The Importance of Combined Technologies in Managing Difficult Clinical Situations

During the last decade we have seen a dramatic expansion of the application of the skill set of invasive cardiologists to challenges beyond the diagnosis and treatment of coronary disease. This issue of the Journal of Invasive Cardiology includes articles covering a broad array of difficult clinical situations that have been managed with this unique skill set. Dr Ruina Hao and collaborators compare magnetic navigation system and CT roadmap-assisted PCI to the traditional approach. Dr Jose M. De la Torre Hernandez describe a randomized trial to evaluate new stent technology. Dr Travis Bench and colleagues report the results of their evaluation of the effect of previous CABG on patients undergoing primary PCI for STEMI. Dr Andrea Rubboli and his Italian collaborators report on their prospective WAR-STENT registry to study the outcomes of warfarin used with stenting. Finally, Dr Antti-Pekka Annala and colleagues present results of OCT evaluation of vascular healing with a bioactive stent. 

In the "Radial Access Technique" section, we have an article exploring a rare complication of neck pain associated with the radial approach. Both articles in the TAVR section explore paravalvular leaks and approaches to management. Dr Eirini Apostholidou and colleagues provide a review of revascularization in patients with left main disease.  The clinical image selection provides a striking image of incidental finding of a malpositioned stent. Don’t miss the thought-provoking piece in the Invasive Thoughts section from E.S. Brilakis and Avantika Banerjee. 

Articles published in our “Online Exclusive” section this month cover an array of interesting topics, including managing ACS patients with von Willebrand disease, the potential impact of exertion at high altitudes on coronary stent thrombosis, an interesting case where transcatheter pulmonary valves were successfully placed in the proximal right and left branch pulmonary arteries, a case showing the use of controlled antegrade and retrograde tracking strategy to treat a difficult total occlusion, difficult closure of an aorto-right ventricular tunnel, a valve-in-valve implantation used in a very young patient and use of the transjugular delivery to close a post operative residual atrial septal defect.

These selections can be found on our website (www.invasivecardiology.com), as well as past issues of the journal. I hope that this issue of the journal demonstrates the variety of technologies that are combined and applied every day by invasive cardiologists dedicated to advancing the treatment of cardiac patients.