Search Results for: Utilizzo degli stent-retriever nell’ictus ischemico acuto

Circulation, Volume 150, Issue Suppl_1, Page A4140084-A4140084, November 12, 2024. Description of case:A 55 yo man with no PMHx presented with a few hours of intermittent left-sided chest tightness.Serial EKG revealed dynamic ST-T wave changes in lateral leads—Figure 1.His lipid panel was abnormal, and the High-Sensitive Troponin T trended up—table 1.Based on the hemoglobin A1C result of 10.6, he was newly diagnosed with DM.Coronary angiography shows two vessel diseases. The left circumflex artery’s first obtuse marginal artery branch (LCX-OM1) received a stent in the first instance.During the planned PTCA for treatment of LAD 48 hours after, he developed sudden bilateral loss of vision while on the table just before stent deployment.In this case, with the emergence of the symptom of vision loss, PTCA was halted to allow the operator to rule out an acute cerebrovascular accident (CVA) through urgent CT head and MRI brain scans.He consented to complete the LAD PTCA the day after, which achieved the intended restenosis without complications.Discussion:Bilateral transient cortical blindness (TCB) is a reversible syndrome of vision loss affecting both eyes in the presence of normal visual pathways due to a brief disturbance in the occipital cortices. TCB is more commonly associated with cerebral angiography but has been rarely reported after coronary angiography.Angiographic contrast toxicity is one of the proposed pathophysiologic mechanisms. During our case, approximately 30 mL of iohexol was used before TCB, while about 120 mL of iodixanol was used for the repeat and conclusive procedure.We are not aware of a previous report in which PTCA was recommenced hours after being halted due to TCB in a patient suffering acute coronary syndrome.The absence of symptom recurrence when the PTCA was recommenced, which underscored the benign nature of TCB, enabled the patient to receive conclusive, definitive treatment for his acute coronary condition.

Circulation, Volume 150, Issue Suppl_1, Page A4137467-A4137467, November 12, 2024. Background:Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) allows better visualization of atherosclerotic plaques than angiography alone. We conducted a systematic review and meta-analysis to comprehensively synthesize the available evidence regarding the efficacy of IVUS-guidance compared to angiography-guided PCI. Moreover, we conducted a sensitivity analysis to determine the applicability of IVUS guidance in complex PCI.Methods:We conducted a comprehensive literature search of major bibliographic databases from inception until May 2024 to identify randomized controlled trials (RCTs) comparing IVUS-guided versus angiography-guided PCI. Risk ratios (RR) with their corresponding 95% confidence intervals (CI) were pooled using the random-effects model, with a p-value

Circulation, Volume 150, Issue Suppl_1, Page A4143937-A4143937, November 12, 2024. Background:Elevated Lp(a) levels are associated with a higher risk of major adverse CV events. Whether elevated Lp(a) levels are associated with a higher risk of complex coronary revascularization procedures or modify the benefit of evolocumab remains unknown.Methods:The FOURIER trial randomized 27,564 pts with stable ASCVD on optimized statin therapy to evolocumab vs placebo (median f/u 2.2 yrs). The association between Lp(a) (≥125 nmol/L) and complex coronary revascularization procedures (complex PCI or any CABG) was assessed in pts from the placebo arm with an adjusted Cox regression model. Complex PCI events were identified through blinded review of all revascularization events and defined as ≥1 of: multivessel PCI, ≥3 stents, ≥3 lesions treated, bifurcation PCI, or total stent length >60 mm. Effect modification between Lp(a), evolocumab and the risk of complex revascularization was assessed by including an interaction term in the model. Kaplan-Meier event rates are reported at 3 yrs.Results:In FOURIER, 4048 (32%) pts had a baseline Lp(a) concentration ≥125 nmol/L. A total of 332 complex coronary revascularization procedures occurred. Pts with higher baseline Lp(a) levels were more frequently female (29% vs 23%) and more likely to have multivessel disease (24% vs 21%), diabetes mellitus (38% vs 34%) or prior PCI (66% vs 60%). Higher baseline Lp(a) was associated with a 27% higher risk of complex coronary revascularization (3.7% vs 3.2%; HRadj 1.27, 95% CI: 1.01-1.59; P=0.04) (Fig 1A), including a 41% higher risk of complex PCI (2.3% vs 1.7%; HRadj 1.41, 95% CI: 1.05-1.90). Evolocumab significantly reduced the risk of complex coronary revascularization procedures by 22% (HR 0.78, 95%CI [0.63, 0.95]) in pts with Lp(a)

