The Corsair collateral channel dilator was designed for retrograde passage in cases of coronary chronic total occlusion (CTO). Its antegrade use is discouraged and the number of published studies regarding such use is limited. Our single-operator experience examines the feasibility and safety of the Corsair in antegrade recanalization of chronic CTOs in a large cohort. We queried the European Registry of Chronic Total Occlusion (ERCTO) for all microcatheters used in antegrade recanalizations between 2008 and 2016. We also retrospectively assessed all 722 coronary interventions for CTOs (624 antegrade, 98 retrograde) between January 2008 and December 2016, performed by a single operator who primarily applied the Corsair as antegrade microcatheter. Patient, procedure, and outcome data was analyzed. In 17,787 cases performed by 93 operators contributing to the ERCTO database, there were 3294 with information on microcatheter type. The FineCross MG (73.9 %) was the most commonly used microcatheter. The Corsair was used in only 1.2 % (excluding patients in the single-operator cohort). In the same period 45.7 % (n = 285) of all 624 antegrade cases handled by our single operator were performed using the Corsair, with no exclusions due to anatomical or morphological criteria. The procedural success rate was 93.7 %. There were 2 cases of cardiac tamponade, 5 cases of minor perforation, and one catheter tip fracture. The Corsair is rarely used for antegrade recanalization. In this single-operator experience, the antegrade use of the Corsair was safe. The success rate was high, although causative conclusions cannot be drawn.
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Side branch compromise after stenting in bifurcation lesions is a matter of concern. It may happen that even low-profile balloon catheters do not cross stent struts after rewiring. The Corsair catheter is a hybrid catheter that has features of a microcatheter and a support catheter. The present study evaluated usefulness of the Corsair catheter to facilitate advancing a low-profile balloon catheter through stent struts in bifurcation lesions. After rewiring, low-profile balloon catheters failed to cross stent struts of 29 bifurcation lesions. The Corsair microcatheter successfully crossed stent struts in all lesions except one (97 %) where a stent was implanted to treat in-stent restenosis (stent-in-stent). Low-profile balloon catheters were able to advance into the side branch of all bifurcation lesions where the Corsair microcatheter crossed stent struts. In conclusion, the Corsair microcatheter may be utilized if low-profile balloon catheters are unable to cross stent struts in bifurcation lesions.
A 77-year-old man presented with dyspnoea and was diagnosed with chronic thromboembolic pulmonary hypertension. Balloon pulmonary angioplasty was attempted; however, the balloons could not be advanced to the total occlusion lesion in the right A3 segment. The obstruction was overcome using a microcatheter Corsair (AsahiKASEI). This technique may be useful in managing a total occlusion lesion.
Percutaneous coronary intervention for left main trifurcation disease is challenging. Although side branch protection techniques such as the jailed balloon technique and jailed Corsair technique are the established methods for treatment of coronary bifurcation lesions, little is known regarding the application and feasibility of these techniques for left main trifurcation disease. We herein describe a 72-year-old man with angina pectoris who was successfully treated with percutaneous coronary stent implantation for a left main trifurcation lesion. In this case, we performed a novel double side branch protection technique, the simultaneous jailed balloon and jailed Corsair technique, with a single 8 Fr guiding catheter. This is the first case report to highlight the feasibility and efficacy of combined use of the jailed balloon and jailed Corsair techniques during percutaneous coronary intervention for left main trifurcation disease.
Behaviour is key to suppressing the COVID-19 pandemic. Maintaining behaviour change can be difficult. We investigated engagement with hand cleaning, reducing the number of outings, and wearing a face covering over the course of the pandemic. We used a series of 64 cross-sectional surveys between 10 February 2020 and 20 January 2022 (n ≈ 2000 per wave). Surveys investigated uptake of hand cleaning behaviours, out of home activity (England only, n ≈ 1700 per wave) and wearing a face covering (England only, restricted to those who reported going out shopping in the last week, n ≈ 1400 per wave). Reported hand cleaning has been high throughout the pandemic period (85 to 90% of participants consistently reporting washing their hands thoroughly and regularly with soap and water frequently or very frequently). Out of home activity has mirrored the easing and re-introduction of restrictive measures. Total number of outings were higher in the second national lockdown than in the first and third lockdowns. Wearing a face covering increased steadily between April to August 2020, plateauing until the end of measurement in May 2021, with approximately 80% of those who had been out shopping in the previous week reporting wearing a face covering frequently or very frequently. Engagement with protective behaviours increased at the start of the pandemic and has remained high since. The greatest variations in behaviour reflected changes to Government rules. Despite the duration of restrictions, people have continued to adopt personal protective behaviours that were intended to prevent the spread of COVID-19.
