Finding the Graft the Hard Way! An Unusual Case
- Fri, 8/1/08 - 11:13am
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- 745 reads
Dear Editor,
Re-do coronary artery bypass graft (CABG) surgeries are associated with increased peri- and postoperative mortality. The increasing use of these reoperations has led to the use of a variety of different kinds of grafts, e.g., from the left axillary artery or the descending aorta, to reduce the incidence of damage to the patent grafts running near the midline. However, with the increasing number of these patients, there has been a steady rise in the difficulty of assessing these grafts when these patients present with acute infarction and limited information is available
Nickel Allergy: Lack of Correlation Between Systemic TH1 Immune Response and Skin Patch Testing
- Fri, 8/1/08 - 11:12am
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- 1484 reads
Dear Editor,
We read with interest the article in the November 2004 issue concerning nickel allergy in a case where an atrial septal defect was being closed.1 To test whether a patient reporting nickel allergy was sensitive to a device, they applied the device to the skin, eliciting a contact allergic response. Nickel allergy has also been implicated in adverse responses to other steel implants. We have had a number of cases where percutaneous coronary intervention was required in patients reporting nickel allergy, raising concern about possible reaction to the stents. Nickel all
Iodixanol and Chronic Kidney Disease
- Fri, 8/1/08 - 11:12am
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- 796 reads
Dear Editor,
I read with great interest the Tadros, et al. article1 entitled Iso-osmolar Radiocontrast Iodixanol in Patients with Chronic Kidney Disease (J Invasive Cardiol 2005;17:211–215).
They concluded that the volume of iso-osmolar radio contrast does not affect the incidence of contrast-induced nephropathy (CIN) in diabetic patients with chronic kidney disease. They also compared the incidence of CIN with the use of iso-osmolar contrast iodixanol compared to a similar historical control, and found a lower incidence of CIN with the former (57% versus 24%).
Alt
Dual Lumen Catheters: More Than Just Aspiration
- Fri, 8/1/08 - 11:12am
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- 1106 reads
To the Editor:
Percutaneous coronary interventions of thrombotic or friable lesions, such as in acute myocardial infarctions, can often result in distal embolization. To circumvent this problem, modern techniques frequently involve pretreatment with thrombectomy devices. The Pronto™ (Vascular Solutions, Inc., Minneapolis, Minnesota) and Export® (Medtronic, Inc., Minneapolis, Minnesota) catheters feature dual-lumen platforms consisting of a central rapid exchange wire lumen as well as an eccentric aspiration lumen. They are designed for rapid, manual syringe aspiration of throm
Don’t Ignore the Right Radial Approach
- Fri, 8/1/08 - 11:11am
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- 789 reads
Dear Editor,
We read with great interest the article by Spargias et al.1 entitled Percutaneous Coronary Intervention in Anomalous Right Coronary Arteries Arising from the Left Sinus of Valsalva: A Report of Two Cases and Observations on the Pattern of Atherosclerosis (J Invasive Cardiol 2006 18:E78–E81). The authors report a total of 31 such cases in the literature, but they did not comment on our case series in which we reported on the use of the right radial approach.2 This omission is regrettable since percutaneous intervention of anomalous right coronary a
Percutaneous Interventions of Acute Left Main Occlusions May Be Necessary
- Fri, 8/1/08 - 11:11am
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- 777 reads
Dear Editor,
We read with great interest the report by Mejia et al entitled “Left Main Coronary Embolism” in the June 2006 issue of the Journal of Invasive Cardiology. We had a similar case of an acute myocardial infarction secondary to left main (LM) thrombosis that was initially treated percutaneously:
A 70-year-old male presented to the emergency room 12 hours after the onset of shortness of breath and chest pain. The patient stated he had similar symptoms during an episode of pneumonia earlier in the year, thus delaying his presentation to the hospital. His initial electro
Too Late! Too Complex! But!
- Fri, 8/1/08 - 11:11am
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- 758 reads
Is There a Need for a Technology that Will Promote
Positive Remodeling and Mild Plaque Increase?
“Favorable vessel remodeling observed in this study is consistent with the result of the previous gamma radiation study noted above,1 as well as those at the non-stented target segment treated with beta radiation.2–5 On the other hand, the exact reasons for the mild plaque mass increase after high-dose radiation exposure at the normal, non-injured segments remain unclear.” — Kaneda et al.6
What is Geographic Miss7?
I
The Steerable Guidewire: A Simple Method to Recross Deployed Stents
- Fri, 8/1/08 - 11:11am
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- 802 reads
Recrossing a deployed stent with a guidewire is sometimes required when a distal lesion is recognized after wire withdrawal, or when a second “buddy wire” is required to facilitate distal advancement of another device. A popular technique is to create a large exaggerated loop on the distal wire tip to avoid passage beneath struts. Difficulty, however, can be encountered in steering such a curve through the proximal vessel, especially if the stent is placed distally in a tortuous artery.
We have found the new Steer-It wire (Cordis Corp., Miami, Florida) to be immensely useful in suc
Difficult Anatomies: Just Hold Your (Patient’s) Breath
- Fri, 8/1/08 - 11:11am
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- 679 reads
To the Editor:
Today’s vast armamentarium of percutaneous coronary interventional devices has both simplified and complicated the procedure. While user-friendly catheters, wires and stents have allowed the seasoned interventionalist to conquer increasingly difficult anatomies, the complexity of these cases has likewise grown. Sometimes, however, a basic maneuver such as breath-holding can be of great assistance.
Deep inspiration causes caudal displacement of the diaphragm, resulting in increased distance between a stationary catheter in the aortic root and the heart. This techniqu
Kounis Syndrome: A Potential Cause of Simultaneous Multivessel Coronary Spasm and Thrombosis after Drug-Eluting Stent Implanta
- Fri, 8/1/08 - 11:11am
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- 1251 reads
In the very interesting report1 and editorial2 published in the December 2006 issue of the Journal, the authors reported and commented on 13 patients who developed severe, diffuse coronary artery spasm after drug-eluting stent insertion. Five patients experienced diffuse multivessel spasm. Of these 5 patients, 2 died. The postmortem examination of one of the patients showed a few scattered mast cells in the adventitia of the left anterior descending coronary artery, possibly pointing to a hypersensitivity reaction to the stent components. The stent components currently