Circulation, Volume 150, Issue Suppl_1, Page A4118070-A4118070, November 12, 2024. Introduction:The advent of leadless pacemaker (LP) technology has revolutionized cardiac rhythm management by minimizing risks associated with traditional transvenous pacemakers. LP use is expected to increase as dual-chamber LP systems emerge into clinical practice. The LP requires a large-bore venous sheath (27-Fr) through a femoral vein. One risk of large bore femoral cannulation is creation of an occult arteriovenous fistula (AVF), which can cause high output heart failure (HOHF) over time. In the LEADLESS II trial, the event rate for AVF was 0.2%. HOHF as a complication of LP implant has not been previously reported. We describe the first case of HOHF in a heart transplant (HT) recipient after LP.Case Presentation:An 82-year-old male with a history of HT 26 years earlier underwent leadless pacemaker for recurrent syncope, deemed associated with conduction system disease. He had no history of cardiac allograft rejection, angiographic coronary allograft vasculopathy or left ventricular dysfunction. Six months post-implant he presented with shortness of breath and bilateral lower extremity edema.Management:Evaluation included: 1) Chest X-ray which was suggestive of pulmonary edema 2) natriuretic peptide level of 5,500 pg/ml (6-fold increase from 6 months prior) 3) echocardiogram showing EF of 69%, and 4) bilateral lower extremity Doppler ultrasound where he was found to have a large AVF between the right superficial femoral artery and superficial femoral vein. Subsequent right heart catheterization was notable for a PCWP of 18 mmHg and a cardiac output/index of 11 L/min and 5.8 L/min/m2 respectively, hence confirming HOHF. Treatment with intravenous diuretic was initiated and percutaneous stent placement to correct the AVF was performed with symptomatic relief.Conclusion:This case highlights the rare but serious complication of unrecognized AVF following leadless pacemaker implant. Given that this event occurred in a HT recipient, a more exhaustive work-up was required to rule-out expected causes of congestion. To our knowledge there is only one other case report describing AVF post-LP implant for which no intervention was performed due to absence of symptoms at 6-month follow up and HOHF was not reported. Our case emphasizes that the differential diagnosis of new onset of signs and symptoms of heart failure that develop post LP implant in general and in HT recipients specifically, should include HOHF related to an unrecognized procedural AVF.

Circulation, Volume 150, Issue Suppl_1, Page A4140714-A4140714, November 12, 2024. Background:Severe mental disorders (SMIs) such as bipolar disorder are associated with a reduced life expectancy of up to two decades, with cardiovascular disease as the leading cause of death. Post-acute coronary syndrome, SMI patients, including bipolar disorder, often face poor prognosis and lower percutaneous coronary intervention (PCI) rates. We aimed to assess PCI prevalence and outcomes in patients with bipolar disorder.Methods:We analyzed the National Inpatient Sample data from 2016-2019, identifying 4,483,509 hospitalized adults with myocardial infarction (MI). These hospitalizations were further stratified based on the presence or absence of bipolar disorder using ICD-10 codes. A multivariate regression model was used to adjust for confounders and analyze the variables.Results:Out of 142,420,378 hospitalizations, 4,483,509 (3.15%) were identified with MI. Among those with MI, 1,221,030 (27.24%) underwent PCI. PCI rates were higher among MI patients without bipolar disorder compared to those with bipolar disorder (27.4% vs. 20%; p

