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Article: COVID-19 Vaccine-Induced Thrombotic Thrombocytopaenia With Venous and Arterial Thrombosis: A Case Report.

Khan, Zahid / Besis, George / Candilio, Luciano

2022 Volume 14, Issue 8, Page(s) e28535

Abstract: Coronavirus disease 19 pandemic has put tremendous pressure on health systems and has caused significant morbidity and mortality throughout the world. Vaccination program against COVID-19 has been effective despite repeated outbreaks across the globe. It ...

Abstract	Coronavirus disease 19 pandemic has put tremendous pressure on health systems and has caused significant morbidity and mortality throughout the world. Vaccination program against COVID-19 has been effective despite repeated outbreaks across the globe. It was however reported that COVID-19 vaccines in particular, the Oxford-AstraZeneca COVID-19 vaccine (AZD1222) was temporarily suspended by some European countries due to risk of thrombosis. COVID-19 is a prothrombotic condition and is associated with venous thromboembolism mainly. The condition can be challenging to diagnose due to its diagnostic variation. Cases of vaccine-induced thrombotic thrombocytopaenia has been reported in several countries. COVID-19 can also cause vaccine-induced thrombosis without thrombocytopaenia. The thrombotic events can affect different parts of the body including brain, heart, and peripheral vessels. We present a case of 54-year-old patient who presented with chest and abdominal pain for 12 hours and evidence of infero-lateral ST segment elevation on electrocardiogram. Patient received COVID-19 AstraZeneca vaccine 10 days prior to admission. Coronary angiography (CAG) showed occlusion of the proximal to mid part of the right coronary artery (RCA) distal to a large Right Ventricular branch with high thrombotic burden and multiple attempts at aspiration of the thrombus resulted in partial restoration of the flow to right coronary artery.
Language	English
Publishing date	2022-08-29
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.28535
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Robotic-Assisted PCI: The Future of Coronary Intervention?

Stevenson, Alexander / Kirresh, Ali / Ahmad, Mahmood / Candilio, Luciano

Cardiovascular revascularization medicine : including molecular interventions

2021 Volume 35, Page(s) 161–168

Abstract: Robotic percutaneous coronary intervention (R-PCI) is a novel approach to performing percutaneous coronary intervention (PCI) whereby the operator can utilise remotely controlled technology to manipulate guidewires and catheter devices. This enables the ... ...

Abstract	Robotic percutaneous coronary intervention (R-PCI) is a novel approach to performing percutaneous coronary intervention (PCI) whereby the operator can utilise remotely controlled technology to manipulate guidewires and catheter devices. This enables the procedure to be undertaken from within a radiation-shielded cockpit. Success in early trials has led to the release of commercially available robotic platforms which have now received regulatory approval and are available for use in clinical practice. Recent trials evaluating R-PCI have demonstrated high technical success rates with low complication rates. Despite this, a significant number of cases, particularly those with complex anatomy, still require at least partial conversion to a manual procedure. Advantages of R-PCI include accurate stent placement, reduced operator radiation exposure and a presumed reduction in orthopedic injuries. Limitations include current incompatibility with certain intravascular imaging catheters and the inability to manipulate multiple guidewires and stents simultaneously. Patients presenting with ST-elevation myocardial infarction requiring primary-PCI have also largely been excluded from existing R-PCI studies. Given these caveats, R-PCI remains a novel technology and has yet to become commonplace in cardiac catheterisation laboratories, however with increasing safety and feasibility data emerging, it is possible that R-PCI may form part of standard practice in the future.
MeSH term(s)	Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/therapy ; Humans ; Percutaneous Coronary Intervention ; Robotic Surgical Procedures/adverse effects ; Stents ; Treatment Outcome
Language	English
Publishing date	2021-04-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2212113-4
ISSN	1878-0938 ; 1553-8389
ISSN (online)	1878-0938
ISSN	1553-8389
DOI	10.1016/j.carrev.2021.03.025
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Zs.A 5562: Show issues

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Article: SARS-CoV-2 and Pre-existing Vascular Diseases: Guilt by Association?

Voulalas, Grigorios / Tsui, Janice / Candilio, Luciano / Baker, Daryll

Clinical Medicine Insights. Cardiology

2021 Volume 15, Page(s) 11795468211010705

Abstract: Severe Acute Respiratory Syndrome coronavirus-2 has rapidly spread and emerged as a pandemic. Although evidence on its pathophysiology is growing, there are still issues that should be taken into consideration, including its effects on pre-existing ... ...

