Comparison of 4-French versus 5-French sheaths for diagnostic coronary angiography via the snuffbox approach

Background: Although a shorter hemostasis duration would be expected when compared with the conventional radial approach as the diameter of the distal radial artery is smaller than that of the conventional radial artery, the optimal duration of hemostasis in diagnostic coronary angiography (CAG) via the distal radial approach, termed the snuffbox approach, has not been well investigated.Methods: Data from 171 patients were retrospectively collected (55 and 116 patients in the 4-French [Fr] and 5-Fr sheath groups, respectively). The patients had suspected myocardial ischemia and were undergoing diagnostic CAG via the snuffbox approach at a single center between January 2019 and August 2019.Results: The mean age of the study population was 67.6 ± 11.0 years, and 69% were male. The left snuffbox approach was performed in 146 (85.4%) patients. The mean snuffbox puncture time, defined as the time interval between local anesthesia and sheath cannulation, was 145.1 ± 120.8 s. The hemostasis duration was significantly shorter in the 4-Fr sheath group than in the 5-Fr sheath group (70 [62–90] vs. 120 [120–130] min; p < 0.001). There were local hematomas, defined as ≤ 5 cm in diameter, at the puncture site in 8 (4.7%) patients. Moreover, there were no conventional and distal radial artery occlusions, assessed by manual pulse, after hemostasis in the study population during hospitalization.Conclusions: Successful hemostasis was obtained within 2 h for diagnostic CAG via the snuffbox approach using the 4-Fr or 5-Fr sheaths

A new technique for lipid core plaque detection by optical coherence tomography for prevention of peri-procedural myocardial infarction

Rationale: Percutaneous coronary intervention (PCI) provides effective revascularization of atherosclerotic coronary arteries but the invasive nature of treatment can result in complications. Patient concerns: A 53-year old man underwent coronary angiography due to chest pain with minimal ST-segment elevation in the inferior leads of the electrocardiogram. Diagnosis: We proceeded directly to coronary angiography and delineated a moderate stenosis with haziness in the mid right coronary artery (RCA). Interventions: Expert analysis of the pre-intervention OCT imaging demonstrated a large lipid core plaque (LCP), upstream of the culprit site, with minimal thrombus burden. Subsequent implantation of a bioresorbable vascular scaffold, protected with distal deployment of a filter protection device provided an excellent result with retrieval of plaque material. Post-hoc attenuation analysis confirmed the presence of large LCP. Outcomes: A post-procedural transthoracic echocardiogram confirmed good left ventricular function with no regional wall motion abnormality. An excellent clinical outcome was achieved. Lessons: Optical coherence tomography (OCT) derived attenuation analysis can provide with qualitative and quantitative detailed evaluation of the underlying plaque substrate. Our case shows OCT can provide the interventionist with qualitative and qualitative assessment of large LCP for prevention of periprocedural complications, which may improve outcome for PCI

Gender differences in the distal radial artery diameter for the snuffbox approach

Background: Recently, interventional cardiologists have been increasingly interested in snuffbox approach for coronary angiography (CAG) and percutaneous coronary intervention (PCI). However, there is lack of data regarding distal radial artery (RA) diameter according to gender. Therefore, the aim herein was to investigate gender differences in the diameter of distal RA diameter. Methods: Left snuffbox approach was done in 117 patients who had planned CAG or PCI for suspected myocardial ischemia between 1 December 2017 and 28 February 2018 at the Chonnam National University Hospital, Gwangju, Korea. Left RA angiography was achieved from 101 patients. Among 101 individuals, 69 (68.3%) men and 32 (31.7%) women were enrolled. There was no significant difference in systolic and diastolic blood pressure, body mass index, left ventricular systolic function, or patients with acute coronary syndrome in either group. Results: The average diameter of distal RA was 2.57 mm in all patients. Women had a significantly smaller diameter of distal RA than men (2.40 mm vs. 2.65 mm, p = 0.016). Nevertheless, CAG via snuffbox approach by 6 Fr sheath was successfully performed in all 117 patients. Regarding success rate of the distal RA approach, women had a lower success rate (32/38) compared with men (72/79), but not significantly (84.2% vs. 91.1%, p = 0.264). Conclusions: Females has a significantly smaller distal RA diameter compared to males. Moreover, the success rate of the distal RA approach tends to be higher in men than in women

Freshwater-salt water interface dynamics during pumping tests

Freshwater-salt water interface (FSI) location is very important information for decision maker in managing coastal aquifer system, however, its temporal change have been hard to get using conventional method such as EC monitoring at one or several fixed depths, geophysical logging or remote sensing techniques. A FSI tracking device, which has density between freshwater and salt water and hence can moves up and down as the freshwater-salt water transition zone moves, is used to get a temporal change data for the interface during several different types of pumping tests, which were performed at coastal monitoring wells in Seocheon, middle west of Korean Peninsula. Four short period pumping tests, three long-period pumping tests, one step-drawdown test, one reverse step-drawdown test were performed at different pumping rate ranging 19.86 to 48.71 m3/d for different pumping period of 60 minutes to 2851 minutes. Time series data shows that the Interface-Egg rises up from -86.0 to -77.6 m amsl after 24-hours pumping and to -40.8 m amsl after 2-days pumping and freshwater lens thickness is getting thinner from 88.1 m to 78.4 m after 24-hours pumping and then 42.3 m after 2-days pumping. These salt water up-coning phenomena are supported by EC profiles which were logged before and after the whole pumping periods. Time series data tell us that salt water upconing in the pumping well happens quickly and recovers at a very slow rate which is about 1.5 cm/d at 3 months after stopping pumping. The time series data of groundwater head and the interface-Egg’s location also shows that there is a tidal influence between pumping periods. The FSI tracker is expected to be practically applied to coastal aquifer management preventing from salt water intrusion, especially at dynamically pumping area for agricultural and/or domestic water supply