Circulation, Volume 150, Issue Suppl_1, Page A4140865-A4140865, November 12, 2024. Introduction:Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is recommended after percutaneous coronary intervention (PCI) to lower the risk of cardiovascular events. However, prolonged DAPT has been shown to increase bleeding risk, while some studies have shown that shorter-duration of DAPT followed by aspirin alone increases ischemic risk.Research question:This study aimed to compare the risks and benefits of monotherapy with P2Y12 inhibitors and DAPT after PCI.Methods:We searched the Medline, Embase, and Cochrane databases for randomized controlled trials (RCTs) involving adult patients hospitalized with ACS who underwent PCI. Our primary outcome was the composite of death, myocardial infarction (MI), and stroke. The secondary outcomes were net adverse clinical events (NACEs which is the primary outcome and risk of major bleeding), all-cause mortality, cardiac death, MI, stroke, stent thrombosis, target vessel revascularization, clinically relevant bleeding, and major bleeding. We used Review Manager 5.4 for the statistical analysis, employing risk ratios (RRs) with 95% confidence intervals (CIs).Results:Nine RCTs were included, involving a total of 34,322 patients, with 48.9% receiving P2Y12 inhibitor monotherapy after 1–3 months of DAPT. Regarding the primary outcomes, the risk of the composite of all-cause mortality, MI and stroke was significantly lower in patients receiving P2Y12 monotherapy as compared to patients on DAPT (RR 0.91[95% CI 0.84–0.98], I2=0%, p=0.01).With respect to the secondary outcomes, there was a significantly lower risk of NACEs (RR 0.86 [95% CI 0.76–0.97], I2=58%, p=0.01), clinically relevant bleeding (RR 0.59 [95% CI 0.38–0.93], I2=92%, p

Circulation, Volume 150, Issue Suppl_1, Page A4113951-A4113951, November 12, 2024. Background:Understanding the intricacies of luminal surface topographic changes in pathologic coronary arteries may yield insight not only on the efficacy of existing clinical interventions (e.g. impact of surface changes on stent anchoring), but also on the subsequent hemodynamic changes and pathophysiology of thrombus formation. In this study, we aim to detect and quantify luminal surface alterations induced by the presence of calcification in cadaveric left anterior descending arteries (LADs) using a novel approach–surface metrology.Methods:LADs (n=10) were harvested from cadaveric hearts using a systematic dissection approach, scanned using the Bruker Skyscan 1173 microCT scanner, and then underwent threshold-based image segmentation on Dragonfly by Object Research Systems to quantify the total calcium volume present throughout the vessel. Each specimen was then splayed open and up to 15 scans were performed at 20X magnification using the Sensofar S Neox optical profiler. Each scan subsequently underwent surface metrologic scale-sensitive fractal analyses in SensoMap 10.Results:Extent of calcification was standardized and expressed using the following ratio: total calcium volume by total vessel length (TC/VL). We considered a TC/VL ratio of 0-0.25 as low calcification and 0.26-0.5 as high calcification. Interestingly, our findings demonstrated statistically significant increases in smooth-rough crossover (SRC) and scale of maximum complexity (Smfc) with positive correlation, but reductions in fractal complexity (Lsfc) and fractal dimension (Dls) with negative correlation, in highly calcified compared to lowly calcified LADs.Conclusions:Our data suggests that the presence of calcium in the walls of LADs may translate to increased roughness in luminal surfaces generally, but smoothness over calcified plaques, locally. Our proposed mechanism is increased endothelial tension directly over areas of calcification, thus reducing surface complexity. Future studies will involve modeling blood flow using smooth particle hemodynamics (SPH) based on complete luminal and surface topographical geometries to evaluate the impact of these surface changes on hemodynamics.

