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Crossing the bridge: Have we gotten to it? [Editorial]

Vales, Lori
PMID: 35779776
ISSN: 1873-2615
CID: 5281552

Management of Postpartum Left Main Spontaneous Coronary Artery Dissection

Krittanawong, Chayakrit; Attubato, Michael J; Lay, Lori Vales
PMID: 37378971
ISSN: 2380-6591
CID: 5524362

Contrast-induced nephropathy (CIN) in patients with renal impairment: Pooled data from three prospective, randomized studies comparing iodixanol 320 mg and iopamidol 370mg [Meeting Abstract]

Staniloae, Cezar; Vales, Lori; Shen, Ningyan; Reininger, Cornelia
ISSN: 1558-3597
CID: 2802572

Physiologic Guidance of Infrainguinal Vascular Interventions Using the Pressure Wire

Staniloae, Cezar S; Vales, Lori; Han, Seol Young; Sloves, Jan; Fallahi, Arzhang
OBJECTIVES: To assess the relationship between the resting (RG) and hyperemic (HG) translesional peripheral gradients, with the functional and anatomic parameters before and after an infrainguinal endovascular procedure. BACKGROUND: RGs and HGs are objective tools in defining the hemodynamic significance of an arterial stenosis. METHODS: In 25 subjects with infrainguinal arterial stenosis, RG and HG were measured via a pressure wire before and after angioplasty. Before and after the procedure, all subjects had an ankle-brachial index (ABI) and Duplex ultrasound evaluation, recording prelesion and in-lesion peak systolic velocity (PSV-L), and calculating a peak systolic velocity ratio (PSV-R). A Pearson R correlation coefficient was calculated. RESULTS: The mean age was 73 +/- 12 years, 70% were men, median Rutherford class 3. At baseline and after angioplasty, mean ABI was 0.78 +/- 0.2 and 0.99 +/- 0.1, mean PSV-L was 459 +/- 110 cm/s and 126 +/- 35 cm/s, and mean PSV-R was 6.7 +/- 4 and 1.2 +/- 0.5, respectively. RG and HG significantly improved (P<.001) from baseline to after angioplasty (28.7 +/- 20.5 mm Hg to 5 +/- 13 mm Hg and 40.2 +/- 21.4 mm Hg to 10 +/- 13 mm Hg, respectively). RG before and after the procedure correlated well with ABI (r = -0.58; r = -0.41), PSV-L (r = 0.40; r = 0.52), and PSV-R (r = 0.46; r = 0.42). An improvement of 9 mm Hg in RG predicted a change of 0.1 in ABI. CONCLUSIONS: Improvement in RG during endovascular intervention in superficial femoral artery correlates well with the improvement in ABI, PSV-L, and PSV-R. A postprocedural decrease in RG of 9 mm HG predicts an improvement in ABI of 0.1.
PMID: 26429850
ISSN: 1557-2501
CID: 1790022

Physiologic Guidance of Infrainguinal Vascular Interventions Using the Pressure Wire [Meeting Abstract]

Staniloae, Cezar S; Vales, Lori; Han, Seol Young; Sloves, Jan
ISSN: 1558-3597
CID: 1764442

Successful expansion of an underexpanded stent by rotational atherectomy

Vales, Lori; Coppola, John; Kwan, Tak
The current routine use of intracoronary stents in percutaneous coronary intervention (PCI) has significantly reduced rates of restenosis, compared with balloon angioplasty alone. On the contrary, small post-stenting luminal dimensions due to undilatable, heavily calcified plaques have repeatedly been shown to significantly increase the rates of in-stent restenosis. Rotational atherectomy of lesions is an alternative method to facilitate PCI and prevent underexpansion of stents, when balloon angioplasty fails to successfully dilate a lesion. Stentablation, using rotational atherectomy to expand underexpanded stents deployed in heavily calcified plaques, has also been reported. We report a case via the transradial approach of rotational-atherectomy-facilitated PCI of in-stent restenosis of a severely underexpanded stent due to a heavily calcified plaque. We review the literature and suggest rotational atherectomy may have a role in treating a refractory, severely underexpanded stent caused by a heavily calcified plaque through various proposed mechanisms.
PMID: 24436587
ISSN: 1061-1711
CID: 759882

Tips and tricks of left main artery stenting

Kwan, Tak W; Vales, Lori
PMID: 23044326
ISSN: 0366-6999
CID: 179277

Transradial measurement of transvalvular pressure gradient in the setting of mechanical aortic and mitral valve prostheses using a coronary fractional flow reserve guidewire

