Volume 4 – Number 1 – February 2018

23 February inIssue, Uncategorized

Featuring editorials from India, Japan, Singapore and South Korea this issue also includes a articles examining the impact on first-generation DES implantation using IVUS as opposed to guidance by angiography alone; TAVI in rheumatic AS and, as AsiaIntervention is not only the official publication of APSIC but the Interventional Cardiology Foundation of India (ICFI) as well, we present the abstracts from the 2018 edition of INDIALIVE.

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AsiaIntervention: the voice of clinical research and publications of the region

21 February inEditorial, Issue

Upendra Kaul
AsiaIntervention 2018;4:5-6, DOI: 10.4244/AIJV4I1A1

It is very appropriate that AsiaIntervention is bringing out this special issue to mark the 9th INDIA LIVE being held in Chennai starting on 28 February 2018. The Interventional Cardiology Foundation of India (ICFI) named this journal the official journal of INDIA LIVE in 2017. This was followed by the Asia Pacific Society of Interventional Cardiology (APSIC) making it their scientific voice. The journal was planned by the thought leaders of this region to become a forum of high-quality research and education in the field of percutaneous and surgical cardiovascular interventions from the Asia-Pacific region.

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Significance of verification of IVUS-guided stent optimisation

26 February inEditorial, Issue

Sung-Jin Hong, Myeong-Ki Hong
AsiaIntervention 2018;4:7-9, DOI: 10.4244/AIJV4I1A2

During percutaneous coronary intervention (PCI), intravascular ultrasound (IVUS) provides anatomic information for the coronary artery lumen, wall, and plaques, which can help the accurate evaluation of the lesion with vessel sizing. Moreover, post-PCI stent underexpansion, malapposition, or edge dissections can be detected for stent optimisation, resulting in improved clinical outcomes. Recently, much evidence demonstrating the clinical usefulness of IVUS has become available, particularly for complex lesions, such as left main disease, chronic total occlusions, and diffuse long lesions.

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Transcatheter aortic valve implantation in rheumatic aortic stenosis

26 February inEditorial, Issue

Paul T.L. Chiam
AsiaIntervention 2018;4:11-13 DOI: 10.4244/AIJV4I1A3

Transcatheter aortic valve implantation (TAVI) has become an established treatment for patients with severe aortic valve stenosis (AS) who are inoperable or at high surgical risk, and an attractive alternative in intermediate surgical-risk patients. Two years after TAVI achieved European commercial approval (CE mark), the technology became established in Asia. As with the global experience, TAVI has been increasingly applied in Asia to off-label indications such as bicuspid AS, degenerated surgical bioprosthesis (valve-in-valve TAVI), non-calcific AS, and pure aortic regurgitation.

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Antegrade approach to cross a native aortic valve

26 February inEditorial, Issue

Kentaro Hayashida
AsiaIntervention 2018;4:14-15, DOI: 10.4244/AIJV4I1A4

Transcatheter aortic valve implantation (TAVI) has become a wellestablished treatment for patients with high and intermediate surgical risk symptomatic severe aortic stenosis (AS). With the widening of the indications for TAVI, the incidence of bicuspid valve in the TAVI cohort is now increasing. Sometimes we encounter difficulty in crossing a bicuspid aortic valve, due to its anomalous anatomy, severe calcification, and enlarged ascending aorta. It is important to have a bail-out solution for cases where there is difficulty in crossing a native aortic valve in order to accomplish transfemoral TAVI successfully.

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National society

Korean Society of Interventional Cardiology (KSIC)

26 February inNational society

Hweung-Kon Hwang, Hyo-Soo Kim
AsiaIntervention 2018;4:16-17, DOI: 10.4244/AIJV4I1A5

The Korean Society of Interventional Cardiology (KSIC) is an academic association representing Korean interventional cardiologists. As of December 2017, it has 585 active members and nine working groups including CTO, TRI, Bifurcation, Imaging and Physiology, Stent Failure, Platelet Research, Complication and Structural Heart Disease.