Abstract	Severe Acute Respiratory Syndrome coronavirus-2 has rapidly spread and emerged as a pandemic. Although evidence on its pathophysiology is growing, there are still issues that should be taken into consideration, including its effects on pre-existing peripheral vascular disease. The aim of this review is to describe the thrombotic and endothelial dysfunctions caused by SARS-CoV-2, assess if cardiovascular comorbidities render an individual susceptible to the infection and determine the course of pre-existing vascular diseases in infected individuals. A search through MEDLINE, PubMed and EMBASE was conducted and more than 260 articles were identified and 97 of them were reviewed; the rest were excluded because they were not related to the aim of this study. Hypertension, cardiovascular disease, diabetes mellitus and cerebrovascular diseases comprised 24.30% ± 16.23%, 13.29% ± 12.88%, 14.82% ± 7.57% and 10.82% ± 11.64% of the cohorts reviewed, respectively. Arterial and venous thrombotic complications rocketed up to 31% in severely infected individuals in some studies. We suggest that hypertension, cardiovascular diseases, diabetes and cerebrovascular diseases may render an individual susceptible to severe COVID-19 infection. Pre-existing vascular diseases are expected to deteriorate with SARS-CoV-2 infection as a consequence of its increased thrombotic burden and the development of endothelial dysfunction. COVID-19 has emerged only a few months ago and it is premature to predict the long-term effects to the vascular system. Its disturbances of the coagulation mechanisms and effects on vascular endothelium will likely provoke a surge of vascular complications in the coming months.
Language	English
Publishing date	2021-05-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2575256-X
ISSN	1179-5468
ISSN	1179-5468
DOI	10.1177/11795468211010705
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Article ; Online: Intralesional delivery of glycoprotein IIb/IIIa inhibitors in acute myocardial infarction: Review and recommendations.

Kirresh, Ali / Candilio, Luciano / Stone, Gregg W

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

2021 Volume 99, Issue 3, Page(s) 641–649

Abstract: Plaque rupture leads to a cascade of events culminating in collagen disruption, tissue factor release, platelet activation and thrombus formation. Pro-inflammatory conditions, hyperglycemia and smoking predispose to high thrombus burden (HTB) which is an ...

Abstract	Plaque rupture leads to a cascade of events culminating in collagen disruption, tissue factor release, platelet activation and thrombus formation. Pro-inflammatory conditions, hyperglycemia and smoking predispose to high thrombus burden (HTB) which is an independent predictor of slow or no-reflow. In patients with acute myocardial infarction (AMI), glycoprotein IIb/IIIa inhibitors (GPI) reduce thrombus burden and improve myocardial perfusion. These agents are typically administered systemically via the intravenous route or locally via an intracoronary (IC) route. However, as higher local concentrations of GPI are associated with enhanced platelet inhibition, intralesional (IL) GPI administration may be particularly effective in cases of HTB. Modest-sized randomized trials comparing IL and IC GPI delivery have reported conflicting outcomes. Some trials have demonstrated improved coronary flow and myocardial perfusion with reduced major adverse cardiac events with IL compared with IC GPI administration, whereas others have shown no significant benefits. Furthermore, although no direct comparison has been made between IL delivery using an aspiration catheter, microcatheter or a dedicated balloon-based "weeping" infusion-catheter, improved outcomes have been most consistent following GPI administration at the site of the lesion and thrombus with the dedicated infusion catheter. This review provides an update on the role and outcomes of IL GPI administration in patients with AMI and HTB. Based on the evidence we offer an algorithm demonstrating when to consider IL administration in patients with AMI undergoing intervention. We conclude with a perspective on the management of patients with STEMI and COVID-19 in whom a prothrombotic state often results in HTB.
MeSH term(s)	COVID-19 ; Humans ; Myocardial Infarction/drug therapy ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/methods ; Platelet Aggregation Inhibitors/adverse effects ; Platelet Glycoprotein GPIIb-IIIa Complex ; SARS-CoV-2 ; Treatment Outcome
Chemical Substances	Platelet Aggregation Inhibitors ; Platelet Glycoprotein GPIIb-IIIa Complex
Language	English
Publishing date	2021-11-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1459995-8
ISSN	1522-726X ; 1522-1946
ISSN (online)	1522-726X
ISSN	1522-1946
DOI	10.1002/ccd.30008
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: COVID-19 Infection and High Intracoronary Thrombus Burden.

