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    The left distal transradial access site could give a safe alternate site for transradial coronary intervention (The Litaunent Study)
    (SAGE Publications Inc, 2023) Acar, Emrah; İzci, Servet; Dönmez, Ibrahim; Yılmaz, Mehmet Fatih; Özgül, Neryan; Güneş, Yılmaz
    Transradial Access (TRA) is the suggested method when performing coronary procedures. TRA has several advantages over the transfemoral approach, but also some restrictions. The present study compared the efficacy and safety of the traditional proximal transradial approach (pTRA) with a newer technique known as the distal transradial approach (dTRA) for performing a coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients (n = 700) were placed into one of two categories (dTRA or pTRA) based on a random technique. The primary endpoint was RAO at follow-up. The secondary endpoints included the time required for sheath insertion, the rate of successful sheath insertion, rate of successful completion of CAG and PCI, total procedure time, total fluoroscopy time, total radiation dose, total contrast volume used, pain perception (visual analog scale 0-10), and hemostasis duration. dTRA patients had more skin punctures, failed punctures, failed wiring, overlap of access sites, sheath insertion time, and pain evaluation scale, while the pTRA group had more hemostasis time and first-time cannulation. RAO and pseudoaneurysm (PseA) were lower in the dTRA group. In this randomized study, dTRA had lower RAO and PseA than pTRA. However, multicenter, larger-patient trials are needed to provide definitive evidence.
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    A mix of aminophylline and heparin plus nitroglycerin can reduce bradycardia during rotational atherectomy on the right coronary artery and dominant circumflex artery
    (Urban & Vogel, 2023) Acar, Emrah; İzci, Servet; Dönmez, İbrahim; Özgül, Neryan; Özcan, Eda; Kaygusuz, Tuba
    BackgroundRotational atherectomy (RA) may cause bradyarrhythmias and transitory atrioventricular block when performed in the right coronary artery (RCA) or a dominant circumflex (CX) coronary artery. However, there are no studies of a solution that can prevent coronary flow deterioration and bradycardia complications that may occur during RA. We aimed to create an alternative rota-flush solution to minimize the risk of bradycardia and complete atrioventricular block (AVB) that can occur during RA.Materials and methodsThe study comprised 60 patients who were randomly divided into two groups: 30 received rotaphylline (= 240 mg aminophylline, 10,000 U unfractionated heparin, and 2000 mcg nitroglycerin to 1000 mL saline), and 30 received the traditional rota-flush (= 10,000 U unfractionated heparin, 2000 mcg nitroglycerin, and 1000 mL saline). The incidence of bradycardia or high-grade AVB (HAVB) during RA, coronary slow-flow phenomenon or no-reflow phenomenon, and coronary spasm were the primary endpoints of the study. Procedure success and RA-related procedural complications were secondary endpoints.ResultsThe use of rotaphylline was an independent predictor of bradycardia and HAVB after accounting for all other factors (OR: 0.47, 95% CI: 0.24-0.79, p < 0.001). Lesion length (OR: 2.17, 95% CI: 1.24-3.04, p < 0.001), burr-to-artery ratio (OR: 0.59, 95% CI: 0.39-1.68, p < 0.001), and total run duration (OR: 0.79, 95% CI: 0.35-1.43, p < 0.001) were additional independent predictors.ConclusionBradycardia and the development of HAVB may be avoided by rotaphylline intracoronary infusion during RA applied to the RCA and dominant CX lesions. Multicenter studies including sizable patient populations should be conducted to validate the present findings.
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    The pulmonary annular motion velocity assessed using tissueDoppler imaging could predict the proximal right coronary arteryocclusion in patients with inferior myocardial infarction
    (2021) Acar, Emrah; Özgül, Neryan; Dönmez, Ibrahim; Yalçin, Osman Yasin; Alan, Sait
    Objective: The right ventricle myocardial infarction (RVMI) is one of the leading reasons for right ventricle(RV) dysfunction. RVMI occurs in 20-50% of inferior infarctions. Echocardiography was applied to study RV involvement and proximal right coronary artery (RCA) occlusion in individuals with acute inferior MI. The objective of this study was to investigate if pulmonary annulus motion velocity (PAMVUT) levels in individuals with acute inferior myocardial infarction were linked to proximal RCA lesions.Method: The study comprised 50 people who had been diagnosed with acute inferior myocardial infarction and had culprit lesions in the right coronary artery. The RCA occlusion in Group A was proximal to the right ventricular branch, while the RCA occlusion in Group B was distant to the RV branch. The PAMVUT was tested, as well as other echocardiographic parameters.Results: In terms of metrics indicating right ventricular function, there were substantial disparities between the groups. A favorable association was established in the univariate correlation analysis between PAMVUT and RV TAPSE, with FAC, and with St.PAMVUT was identified as an independent predictor of proximal RCA occlusion in a multivariate logistic regression test. In the ROC analysis, PAMVUT<8,5 cm/s indicated proximal RCA occlusion with 85 percent sensitivity and 69 percent specificity (AUC=0.80, p<0.001).Conclusion: PAMVUT measurements were revealed to be an important predictor of proximal RCA occlusions in this investigation.
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    The right ventricle systolic force ratio could predictthe severity of the tricuspid regurgitation-RIVIERA ratio
    (Wiley, 2023) Acar, Emrah; İzci, Servet; Dönmez, İbrahim; Yılmaz, Mehmet Fatih; Özgül, Neryan; Seymen, Hande; Özcan, Eda; Güneş, Yılmaz
    Purpose: For assessing the severity of tricuspid regurgitation (TR), there is no gold standard. We developed a parameter, the right ventricular systolic force ratio-RIVIERA, using the continious wave Doppler analysis of TR and pulsed-wave analysis of the right ventricle outflow tract. We hypothesized that the RIVIERA would facilitate the ability to identify severe TR in clinical settings.Materials and Methods: We obtained data from routine transthoracic echocardiograms. All records reporting no or mild TR (n = 732), moderate TR (n = 584), and severe TR (n = 519) TR were reanalyzed to measure vena contracta (VC) width, TR jet area, effective regurgitant orifice (EROA) derived with the proximal isovelocity surface area method, the RIVIERA, and right-sided chamber volumes.Results: Significant linear trends were demonstrated for right atrial volume index, end-diastolic volume index, RVOT velocity time integral, TR jet area, TR-Vmax, TR-VTI, TR acceleration, VC width, EROA with increasing TR severity. Independent predictors of severe RT included RIVIERA <4.8, VC width =0.7 cm, TR jet area > 10 cm(2), and EROA =0.4 cm(2).Conclusion: The RIVIERA is a feasible, effective, and independent predictor of severe TR that enhances established techniques for estimating TR severity. For clinical decision-making and management, accurate measurement and classification of TR severity are essential. Therefore, it should be thought about include the RIVIERA in the integrative method to assessing TR severity.