Circulation, Volume 150, Issue Suppl_1, Page A4139659-A4139659, November 12, 2024. Introduction:Significant coronary atherosclerotic lesions that involve the ostium of the left anterior descending (LAD) artery (Medina 0,1,0) pose unique challenges. The two main techniques used for percutaneous coronary intervention (PCI) of ostial LAD lesions are ostial stenting (OS) and crossover stenting (CS), in which a stent is deployed across the lesion extending from the left main (LM) artery into the LAD. Several observational studies have compared the efficacy of the two techniques, but the results have been mixed with respect to clinical outcomes.Research Question:Is there a difference in efficacy between CS and OS in ostial LAD lesions based on pooled data from existing studies?Methods:A systematic review was performed for studies comparing CS and OS techniques with respect to long-term outcomes (≥1 year). We used the Mantel-Haenszel random effects model to compute relative risk (RR) with 95% confidence intervals (CI) comparing rates of major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) between groups using the CS and OS techniques. In the secondary analysis, we included only studies with a high proportion ( >50%) of intravascular ultrasound (IVUS) use in the CS group, given guideline recommendations of intravascular imaging in LM stenting.Results:We included 1448 patients across eight studies. In the primary meta-analysis, there was no significant association between the stenting technique and MACE (RR 0.72, 95% CI 0.38-1.39), all-cause mortality (RR 0.88, 95% CI 0.34-2.33), MI (RR 0.73, 95% CI 0.36-1.48), and TLR (RR 0.62, 95% CI 0.38-1.01). CS was favored with respect to ST (RR 0.34, 95% CI 0.13-0.93, p=0.04). There was significant heterogeneity between studies. In the secondary analysis, CS was favored with respect to MACE (RR 0.56, 95% CI 0.34-0.94, p=0.03) when including only studies that employed a high percentage of IVUS use in LM stenting. No significant differences were found with respect to all-cause mortality, MI, TLR, or ST.Conclusion:Based on our study, CS and OS appeared similar with respect to MACE, death, MI, and TLR, though there was significant heterogeneity across studies. CS did appear to be associated with lower ST. Moreover, CS was more favorable with a lower risk for MACE when IVUS was used more frequently, suggesting the importance of intravascular imaging in ostial LAD PCI.

Circulation, Volume 150, Issue Suppl_1, Page A4145631-A4145631, November 12, 2024. Description of Case:A 64-year-old male with complex medical history, including infective endocarditis of the aortic valve requiring surgical replacement with a bioprosthetic valve and recurrent infective endocarditis of the bioprosthetic valve, presented with two hours of crushing chest pain and found to have ST elevations. Urgent angiography revealed complete occlusion with thrombus of the proximal left anterior descending (LAD) coronary artery. The patient underwent aspiration thrombectomy, followed by intracoronary vasodilators, without improvement of flow. Due to ongoing shock despite initial mechanical support, the patient was escalated to an Impella CP device after a transthoracic echo confirmed no left ventricle thrombus. Once stabilized, intravascular ultrasound showed significant thrombus and plaque in the LAD. This was treated with a drug-eluting stent, but TIMI 3 flow was not achieved. The patient was placed on an integrilin drip with plans to reevaluate in 24 hours. While preparing for transport to the cardiac ICU, the Impella device malfunctioned, and function could not be restored. With ongoing hemodynamic collapse, a second Impella device was placed, but it malfunctioned almost immediately, and the patient suffered a pulseless electrical activity arrest. Advanced Cardiac Life Support was initiated, but the patient ultimately expired. Abiomed’s investigation following the case identified an unknown biological material obstructing both Impella devices. In light of a leukocytosis of 14,000 and a recent urine sample positive for E. coli, there is a high suspicion that the patient suffered from recurrent infective endocarditis causing septic embolization and subsequent Impella device failure from aspiration of bacterial vegetations.Discussion:This is the first known reported case of Impella device failure resulting from the aspiration of vegetation in a patient with infective endocarditis of a bioprosthetic aortic valve. The case highlights the challenges of diagnosing endocarditis in bioprosthetic valves and emphasizes the importance of transesophageal echo in cases with high clinical suspicion. Additionally, considering the recent FDA recall of Impella devices in patients who have had transcatheter aortic valve replacement (TAVR) procedures due to the risk of motor damage after contact with TAVR stents, this case calls attention to a need for further research of the use and safety of Impella devices in patients with non-native aortic valves.

