PCI of the Right Coronary Artery via or under Struts of Stents Protruding into the Aorta
ABSTRACT: Reported are two cases in which stent protrusion from the right coronary ostium into the aorta caused considerable difficulty in interventions. Two different methods were applied to overcome this problem. In the first (elective) case a new orifice was created at the side of the protruding stent. In the second case (acute inferoposterior and right myocardial infarction associated with complete heart block, recurrent ventricular fibrillation and shock), a new track was created underneath the underexpanded protruding stent, and the protruding stent was crushed under a new stent. Stents protruding from the right coronary artery into the aorta may present a considerable challenge during interventions, which can be managed by certain technical modifications. J INVASIVE CARDIOL 2007;19:E207?E209
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A Three-Dimensional Intravascular Ultrasound Comparison between the New Zotarolimus-Eluting Stent (ZoMaxx?) and the Non-Drug-Eluting TriMaxx? Stent
ABSTRACT: Background. Despite the effectiveness of sirolimusand paclitaxel-eluting stents in reducing intimal hyperplasia (IH) and the need for repeat revascularization, concerns about their long-term safety have motivated the search for new drug-eluting stents (DES). Recently developed, the ZoMaxx? stent combines a sirolimus-analogous agent (zotarolimus), featuring a phosphorycoline polymer and stainless steel and tantalum platform. We sought to assess the efficacy of this new DES in reducing IH. Methods. A total of 40 patients were treated with the ZoMaxx stent and compared to 50 patients treated with its non-drug-eluting equivalent, the TriMaxx? stent. Only single de novo lesions in native coronary vessels ≥ 3.0 mm were enrolled. Serial quantitative coronary angiography and intravascular ultrasound (IVUS) images were obtained at baseline and 6- month follow up. All patients were clinically followed for 1 year. This analysis aimed to compare the percent of IH between the 2 stents. Secondarily, we assessed in-segment late loss, binary restenosis and major adverse cardiac events. Results. Baseline patient and lesion characteristics were comparable between the 2 groups. At follow up, zotarolimus efficiently suppressed neointimal hyperplasia formation with a marked reduction in the percentage of stent obstruction by IVUS (4.6 ± 3.6% vs. 31.2 ± 16%; p < 0.0001). Almost 90% of the segments stented with ZoMaxx did not exhibit more than 10% of obstruction. After 1 year, 12 patients treated with the TriMaxx and 2 patients treated with the ZoMaxx presented in-segment binary restenosis (p = 0.03). Conclusions. In this initial experience, ZoMaxx proved to be clinically safe and superior to its non-drug-coated equivalent in reducing in-stent IH formation and restenosis. J INVASIVE CARDIOL 2007;19:303?308
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Subclavian-Vertebral Artery Bifurcation Stenting Using Drug-Eluting Stents: A Report of Two Cases Using Different Techniques
ABSTRACT: Endovascular treatment of vertebral artery stenosis and subclavian artery stenosis are low-risk procedures, but there are few reports of the best approach for subclavian-vertebral artery stenoses where there is an ostial stenosis of a vertebral artery that arises from a stenosed segment of the subclavian artery. This is a report of two cases with subclavian-vertebral artery stenosis that were treated with two different techniques. One-year follow up demonstrated widely patent stents. Also, to our knowledge, this is the first report of the use of the crush-stenting technique using drug-eluting stents in subclavian-vertebral artery bifurcation lesions.
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Old Technique, New Use: Novel Use of a Buddy Wire to Deploy a Detached Stent
ABSTRACT: Stent dislodgement or loss in a coronary artery carries significant risks of infarction, thrombosis and requirement for emergency bypass surgery.1 Even with the advent of premounted stents, stent loss can occasionally occur, especially when performing intervention in calcified and tortuous anatomy. Multiple stent retrieval/stent exclusion techniques have been described to overcome this dreaded complication.2?7 We describe the first case of deploying a dislodged stent using a buddy wire technique with both wires through the center of the dislodged stent, and subsequent use of the small balloon technique to successfully deploy a dislodged stent in a heavily calcified and tortuous circumflex artery.
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Carotid Artery In-Stent Restenosis in a Patient with Contralateral Total Occlusion, Resolved with Drug-Eluting Stenting
ABSTRACT: A 70-year-old male patient with 90% stenosis of the right carotid artery and total occlusion of the left carotid artery underwent right carotid stenting. Two weeks after the procedure, the patient experienced grand mal seizures, and had angioplasty after 6 and 11 months, respectively, for recurrent in-stent restenosis. During drug-eluting stent deployment, the patient developed acute stent thrombosis, but he recovered quickly and completely after local thrombolysis and balloon angioplasty. For the 1 year of follow up to date, the patient has been sympto-free and without restenosis. At 6 months from the last-mentioned study, the patient was admitted for intermittent claudication, fatigability and severe hypertension. A Doppler study of the carotid stent showed normal velocities, and the the neurological exam was similar to the previous one. Angiography confirmed bilateral ostial stenosis of the renal arteries and we performed bilateral renal stenting at that time.
