asians with dyslipidemia

Catalin Mindrescu1,2,3, Rakesh P Gupta1,3, Eileen V Hermance1, Mary C DeVoe1, Vikas R Soma1, John T Coppola1,2, Cezar S Staniloae1,21Comprehensive Cardiovascular Center, Saint Vincent’s Hospital Manhattan, New York, NY, USA; 2New York Medical College, Valhalla, NY, USA; 3Rakesh P Gupta and Catalin Mindrescu contributed equally to this article.Background: The present study was undertaken to investigate the effect of statins plus omega-3 polyunsaturated fatty acids (PUFAs) on endothelial function and lipid profile in South Asians with dyslipidemia and endothelial dysfunction, a population at high risk for premature coronary artery disease.Methods: Thirty subjects were randomized to rosuvastatin 10 mg and omega-3-PUFAs 4 g or rosuvastatin 10 mg. After 4 weeks, omega-3-PUFAs were removed from the first group and added to subjects in the second group. All subjects underwent baseline, 4-, and 8-week assessment of endothelial function and lipid profile.Results: Compared to baseline, omega-3-PUFAs plus rosuvastatin improved endothelial-dependent vasodilation (EDV: −1.42% to 11.36%, p = 0.001), and endothelial-independent vasodilation (EIV: 3.4% to 17.37%, p = 0.002). These effects were lost when omega-3-PUFAs were removed (EDV: 11.36% to 0.59%, p = 0.003). In the second group, rosuvastatin alone failed to improve both EDV and EIV compared to baseline. However, adding omega-3-PUFAs to rosuvastatin, significantly improved EDV (−0.66% to 14.73%, p = 0.001) and EIV (11.02% to 24.5%, p = 0.001). Addition of omega-3-PUFAs further improved the lipid profile (triglycerides 139 to 91 mg/dl, p = 0.006, low-density lipoprotein cholesterol 116 to 88 mg/dl, p = 0.014).Conclusions: Combined therapy with omega-3-PUFAs and rosuvastatin improves endothelial function in South Asian subjects with dyslipidemia and endothelial dysfunction.Keywords: omega-3 fatty acids, endothelial function, South Asians, dyslipidemia, rosuvastati

Histopathologic changes of the radial artery wall secondary to transradial catheterization

Cezar S Staniloae1, Kanika P Mody1, Kintur Sanghvi1, Catalin Mindrescu1, John T Coppola1, Cristina R Antonescu2, Sanjay Shah3, Tejas Patel31Saint Vincent’s Hospital Manhattan, New York, NY, USA; 2Memorial Sloan-Kettering Cancer Center, New York, NY; 3Total Cardio Vascular Solutions, Ahmedabad, IndiaObjective: The immediate effects of transradial access on the radial artery wall are unknown. In this study we sought to assess the histological changes induced by catheterization on the radial artery.Methods: Thirty-four patients undergoing coronary artery bypass grafting (CABG) had radial arteries harvested to serve as bypass conduits. The proximal and distal ends of the radial artery conduits were sectioned and embedded in paraffin. Both ends of all specimens were evaluated by a blinded pathologist for intimal hyperplasia, medial inflammation, medial calcification, periarterial tissue or fat necrosis, adventitial inflammation, adventitial necrosis, and adventitial neovascularization. Fisher’s exact test was used for statistical analysis.Results: Fifteen previously catheterized radial arteries (TRA group) were compared with 19 noncatheterized arteries (NCA group). The distal ends of the TRA group showed significantly more intimal hyperplasia (73.3% vs 21.1%; p = 0.03), periarterial tissue or fat necrosis (26% vs 0%; p = 0.02), and more adventitial inflammation (33.3% vs 0%; p = 0.01) than the distal ends of the NCA group. The distal ends of the TRA group also showed significantly more intimal hyperplasia (73.3% vs 26.6%; p = 0.03) and adventitial inflammation (33.3% vs 0%; p = 0.01) than the proximal ends of the same arteries. There were no histological differences in the proximal ends of the two groups. Conclusion: Transradial catheterization induces significant histological changes suggestive of radial artery injury limited to the puncture site in the form of intimal hyperplasia, medial inflammation, and tissue necrosis. Both the proximal and distal ends of the radial artery show a spectrum of atherosclerotic changes independent of its use for transradial catheterization. Keywords: radial artery, catheterization, pathology, medial calcifications, intimal hyperplasia, atherosclerosi

<i>Enterococcus Faecalis</i> Infective Endocarditis Following Percutaneous Edge-to-Edge Mitral Valve Repair

<i>Enterococcus Faecalis</i> Infective Endocarditis Following Percutaneous Edge-to-Edge Mitral Valve Repai