Circulation, Volume 150, Issue Suppl_1, Page A4123480-A4123480, November 12, 2024. Introduction:Aspirin (ASA) hypersensitivity is a challenge in determining the appropriate, cost-effective therapy in patients after percutaneous coronary intervention (PCI). Various ASA desensitization protocols were studied and showed favorable outcomes. In this case, we highlight the use of rapid ASA desensitization protocols for patients requiring dual antiplatelet therapy (DAPT) post urgent PCI.Case:A 52-year-old male presented with severe left-sided chest pain associated with diaphoresis. He had a history of allergic reaction to ASA at the age of 18 years with swelling of the face and throat without shortness of breath or hypotension. Physical examination was unremarkable except for tachycardia. Workup showed no ECG abnormalities but significantly elevated, uptrending high sensitivity troponin. Medical management included clopidogrel load, heparin drip, and nitropaste for persistent pain. Urgent coronary angiography showed a severe bifurcating lesion in the LCx and OM1 arteries, successfully treated with the T stent technique using a drug-eluting stent. He received cilostazol and prasugrel, overlapped with a tirofiban drip post PCI. ASA desensitization was performed with oral ASA every 90 minutes for four doses (Figure). Vital signs were monitored every 30, 60, and 90 minutes after each dose. He was discharged home with no reported symptoms on follow up.Discussion:DAPT with ASA and oral P2Y12 inhibitors is recommended for patients with PCI. ASA desensitization could be considered for patients who are intolerant to ASA. Major clinical ASA desensitization protocols, like in ADAPTED and SCRIPPS studies, showed good outcomes in major adverse cardiovascular events. However, one limitation of these widely used protocols is the prolonged time required to achieve desensitization. The rapid protocol used in our patient who did not have ASA exacerbated respiratory disease showed effectiveness with shorter hospital stay.Conclusion:ASA desensitization is an appropriate option for patients with a history of ASA allergy requiring DAPT. Rapid desensitization protocols are associated with shorter hospitalization courses, and future efforts should evaluate their effectiveness in randomized controlled trials.

Circulation, Volume 150, Issue Suppl_1, Page A4136442-A4136442, November 12, 2024. Introduction:Coronary in-stent restenosis (ISR) remains challenging despite stent technology advancements. Paclitaxel-coated balloons (PCB) offer a promising non-implant approach to deliver antiproliferative agents directly to the vessel wall. This meta-analysis aims to evaluate the comparative effectiveness of PCB versus uncoated balloons (UCB) in managing coronary ISR to address emerging safety concerns.Methodology:Medline, Scopus and Embase were searched until April 2024 for randomized controlled trials (RCTs) comparing PCB versus UCB in patients undergoing coronary ISR. Primary outcomes were in-segment late lumen loss (LLL), binary restenosis, target lesion revascularization (TLR), major adverse cardiac events (MACE), and mortality. Secondary outcomes included in-stent LLL, in-stent binary restenosis, myocardial infarction (MI), cardiac death, target vessel MI, and target vessel revascularization (TVR).Results:This meta-analysis includes seven RCTs with 1,408 patients (PCB = 864, UCB = 544). PCB significantly reduced in-segment LLL (MD= -0.50, 95% CI [-0.67, -0.33]; P < 0.00001), in-segment binary restenosis (RR= 0.25, 95% CI [0.14, 0.45]; P < 0.00001), target lesion revascularization (RR= 0.43, 95% CI [0.32, 0.58]; P < 0.00001), mortality (RR=0.56, 95% CI [0.39, 0.80]; P=0.001), and MACE (RR= 0.36, 95% CI [0.25, 0.51]; P < 0.00001). PCB also significantly decreased in-stent LLL (MD= -0.52, 95% CI [-0.72, -0.32]; P < 0.00001), in-stent binary restenosis (RR = 0.19, 95% CI [0.11, 0.35]; P < 0.00001), and TVR (RR = 0.45, 95% CI [0.29, 0.70]; P = 0.0003). PCB showed a short-term reduction in MACE and target lesion revascularization at 6 months, 1 year and 3 years of followup. No difference was observed in MI, cardiac death, or target vessel MI.Conclusion:In patients with coronary ISR, PCB are associated with reduced in-segment LLL, in-segment binary restenosis events, target lesion revascularization, mortality, MACE, in-stent LLL, in-stent binary restenosis and target vessel revascularization.

