Cardiovascular intervention and therapeutics
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Cardiovasc Interv Ther · Jan 2021
ReviewDistal radial approach: a review on achieving a high success rate.
The transradial approach is the standard for percutaneous coronary intervention (PCI). Moreover, to lead to the evolution of PCI, a new approach site was developed, namely the distal radial approach (dRA). ⋯ The dRA is a new approach site for PCI. Further research is warranted for the selection of suitable patients to undergo PCI through the dRA.
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Cardiovasc Interv Ther · Apr 2020
ReviewBalloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.
Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as Group-4 pulmonary hypertension caused by organized thrombi in pulmonary arteries. Pulmonary endarterectomy (PEA) has been shown to improve the symptoms and prognoses of patients with proximal CTEPH. ⋯ This review summarizes the history, indications, procedures and complications of BPA. Finally, we discuss the future perspective of BPA for better management of CTEPH.
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Cardiovasc Interv Ther · Jan 2020
ReviewAntithrombotic therapy after percutaneous coronary intervention from the Japanese perspective.
Percutaneous coronary intervention (PCI) has become a standard-of-care procedure in patients with acute and chronic coronary syndrome. Adjunctive antithrombotic therapy following PCI is the cornerstone of pharmacological treatment to prevent ischemic events. Dual antiplatelet therapy, a combination of aspirin and a P2Y12 inhibitor, has been proven as an initial antithrombotic regimen to reduce thrombotic events in patients undergoing PCI. ⋯ Since Japanese patients have different risk profiles for both thrombotic and bleeding events compared with Western population, optimal antithrombotic regimen may be different. Recently, the evidence in this field has been rapidly evolving and the antithrombotic strategy varies widely in clinical practice. In this clinical expert consensus document, we provide an in-depth review concerning antithrombotic strategies after PCI from Japanese perspective.
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Cardiovasc Interv Ther · Oct 2019
Acquired von Willebrand syndrome in patients treated with veno-arterial extracorporeal membrane oxygenation.
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a powerful device for treatment of patients with life-threatening heart failure. Although bleeding is often associated with VA ECMO and sometimes results in a fatal outcome, its precise causes remain unknown. On the other hand, excessive high shear stress in the cardiovascular system causes acquired von Willebrand syndrome (aVWS), characterized by loss of von Willebrand factor (vWF) large multimers. vWF large multimers of five consecutive patients treated with VA ECMO were quantitatively evaluated using the vWF large multimer indices, defined as the ratio of the large multimer ratio of a patient to that of a healthy subject analyzed simultaneously. ⋯ Their vWF large multimer indices were 20.8, 28.8, 27.6, 51.0, and 31.0% (means 31.8 ± 11.4%). Surprisingly, these values are much lower than those observed in severe aortic stenosis reported previously by us (Tamura et al. in J Atheroscler Thromb 22:1115-1123, 2015), where vWF multimer indices in 31 severe aortic stenosis patients with peak pressure gradient through the aortic valves of 85.1 ± 29.4 mmHg were 75.0 ± 21.7% (p < 0.0001), indicating that much higher grade of aVWS occurred in patients with VA ECMO than severe aortic stenosis patients. All the 5 patients treated with VA ECMO developed aVWS that was much more severe than in patients with severe aortic stenosis.
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Cardiovasc Interv Ther · Oct 2019
Observational StudyEvaluation of the diameter of the distal radial artery at the anatomical snuff box using ultrasound in Japanese patients.
Catheter angioplasty or angiography via the distal access point of the radial artery (dRA), located at the anatomical snuff box, is a less invasive strategy for coronary intervention attracting considerable attention. Determining the diameter of the dRA is necessary to minimize the risk of artery occlusion and safely perform catheter intervention. This was a retrospective observational study including patients who underwent coronary angiography or coronary intervention at Aomori Kyoritsu Hospital, Aomori, Japan, between February 2018 and August 2018. ⋯ The size and anatomy of the dRA varied considerably. Thus, it is difficult to predict the actual diameter of the artery. Customized selection of the size of the sheath and site of intervention is essential for each patient to safely perform ultrasound examination prior to cannulation.