Kirresh, Ali / Coghlan, Gerry / Candilio, Luciano

Cardiovascular revascularization medicine : including molecular interventions

2020 Volume 28, Page(s) 82–87

Abstract: Coronavirus 2019 (COVID-19) is an acute respiratory disease that has rapidly spread around the world and been declared a global pandemic by the World Health Organization. Emerging evidence demonstrates a strong association with a pro-thrombotic state and ...

Abstract	Coronavirus 2019 (COVID-19) is an acute respiratory disease that has rapidly spread around the world and been declared a global pandemic by the World Health Organization. Emerging evidence demonstrates a strong association with a pro-thrombotic state and we present the first patient admitted with COVID-19 and an inferior ST-segment elevation myocardial infarction (STEMI) with evidence of high intracoronary thrombus burden. We review the mechanism of the high thrombus burden, which may be driven by the significant cytokine storm, endothelial dysfunction, increase risk of coronary plaque rupture and hypercoagulability.
MeSH term(s)	COVID-19 ; Coronary Thrombosis/diagnostic imaging ; Humans ; Percutaneous Coronary Intervention ; SARS-CoV-2 ; ST Elevation Myocardial Infarction/diagnostic imaging
Keywords	covid19
Language	English
Publishing date	2020-07-30
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2212113-4
ISSN	1878-0938 ; 1553-8389
ISSN (online)	1878-0938
ISSN	1553-8389
DOI	10.1016/j.carrev.2020.07.032
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Zs.A 5562: Show issues

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Article: Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T.

Sharma, Vikram / Zheng, Huili / Candilio, Luciano / Nicholas, Jennifer M / Clayton, Tim / Yellon, Derek M / Bulluck, Heerajnarain / Hausenloy, Derek J

Journal of clinical medicine

2023 Volume 12, Issue 13

Abstract: Objective: Cut-offs for high-sensitivity troponin (hs-Tn) elevations to define prognostically significant peri-operative myocardial injury (PMI) in cardiac surgery is not well-established. We evaluated the associations between peri-operative high- ... ...

Abstract	Objective: Cut-offs for high-sensitivity troponin (hs-Tn) elevations to define prognostically significant peri-operative myocardial injury (PMI) in cardiac surgery is not well-established. We evaluated the associations between peri-operative high-sensitivity troponin T (hs-TnT) elevations and 1-year all-cause mortality in patients undergoing cardiac surgery. Methods: The prognostic significance of baseline hs-TnT and various thresholds for post-operative hs-TnT elevation at different time-points on 1-year all-cause mortality following cardiac surgery were assessed after adjusting for baseline hs-TnT and EuroSCORE in a post-hoc analysis of the ERICCA trial. Results: 1206 patients met the inclusion criteria. Baseline elevation in hs-TnT >x1 99th percentile upper reference limit (URL) was significantly associated with 1-year all-cause mortality (adjusted hazard ratio 1.90, 95% confidence interval 1.15-3.13). In the subgroup with normal baseline hs-TnT ( Conclusions: Both baseline and post-operative hs-TnT elevations are independently associated with 1-year all-cause mortality in patients undergoing cardiac surgery. The optimal threshold to define a prognostically significant PMI in our study was ≥50 × URL elevation in hs-TnT at 24 h.
Language	English
Publishing date	2023-06-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12134291
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Article: Is there a role for ischaemic conditioning in cardiac surgery?

Candilio, Luciano / Hausenloy, Derek

F1000Research

2017 Volume 6, Page(s) 563

Abstract: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Coronary artery bypass graft (CABG) surgery is the revascularisation strategy of choice in patients with diabetes mellitus and complex CAD. Owing to a number of factors, ...

Abstract	Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Coronary artery bypass graft (CABG) surgery is the revascularisation strategy of choice in patients with diabetes mellitus and complex CAD. Owing to a number of factors, including the ageing population, the increased complexity of CAD being treated, concomitant valve and aortic surgery, and multiple comorbidities, higher-risk patients are being operated on, the result of which is an increased risk of sustaining perioperative myocardial injury (PMI) and poorer clinical outcomes. As such, new treatment strategies are required to protect the heart against PMI and improve clinical outcomes following cardiac surgery. In this regard, the heart can be endogenously protected from PMI by subjecting the myocardium to one or more brief cycles of ischaemia and reperfusion, a strategy called "ischaemic conditioning". However, this requires an intervention applied directly to the heart, which may be challenging to apply in the clinical setting. In this regard, the strategy of remote ischaemic conditioning (RIC) may be more attractive, as it allows the endogenous cardioprotective strategy to be applied away from the heart to the arm or leg by simply inflating and deflating a cuff on the upper arm or thigh to induce one or more brief cycles of ischaemia and reperfusion (termed "limb RIC"). Although a number of small clinical studies have demonstrated less PMI with limb RIC following cardiac surgery, three recently published large multicentre randomised clinical trials found no beneficial effects on short-term or long-term clinical outcomes, questioning the role of limb RIC in the setting of cardiac surgery. In this article, we review ischaemic conditioning as a therapeutic strategy for endogenous cardioprotection in patients undergoing cardiac surgery and discuss the potential reasons for the failure of limb RIC to improve clinical outcomes in this setting. Crucially, limb RIC still has the therapeutic potential to protect the heart in other clinical settings, such as acute myocardial infarction, and it may also protect other organs against acute ischaemia/reperfusion injury (such as the brain, kidney, and liver).
Language	English
Publishing date	2017-04-25
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2699932-8
ISSN	2046-1402
ISSN	2046-1402
DOI	10.12688/f1000research.10963.1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: COVID-19 infection and high intracoronary thrombus burden

