Prognostic Impact of a Chronic Occlusion in a Noninfarct Vessel in Patients with Acute Myocardial Infarction and Multivessel Disease Undergoing Primary Percutaneous Coronary Intervention
Background. Among patients with acute myocardial infarction (AMI) referred for primary percutaneous coronary intervention (PCI), those with multivessel disease have worse clinical outcomes. This study sought to elucidate the impact of a chronic occlusion in a noninfarct vessel among patients with multivessel disease undergoing PCI for AMI. Methods and Results. We studied 630 patients with AMI treated with PCI within 12 hours of symptom onset. Three groups of patients were defined: Group 1 (single-vessel disease; n = 345); Group 2 (multivessel disease with no chronic coronary occlusion in another vessel; n = 201); and Group 3 (chronic coronary occlusion in another vessel; n = 84). The probability of being free from events was lower in patients with multivessel disease than in Group 1 (84 ± 2% vs. 92 ± 1% at 30 days; 71 ± 3% vs. 81 ± 3% at 2 years; Log-Rank: p = 0.001; Breslow: p < 0.001 ), and in Group 3 than in Group 2 (76 ± 5% vs. 87 ± 2% at 30 days; 63 ± 6% vs.75 ± 4% at 2 years; Log-Rank: p = 0.014; Breslow: p = 0.008 ). Freedom from cardiac death was lower in patients with multivessel disease than in Group 1 (88 ± 2% vs. 94 ± 1% at 30 days; 84 ± 2% vs. 91 ± 2% at 2 years; Log-Rank: p = 0.003; Breslow: p = 0.002), and in Group 3 than in Group 2 (82 ± 4% vs. 90 ± 2% at 30 days; 77 ± 5% vs. 88 ± 3% at 2 years; Log-Rank and Breslow: p = 0.020). Among patients with multivessel disease, the presence of cardiogenic shock, left main disease and anterior location, but not the presence of a chronic occlusion in another vessel, were independent predictors of mortality. Conclusion. Among patients with AMI and multivessel disease, those with a chronic occlusion in a noninfarct-related vessel constitute a subgroup with very poor clinical outcomes.
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Initial Experience in the Treatment of Chronic Superficial Femoral Artery Occlusions with Fiberoptic Guidance Technology
Background. Although procedural success rates for treating chronic occlusions are relatively high, dissections and perforations often require stenting. Methods. A fiberoptic guidance system that visualizes lesion characteristics and incorporates a radiofrequency energy source to aid in crossing total occlusions was used in three men and one woman with superficial femoral artery lesions that were 8?50 cm long and 5?144 months old. Results. Five lesions were attempted and successfully crossed, and there were no observed dissections or perforations. Ankle-brachial indexes returned to normal in two of the four patients. The guidance system was useful in visualizing and treating chronic total femoral occlusions.
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January 2006
This issue also includes a Rapid Communication submission. In the Clinical Images special section, Drs. This issue also includes excellent case reports that can be found online.
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Pedal-Plantar Loop Technique for a Challenging Below-the-Knee Chronic Total Occlusion: A Novel Approach to Percutaneous Revascularization in Critical Lower Limb Ischemia
Arterial revascularization by means of percutaneous transluminal angioplasty (PTA) is a mainstay in the management of patients with peripheral artery disease and critical limb ischemia (CLI). However, when employing standard approaches, percutaneous transluminal angioplasty (PTA) of below-the-knee arteries may fail in up to 20% of cases. In the present article, we report on a novel interventional strategy, the pedal-plantar loop technique, which we successfully employed in a patient with critical lower limb ischemia. This technique may sensibly increase success rates of PTA in very challenging total occlusions of below-the-knee arteries (e.g., those lacking a proximal occlusion stump). Technical points pertinent to this case are clearly illustrated, including the need to accurately choose guidewires and balloons of appropriate length, and the extensive use of the subintimal angioplasty technique. J INVASIVE CARDIOL 20007;19:E34?E36
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Novel Intracoronary Steerable Support Catheter for Complex Coronary Intervention
Novel Intracoronary Steerable Support Catheter for Complex Coronary Intervention Clinical Images: Novel Intracoronary Steerable Support Catheter for Complex Coronary Intervention - Srihari S. Naidu, MD and Shing-Chiu Wong, MD Case Description. Discussion. Interventional cardiologists are being asked to perform angioplasty in increasingly complex lesion subsets.
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Successful Revascularization of a Long Chronic Total Occlusion With Blunt Microdissection Complicated by Coronary Artery Dissection
We report a case of successful percutaneous revascularization of a chronic total occlusion using the LuMend Frontrunner catheter. The case was complicated by a long coronary artery dissection, with inability to access the true lumen. With favorable healing at 7 weeks, the true lumen was accessible which led to procedural success.
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Acute Right Coronary Artery Occlusion in an Adult Patient After Radiofrequency Catheter Ablation of a Posteroseptal Accessory Pathway
Acute Right Coronary Artery Occlusion in an Adult Patient After Radiofrequency Catheter Ablation of a Posteroseptal Accessory Pathway Electrophysiology Corner: Acute Right Coronary Artery Occlusion in an Adult Patient After Radiofrequency Catheter Ablation of a Posteroseptal Accessory Pathway - Truong Duong, MD, Peter Hui, MD, James Mailhot, MD Radiofrequency catheter ablation (RFCA) of accessory pathways (APs) is recommended as definitive therapy for...
