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Experience in Complex Bifurcation Intervention by Crusade Microcatheter Assissted Reverse Wiring Technique
418
Heart, Lung and Circulation 2011;20:376–419
Abstracts
ABSTRACTS
further DCCV. At latest follow up (median 55 weeks), 49% remained in SR. Conclusion: A high rate of SR was achieved immediately post-DCCV with most experiencing symptomatic improvement. However, many relapsed over time and required further cardioversion. The use of antiarrhythmics reduced the recurrence of AF. doi:10.1016/j.hlc.2011.03.108 The Psychology of Earthquake Stress Cardiomyopathy, Non-cardiac Chest Pain and Myocardial Infarction J.A. Zarifeh 1,∗ , R.T. Mulder 2 , A.J. Kerr 3 , C.W. Chan 4 , P.G. Bridgman 4 1 Psychiatric
Consultation/Liaison Service, Canterbury DHB, New Zealand 2 University of Otago, Christchurch, New Zealand 3 Department of Cardiology, Middlemore Hospital, Auckland, New Zealand 4 Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand Background: Stress cardiomyopathy is the classic psychologically precipitated physical illness. Non-cardiac chest pain and myocardial infarction can also be triggered by emotional stress. The September 2010 Christchurch earthquake provided a unique opportunity to compare the psychological factors underlying these three conditions. We hypothesised that patients with non-cardiac chest pain or stress cardiomyopathy may be more psychologically vulnerable than those with myocardial infarction. Methods: Cardiology admitting staff in the week following the earthquake prospectively identified patients with earthquake precipitated chest pain. Males were excluded from our study. All consenting women included had to meet strict diagnostic criteria for one of the three conditions. Patients underwent semi-structured interview with a senior clinical psychologist. Pre-morbid psychological factors, experience of the earthquake and psychological response to the earthquake were assessed using validated tools. Results: Seventeen women were included in the study, six with stress cardiomyopathy, five with myocardial infarction and six with non-cardiac chest pain. Earthquake experiences were notably similar across the groups. Patients with non-cardiac chest pain scored high on the HADS anxiety scale, the Eysenck neuroticism scale and the Impact of Event scale. Women with stress cardiomyopathy scored as the most psychologically robust. Depression and extroversion scores were the same across groups. Conclusion: Stress cardiomyopathy following an earthquake does not appear to be specific to psychologically vulnerable women. Women presenting with non-cardiac chest pain have both higher health anxiety, and generalized anxiety, and score more highly on neuroticism scales, when compared with women diagnosed with either MI or stress cardiomyopathy. doi:10.1016/j.hlc.2011.03.109
Same-day Discharge Following Elective PCI – 10 Year Single Center Experience Z.H. Zhang 1,∗ , A. Ranchord 1 , M. Webber 1 , M. Simmonds 1 , P. Matsis 1 , A. Aitken 1 , A. Sasse 1 , D.W. Luo 2 , S.A. Harding 1 1 Department of Cardiology, Wellington Hospital, Wellington, New Zealand 2 Statistician, Ag Research NZ Pty Ltd, Palmerston North, New Zealand
Aim: We assessed the feasibility and safety of same-day discharge in an unselected cohort of patients undergoing elective percutaneous coronary intervention (PCI). We also aimed to identify factors predicting failure of same day discharge following elective PCI. Methods: Consecutive patients (n = 1955) undergoing elective PCI between January 2001 and December 2010 were included. Decisions regarding the suitability for same-day discharge were made six hours post procedure. Patient demographics, procedural variables and outcomes were obtained from review of the cardiac catheterisation laboratory database, medical records and a telephone survey. Results: A total of 2619 lesions were treated. The rate of angiographic success was 96.8% and procedural success was achieved in 93.9% of patients. Same day discharge occurred in 1679(85.8%) patients. The primary reasons for failure to discharge included periprocedural myocardial infarction or ischaemia (26%), use of glycoprotein IIb/IIIa inhibitors (9%), haematomas (11%), late sheath removal (8%) and social reasons (22%). By logistic regression analysis female, age >80 years old, BMI> 30, hypertension, sheath size ≥7F, femoral access and abciximab use predicted failure of same day discharge whilst use of bivalirudin or an angioseal predicted successful same-day discharge. Only 14 patients (0.7%) experienced complications during the 24 hours following same-day discharge. There were no deaths during this time period. Conclusions: Our study demonstrates that same-day discharge can be achieved safely in a broad range of patients undergoing elective PCI. The use of radial access and smaller sheath sizes, bivalirudin, or an angioseal may facilitate day-case PCI. doi:10.1016/j.hlc.2011.03.110 Experience in Complex Bifurcation Intervention by Crusade Microcatheter Assissted Reverse Wiring Technique Z.H. Zhang ∗ , S. Harding Department of Cardiology, Wellington Hospital, New Zealand Background: It is unlikely to wire a side branch of an extremely angulated bifurcation by conventional techniques. We would like to share our recent three successful cases by using reverse wiring technique (RWT). The technique is to use a double lumen Crusade microcatheter to deliver the second hairpin shape wire distally to the bifurcation. By pulling back the hairpin wire it will spontaneously prolapse into the side branch.
