Patient Characteristics, Procedural Details, and Outcomes of Contemporary Percutaneous Coronary Intervention in Real-World Practice: Insights from Nationwide Thai PCI Registry.

Background: Percutaneous coronary intervention (PCI) practice and outcomes vary substantially in different parts of the world. The contemporary data of PCI in Asia are limited and only available from developed Asian countries. Objectives: To explore the pattern of practice and results of PCI procedures in Thailand as well as a temporal change of PCI practice over time compared with the registry from other countries. Methods: Thai PCI Registry is a prospective nationwide registry that was an initiative of the Cardiac Intervention Association of Thailand (CIAT). All cardiac catheterization laboratories in Thailand were invited to participate during 2018-2019, and consecutive PCI patients were enrolled and followed up for 1 year. Patient baseline characteristics, procedural details, equipment and medication use, outcomes, and complications were recorded. Results: Among the 39 hospitals participated, there were 22,741 patients included in this registry. Their mean age (standard deviation) was 64.2 (11.7) years and about 70% were males. The most common presentation was acute coronary syndrome (57%) with a high proportion of ST-elevation myocardial infarction (28%). Nearly two-thirds of patients had multivessel disease and significant left main stenosis was reported in 11%. The transradial approach was used in 44.2%. The procedural success rate was very high (95.2%) despite the high complexity of the lesions (56.9% type C lesion). The incidence of procedural complications was 5.3% and in-hospital mortality was 2.8%. Conclusion: Thai PCI Registry provides further insights into the current practice and outcomes of PCI in Southeast Asia. The success rate was very high, and the complications were very low despite the high complexity of the treated lesions.

Drug-eluting stent for unprotected left main coronary artery disease: early and mid-term outcomes.

BACKGROUND: PCI is increasingly performed in patients with ULMCA disease. The efficacy and safety of drug-eluting stents in ULMCA disease have been reported. OBJECTIVE: To evaluate the early and mid-term clinical outcome of the Percutaneous Coronary Intervention (PCI) with Drug-Eluting stent (DES) in unprotected left main coronary artery (ULMCA) disease patients. MATERIAL AND METHOD: PCI with DES was performed with 90 consecutive patients having ULMCA disease between January 2006 and June 2009. RESULTS: At a median follow-up of 22.8 +/- 12.2 months, major adverse cardiac or cerebrovascular events (MACCE) occurred in 11 (12.2%) patients. There were seven (7.8%) deaths including two (2.2%) cardiac deaths and five (5.6%) non-cardiac deaths. There was one MI (1.1%), and four (4.4%) target vessel revascularization. Restenosis in the left main occurred only in two patients (2.2%) and definite stent thrombosis occurred in two patients (2.2%). CONCLUSION: The present study demonstrates that PCI with Drug-Eluting stent implantation in unprotected left main coronary artery disease is a safe form of treatment and has favorable outcomes.

Comparison of ticlopidine vs. clopidogrel in addition to aspirin after paclitaxel-eluting stent implantation: insights from the TRUE (Taxusin Real-life Usage Evaluation) Study.

Thienopyridines and aspirin are beneficial in patients undergoing bare-metal stent implantation, and aspirin and clopidogrel treatment have also been proved effective after drug-eluting stent (DES) implantation. However, despite the common substitution of clopidogrel with ticlopidine because of cost or patient intolerance, there are no data on the comparison of ticlopidine vs. clopidogrel after DES implantation. We hereby compare ticlopidine vs. clopidogrel after paclitaxel-eluting stent implantation in subjects enrolled in the prospective multicenter Taxus in Real-life Usage Evaluation (TRUE) Study. Across the 505 analyzed patients (112 treated with ticlopidine and 393 with clopidogrel), similar rates of early and mid-term (7 months) adverse thrombotic events were found with either antiplatelet regimen, with the notable exception of 2 cases of late stent thrombosis in patients who had prematurely withdrawn ticlopidine treatment just 3 months after the procedure. These findings thus support the overall safety and effectiveness of ticlopidine after DES implantation, and also confirm the increased risk of late thrombosis when premature withdrawal of thienopyridines occurs.

Sandwich drug-eluting stenting: a novel method to treat high-risk coronary lesions.

OBJECTIVES: To describe a novel approach to drug-eluting stent (DES) implantation, the sandwich technique, comprised of the simultaneous implantation of two completely overlapping DES in the same target lesion. BACKGROUND: DES effectively prevent restenosis in selected coronary lesions. However, adverse lesion characteristics may detrimentally affect outcomes after DES implantation by means of plaque prolapse, recoil or excessive neointimal hyperplasia. METHODS: From July 2002 to November 2004, the sandwich technique was performed in 10 patients with very high-risk lesions. Two DES of identical size and length were implanted, one inside the other, with almost complete overlap. High-pressure postdilatation (up to 28 atm) was carried out in 6 cases. The endpoints of this preliminary evaluation were: technical feasibility, early (30-day) safety, restenosis rate and freedom from adverse events at 9-month follow up. RESULTS: Procedural and angiographic success was achieved in all cases. At follow-up, there were no deaths, myocardial infarctions or stent thromboses. All patients underwent angiographic follow-up; target lesion revascularization was carried out in 3 patients (30%). Of note, in no case was there evidence of aneurysmal remodeling. CONCLUSIONS: This study suggests that implanting 2 DES, one inside the other in a sandwich fashion, is feasible and apparently safe. This approach could be considered in situations such as plaque prolapse or stent recoil where additional scaffolding may be needed.

Percutaneous saphenectomy: a potentially dreadful complication of cutting balloon angioplasty in saphenous vein grafts.

Vessel perforation is an uncommon but potentially life-threatening complication of percutaneous coronary intervention and is often associated with the use of atheroablative devices. While effective management means are currently available, such as PTFE-covered stent, pericardiocentesis, and perfusion balloon, a timely and skillful approach is of paramount importance to solve this dreadful complication. We hereby describe a case of saphenous vein graft (SVG) perforation occurring after cutting balloon angioplasty for in-stent restenosis. Despite the immediate occurrence of cardiac arrest due to massive extravasation of contrast in the mediastinum with pericardial tamponade, deep catheter intubation enabled the deployment of two PTFE-covered stents and subsequent sealing of the leak with repeated inflation of a perfusion balloon, while hemopericardium was drained by pericardiocentesis. This clinical vignette emphasizes the role of optimal backup in order to deploy life-saving devices and successfully manage life-threatening pericardial tamponade due to SVG rupture.