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Temporal Spectrum of Ischemic Complications with Percutaneous Coronary Intervention: The ESPRIT Experience
We determined the timing of ischemic complications within 30 days after percutaneous coronary intervention (PCI) in patients enrolled in the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial. Complications (death, myocardial infarction [MI], target vessel revascularization) occurred in 178 of 2064 patients (8.6%) within 30 days. More than 85% of complications occurred within the 24 hours following randomization, with the greatest risk hazard at 12?18 hours. Unexpectedly, 31% of patients who ultimately met criteria for an endpoint MI within 24 hours of PCI had completely normal CK-MB concentrations at the first 6-hour measurement. There was no ?rebound? increase in events after cessation of eptifibatide. Treatment benefit persisted to 30 days. Post-procedural MI is often not detected until >= 12 hours after PCI. Treatment with a glycoprotein IIb/IIIa inhibitor is the only modifiable parameter that reduces the risk for early ischemic complications.
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Blunt Microdissection and Rotational Atherectomy: An Effective Combination for the Resistant Chronic Total Occlusion
Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has a lower success rate than nontotal occlusions. Like nontotal coronary occlusions, successful procedural outcomes of CTOs confers improvement in clinical outcomes. Reasons for unsuccessful PCI of CTOs may stem from various steps of the procedure including failure to cross the occlusion with a guidewire or a balloon, or failure to adequately dilate or modify the lesion. The Frontrunner? blunt microdissection device is designed to improve the odds of guidewire passage through coronary occlusions, whereas the Rotablator® rotational atherectomy device is intended for plaque modification, especially in resistant, elastic or calcific lesions. The Frontrunner and Rotablator can each facilitate the procedure at their respective junctures; the combined use of these technologies can enhance the overall PCI success rates, especially regarding difficult CTOs. This case presentation encounters two technical challenges: the inability of the balloon catheter to cross the CTO, and the inability to recross the occlusion with the less favorable RotaWire?. In this case, the combined use of the Frontrunner and Rotablator devices was necessary to achieve overall procedural success. When tackling difficult CTOs, a comprehensive strategy that encompasses multiple devices and technologies can enable ultimate procedural success.
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Use of an Emboli Containment and Retrieval System During Percutaneous Coronary Angioplasty in Native Coronary Arteries
Use of an Emboli Containment and Retrieval System During Percutaneous Coronary Angioplasty in Native Coronary Arteries Feature: Use of an Emboli Containment and Retrieval System During Percutaneous Coronary Angioplasty in Native Coronary Arteries - G. Sütsch, W. Kiowski, A. Bossard, T.F. Lüscher, W. Maier, *P. Vogt, F.W. Amann ABSTRACT: Background. This preliminary report demonstrates the feasibility of using a protection device in native coronary arteries to prevent distal embolization of ...
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 Electrophysiologic Perspective on the BIPOLAR RF EPICARDIAL ABLATION Procedure for Atrial Fibrillation
Complimentary Accredited Breakfast Symposium
Click Here for More Info.
Location: The St. Regis San Francisco
125 3rd Street
San Francisco, CA 94103
3rd and Mission Streets
Gallery Ballroom, 2nd floor
This activity is supported by an educational grant from AtriCure, Inc.
This program is not part of the Heart Rhythm 2008 Official Scientific Sessions as planned by the Heart Rhythm Society Scientific Sessions Committee. This event is neither sponsored nor endorsed by the Heart Rhythm Society.
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 Newest Perspectives on Drug-Eluting Stents
Complimentary CME Accredited Dinner Meetings Click Here for More Info.
Miami, FL - Date: Friday, April 4, 2008 6:00pm EST -8:00 pm EST
Birmingham, AL - Date: Friday, May 9, 2008 6:00pm EST -8:00 pm EST
This activity is supported by an educational grant from Abbott Vascular.
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 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE
On Demand Web Archive
Non-Accredited
This activity is supported by an educational grant from Terumo Medical Corporation.
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 Pharmacoinvasive Management of Acute Coronary Syndrome: Incorporating the 2007 ACC/AHA Guidelines
Complimentary Accredited CME Program
This activity is supported by an educational grant from Sanofi-Aventis.
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 Varicose Veins: Causes, Symptoms, Diagnosis and Treatment of Chronic Venous Insufficiency
A Complimentary Accredited ON-DEMAND Webcast
This activity is supported by an educational grant from Diomed, Inc.
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 Create a Successful Vena Cava Filter Practice
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This activity is supported by an educational grant from Cook Incorporated and has been designed for Interventional Cardiologists, Vascular Surgeons, Fellows and Interventional Cardiovascular Nurses and Technologists.
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Webcast and Web Archives |
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 Achieving Optimal Outcomes in Carotid Stenting: Lessons Learned from Recent Clinical Trials
Complimentary Accredited ON DEMAND Webcast
Topics
1. EVA-3S & Space-Bumps in the road
2. CAPTURE 3500-Lesion morphology & Predictors for Stroke
3. CAPTURE II vs. EXACT 1500-Does open or Closed Cell Stent design really matter?
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Neurologists, Interventional Nurses and Technologists with an interest in the diagnosis and treatment of peripheral artery disease. |
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 Anticoagulation Techniques for Peripheral Vascular Interventions
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 New Treatment Strategies for the Endovascular Approach to Critical Limb Ischemia: ADVANCEMENTS IN LIMB SALVAGE MEDICINE
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 Reducing the Incidence of CIN during Cardiac Catheterization and PCI
Complimentary Accredited ON DEMAND
Educational Web Archive
This activity has been developed for nurses and technologists. |
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March 2007 Supplement
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On-Demand Webcast
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Archived Webcast
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Release Date: December 8, 2006