Cystatin C in risk prediction after transcatheter aortic valve replacement: a retrospective analysis.

AIMS: No study has evaluated the prognostic value of the chronic kidney disease (CKD) classification by cystatin C-based estimated glomerular filtration rate (eGFR) (CKDCys classification) in patients undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare the prognostic value of CKDCys classification and CKD classification by creatinine-based eGFR (CKDCr classification) in risk prediction after TAVR. METHODS AND RESULTS: We retrospectively analysed consecutive 219 patients with symptomatic severe aortic stenosis who underwent TAVR at our institute between December 2016 and June 2019. Pre-operative CKDCr and CKDCys classifications were evaluated for their prognostic value of 2-year major adverse cardiovascular and cerebrovascular events (MACCE) after TAVR. MACCE was defined as the composite of all-cause mortality, non-fatal myocardial infarction, stroke, and rehospitalization for worsening congestive heart failure. Participants had a median age of 86.0 years and were predominantly female (76.9%). In 96.6% of the cases, TAVR was performed using transfemoral access. The median creatinine-based eGFR (52.85 mL/min/1.73 m2 ) was higher than the cystatin C-based eGFR (41.50 mL/min/1.73 m2 ). Downward reclassification in CKD stages based on eGFRCys was observed in 49.0% of patients. During a median follow-up period of 575.5 (interquartile range: 367.0-730.0) days, 58 patients presented with MACCE. CKDCys classification, but not CKDCr classification, significantly stratified the risk of 2-year MACCE in patients after TAVR by log-rank test (P = 0.003). In multivariate Cox regression analysis, only CKDCys stage 3b [hazard ratio (HR) = 4.37; 95% confidence interval (CI): 1.28-14.91; P = 0.019] and CKDCys stage 4 + 5 (HR = 3.72; 95% CI: 1.06-12.99; P = 0.040) were significant predictors of MACCE after adjustment for potential confounders. CONCLUSIONS: The CKDCys classification could better assess the risk than the CKDCr classification in patients undergoing TAVR. CKDCys stage 3b and stage 4 + 5 correlated with adverse outcomes.

Successful Endovascular Treatment for Aortic Thrombosis Due to Primary Antiphospholipid Syndrome: A Case Report and Literature Review.

A 60-year-old man with a history of Raynaud's phenomenon presented with bilateral intermittent claudication and an ulcer on his right toe. The ankle-brachial index of the right and left legs was 0.77 and 0.75, respectively. Laboratory data showed prolongation of the activated partial thromboplastin time and a positive result on the lupus anticoagulant test. Computed tomography angiography revealed isolated infrarenal aortic stenosis with irregular surface and noncalcified plaques. Intravascular ultrasonography examination demonstrated a noncalcified, irregular, and mobile plaque, suggestive of abdominal aortic thrombosis. In addition to anticoagulant and dual antiplatelet therapy, endovascular treatment was performed. A total of three 40-mm-long balloon-expandable stents were successfully implanted on a 15-mm balloon. The final angiography showed good results except for minimal plaque shifting in the terminal aorta. Three months later, the ulcer resolved and a final diagnosis of primary antiphospholipid syndrome (APS) was made. Clinicians should recognize that APS can affect the abdominal aorta, leading to aortic thrombosis. Endovascular treatment may be the one good treatment option for this rare condition.

Feasibility and Safety of Reverse Catheterization Technique of the Superficial Femoral Artery in Single-Stage Endovascular Treatment of Bilateral Infrainguinal Diseases.

