State-of-art review: intravascular imaging in percutaneous coronary interventions.

The history of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) reflects the relentless pursuit of innovation in interventional cardiology. These intravascular imaging technologies have played a pivotal role in our understanding of coronary atherosclerosis, vascular pathology, and the interaction of coronary stents with the vessel wall. Two decades of clinical investigations demonstrating the clinical efficacy and safety of intravascular imaging modalities have established these technologies as staples in the contemporary cardiac catheterization lab's toolbox and earning their place in revascularization clinical practice guidelines. In this comprehensive review, we will delve into the historical evolution, mechanisms, and technical aspects of IVUS and OCT. We will discuss the expanding evidence supporting their use in complex percutaneous coronary interventions, emphasizing their crucial roles in optimizing patient outcomes and ensuring procedural success. Furthermore, we will explore the substantial advances that have propelled these imaging modalities to the forefront of contemporary interventional cardiology. Finally, we will survey the latest developments in the field and explore the promising future directions that have the potential to further revolutionize coronary interventions.

Utility of Radiopaque Bypass Graft Markers During Coronary Angiography Following Coronary Artery Bypass Graft Surgery.

BACKGROUND: Radiopaque bypass graft markers allow easy visualization of the location of the graft and can minimize contrast use and radiation exposure during follow-up coronary angiography. METHODS: This retrospective study analyzed coronary artery bypass graft patients who underwent subsequent coronary angiography in the John Cochrane Veterans Affairs Medical Center from January 2009 until September 2017. RESULTS: Patients who underwent diagnostic coronary angiography with proximal graft markers required less contrast use (P<.02) and less fluoroscopy time (P<.01). The presence or absence of proximal graft markers had no significant difference on the rise of creatinine following coronary angiography (P=.28). CONCLUSION: Bypass graft markers reduce contrast and radiation use in follow-up coronary angiography and reduce incidence of contrast-induced acute kidney injury.

Percutaneous repair of post-myocardial infarction ventricular septal rupture presenting with cardiogenic shock.

Ventricular septal rupture (VSR) is an uncommon and devastating complication with a high mortality rate due to limited available interventions required by expert hands in a small window of opportunity. Most commonly seen following delayed myocardial infarctions (MI), the rate of VSR has decreased partly from protocol driven reperfusion therapy; however, cases are still present, particularly when diagnosis is delayed. We present a case of a critically ill patient in cardiogenic shock following a large anterolateral wall ST-elevation MI complicated by a large VSR whom was transferred to our academic institution for percutaneous repair. Of note, such intervention was initially performed by Lock in 1988 and a comprehensive review published in 2016 noted only 273 such cases. This review noted patient cases since that initial percutaneous closure by Lock with a majority of cases utilizing an Amplatzer system; others being Clamshell and CardioSEAL. Our patient underwent the percutaneous VSR closure utilizing an Amplatzer Occluder delivery system with successful insertion of an 18 mm muscular VSD Amplatzer closure device. Although the rarely performed procedure was successful and provided invaluable insights into the treatment and management of VSR, the patient succumbed to multiple critical disease processes in the following days post intervention. Patient consent and ethics committee approval for publication, as per Saint Louis University case publication guidelines, were confirmed and approved.

Biological and environmental datasets from the August 2017 total solar eclipse.

The datasets in this article are associated with the research article 'Assessing biological and environmental effects of a total solar eclipse with passive multimodal technologies' (Brinley Buckley et al., 2018). We documented biotic and abiotic changes during a total solar eclipse on 21 August 2017, in south-central Nebraska, USA, with a multimodal suite of tools, including time-lapse camera systems, data loggers, and sound recording devices. Time-lapse images were used to approximate changes in light, data loggers were used to record temperature and humidity, and sound recordings were used to calculate acoustic indices characterizing variation in the soundscape, as well as to manually identify and estimate avian vocalization activity.

Anomalous left circumflex artery from the right coronary cusp: a benign variant?

OBJECTIVE: To determine the incidence of angiographically evident coronary artery disease (CAD) of the anomalous left circumflex artery (ALCx). BACKGROUND: Due to the acute angulation of its origin from the aorta and its retroaortic course, some have proposed an increase in CAD in these vessels. METHODS: We performed a retrospective cohort study of all patients (n = 5205) presenting for left heart catheterization at the St Louis Veterans Affairs hospital from 2006-2012. Quantitative coronary angiography (QCA) was performed by two independent operators for all cases identified as having ALCx (n = 18). RESULTS: We identified 18 patients (0.346%) with this anomaly. Sixteen of 18 cases (89%) had atherosclerosis involving the ALCx. QCA performed on the ALCx for all 18 patients resulted in a mean stenosis of 61% (range, 10%-100%). Seven out of 18 patients (39%) had obstructive CAD of the ALCx with the majority (n = 6; 86%) also having concomitant obstructive disease in the left anterior descending (LAD) or right coronary artery (RCA). In the 5 cases where the ALCx underwent intervention, the mean diameter stent was 2.25 mm, with a mean length of 15 mm, indicating that these vessels were small in caliber with focal disease. At a mean follow-up of 18 months for all patients, there was 1 non-cardiac death in the non-intervened group, with the 17 remaining patients (94.7%) free of major adverse cardiovascular events (target lesion revascularization, target vessel revascularization, or death). CONCLUSIONS: This study suggests that indeed this most common anomaly appears to be benign in that its unique origin and/or retroaortic course do not increase the occurrence of atherosclerosis relative to the LAD and RCA.

Hemodynamic abnormalities across an anomalous left main coronary artery assessment: evidence for a dynamic ostial obstruction.

Anomalous left main coronary arteries have been associated with sudden cardiac death, especially when arising from the right coronary cusp and following an anterior course. To date, imaging procedures have been the mainstay of the decision-making process in determining which patients should undergo surgery for correction of this anomaly and which patients are presumed to be at low risk. We report on the hemodynamic evaluation of an anomalous left main performed in support of elected surgical correction in a young patient.