[This corrects the article DOI: 10.1177/11786302211015588.].
To investigate uptake of lateral flow testing, reporting of test results and psychological, contextual and socio-demographic factors associated with testing. A series of four fortnightly online cross-sectional surveys. Data collected from 19 April 2021 to 2 June 2021. People living in England and Scotland, aged 18 years or over, excluding those who reported their most recent test was a polymerase chain reaction (PCR) test (n=6646, n≈1600 per survey). Having completed at least one lateral flow test (LFT) in the last 7 days. We used binary logistic regressions to investigate factors associated with having taken at least one LFT. Increased uptake of testing was associated with being vaccinated (adjusted ORs (aORs)=1.52-2.45, 95% CI 1.25 to 3.07, analysed separately by vaccine dose), employed (aOR=1.94, 95% CI 1.63 to 2.32), having been out to work in the last week (aOR=2.30, 95% CI 1.94 to 2.73) and working in a sector that adopted LFT early (aOR=2.54, 95% CI 2.14 to 3.02) . Uptake was higher in people who reported cardinal COVID-19 symptoms in the last week (aOR=1.89, 95% CI 1.34 to 2.66). People who had heard more about LFTs (aOR=2.28, 95% CI 2.06 to 2.51) and knew they were eligible to receive regular LFTs (aOR=2.98, 95% CI 2.35 to 3.78) were also more likely to have tested. Factors associated with not taking a test included agreeing that you do not need to test for COVID-19 unless you have come into contact with a case (aOR=0.51, 95% CI 0.47 to 0.55). Uptake of lateral flow testing is low. Encouraging testing through workplaces and places of study is likely to increase uptake, although care should be taken not to pressurise employees and students. Increasing knowledge that everyone is eligible for regular asymptomatic testing and addressing common misconceptions may drive uptake.
Side branch occlusion, which was one of the common complications in percutaneous coronary interventions, was closely associated with cardiac death and myocardial infarction. Clinical guidelines also support the importance of preservation of physiologic blood flow in SB during PCI to bifurcation lesions. In order to avoid side branch occlusion during stent implantation, we often performed the jailed wire technique, in which a conventional guide wire was inserted to the side branch before stent implantation to the main vessel. However, the jailed wire technique could not always prevent side branch occlusion. In this case report, we described a case of 72-year-old male suffering from angina pectoris. Coronary angiography revealed the diffuse calcified stenosis in the proximal and middle of left anterior descending coronary artery, and the large diagonal branch originated from the middle of the stenosis. To prevent side branch occlusion, we performed a novel side branch protection technique by using the Corsair microcatheter (Asahi Intecc, Nagoya, Japan). In this case report, we illustrated this "Jailed Corsair technique", and discussed the advantage compared to other side branch protection techniques such as the jailed balloon technique.
BACKGROUND Retrograde advancement of microcatheters through septal/epicardial connectors can be challenging. Although several tricks might help to do so (e.g., balloon trap of retro wire in second guiding, balloon trap of retro wire in native coronary artery, and use of antegrade extension to approximate the antegrade conduit to the retrograde gear), these tricks cannot always be applied, especially in patients with poor access. Also, puncturing, knuckling, and crossing of the distal CTO cap (or the aorta as described in 1 of the cases) sometimes needs a lot of backup of the microcatheter. CASE REPORT We describe 3 cases in which we used a novel telescopic technique with 5F Guidion (IMDS®) supported retrograde Corsair (Asahi®) advancement in complex CTO lesions. CONCLUSIONS The telescopic Corsair in 5F Guidion may offer the support needed to end successfully in these situations.
The safe use of radiotherapy (RT) requires compliance with dose/volume constraints (DVCs) for organs at risk (OaRs). However, the available recommendations are sometimes conflicting and scattered across a number of different documents. Therefore, the aim of this work is to provide, in a single document, practical indications on DVCs for OaRs in external beam RT available in the literature. A multidisciplinary team collected bibliographic information on the anatomical definition of OaRs, on the imaging methods needed for their definition, and on DVCs in general and in specific settings (curative RT of Hodgkin's lymphomas, postoperative RT of breast tumors, curative RT of pediatric cancers, stereotactic ablative RT of ventricular arrythmia). The information provided in terms of DVCs was graded based on levels of evidence. Over 650 papers/documents/websites were examined. The search results, together with the levels of evidence, are presented in tabular form. A working tool, based on collected guidelines on DVCs in different settings, is provided to help in daily clinical practice of RT departments. This could be a first step for further optimizations.
