Management of Percutaneous Coronary Intervention Complications

Means, Gregory T.; End, Christopher; Kaul, Prashant

doi:10.1007/s11936-017-0526-6

Cited by 17 publications

(15 citation statements)

References 66 publications

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“…Vascular complications were defined as access site-or access-related vascular injury, as defined by the Valve Academic Research Consortium-2 [19]. Coronary complications were defined as acute stent thrombosis, dissection, no reflow, or coronary perforation [20].…”

Section: Methodsmentioning

confidence: 99%

Impact of Diabetes Mellitus on Outcomes after High-Risk Interventional Coronary Procedures

Johannsen¹,

Soldat²,

Krueger³

et al. 2020

JCM

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An increasing number of patients with coronary artery disease are at high operative risk due to advanced age, severe comorbidities, complex coronary anatomy, and reduced ejection fraction. Consequently, these high-risk patients are often offered percutaneous coronary intervention (PCI) as an alternative to coronary artery bypass grafting (CABG). We aimed to investigate the outcome of patients with diabetes mellitus (DM) undergoing high-risk PCI. We analyzed consecutive patients undergoing high-risk PCI (period 01/2016–08/2018). In-hospital major adverse cardiac and cerebrovascular events (MACCEs), defined as in-hospital stroke, myocardial infarction and death, and the one-year incidence of death from any cause were assessed in patients with and without DM. There were 276 patients (age 70 years, 74% male) who underwent high-risk PCI. Eighty-six patients (31%) presented with DM (insulin-dependent DM: n = 24; non-insulin-dependent DM: n = 62). In-hospital MACCEs occurred in 9 patients (3%) with a non-significant higher rate in patients with DM (n = 5/86, 6% vs. n = 4/190 2%; p = 0.24). In patients without DM, the survival rate was insignificantly higher than in patients with DM (93.6% vs. 87.1%; p = 0.07). One-year survival was not significantly different in DM patients with more complex coronary artery disease (SYNTAX I-score ≤ 22: 89.3% vs. > 22: 84.5%; p = 0.51). In selected high-risk patients undergoing high-risk PCI, DM was not associated with an increased incidence of in-hospital MACCEs or a decreased one-year survival rate.

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Section: Methodsmentioning

confidence: 99%

Impact of Diabetes Mellitus on Outcomes after High-Risk Interventional Coronary Procedures

Johannsen¹,

Soldat²,

Krueger³

et al. 2020

JCM

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“…The most common vascular access site complications include hematomas, pseudoaneurysms, AVFs, femoral artery dissections, and retroperitoneal hemorrhages 1,5 . CT angiography is beneficial for the diagnosis of a hematoma, particularly when there is a concern for a deep‐seated hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Femoral vascular complications after catheter ablation in the current era: The utility of computed tomography imaging

Ishikawa

Miyazaki

Mukai

et al. 2020

Cardiovasc electrophysiol

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Background: Few studies have examined the characteristics of catheter ablation vascular complications, and recently physicians increasingly use computed tomography angiography (CTA) for diagnosing.Objective: We sought to investigate the incidence of femoral vascular complications in catheter ablation and factors associated with complications in the current era. Methods: This single-center observational study consisted of 311 consecutive (atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, and ventricular arrhythmias in 222 [71.4%], 7 [2.3%], 43 [13.8%], and 39 [12.5%]) patients who underwent catheter ablation. The detailed patient data and clinical outcomes were obtained from the medical records.Results: Emergent CTA was performed in a total of 8 (2.6%) patients at a median of 4.5 (2.0-12.5) days postprocedure, and the precise diagnosis was obtained in all.Among them, pseudoaneurysms, arteriovenous fistulae (AVF), and actively bleeding hematomas were identified in two, one, and one patient, respectively, and all required readmissions after discharge. AVF was diagnosed by a Doppler ultrasound examination in another patient. In total, 5 (1.6%) patients exhibited major femoral vascular complications including two pseudoaneurysms, two AVFs, and one active bleeding hematoma. The pseudoaneurysms and AVFs were successfully eliminated by direct compression, and extravasation from the femoral circumflex artery required coil embolization. Antiplatelet therapy and the use of larger arterial sheaths (≥7-Fr) increased the major femoral arterial complications, but atrial fibrillation ablation under uninterrupted anticoagulation therapy or the use of larger venous sheaths did not.Conclusion: Vascular complications are still not negligible procedure-related complications during catheter ablation in the current era. CTA provides a rapid and precise diagnosis for optimal treatment strategies. K E Y W O R D Sarteriovenous fistula, catheter ablation, complication, pseudoaneurysm 1392 | ISHIKAWA ET AL. endovascular, and surgical treatments. Antiplatelet therapy and larger arterial sheath use were associated with a higher incidence of major vascular complications.

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“…Furthermore elderly patients are less likely to receive drug eluting stents due to concerns about prolonged DAPT (10,(86)(87)(88). The complex, calcified lesions in elderly patients are technically more challenging to treat with PCI, and have a higher peri-procedural complication rate (89). In addition, advanced age is independently associated with a reduced effectiveness of adenosine diphosphate (ADP) antagonists and a higher rate of high residual on-treatment platelet reactivity in patients receiving DAPT (90).…”

Section: Lack Of Evidence For Dapt In the Elderlymentioning

confidence: 99%

Antiplatelet agents in uncertain clinical scenarios—a bleeding nightmare

Esmonde

Sharma

Peace

2018

Cardiovasc. Diagn. Ther

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Despite over 40 years since the first percutaneous coronary intervention (PCI) was performed, the optimal dual antiplatelet therapy (DAPT) regime poses a significant challenge for clinicians, especially in certain scenarios. DAPT is the standard of care in PCI following an acute coronary syndrome (ACS) or for elective patients with obstructive coronary artery disease (CAD). There remains significant uncertainty regarding DAPT in patients at high risk of bleeding, such as the elderly and patients requiring anticoagulation. More and more clinicians are faced with a dilemma of weighing risks and benefits from the increasing list of potent, new antiplatelet agents and direct oral anticoagulants (DOACs) in a growing, aging population. Historically, most studies failed to recognize bleeding risk, instead focusing on ischemic risk. In recent years however, bleeding has been recognized as a very significant driver of morbidity and mortality in patients undergoing PCI. There is a paucity of data in this cohort leading to divergent and sometimes conflicting recommendations, largely based on expert consensus of opinion. In the current review, we critically evaluate the available evidence in these uncertain scenarios.

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Management of Percutaneous Coronary Intervention Complications

Cited by 17 publications

References 66 publications

Impact of Diabetes Mellitus on Outcomes after High-Risk Interventional Coronary Procedures

Impact of Diabetes Mellitus on Outcomes after High-Risk Interventional Coronary Procedures

Femoral vascular complications after catheter ablation in the current era: The utility of computed tomography imaging

Antiplatelet agents in uncertain clinical scenarios—a bleeding nightmare

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