Circulation, Volume 150, Issue Suppl_1, Page A4125106-A4125106, November 12, 2024. Background:Internationally, drug-coated balloons have emerged as a new treatment approach in In-Stent Restenosis (ISR) offering localized drug delivery to inhibit neointimal growth without the need for additional stent layers. However, their use has not been assessed or approved in the United States. Paclitaxel-coated balloons (PCBs) are gaining traction as alternatives for in-stent restenosis patients. Yet, their safety and effectiveness compared to uncoated balloons remain uncertain. This meta-analysis seeks to systematically assess PCBs’ safety and efficacy for ISR treatment by comparing them to uncoated balloons.Research Question:Are paclitaxel-coated balloons (PCBs) superior to uncoated balloons (UCBs) in terms of safety and efficacy for the treatment of coronary in-stent restenosis (ISR)?Aims:Systematically assess the safety and efficacy of paclitaxel-coated balloons (PCBs) compared to uncoated balloons (UCBs) for the treatment of coronary in-stent restenosis (ISR).Methods:A comprehensive literature review was conducted utilizing multiple databases up to May 2024, focusing on randomized controlled trials comparing PCB vs UCB in patients with coronary in-stent restenosis. Six randomized controlled trials with a total of 1,347 patients who completed 1-year follow-up were included. Dichotomous data were calculated as odds ratios (ORs) and 95% confidence intervals (95% CI). P

Circulation, Volume 150, Issue Suppl_1, Page A4143746-A4143746, November 12, 2024. Background:Necrotizing enterocolitis (NEC) is a rare comorbidity in infants with heart disease, specifically those with shunt-dependent congenital heart disease (SDCHD). We aimed to describe NEC incidence and cofactors in our center’s SDCHD population and diagnostic practice changes.Methods:A retrospective case-control study in patients who underwent first staged palliation for SDCHD between 1/1/2013 and 6/30/2022. Palliation procedures included stage one Norwood with a BTTS or RV to PA conduit, hybrid, BTTS only or PDA stent. Demographics, clinical factors, and diagnostics including abdominal ultrasound (AUS) were abstracted for subjects for 21 days after palliation. NEC was defined with Bell’s criteria from databases and AUS was assessed by chart review. Hierarchical logistic regression models assessed surgical era rates into three cohorts 2013-2016, 2017-2019, and 2020-2022. Groups were compared with Chi-square, Fisher’s exact test, Wilcoxon rank-sum tests, and trends over time with logistical regression.Results:Of 531 patients included, 77 (14.5%) had NEC. There was no association of NEC diagnosis with sex, race, and ethnicity, presence of genetic syndromes or extracardiac abnormalities. The primary and majority SDCHD diagnosis was hypoplastic left heart syndrome and variants (61%). On univariate analysis, risks significantly associated with NEC include younger gestational age, delayed sternal closure, catheter reintervention, ECMO, cardiac arrest, seizures, >/= moderate ventricular dysfunction, increased pre- and post-procedural VIS scores, and postoperative anemia. Logistic regression found a significant increase in NEC by year, with a 23% increase in odds for each increasing year across the time range (OR 1.23, 95% CI 1.12-1.36, p

Circulation, Volume 150, Issue Suppl_1, Page A4118076-A4118076, November 12, 2024. Introduction:The occurrence of innominate artery stenosis is less prevalent compared to subclavian artery disease. Small studies suggest up to 8% of individuals initially diagnosed with suspected subclavian steal syndrome may present with innominate artery lesions. Deployment of an embolic protection filter within the internal carotid artery during percutaneous intervention of the innominate artery presents a solution to mitigate embolism.Case:A 70-year-old female with a history of peripheral vascular disease presented with claudication in both arms, manifested as pain in both arms. Her left subclavian was stented months prior to presentation. An aortogram revealed severe stenosis of the innominate artery (Figure 1). Since multiple attempts to cross the lesion antegrade from the femoral access site were unsuccessful, we proceeded with the successful deployment of an embolic protection filter in the right internal carotid artery via our right radial artery access site (Figure 2). Using the right radial artery, we passed a long run-through guidewire into the distal abdominal aorta. Due to severe aortic tortuosity, we were unable to snare the wire from the aorta. Therefore, we upsized the radial sheath to 7 French over both wires (runthrough and bare). Using a support catheter, we exchanged the runthrough wire for a Glidewire Advantage. We advanced an 8 x 29mm balloon expandable stent to the area of innominate stenosis and deployed it (Figure 3). We postdilated the stent with a 14mm balloon. Angiography demonstrated adequate expansion. On follow up, the patient was without claudication and had triphasic flow in the innominate and left subclavian arteries.Discussion:Treating innominate artery stenosis via radial access employing a sole entry point for both embolic protection and treatment administration offers a substitute where additional access is infeasible. Modern embolic protection techniques are superior due to their flexibility and ease of use. In this case, placing the embolic protection device in the carotid artery was mandatory through the sole radial access to prevent trapping the filter behind the innominate artery stent. We were able to perform both the embolic device placement and the stenting with the same radial access.Conclusion:Endovascular intervention of innominate artery stenosis via radial access, utilizing a single radial access for both embolic protection and treatment delivery, presents an alternative when femoral access is not feasible.