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Comparison of Nonuniform Strut Distribution between Two Drug-Eluting Stent Platforms
ABSTRACT: Objective. To compare the difference of strut distribution between two clinically available drug-eluting stent platforms (Bx Velocity and Express II stents) using intravascular ultrasound (IVUS). Background. Nonuniform strut distribution (NSD) has been shown to be associated with increased intimal hyperplasia after drug-eluting stent implantation. Methods. IVUS imaging was performed on Bx Velocity (n = 6) and Express II stents (n = 6) after inflation pressures of 10, 16, and 26 atm in a bench test model. Percent NSD was defined as the length of segments with NSD (interstrut angle > 90°)/stent length. NSD was also assessed in postprocedure IVUS images in 53 clinical cases (32 Cypher, 21 Taxus) using 3-dimensional IVUS analysis. Results. Frequency of NSD segment and %NSD were lower in Bx Velocity stents than in Express II stents at the inflation pressures of 16 and 26 atm (%NSD: 16 atm, 0% vs. 13.8 ± 9.4%; p < 0.005; 26 atm, 1.1 ± 2.6% vs. 19.9 ± 6.9%; p < 0.0001). In postprocedural images from clinical cases, the frequency of NSD segment and %NSD were lower in Cypher stents than in Taxus stents (%NSD: 0.5 ± 1.6 vs. 6.8 ± 7.2; p < 0.0001). Conclusion. NSD segment was observed less in Bx Velocity stents than in Express II stents.
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Complete Cypher? Stent Fracture and Migration in the Ostium of the Right Coronary Artery
Case Report. The most unique finding in our case is stent migration into the aortic root. In conclusion, we report the first case of a fortunately uneventful complete stent fracture associated not only with physical discontinuity between Cypher stent segments, but also migration of the proximal fractured stent into the aorta.
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Late Stent Thrombosis Associated with Coronary Aneurysm Formation after Sirolimus-Eluting Stent Implantation
ABSTRACT: Stent thrombosis is a rare but potentially fatal complication of coronary stent implantation. Its occurrence late after drug-eluting stent (DES) deployment has led to concerns regarding their long-term safety. We report a case of late stent thrombosis 26 months after sirolimus-eluting stent (SES) (Cypher?, Cordis Corp., Miami, Florida) implantation. This was associated with marked positive vessel remodeling and coronary aneurysm formation involving the stented segment of the coronary artery. The patient was on dual antiplatelet therapy at the time.
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DK Crush (Double-Kissing and Double-Crush) Technique for Treatment of True Coronary Bifurcation Lesions: Illustration and Comparison with Classic Crush
ABSTRACT: Background. Classic crush has a lower success rate compared to final kissing balloon inflation (FKBI). We previously reported the double-kissing (DK) crush technique that involves double-kissing along with double-crushing for the treatment of true bifurcation coronary lesions in 2005. Methods and Results. This is a consecutive, nonrandomized, open-label study. Eighty-eight consecutive patients with single, true coronary bifurcation lesions according to Lefevre Classification2 and side branch diameter >2.0 mm were enrolled. The first 44 patients (from October 2004 to January 2005) were assigned to the classic crush treatment arm and the next 44 patients (from February 2005 to June 2005) were assigned to the DK crush technique arm, respectively. Data within 30 days were analyzed. Patients in the DK crush group, compared to those in classic crush group, were characterized by longer lesion length in the side branch (13.5 ± 3.4 mm vs 7.8 ± 3.1 mm; p <0.05), shorter procedural time (44 ± 12 minutes vs 68 ± 17 minutes; p <0.05 ), higher success rate of FKBI (100% vs 70%; p <0.01), and lower contrast volume required (102 ± 38 mm vs 176 ± 46 mm; p <0.05). There was a trend toward a larger distal angle between the main vessel and the side branch (57 ± 180 vs 47 ± 150) in the DK crush group, as well as longer lesion length in the main vessel (24.3 ± 8.6 mm vs 21.1 ± 7.3 mm), though without significant differences (p >0.05). Subacute stent thrombosis was detected in 2 patients with failure of FKBI in the classic crush group (4.3%). In addition, patients in the classic crush group were characterized by a smaller minimum lumen diameter (MLD) at the side branch ostium (2.74 ± 0.12 mm vs 3.01 ± 0.13 mm; p <0.01) and had a higher degree of residual stenosis at the ostial side branch (17.4 ± 11.2% vs 7.3 ± 8.6%; p <0.05). Conclusions. Compared with classic crush, DK crush has the potential to improve the clinical outcome in patients with co
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Sirolimus-Eluting, Bioabsorbable Polymer-Coated Constant Stent (Cura?) in Acute ST-Elevation Myocardial Infarction: A Clinical and Angiographic Study (CURAMI Registry)
ABSTRACT: Background. There are safety concerns over the current polymer-based drug-eluting stents (DES) on the possible delayed healing process and adverse reactions to the polymer when drug elution is completed. Cura? (Orbus Neich) is a sirolimus-eluting, bioabsorbable, polymer-coated constant stent. Methods. From March 1 to June 30, 2005, Cura stent implantation was instituted as the default strategy for percutaneous coronary intervention in 49 consecutive ST-Elevation Myocardial Infarction (STEMI) patients (male 86%; average age 55 ± 10 years; diabetes 31%). Results. The angiographic success rate was 100%. In-hospital adverse events consisted of 1 in-hospital death (2% heart failure). A total of 27 patients (56%) underwent 8-month angiographic follow up. Binary restenosis occurred in 6 patients (22%), and late loss was 0.74 ± 0.89 mm. At 9-month follow up, a total of 5 patients had 6 major adverse events (1 death, 1 reinfarction, and 4 target lesion revascularizations). There was no incidence of stent thrombosis. Conclusion. Cura stent implantation appears to be feasible and safe in the treatment of STEMI. However, the binary restenosis rate and late loss at angiographic follow up were similar to that of bare-metal stents, and therefore compare unfavorably with other proven benchmark DES.
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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
Accredited CD
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