The Visible Heart® Laboratory is an original experimental laboratory in which harvested animal hearts are resuscitated and connected to a support machine in order to beat outside the animal body. Resuscitated animal hearts may be exposed to various types of endovascular intervention under full, multimodality inspection. This unique experimental setting allows the performance of percutaneous coronary intervention (PCI) in a setting which resembles a standard catheterisation laboratory set-up, and contemporaneously allows unique multimodality imaging. For these reasons, the performance of PCI on bifurcations in the Visible Heart® Laboratory may improve the knowledge of the dynamic stent deformations and stent-vessel wall interactions associated with the different steps of the various techniques for bifurcation stenting. Furthermore, the collected images may also serve as a novel educative resource for physicians. The performance of bifurcation stenting in the Visible Heart® Laboratory is a promising experimental setting to gain novel information regarding any existing or future PCI technique to treat coronary bifurcations.

A 45-year old male with no prior cardiac history, presented with cardiogenic shock in the setting of an anterolateral ST elevation myocardial infarction. We first placed a 2.5 Impella for hemodynamic support, and proceeded with emergent percutaneous coronary intervention to the proximal LAD. Several hours following percutaneous coronary intervention (PCI), the patient became acutely hypotensive and an echocardiogram revealed the Impella catheter was kinked within the left ventricle. The patient was taken back to the cath lab for Impella adjustment; however, damage to the distal catheter required the Impella be exchanged. As the patient was therapeutically anticoagulated and on dual antiplatelet therapy, we modified the Impella catheter in order to maintain existing vascular access during Impella exchange. This case demonstrates our method for maintaining vascular access during Impella exchange, thereby eliminating the need for a second arterial puncture. © 2017 Wiley Periodicals, Inc.

Background:Overlapping first generation drug eluting stents (DES) have been demonstrated in preclinical models to show evidence of a persistent inflammatory response, fibrin deposition and delayed endothelialisation. The SIRTAX (Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization) Trial (nϭ1012) associated the implantation of overlapping first generation DES with impaired angiographic and adverse 3-year clinical outcomes, including death or myocardial infarction (MI). Methods: Patient level data from 5 controlled studies of the RESOLUTE Global Clinical Program evaluating the RESOLUTE zotarolimus-eluting stent (R-ZES) were pooled (nϭ5130). Enrolment criteria encompassed more complex patients, including acute MI, long lesions, unprotected left main, bifurcations, total occlusions, bypass grafts & visible thrombus. The position of the R-ZES in relation to the previous implanted stents during the index or staged procedures were reported by the study site as either 'separate,' 'abutting' or 'overlapping.' Comparisons of clinical outcomes -using propensity score adjustment of baseline anatomical and clinical characteristics -were undertaken between patients implanted with at least one overlapping DES against patients with no overlapping DES (Kaplan Meier analyses). Results: 644 of 5130 study patients (12.6%) underwent overlapping DES implantation. Baseline characteristics indicated that the implantation of overlapping DES compared to non-overlapping DES (nϭ4486) were performed more frequently in the RCA and in more complex coronary lesions. Thirty day, 1 & 2 year clinical outcomes indicated comparable all-cause death (2 year overlap vs. non overlap: 5.1% vs. 3.5%, pϭ0.13), cardiac death (3.0% vs. 2.1%, pϭ0.36), MACE (13.3% vs. 10.7%, pϭ0.19), target lesion (10.9% vs. 9.0%, pϭ0.41) & target vessel (12.8% vs. 10.6%, pϭ0.25) failure, and stent thrombosis (ARC definite/probable 1.4% vs. 0.9%, pϭ0.16). Conclusions: The adverse clinical outcomes associated with 1st generation DES were not apparent with 2nd generation DES. Overlapping second generation DES (compared to the non overlap) is safe & effective with comparable 2 year clinical outcomes, including repeat revascularisation.Background: Dissections during stenting are rare but can lead to clinical complications and necessitate use of a secondary stent thus increasing direct cost of the procedure. This study examined four popular DES products (Resolute Integrity-Medtronic; Xience Prime and Xience V-Abbott; and Promus Element-Boston Scientific) using a bench model developed to explore factors that contribute to dissections. Methods: Devices (nϭ5) were inserted into mock vessels designed to match the compliance of a native artery and inflated from nominal to 20-atm pressure. Inner diameters and outward pressures against the vessel wall were ascertained at 500-m increments at each inflation pressure. Desired forces within stent body were compared to undesired forces associated with balloon transition and overhang. Results: Resolute Integrity an...