Circulation, Volume 150, Issue Suppl_1, Page A4138322-A4138322, November 12, 2024. Backgrounds:We have previously used a handmade branched stent graft (SG) to treat thoracic aortic aneurysms. In this study, we examined the long-term results of treatment for dissecting thoracic aortic aneurysms.Methods:Between 2004 and 2014, we treated 28 patients with dissecting thoracic aneurysms using the branched SGs.Results:The mean age was 65 ± 14 years; 17 were over 70, and 22 were male. The mean time from the onset of dissection was 5.7 ± 6.3 years; 6 were operated within one year. The mean aneurysm diameter was 59 ± 8 mm. All dissecting aneurysms were located after zone 3. SG branches were one in 24 cases, two in 2, and three in 2. Twenty-two were treated for entry closure and distal landing in the true lumen. Six with limited dissecting aneurysms were treated for entry closure and distal landing in a non-dissected lumen. The cause of perioperative death was pneumonia in 1. The mean follow-up was 8.3 ± 5.3 years. Entry closure was achieved at 86%, branch patency was 94%, and aneurysm diameter was reduced by an average of 5 ± 14%. There were 6 aneurysm-related deaths. Two were aneurysm ruptures, and each of the 4 was additional operative death, sudden death, SMA occlusion, and type A dissection. The aneurysm-related mortality was 26% at eight years; there was no difference between under 70 and over 70 years old. The cumulative risk of additional procedures was 57% at eight years, and the risk was higher in those over 70 than those under 70 (p

Circulation, Volume 150, Issue Suppl_1, Page A4141955-A4141955, November 12, 2024. Introduction:Whereas low testosterone levels have been associated with poor cardiovascular outcomes and testosterone replacement therapy (TRT) in middle-to-older age adults with cardiovascular risk factors is considered safe, there is little data on the adverse cardiovascular effects of TRT in young adults.Case Report:A 38-year-old male with a past medical history of hypogonadism, recently started on intramuscular testosterone cypionate injections, presented to the hospital with altered mentation. Laboratory workup was remarkable for hemoglobin of 19 g/dL. Computed tomography (CT) angiogram of the head demonstrated a left middle cerebral artery infarct with a filling defect, requiring mechanical thrombectomy. A transthoracic echocardiogram (TTE) was done which revealed a dilated left ventricle (LV) with severely reduced LV systolic function, EF 20%, and global hypokinesis. There was no LV thrombus or evidence of a patent foramen ovale with contrast saline injection. He did not have any episodes of atrial fibrillation on telemetry monitoring. His hospital course was further complicated by an inferolateral ST elevation myocardial infarction (STEMI) due to distal left anterior descending (LAD) artery occlusion. He underwent drug-eluting stent placement and was started on dual antiplatelet therapy. Repeat TTE demonstrated new apical akinesis along with an LV apical thrombus of 1.1 x 0.8 cm. CT abdomen/pelvis with contrast demonstrated left renal and right iliofemoral thrombosis and the patient was also started on systemic anticoagulation.Discussion:Data suggests that physiologic levels of testosterone exhibit cardioprotective effects and low testosterone levels are associated with increased cardiovascular mortality. However, studies have also shown that testosterone use is associated with an increased risk of thrombosis and coronary artery disease. Additionally, testosterone use has been associated with myocardial apoptosis and adverse cardiac remodeling from dysregulation of androgenic receptors, which results in dilated cardiomyopathy. There is an ongoing debate on the safety of TRT, however, studies on TRT have largely included the middle and older male population and there is little data on younger patients. Herein, we demonstrate a case of TRT in a patient with several cardiovascular risk factors, who developed evidence of possible TRT-associated cardiomyopathy in addition to hypercoagulability.