The optimal technique for percutaneous coronary intervention (PCI) of a bifurcation lesion remains uncertain. JBT/JCT techniques are now emerging for protection of the side branch (SB). We aimed to compare jailed balloon (JBT) and jailed Corsair (JCT) techniques to the conventional jailed wire technique. We analyzed 850 consecutive patients (995 bifurcation lesions), who underwent PCI. The bifurcation lesions were classified as jailed wire (-), jailed wire (+), JBT, and JCT. We assessed temporary thrombolysis in myocardial infarction (TIMI) flow grade ≤2, permanent TIMI flow grade ≤2 in the SB, and SB occlusion related myocardial infarction and compared these endpoints with inverse probability treatment weighted analysis. The percentage of each group is as follows: jailed wire (-); 44.7%; jailed wire (+) 50.9%; JBT 1.7%; JCT 2.7%. The Corsair could not be delivered with a stent because of severe calcifications (3.7%) and a jailed balloon was entrapped with the stent after dilatation (5.9%). Compared to the jailed wire (+), JBT/JCT had a higher percentage of true bifurcations, arterial sheath size ≥7 Fr, and a lower proportion of wire recrossing (all, P < 0.05). After adjustment, temporary and permanent TIMI flow grade ≤2 in the SB, and SB occlusion related myocardial infarction were not significantly different (OR: 1.08, CI: 0.32-3.71, P = 0.90; OR: 0.88, CI: 0.11-6.91, P = 0.91; OR: 1.94, CI: 0.23-16.5, P = 0.55 respectively). Our data could not prove the efficacy of JBT/JCT, but revealed novel insights about these techniques. A larger study is necessary to prove the efficacy of JBT/JCT.
Injection and aspiration efficacy via microcatheter are important in complex percutaneous coronary intervention (PCI). The aim of this study was to compare the injection and aspiration performance of different microcatheters under identical conditions. In the injection bench test, injection volumes and times for each microcatheter were measured three times using an auto-injector. In the aspiration bench test, each microcatheter was connected to a two-way stopcock and an aspiration syringe. Times required to aspirate 5 mL (T1) and 10 mL (T2) of blood-mimicking fluid were measured. For the injection bench test, flow rates and resistance ratios were calculated, for the aspiration bench test, resistance ratios were calculated. The resistance ratio of the Finecross GT 130 cm was set as 1.0 (reference). The fastest flow rate (0.66 mL/s) and lowest resistance ratio (0.74) in the injection test were observed with the Zizai 130 cm. Conversely, dual-lumen catheters exhibited the slowest flow rates (Sasuke and Crusade Type R: 0.14 mL/s, 0.19 mL/s) and highest resistance ratios (Sasuke and Crusade Type R: 3.43, 2.53). In the aspiration bench test, the Zizai 130 cm exhibited the shortest aspiration times (T1, 73.0 s, T2, 140.7 s) and lowest resistance ratio (average R1, R2: 0.74), whereas the Corsair Pro 135 cm exhibited the longest aspiration times (T1, 174 s, T2, 330.3 s) and highest resistance ratios (R1, 1.78, R2, 1.72; average, 1.75). To our knowledge, this is the first comparison of injection efficacy and aspiration resistance among various microcatheters for PCI, providing practical guidance for microcatheter selection in complex PCI.
A percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) carries a significant risk of coronary artery perforation (CAP). The typical treatment for proximal large CAP often requires the deployment of covered stents. However, this becomes impractical in situations where the antegrade wire has not successfully crossed the CTO lesion. In addition, emergency coronary artery bypass grafting for perforation after CTO-PCI is associated with a high in-hospital mortality rate. A patient presented with a left anterior descending artery (LAD) CTO involving the large first diagonal (D1) branch within the CTO segment. The D1 vessel was recanalized successfully using an antegrade approach. Before several attempts, the LAD CTO could n't be crossed, and an Ellis type Ⅲ perforation was visualized in the mid-LAD segment after bifurcation of the D1 vessel, which was created using a knuckled wire supported with a Corsair microcatheter. Subsequently, the perforation was effectively controlled by a tamponade balloon deployed from the D1 vessel to the proximal LAD. Before the retrograde wire crossed the LAD CTO, the dissection and re-entry techniques (DARTs) were used to recanalize the CTO lesion, intentionally creating subintimal dissection flaps. These autologous dissection flaps, together with drug-eluting stents instead of covered stents, successfully sealed the perforation. The innovative approach of using autologous dissection flaps created with DART in CTO-PCI to seal perforations is clinically feasible and effective.