PURPOSE:: We evaluated the feasibility and safety of the reverse catheterization technique of the superficial femoral artery (ReCAT) for single-stage endovascular treatment (EVT) in patients with bilateral infrainguinal diseases. MATERIALS AND METHODS:: We retrospectively evaluated 24 consecutive patients (overall median age: 79 years; male patients: 21 [87.5%]) who underwent EVT for bilateral infrainguinal diseases. The objective of ReCAT was to perform single-stage EVT in patients with bilateral infrainguinal diseases with a one-time unilateral femoral artery puncture. The main outcomes were the incidence of puncture site complications, including major bleeding or hematoma requiring transfusion, pseudoaneurysm, and arteriovenous fistula, and ReCAT procedure-related arterial dissection or perforation, which were assessed by ultrasonography on the day after the procedure. The secondary outcome measures were in-hospital mortality and in-hospital amputation. RESULTS:: Reverse catheterization technique of the superficial femoral artery was successful in 23 (95.8%) of the 24 patients; it failed in 1 patient due to severe calcification and a previously implanted stent in the ipsilateral iliac artery. The median operation time, radiation time, and the volume of contrast media used were 108 (84-142) minutes, 37 (27-55) minutes, and 111 (80-157) mL, respectively. There were no incidences of puncture site complications and arterial dissection related to the ReCAT procedure. One case of vessel perforation in a branch of the ipsilateral superficial femoral artery occurred due to flipped guidewire injury. CONCLUSION:: Reverse catheterization technique of the superficial femoral artery is safe and effective in performing single-stage EVT for bilateral infrainguinal diseases. It might also reduce the number of EVTs and complications due to multiple femoral artery punctures.

Lipohyperplasia of the ileocaecal valve.

A 54-year old woman presented to the emergency department with a 7-day history of recurrent abdominal pain and diarrhoea. Computed tomography of the abdomen revealed a classic 'target sign' in the axial and sagittal view of the transverse colon, and a fat-density tumour with a pedicle in the coronal view. A diagnosis of intestinal intussusception was made. Histological assessment of the resected specimen revealed submucosal infiltration by adipose tissue, indicating lipohyperplasia of the ileocaecal valve.

Two-Wire Technique With a Gooseneck Snare to Bail Out the Tip Separation of a Crosser Catheter.

Tip separation of a Crosser catheter is a serious complication; however, there is limited information on bailout methods. Here, we describe a case of successful retrieval of the separated tip of a Crosser catheter using a 2-wire technique with a gooseneck snare. A 76-year-old woman with a history of hemodialysis and diabetes mellitus who developed ulcers on her right toes was diagnosed as having critical limb ischemia and underwent transfemoral antegrade endovascular treatment of the anterior tibial artery (ATA). A 0.014-inch guidewire was passed through the ATA chronic total occlusion, and then a Crosser catheter was advanced along the wire. During catheter withdrawal, the tip completely detached from the shaft and remained in the ATA. We passed another 0.014-inch guidewire into the distal ATA through the small space beside the tip. A gooseneck snare catheter was advanced to the distal side of the tip along the new wire, and subsequently the 2 wires were entrapped by the snare. The detached tip was finally retrieved with the entire system as a unit and successfully withdrawn into the guiding sheath with no complications. Interventionists should be familiar with the bailout method of this unfavorable complication. Our technique may be widely adapted for various situations involving this complication.

Prostatic abscess in a patient with ST-elevation myocardial infarction: a case report.

BACKGROUND: In patients with ST-elevation myocardial infarction (STEMI), urinary tract infection is the most common infection-related complication. Prostatic abscess in a patient with STEMI is very rare. CASE PRESENTATION: We report the case of a 49-year-old Japanese man who developed fever and shaking chills during hospitalization for STEMI. We initially diagnosed catheter-associated urinary tract infection. However, subsequent contrast-enhanced computed tomography revealed multiple large abscesses in his prostate. We decided to treat with antimicrobial agents alone because the patient was receiving dual-antiplatelet therapy and discontinuation is very high risk for in-stent thrombosis. The patient recovered remarkably after treatment without drainage or surgery. CONCLUSIONS: Here, we described the world's first reported case of prostatic abscess in an immunocompetent patient with STEMI. Early removal of indwelling bladder catheters in patients with STEMI receiving dual-antiplatelet therapy is important to avoid development of prostatic abscess. Furthermore, unnecessary invasive instrumentation should be avoided or limited to diminish the risk of infections.