Vales, Lori; Cherukuri, Sanjay; Kwan, Tak
Accurate measurement of transvalvular pressure gradients is essential to comprehensively evaluate whether mechanical prosthetic valves are functioning normally. Direct measurements can be technically complicated, traditionally requiring direct, transapical puncture in the setting of both aortic and mitral mechanical valve prostheses. Very few case reports have proposed the use of guidewires indicated for coronary fractional flow reserve assessment to evaluate the transvalvular pressure gradients and hemodynamic status of patients with both aortic and mitral valve mechanical prostheses. We present one such case of a 59-year-old male with history of rheumatic heart disease and double mechanical valve replacements of the aortic and mitral valves presenting with contradictory clinical signs and noninvasive testing evidence of decompensated congestive heart failure and possible dysfunction of a mechanical, bi-leaflet aortic valve prosthesis. The use of a low-profile, intracoronary guidewire with a pressure transducer near the distal tip indicated for coronary fractional flow reserve determination proved very useful to answer this important question. Additionally, we report the first case of the use of this technology for this purpose via the radial artery access approach.
PMID: 22294537
ISSN: 1042-3931
CID: 159834

Transradial cardiac catheterization: A Review of Access Site Complications

Kanei, Yumiko; Kwan, Tak; Nakra, Navin C; Liou, Michael; Huang, Yili; Vales, Lori L; Fox, John T; Chen, Jack P; Saito, Shigeru
Transradial catheterization (TRC) has been associated with a lower incidence of major access site related complications as compared to the transfemoral approach. With the increased adoption of transradial access, it is essential to understand the potential major and minor complications of TRC. The most common complication is asymptomatic radial artery occlusion, which rarely leads to clinical events, owing to the dual collateral perfusion of the hand. Adequate anticoagulation, appropriate compression techniques, and smaller sheath size can minimize the risk of radial artery occlusion. Hand ischemia with necrosis has never been reported during TRC with thorough pre-examination of intact collateral circulation. Radial artery spasm is relatively common, and can result in access and procedural failure. It can be prevented by the use of vasodilator cocktails and hydrophilic sheaths. Radial artery perforation can lead to severe forearm hematoma and compartment syndrome if not managed promptly. Careful observation, prompt detection of the hematoma, and management with a pressure bandage dressing are critical to avoid serious complications. Pseudoaneurym and arteriovenous fistula are rare complications, which can likely be managed conservatively without surgical intervention. Nerve injury occurring during access has been reported. Close observation for improvement is necessary, although symptoms usually improve over time. In summary, to prevent access site complications, avoidance of multiple punctures, gentle catheter manipulation, use of guided compression, coupled with careful observation for adverse warning signs such as hematoma, loss of pulse, pain, are critical for safe and effective TRC. (c) 2011 Wiley Periodicals, Inc
PMID: 21567879
ISSN: 1522-726x
CID: 141332

The impact of iso-osmolar contrast use in emergent percutaneous coronary intervention for ST-segment elevation myocardial infarction

Kanei, Yumiko; Ayabe, Kengo; Ratcliffe, Justin; Vales, Lori; Nakra, Navin; Friedman, Patricia; Fox, John
The incidence of contrast-induced nephropathy (CIN) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was previously reported to be as high as 19%. Iso-osmolar contrast has frequently been used for populations at high risk for CIN, but a recent meta-analysis did not show a significant benefit of using iso-osmolar contrast in preventing CIN. The aim of our study is to evaluate the impact of iso-osmolar contrast use in patients undergoing emergent PCI. We performed a retrospective analysis of patients who underwent primary and rescue PCI for STEMI. The PCI strategy, including the contrast choice, was left at the discretion of the operator. CIN was defined as an increase in creatinine of more than 0.5 mg or 25% from the baseline within 72 hours. Among 212 patients, CIN was seen in 33 patients (16%). Patients who received iso-osmolar contrast were older, and included more patients at risk for CIN. The incidence of CIN was 14% in the low-osmolar contrast group and 17% in the iso-osmolar contrast group (P=.799). After logistic regression analysis, CIN was seen more frequently in patients who had lower ejection fraction, post-PCI TIMI flow <3, and lower hemoglobin. The use of iso-osmolar contrast was not associated with a lower incidence of CIN in patients undergoing emergent PCI for STEMI.
PMID: 22045075
ISSN: 1042-3931
CID: 161681