Use of Outback(®) LTD(®) Re-Entry Catheter is a safe and valuable option for PIER/subintimal angioplasty and recanalization in patients with symptomatic lower-extremity CTOs. However, long-term patency remains unknown.

SummaryCase: A 43-year-old female presented with sudden onset of palpitations, chest pain, and shortness of breath associated with hypoxemia. A helical computed tomography (CT) scan of the chest revealed a large saddle pulmonary embolism. Intravenous tPA relieved the shortness of breath and improved the hypoxemia. Inferior vena cava (IVC) filter (TrapEase, Cordis Corp., Miami, FL, USA) was placed. On day 6 of her hospitalization, she went into cardiopulmonary arrest while walking back from the rest room. The patient died despite a prolonged attempt at cardiopulmonary resuscitation. At that time, ventricular tachycardia and then ventricular fibrillation were recorded. Autopsy of the heart showed the IVC filter entrapped within the tricuspid valve.Discussion: The incidence of IVC filter migration ranges from 0.3 to 6% with rare migration to the heart or lung (0.1-1.25%). Sudden cardiac death from migration of IVC filter is extremely rare. We report the first case of sudden cardiac death caused by migration of the TrapEase filter to the heart. There are two reports in the literature of death from migrating Greenfield and Antheor filters.Conclusion: An IVC filter migration to the heart, although rare, can cause serious arrhythmia and sudden cardiac death.

No abstract

Introduction: Transcarotid artery revascularization (TCAR) is a novel procedure to intervene on clinically significant carotid artery stenosis. Periprocedural rates of stroke have remained exceedingly low in clinical trials (<1.5%). Diabetics are known to have elevated risk of periprocedural adverse events with both carotid endarterectomy and carotid artery stenting. TCAR may offer lower periprocedural rates of cerebrovascular accident given its novel flow reversal technique. However, outcomes among diabetics undergoing TCAR remain unknown. We sought to determine periprocedural cardiovascular and cerebrovascular events (MACCE) among diabetics undergoing the TCAR procedure in a large national database. Methods: The Vascular Quality Initiative database was queried for all TCAR procedures performed from January 2012 to March 2021. Baseline demographic information as well as periprocedural outcomes were obtained. In cases in which a patient had multiple procedures, only the most recent procedure was evaluated. Results: A total of 19,341 patients (median age 74 (IQR 67-80), 63.7% male and 90.3% white) underwent the TCAR procedure. Of this n=7,427 (38.4%) were diabetics. Compared to non-diabetics, the diabetic cohort had a higher risk of stroke (1.7% vs 1.3%, p=.02), transient ischemic attack (0.7% vs 0.4% p =.027), and myocardial infarction (0.7% vs 0.5% p=.064). Death remained a rare outcome, with diabetics having 0.5% periprocedural mortality vs 0.4% among non-diabetics (p=.096). Conclusions: TCAR is a safe revascularization method for significant carotid artery stenosis with an elevated risk of periprocedural MACCE in diabetics compared to non-diabetics. Further study is needed to define optimal patient selection for this novel and less-invasive management strategy for carotid artery disease.

Background Transcarotid artery revascularisation (TCAR) is a novel procedure to intervene on carotid artery stenosis. It has previously shown to have lower rates of periprocedural adverse events compared to transfemoral carotid artery stenting (TFCAS) and carotid endartectomy (CEA). To date, no study has examined outcomes among diabetics undergoing TCAR compared to TFCAS and CEA. Purpose We sought to determine the rates of adverse periprocedural outcomes related to TCAR, TFCAS and CEA in diabetics. Methods The Vascular Quality Initiative Database was queried for all patients from March 2009 to April 2021 for diabetic patients undergoing carotid artery revascularisation via TCAR, TFCAS or CEA. Baseline demographic information as well as periprocedural outcomes were obtained. Results A total of 57,716 diabetic patients underwent carotid artery revascularisation. Of these 11.3% underwent TCAR (n=6569), 8.1% (n=4703) underwent TFCAS, and 80.4% (n=46,444) underwent CEA. 39% (n=22,528) were female and 87.3% (n=50,377) were white. Compared to TFCAS, TCAR demonstrated lower rates of stroke (1.6% vs 2.2%, p=0.026), stroke/transient ischemic attack (2.2% vs 3.0%, p&lt;0.001), and death (0.4% vs 1.3%, p&lt;0.001) but remained higher than CEA for both stroke (1.6% vs 1.3%), stroke/TIA (2.2% vs 1.9%) and death (0.4% vs 0.3%). Conclusions TCAR appears to be a safe revascularisation procedure for carotid artery stenosis with lower rates of stroke, stroke/TIA, and death in diabetics compared to TFCAS. However, rates remain higher than CEA. TCAR may thus be a viable alternative in diabetics who otherwise would be poor candidates for revascularisation via CEA. Funding Acknowledgement Type of funding sources: None.

We describe the case of a 38-year-old woman who presented with symptoms of chest pain and shortness of breath that had worsened over the previous 6 months and was found to have a large pseudoaneurysm (PSA) of the thoracic aorta. She underwent surgical repair of aortic coarctation at the age of 16 and a revision of her bypass graft at age 28 when she presented with hemoptysis due to aortic PSA and aortobronchial fistula. Our cardiothoracic surgical team deemed a third surgery very high risk; therefore, she was referred to us for percutaneous repair of aortic PSA. We describe the successful treatment of the PSA using a technique of microcoil embolization and Amplatzer® vascular plug (AGA Medical Corp., Plymouth, MN).

No abstract

No abstract