Interventional radiology treatments for iatrogenic severe bleeding during percutaneous coronary interventions

Purpose: Interventional cardiology and interventional radiology are separate medical disciplines in which intra-arterial contrast media are used. Interventional cardiology has resigned from many types of treatment techniques that are now used and developed in the field of interventional radiology. In the event of iatrogenic bleeding during coronary interventions, there is an urgent need to use safe and efficient rescue procedures that are as efficient as cardiosurgery but use simpler treatment options. Serious perforations require immediate endovascular interventions. Medical history may reveal risk factors for artery perforation. Medicines, location of artery perforation, and extent of bleeding are directly associated with the prognosis. Most often, arterial perforations are due to inappropriate wire manipulation or use of oversized balloons or cutting balloons. Prolonged, artery-occluding balloon inflation, covered stent implantation, and embolisation with different agents are among the available treatment options for artery ruptures. Material and methods: A retrospective analysis was carried out among selected patients with iatrogenic vascular complications during procedures involving either coronary or non-coronary arteries. Results: Only representative cases were selected and presented in the patient subsection. Conclusions: Artery perforation during cardiac catheterisation can lead to dire consequences. To manage this complication, clinicians need pre-established procedures, adequate resources, and knowledge. Interventional radiology can be used as a salvage therapy in such cases

Impact of routine invasive physiology at time of angiography in patients with multivessel coronary artery disease on reclassification of revascularization strategy results from thedefinereal study

Objectives: This study sought to prospectively assess the impact of routine invasive physiology at the time of angiography on reclassification of therapeutic management of multivessel disease (MVD) patients, and to assess how implementation of instantaneous wave-free ratio (iFR) alters the process. Background: Routine invasive physiology in intermediate coronary lesions at the time of diagnostic angiography, primarily in patients with single-vessel disease and using fractional flow reserve (FFR), reclassifies coronary revascularization management in 26% to 44% of patients. The role of invasive physiology in patients with MVD is unclear. Methods: In 18 centers, 484 patients undergoing diagnostic angiography disclosing MVD with lesions >40% by visual assessment were included. Investigators were asked to prospectively define their initial management strategy based on angiography and clinical information. Invasive physiology (FFR or iFR driven) was then performed and final strategy defined. Initial and final vessel, patient, procedural, and overall management were described. Reclassification was defined as the difference between initial and final strategy. Results: The majority of patients were clinically stable (82.2%). Two- and 3-vessel disease was present in 73.3% and 26.7% of patients, respectively. Lesions investigated were “intermediate” with median percent stenosis, median FFR, and median iFR at 60% (interquartile range [IQR]: 50% to 70%), 0.84 (IQR: 0.78 to 0.90), and 0.92 (IQR: 0.85 to 0.96), respectively. Vessel management was reclassified by physiology in 30.0% (249 of 828) of vessels. Patient and overall management were reclassified in 26.9% (130 of 484) and 45.7% (211 of 484) of patients, respectively. Reclassification rates were high irrespective of initial management (optimal medical therapy, percutaneous coronary intervention, or coronary artery bypass grafting), and performance and results of pre-procedural noninvasive tests. Reclassification of overall management in particular increased with the number of vessels investigated (1 vessel: 37.3%; 2 vessels: 45.0%; 3 vessels: 66.7%; p = 0.002). Incorporating iFR in the decision process was associated with investigation of more vessels (p = 0.04) and higher reclassification (p = 0.0001). Conclusions: In patients with MVD and intermediate coronary lesions, invasive physiology at time of angiography reclassifies revascularization strategy in a large proportion of cases (26.9%) and investigation of more vessels is associated with higher reclassification rates