Abstracts
Methods and results: Case 1
2
3
Age/gender Lesion
62/M LAD/D1 bifurcation CTO with further 90% LAD lesion post the CTO
82/M long CTO lesion from ostial RCA to Crux
Elective/Adhoc Approach
Elective Right femoral 7 F Right femoral 7 F and left femoral 5 F. With Ichiban-Yari Microcatheter support a Fielder FC wire was crossed through D1. When attempting to wire LAD, changed to Field XT wire with changes of tip shape → prolapsing technique → balloon deflection technique → RWT → success With a Fine-cross Microcatheter support a Conquest Pro wire was successfully crossed through the CTO to AM branch. When attempting to wire mid RCA → change of wire and tip shape → RWT → success After failure of PLV wiring by changes of wire and tip shape → RWT → success
Elective
50/M 90 degree angulated PDA and PLV bifurcation lesion in NSTEMI Ad hoc
Escalating techniques
Right radial 6 F
419
Conclusion: Crusade microcatheter assisted reverse wiring technique by using side branch or main branch as a support lumen to wire the main branch or side branch is a useful and safe technique in complex extremely angulated bifurcation intervention. doi:10.1016/j.hlc.2011.03.111
ABSTRACTS
Heart, Lung and Circulation 2011;20:376–419
Heart, Lung and Circulation 2011;20:376–419
Abstracts
ABSTRACTS
further DCCV. At latest follow up (median 55 weeks), 49% remained in SR. Conclusion: A high rate of SR was achieved immediately post-DCCV with most experiencing symptomatic improvement. However, many relapsed over time and required further cardioversion. The use of antiarrhythmics reduced the recurrence of AF. doi:10.1016/j.hlc.2011.03.108 The Psychology of Earthquake Stress Cardiomyopathy, Non-cardiac Chest Pain and Myocardial Infarction J.A. Zarifeh 1,∗ , R.T. Mulder 2 , A.J. Kerr 3 , C.W. Chan 4 , P.G. Bridgman 4 1 Psychiatric
Consultation/Liaison Service, Canterbury DHB, New Zealand 2 University of Otago, Christchurch, New Zealand 3 Department of Cardiology, Middlemore Hospital, Auckland, New Zealand 4 Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand Background: Stress cardiomyopathy is the classic psychologically precipitated physical illness. Non-cardiac chest pain and myocardial infarction can also be triggered by emotional stress. The September 2010 Christchurch earthquake provided a unique opportunity to compare the psychological factors underlying these three conditions. We hypothesised that patients with non-cardiac chest pain or stress cardiomyopathy may be more psychologically vulnerable than those with myocardial infarction. Methods: Cardiology admitting staff in the week following the earthquake prospectively identified patients with earthquake precipitated chest pain. Males were excluded from our study. All consenting women included had to meet strict diagnostic criteria for one of the three conditions. Patients underwent semi-structured interview with a senior clinical psychologist. Pre-morbid psychological factors, experience of the earthquake and psychological response to the earthquake were assessed using validated tools. Results: Seventeen women were included in the study, six with stress cardiomyopathy, five with myocardial infarction and six with non-cardiac chest pain. Earthquake experiences were notably similar across the groups. Patients with non-cardiac chest pain scored high on the HADS anxiety scale, the Eysenck neuroticism scale and the Impact of Event scale. Women with stress cardiomyopathy scored as the most psychologically robust. Depression and extroversion scores were the same across groups. Conclusion: Stress cardiomyopathy following an earthquake does not appear to be specific to psychologically vulnerable women. Women presenting with non-cardiac chest pain have both higher health anxiety, and generalized anxiety, and score more highly on neuroticism scales, when compared with women diagnosed with either MI or stress cardiomyopathy. doi:10.1016/j.hlc.2011.03.109