KSIC was founded as a working group under the Korean Society of Cardiology on 19 June 1997, and has served as the largest group in the field of cardiology. Currently, KSIC has become a representative academic association of interventional cardiological practice in Korea, both in name and reality, since its independence from the Korean Society of Cardiology in 2012. The current leadership of the KSIC comprises Professor Hyo-Soo Kim (Seoul National University Hospital) who is working as the Chairman of the Board of Directors since 2016, and Professor Hweung-Kon Hwang (Konkuk University Medical Center) who has been the President since 2017.

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Coronary Interventions

A weighted angiographic scoring model (W-CTO score) to predict success of antegrade wire crossing in chronic total occlusion: analysis from a single centre

26 February inCoronary Interventions, Issue, Table of content TOP

Roopali Khanna, Chandra M. Pandey, Sonam Bedi, Fauzia Ashfaq, Pravin Goel
AsiaIntervention 2018;4:18-25, DOI: 10.4244/AIJ-D-17-00025

Aims: The aim of this study was to derive a weighted score model predicting success/failure of antegrade wire crossing in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods and results: Four hundred and four consecutive CTO cases (408 lesions) undergoing CTO-PCI between January 2009 and March 2015 were included. Data were divided into two sets, namely “derivation” and “validation”, in a 70:30 ratio. The score was derived using multivariate analysis to identify independent predictors of wire crossing failure from the derivation set (n=285 lesions) and validated on the remaining 123 lesions (validation set). The overall procedural success rate was 83.6%. Independent predictors of CTO-PCI failure and their contribution to the weighted score were a blunt stump (beta coefficient 2.12), length of occlusion >20 mm (beta coefficient 1.71), presence of calcification (beta coefficient 0.72), presence of tortuosity (beta coefficient 1.06) and collateral with Rentrop grade 2-4 and >4 were classified as low, intermediate and high levels of difficulty for CTO-PCI success and were associated with 98%, 74.2%, and 42.5% (p<0.0001), respectively, of antegrade wire crossing success in the derivation set. This was also validated on the validation set with CTO success in the three derived difficulty levels being 100%, 82.4% and 48.4%, respectively.

Conclusions: Our weighted angiographic CTO score is a strong predictor of final antegrade wire crossing success and could be used in day-to-day clinical practice of CTO interventions.

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Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention with drug-eluting stents: five-year outcomes from the CREDO-Kyoto PCI/CABG registry

26 February inCoronary Interventions, Issue, Table of content TOP

Hiroki Watanabe, Takeshi Morimoto, Hiroki Shiomi, Yutaka Furukawa, Yoshihisa Nakagawa, Kenji Ando, Kazushige Kadota, Takeshi Kimura
AsiaIntervention 2018;4:26-33, DOI: 10.4244/AIJ-D-17-00003

Aims: We sought to investigate the clinical impact of intravascular ultrasound (IVUS) use in first-generation drug-eluting stent (DES) implantation as compared with angiography guidance only.

Methods and results: From the CREDO-Kyoto registry cohort-2, the current study population consisted of 4,768 patients treated with first-generation DES only without acute myocardial infarction (AMI) at enrolment. As a retrospective cohort study, we compared clinical outcomes between the two groups of patients with or without IVUS use during the procedure (IVUS group: N=2,768, angiography group: N=2,000). The outcome measures were target vessel revascularisation (TVR), target lesion revascularisation (TLR), all-cause death, myocardial infarction, stent thrombosis, and major adverse cardiovascular events. There was no significant difference between the groups in the cumulative incidence of TVR (21.5% vs. 22.2%, p=0.57). Even after adjusting the confounders, the risk of IVUS use relative to angiography guidance for TVR remained neutral (HR: 1.09, 95% CI: 0.90-1.32, p=0.37).

Conclusions: IVUS-guided PCI as compared with angiography-guided PCI was not associated with a lower risk of TVR in non-AMI patients treated with first-generation DES.

