Clinical Research Directory

Outcomes of Different Techniques of Aortoostial Coronary Intervention Assessed by Coronary Computed Tomography Angiography

Aorto-ostial coronary lesions (AOL) are defined as a stenosis \>50% within 3 mm of the orifice of the right coronary artery (RCA) or left main coronary artery (LMCA). The prevalence of AOL varies according to the studied population and is more common in the RCA. Aorto-ostial lesions commonly have a unique three-dimensional funnel-shaped morphology with a variable angle of takeoff of the coronary artery from the aorta. Percutaneous treatment of AOL is challenging due to a variety of factors which include unfavorable lesion histology, complex 3D anatomy, inability of conventional angiography to reliably delineate the aorto-ostial plane and guide the intervention and unsuitability of current tubular stent designs for this lesion subset. Coronary computed tomography angiography (CCTA) clearly defines AOL anatomy, its relation to the aortic wall and the degree of plaque calcification. CCTA is uniquely suited to assess the accuracy of AOL stent implantation. While conventional single wire technique is the most commonly used approach for AOL stenting, An approach uses an accessory free floating guide-wire placed within the aortic sinus to mark the aorto-ostial plane and prevent entry of the catheter into the coronary artery is called floating wire technique \& is being used now. Aim of work: 1-Comparison between 2D angiography versus Floating wire technique regarding aorto-ostial stent implantation site within the AOLZ assessed by CCTA . 2- Short term outcomes regading MACE in both groups including : myocardial infarction (MI), stroke, all-cause mortality and target vessel revascularisation (TVR). * Type of the study: This is a randomized prospective cross sectional study * Duration of the study: Patients will be recruited over a period of 12 months. * Study Population: The study will include all patients who will undergo aorto-ostial coronary stenting \& patients will be categorized into 2 groups Group A:patients who will undergo 2D convnetional angiography Aorto-ostial stenting. Group B: Patients who will undergo Aorto-ostial stenting with Floating wire technique. Patients will undergo CCTA to detect geographic miss within 6 months of stent impalntation. Both groups will be followed up clinically to detect adverse clinical outcomes such as AMI, recurrent chest pain,….etc. Methdos: Optimal AOL stenting requires placement of the entire circumference of the proximal stent edge within the aorto-ostial landing zone (AOLZ), defined as the area along the axis of the coronary artery located within 1 mm of the aorto-ostial plane. Stent geographic miss may be diagnosed when at least a segment of the circumference of the proximal stent edge is located proximal or distal to the AOLZ. Accurate AOL stent implantation is crucial. If geographic miss was attributed to the angulated vessel take-off from the aorta preventing precise localisation of the cylindrical stent structure within the constraints of the AOLZ, it is defined as anatomy-dependent. Geographic miss in which all aspects of the proximal stent edge extended beyond the AOLZ either proximally or distally was attributed to incorrect implantation of the stent and was defined as procedure-dependent.

Vascular Access Registry

The Vascular Access Registry (VARegistry) is a prospective patient registry that will be conducted at the Hemodynamic Laboratory of the Cardiology Clinic of the University General Hospital of Patras. The puncture of the vessel will be performed either using palpation, anatomical landmarks or using ultrasound guidance, depending on the ability and preference of each operator. Patients who meet all admission criteria and no exclusion criteria will be admitted to the study. Patients \>18 years of age presented with indication for any percutaneous cardiac procedure will be included in the study. No exclusion criteria exist. The vascular puncture will be performed according to current guidelines and on the basis of recent scientific data. If the attempt to obtain access from the selected location is unsuccessful, the access location will be changed. The choice of the new access location in case of failure of the originally selected one is subject to the preference of each operator. Participants will be monitored for the period they remain hospitalized, depending on the initial indication of intervention, and a follow-up with a vascular ultrasound after one month is recommended. The primary endpoint is the percentage of success of the puncture at the initial access point. The secondary endpoints are as follows: * Percentages of successful puncture of vascular access with and without the use of ultrasound guidance * Occlusion rate of the access artery before discharge * Crossover rate of access site during procedure * Time to sheath placement during procedure * Total intervention time * Procedure duration (from the sheath insertion to the completeness of the procedure) * Total fluoroscopy time * Total DAP (Dose area product) * Air Kerma * Time required for hemostasis * Vascular complications \* * Classification of hematomas (modified classification by EASY)\*\* * Vascular implication of access artery using ultrasound monitoring of patients at 30 days * VARC criteria \*\* if the forearm has been used