Pulmonary arterial hypertension (PAH) clinical trials largely rely on clinically relevant intermediate outcomes, as mortality and lung transplant are infrequent and remote outcomes. The change in 6-minute walk distance (Δ6MWD) is utilized as an intermediate endpoint and is used as a surrogate for clinical worsening events. We investigate whether the change in 4 composite risk assessment scores-REVEAL Lite 2 (ΔRL2), European Four Strata (ΔE4), European Three Strata (ΔE3), and French Noninvasive score (ΔFPHN)-are potentially stronger surrogate endpoints than the single-component Δ6MWD in PAH studies. Using data from the AMBITION and FREEDOM-EV trials, we estimated the percentage of treatment effect in reducing clinical worsening events within 1 year that is attributed to the change on each of the 5 scores between baseline and 12-16 weeks' follow-up. We conducted bootstrap analysis to provide head-to-head comparisons. Our analysis shows that all 4 composite scores mediate significantly more of the treatment effect compared to 6MWD (29% for ΔRL2 and ΔE4 compared to 19% for Δ6MWD; both P <10-15). The drug treatment effect accounted for by all 5 scores increases with intermediate/high-risk patients, and ΔRL2 had the highest % mediation (37% for ΔRL2 vs 28% for Δ6MWD; P < 10-15). RL2 and E4 were the strongest mediators, with RL2 showing the highest mediation in intermediate/high-risk patients. Until better surrogates are found that mediate over 50% of the treatment effect, RL2 or E4 may serve as alternatives to the 6MWD as intermediate endpoints.
Right heart catheterization is the gold standard for the diagnosis of pulmonary hypertension. There are variations in practice and several pitfalls introducing errors in diagnosis that can significantly affect treatment. Errors in assessing the correct pulmonary artery wedge pressure can significantly affect accurate classification of patients with pulmonary hypertension and lead to potentially deleterious treatment decisions. This review focuses on best practices in right heart catheterization performance, emphasizing practical and pathophysiological principles to obtain the most accurate result, as well as advanced applications in pulmonary hypertension.
Cancer patients are more susceptible to an aggressive course of COVID-19. Developing biomarkers identifying cancer patients at high risk of COVID-19-related death could help determine who needs early clinical intervention. The miRNAs hosted in the genomic regions associated with the risk of aggressive COVID-19 could represent potential biomarkers for clinical outcomes. Plasma samples were collected at The University of Texas MD Anderson Cancer Center from cancer patients (N = 128) affected by COVID-19. Serum samples were collected from vaccinated healthy individuals (n = 23) at the Municipal Clinical Emergency Teaching Hospital in Timisoara, Romania. An in silico positional cloning approach was used to identify the presence of miRNAs at COVID-19 risk-associated genomic regions: CORSAIRs (COvid-19 RiSk AssocIated genomic Regions). The miRNA levels were measured by RT-qPCR. We found that miRNAs were enriched in CORSAIR. Low plasma levels of hsa-miR-150-5p and hsa-miR-93-5p were associated with higher COVID-19-related death. The levels of hsa-miR-92b-3p were associated with SARS-CoV-2 test positivity. Peripheral blood mononuclear cells (PBMC) increased secretion of hsa-miR-150-5p, hsa-miR-93-5p, and hsa-miR-92b-3p after in vitro TLR7/8- and T cell receptor (TCR)-mediated activation. Increased levels of these three miRNAs were measured in the serum samples of healthy individuals between one and nine months after the second dose of the Pfizer-BioNTech COVID-19 vaccine. SARS-CoV-2 infection of human airway epithelial cells influenced the miRNA levels inside their secreted extracellular vesicles. MiRNAs are enriched at CORSAIR. Plasma miRNA levels can represent a potential blood biomarker for predicting COVID-19-related death in cancer patients.
 The aim of this study was to clarify the effectiveness of a collateral channel dilator microcatheter in antegrade percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of a coronary artery.  The Corsair microcatheter, which was originally developed as a collateral channel dilator, has been reported to be useful for retrograde CTO-PCI.  We compared the success rate of the Corsair microcatheter collateral channel dilator for antegrade CTO-PCI with a previously available microcatheter. We analyzed the data from 27 patients (32 CTOs) using the FinecrossMG (Finecross group) and the data from 31 patients (34 CTOs) using the Corsair (Corsair group).  There were no significant differences in the clinical or lesion characteristics between the 2 groups. The success rate for crossing the CTO by the microcatheter was 62.5% in the Finecross group and 85.3% in the Corsair group (P < 0.05). After the Corsair crossed the CTO, a 2-mm diameter balloon catheter crossed the lesion in all the cases, but it crossed the lesion in only 17 of 20 cases in the Finecross group (85.0%, P < 0.05). The number of balloon catheters used for predilation was significantly less in the Corsair group compared with the Finecross group (P < 0.05).  The success rate for crossing of the microcatheters and the balloon catheters through the occlusion in antegrade CTO-PCI was better with the Corsair than with the FinecrossMG. In addition, the use of the Corsair reduced the number of balloon catheters used for predilation in antegrade CTO-PCI.