Balloon uncrossable coronary lesions are lesions that cannot be crossed with a balloon after successful guidewire crossing. The strategies used to facilitate the treatment of such lesions can be classified into strategies that provide lesion modification and strategies that increase support. We describe a systematic, algorithmic approach to treat balloon uncrossable lesions, starting with use of small balloons, followed by increase in guide catheter support, use of microcatheters, wire cutting or puncture techniques, laser, atherectomy, and subintimal modification techniques. Sequential and simultaneous application of the aforementioned techniques can result in successful treatment of these challenging lesions.
Background: There is increased risk of cardiovascular complications in hepatitis C virus (HCV)-infected patients regardless of the severity of the liver disease or the common cardiovascular risk factors.
Aim of the Study:This study is conducted to evaluate the effect of associated hepatitis C viral infection on the short-term clinical outcome of acute decompensated heart failure (ADHF) patients during their in-hospital stay and one month after discharge. Methods: This is a prospective observational study that was conducted on patients with ADHF, who were admitted in cardiovascular department at specialized medical hospital, Mansoura University during the period between January 2018 and January 2019. The study included 100 patients with heart failure (HF), 63 males and 37 females, and their ages ranged from 28 -88 years. Results: There was no significant changes between heart failure (HF) patients with and without HCV regarding all demographic data, and HF risk factors. There was statistically non-significant increase in prevalence of HF with reduced ejection fraction (HFrEF) among HF patients with HCV (70.3%) than those without HCV (57.1% P>0.05). HCV infection had no significant effect on the outcome of HF clinical course, although, there was statistically significant increase in prevalence of pulmonary hypertension in HF patients with HCV 35.1% than without HCV 11.1%. Conclusion: HCV-Infection in patients with ADHF has no effect on all aspects of patient's clinical states. Among patients with ADHF, the main predictors of short-term post discharge clinical status are patient age and the whole duration of chronic HF disease.
Background: Optimal femoral artery access plays an important role in minimizing complications associated with cardiac catheterization. Suboptimal access can occur with traditional method. Ultrasound guided femoral access can minimize the vascular complications by reducing the attempts to catheterize the artery.
Aim of the Study:This study is conducted to compare the procedural and clinical outcomes of femoral arterial access with ultrasound (US) guidance versus traditional approach. Patients and Methods: We investigated a total of 50 patients undergoing elective coronary angiography via the femoral artery in Mansoura cardiology department between January 2020 to January 2022 as prospective comparative cross-sectional study. Results: Successful CFA cannulation occurred in 92.0% of US guided procedures compared with 56% of traditional approach (P <0.05). Time of sheath/ seconds was higher in traditional approach group, median = 120, ranged from 2 to 360 as compared to median=60, ranged from 5 to 300 with statistically significant difference (p value ≤0.05). First pass was higher among ultrasound guidance group, representing 72% as compared to 40% among traditional approach group. Venipuncture was higher among traditional approach group (52%) as compared to 12% among ultrasound guidance group with statistically significant difference (p value ≤0.05). Vascular complications were higher among traditional approach group, representing 40% as compared to only 4% among ultrasound guidance group with statistically significant difference (p value ≤0.05). Conclusion: Ultrasound guided femoral access reduced time to access, risk of venipunctures, and vascular complications.
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