Same-day Discharge Following Elective PCI – 10 Year Single Center Experience Z.H. Zhang 1,∗ , A. Ranchord 1 , M. Webber 1 , M. Simmonds 1 , P. Matsis 1 , A. Aitken 1 , A. Sasse 1 , D.W. Luo 2 , S.A. Harding 1 1 Department of Cardiology, Wellington Hospital, Wellington, New Zealand 2 Statistician, Ag Research NZ Pty Ltd, Palmerston North, New Zealand
Aim: We assessed the feasibility and safety of same-day discharge in an unselected cohort of patients undergoing elective percutaneous coronary intervention (PCI). We also aimed to identify factors predicting failure of same day discharge following elective PCI. Methods: Consecutive patients (n = 1955) undergoing elective PCI between January 2001 and December 2010 were included. Decisions regarding the suitability for same-day discharge were made six hours post procedure. Patient demographics, procedural variables and outcomes were obtained from review of the cardiac catheterisation laboratory database, medical records and a telephone survey. Results: A total of 2619 lesions were treated. The rate of angiographic success was 96.8% and procedural success was achieved in 93.9% of patients. Same day discharge occurred in 1679(85.8%) patients. The primary reasons for failure to discharge included periprocedural myocardial infarction or ischaemia (26%), use of glycoprotein IIb/IIIa inhibitors (9%), haematomas (11%), late sheath removal (8%) and social reasons (22%). By logistic regression analysis female, age >80 years old, BMI> 30, hypertension, sheath size ≥7F, femoral access and abciximab use predicted failure of same day discharge whilst use of bivalirudin or an angioseal predicted successful same-day discharge. Only 14 patients (0.7%) experienced complications during the 24 hours following same-day discharge. There were no deaths during this time period. Conclusions: Our study demonstrates that same-day discharge can be achieved safely in a broad range of patients undergoing elective PCI. The use of radial access and smaller sheath sizes, bivalirudin, or an angioseal may facilitate day-case PCI. doi:10.1016/j.hlc.2011.03.110 Experience in Complex Bifurcation Intervention by Crusade Microcatheter Assissted Reverse Wiring Technique Z.H. Zhang ∗ , S. Harding Department of Cardiology, Wellington Hospital, New Zealand Background: It is unlikely to wire a side branch of an extremely angulated bifurcation by conventional techniques. We would like to share our recent three successful cases by using reverse wiring technique (RWT). The technique is to use a double lumen Crusade microcatheter to deliver the second hairpin shape wire distally to the bifurcation. By pulling back the hairpin wire it will spontaneously prolapse into the side branch.
Abstracts
Methods and results: Case 1
2
3
Age/gender Lesion
62/M LAD/D1 bifurcation CTO with further 90% LAD lesion post the CTO
82/M long CTO lesion from ostial RCA to Crux
Elective/Adhoc Approach
Elective Right femoral 7 F Right femoral 7 F and left femoral 5 F. With Ichiban-Yari Microcatheter support a Fielder FC wire was crossed through D1. When attempting to wire LAD, changed to Field XT wire with changes of tip shape → prolapsing technique → balloon deflection technique → RWT → success With a Fine-cross Microcatheter support a Conquest Pro wire was successfully crossed through the CTO to AM branch. When attempting to wire mid RCA → change of wire and tip shape → RWT → success After failure of PLV wiring by changes of wire and tip shape → RWT → success
Elective
50/M 90 degree angulated PDA and PLV bifurcation lesion in NSTEMI Ad hoc
Escalating techniques
Right radial 6 F
419
Conclusion: Crusade microcatheter assisted reverse wiring technique by using side branch or main branch as a support lumen to wire the main branch or side branch is a useful and safe technique in complex extremely angulated bifurcation intervention. doi:10.1016/j.hlc.2011.03.111
ABSTRACTS
Heart, Lung and Circulation 2011;20:376–419