Kirresh, Ali / Coghlan, Gerry / Candilio, Luciano

Cardiovascular Revascularization Medicine ; ISSN 1553-8389

2020

Keywords	Cardiology and Cardiovascular Medicine ; General Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
DOI	10.1016/j.carrev.2020.07.032
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T

Vikram Sharma / Huili Zheng / Luciano Candilio / Jennifer M. Nicholas / Tim Clayton / Derek M. Yellon / Heerajnarain Bulluck / Derek J. Hausenloy

Journal of Clinical Medicine, Vol 12, Iss 4291, p

2023 Volume 4291

Abstract	Objective: Cut-offs for high-sensitivity troponin (hs-Tn) elevations to define prognostically significant peri-operative myocardial injury (PMI) in cardiac surgery is not well-established. We evaluated the associations between peri-operative high-sensitivity troponin T (hs-TnT) elevations and 1-year all-cause mortality in patients undergoing cardiac surgery. Methods: The prognostic significance of baseline hs-TnT and various thresholds for post-operative hs-TnT elevation at different time-points on 1-year all-cause mortality following cardiac surgery were assessed after adjusting for baseline hs-TnT and EuroSCORE in a post-hoc analysis of the ERICCA trial. Results: 1206 patients met the inclusion criteria. Baseline elevation in hs-TnT >x1 99th percentile upper reference limit (URL) was significantly associated with 1-year all-cause mortality (adjusted hazard ratio 1.90, 95% confidence interval 1.15–3.13). In the subgroup with normal baseline hs-TnT ( n = 517), elevation in hs-TnT at all post-operative time points was associated with higher 1-year mortality, reaching statistical significance for elevations above: ≥100 × URL at 6 h; ≥50 × URL at 12 and 24 h; ≥35 × URL at 48 h; and ≥30 × URL at 72 h post-surgery. Elevation in hs-TnT at 24 h ≥ 50 × URL had the optimal sensitivity and specificity (73% and 75% respectively). When the whole cohort of patients was analysed, including those with abnormal baseline hs-TnT (up to 10 × URL), the same threshold had optimal sensitivity and specificity (66% and 70%). Conclusions: Both baseline and post-operative hs-TnT elevations are independently associated with 1-year all-cause mortality in patients undergoing cardiac surgery. The optimal threshold to define a prognostically significant PMI in our study was ≥50 × URL elevation in hs-TnT at 24 h.
Keywords	peri-operative myocardial injury ; high-sensitivity troponin ; coronary artery bypass graft surgery ; mortality ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Procedural and follow-up insights from optical coherence tomography-guided management of intracoronary stent loss and crushing.

Azzalini, Lorenzo / Mitomo, Satoru / Candilio, Luciano / Colombo, Antonio

Cardiology journal

2018 Volume 24, Issue 6, Page(s) 702–703

MeSH term(s)	Chronic Disease ; Coronary Occlusion/diagnosis ; Coronary Occlusion/surgery ; Coronary Vessels/diagnostic imaging ; Coronary Vessels/surgery ; Drug-Eluting Stents/adverse effects ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention/adverse effects ; Postoperative Complications/diagnosis ; Prosthesis Failure ; Surgery, Computer-Assisted/methods ; Time Factors ; Tomography, Optical Coherence/methods
Language	English
Publishing date	2018-01-03
Publishing country	Poland
Document type	Case Reports ; Journal Article ; Video-Audio Media
ZDB-ID	2488680-4
ISSN	1897-5593 ; 1897-5593
ISSN (online)	1897-5593
ISSN	1897-5593
DOI	10.5603/CJ.2017.0145
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