0000000000434661
AUTHOR
Sebastiano Puglisi
Myocardial infarction with non-obstructive coronary arteries (MINOCA): Intracoronary imaging-based diagnosis and management.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography. This condition is present in about 5% to 25% of patients presenting with acute coronary syndromes. MINOCA is a working diagnosis. Current guidelines and consensus recommend identification of underlying causes of MINOCA in order to optimize treatment, improve prognosis, and promote prevention of recurrent myocardial infarction. An accurate evaluation of patient history, symptoms and use of invasive and non-invasive imaging should lead to identification of epicardial or microvascular causes of MINOCA an…
Dual guidewire balloon antegrade fenestration and re‐entrytechnique for coronary chronic total occlusions percutaneouscoronary interventions
Objectives:To describe the experience of coronary chronic total occlusions (CTOs)percutaneous coronary interventions (PCI) using antegrade fenestration and re‐entry(AFR) technique with a dedicated dual guidewire balloon (DGB).Background:Antegrade dissection and re‐entry (ADR) techniques has beenemphasized in recent worldwide CTO consensus documents. We investigated thefeasibility and safety of DGB as a dedicated device to perform guidewire‐based AFR.Methods and Results:Fourteen consecutive patients with complex CTO (J‐CTOscore: 3.1 ± 0.9) underwent DGB‐AFR in the years 2020–2021. DGB‐AFR consists inadvancing the DGB over a guidewire that reached the vessel distal to the CTO in anextra plaqu…
When, why, and how to perform wire-based antegrade dissection and reentry technique
Antegrade dissection and reentry (ADR) refers to an attempt to cross a coronary chronic total occlusion (CTO) lesion through wire and/or equipment passage in the subintimal space followed by reentry to the distal true lumen. From the original subintimal tracking and reentry (STAR) technique description by Colombo in 2005, refinement of the technique, improved characteristics of the microcatheters and wires, and better understanding of subadventitial vessel trauma have led to higher success rates, lower complications rates, and improved long-term outcomes. In this chapter, we discuss the technique, its outcomes, and limitations.