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Left main bifurcation percutaneous coronary intervention using a drug-eluting stent and drug-coated balloon: optical frequency domain imaging follow-up

26 February inCoronary Interventions, Issue

Kazuhiro Dan, Yuya Takahashi, Kei Ichihashi, Masanori Teramura, Hiroki Ishihara, Takuya Maeda, Nobukiyo Taknaka, Tomohiko Teramoto
AsiaIntervention 2018;4:34, DOI: 10.4244/AIJ-D-17-00028

A 65-year-old man with stable angina pectoris was admitted for percutaneous coronary intervention. Coronary angiography (CAG) detected a left main artery (LM) true bifurcation lesion with the following stenotic percentages: 90%, distal LM; 90%, left circumflex artery (LCX); and 75%, left anterior descending artery (LAD) (Panel A). A 3.5×18 mm Resolute Integrity® drug-eluting stent (DES) (Medtronic Vascular, Santa Rosa, CA, USA) was implanted between the LM and the proximal LCX. CAG was performed after kissing balloon inflation using a 3.0×15 mm SeQuent Please® drug-coated balloon (DCB) (B. Braun, Melsungen, Germany) for the LAD and delivery balloon for the LCX (Panel B). Intravascular ultrasound showed a well-dilated stent in the LM (Panel D) and LCX (Panel F), and a high echoic intimal layer at the intimal surface, considered paclitaxel in the LAD (Panel E).

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Interventions for vascular disease and heart failure

SAPIEN 3 valve implantation in rheumatic aortic stenosis with a functioning mitral prosthesis: first case report from India

26 February inInterventions for vascular disease and heart failure, Issue, Table of content BOTTOM

Sengottuvelu Gunasekaran, Raghul Ganesapandi, Muthukumaran Chinnasamy Sivaprakasam, Srinivasan Kanthallu Naryana Moorthy
AsiaIntervention 2018;4:35-37, DOI: 10.4244/AIJ-D-17-00023

Transcatheter aortic valve implantation (TAVI) is a rapidly evolving therapeutic option for patients with severe aortic stenosis who are high risk for surgery or for inoperable patients. Indications for TAVI are evolving as it is being used as an option for intermediate- risk and low-risk patients. Data on the use of TAVI in rheumatic aortic stenosis are not widely available and have not been reported from India.

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Hybrid technique to bail out an unsuccessful transfemoral TAVR attempt

26 February inInterventions for vascular disease and heart failure, Issue, Table of content BOTTOM

Edgar Tay, Devinder Singh, William K. Kong, Jimmy K.F. Hon
AsiaIntervention 2018;4:38-40, DOI: 10.4244/AIJ-D-17-00032

The most common route to perform transcatheter aortic valve replacement (TAVR) is via the transfemoral access. The success of this technique hinges on the successful passage of guidewires across the stenosed aortic valve. Although this is possible in the majority of cases, this case illustrates an occasional anomaly. In this report, we describe a novel hybrid technique involving a transseptal access as well as the formation of a continuous arteriovenous loop to complete the procedure successfully. This technique also has an additional advantage as it maintains the feasibility of performing the procedure under local anaesthesia and conscious sedation.

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Transfemoral aortic valve implantation using the reverse X-ray image in a patient with dextrocardia situs inversus

26 February inInterventions for vascular disease and heart failure, Issue

Tomohiro Kawaguchi, Shinichi Shirai, Hiroyuki Jinnouchi, Kenji Ando
AsiaIntervention 2018;4:41-44, DOI: 10.4244/AIJ-D-17-00047

A frail 94-year-old man, who had dextrocardia situs inversus and symptomatic severe aortic stenosis, underwent transcatheter aortic valve implantation (TAVI) using the femoral approach. Computed tomography showed that there were no other cardiovascular malformations. Generally, it was difficult to maintain awareness of the position between his heart and ascending aorta during the procedure because of the inversion of these structures. Therefore, the reverse X-ray image was used to facilitate TAVI, and the procedure was successful without complications. However, nine days after TAVI, he developed complete atrioventricular block that was symptomatic. Therefore, he underwent cardiac pacemaker implantation using the reverse X-ray image to help position the atrial and ventricular leads.

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Abstracts of INDIALIVE 2018

27 February inAbstracts, Issue

AsiaIntervention 2018;4:45-64

“The scientific abstracts received for the meeting will be published in this special edition of AsiaIntervention. The best abstracts will be rewarded. Authors of these abstracts will then be invited to submit full manuscripts which, after peer review, could be published in future issues of the journal.” Upendra Kaul, Course Director INDIA LIVE and Chief Editor AsiaIntervention

To browse all these abstracts, please download the PDF.