Dear Readers,

       This issue of the Journal of Invasive Cardiology includes original research articles, a review, “Clinical Images”, and online case reports. These case reports can be found on our web site (www.invasivecardiology. com). I encourage you to visit the website to read these interesting and informative case reports.

       In the first original article, Dr. Francesco Burzotta and colleagues from the Catholic University of the Sacred in Rome, Italy describe their study to assess the feasibility of the sequential combination of thrombus-aspiration and filter distal protection in the management of lesions with a very high thrombus burden. Although the authors found improvement in blood flow following the use of the thrombus-aspiration device, there was not significant improvement following the distal filter protection device, suggesting that the increased complexity of adding this device may not be warranted. Dr. On Topaz of the editorial board has included a commentary to accompany the Burzotta et al. article.

       In the next original research article, Dr. Edo Kaluski and colleagues from the Department of Cardiology at the University Medical Center in Newark, New Jersey, Brigham and Women Hospital and Harvard Medical School and the Biomedical Engineering Center, Experimental Cardiovascular Interventional Laboratory in Boston, Massachusetts present an animal study evaluating deliverability and safety of a novel stent design utilizing an ultra-thin polymer mesh sleeve attached to the external surface of the stent (M-Guard). Compared to bare metal stents, the M-guard stent had similar success in delivery and comparable restenosis profile at 30 days compared to the bare metal stents.

       Dr. Kunadian Vijayalakshmi and collaborators from the Department of Cardiology at the James Cook University Hospital and the School of Health and Social Care in Middlesbrough, UK describe their randomized study in highrisk, non-shock patients to assess the effect of intra-aortic counterpulsation on coronary flow and tissue perfusion after PCI. They found that intra-aortic counterpulsation did not have measurable beneficial effects on early coronary flow nor on 1 or 30-day assessment echocardiographic wall motion index. Drs. Sukesh Burjonroppa, AJ Boyle and Yerem Yeghiazarians from the University of California San Francisco have provided a commentary to accompany the article by Dr. Vijayalakshmi et al.

       In the next original research article, submitted by Dr. Oleg Roussanov and associates from the Cardiology Section of the Salem VA Medical Center in Salem, Virginia, the authors report on their study of the cost effectiveness of the radial versus femoral artery approach for diagnostic cardiac catheterization. They found that the radial approach was more cost effective than the femoral approach for diagnostic cardiac catheterization, with or without the use of femoral closure devices. Professor Ferdinand Kiemeneij from OLCV has provided a commentary.

       In the last original research article, Dr. Gregory Mishkel and associates from Prairie Heart Institute at St. John’s Hospital and Southern Illinois University School of Medicine in Springfield, Illinois present their assessment of the short and long term clinical outcomes of coronary drug-eluting stent patients who presented with chronic renal disease. Using glomerular filtration rate (GFR) and need for long-term dialysis to stratify patients, they found that rates of in-hospital events increased as GFR decreased, and at 2-year follow-up, GFR < 60ml/min was associated with increased mortality and MACE but not with the need for target vessel revascularization. Dr. Ted Parris of the editorial board has provided a commentary to accompany the article by Mishkel et al.

       In this month’s Clinical Images section, edited by Dr. David Rizik from the Scottsdale Heart Group at Scottsdale Healthcare Hospital in Scottsdale, Arizona. Drs. Mohammed Ali Ostovan and Amir Aslani from Shiraz University of Medical Sciences in Shiraz, Iran, present their quick and life-saving strategies used to manage a patient who developed a massive pulmonary air embolism during permanent pacemaker insertion.

       This issue of the journal also includes case reports that are published on-line, Drs. Ioannis Stathopoulos and Gary Roubin from the Department of Interventional Cardiac and Vascular Services at Lenox Hill Heart and Vascular Institute of New York have provided a case demonstrating their use of PCI to manage a patient who presented with a chronic occlusion of a saphenous vein graft. In the next case report, Drs. Mimi Le and Frederick Ling from the University of Rochester Medical Center in Rochester, New York describe an unusual occurrence of spontaneous left main coronary artery dissection and their management of the patient. Drs. Tiziana Claudia Aranzulla, Antonio Colombo and Giuseppe Massimo Sangiorgi from the Interventional Cardiology Unit, San Raffaele Hospital and EMO Centro Cuore Columbus in Milan, Italy report on their use of a new steerable system to successfully treat apatient with renal artery aneurysm. In the next case report, Dr. Francis Ponnuthurai and colleagues from the John Radcliffe Hospital in Oxford, UK describe their successful management of a distal coronary artery perforation using microcoil embolization, eliminating the need to reverse anticoagulation. Drs. Sanjay Rajdev, Raymond Benza and Vijay Misra from the University of Alabama in Birmingham, Alabama present their initial use of the Tandem Heart as a temporary hemodynamic support for a patient with severe pulmonary artery hypertension complicated by cardiogenic shock. In the next case report, Dr. Nicholas Collins and colleagues from the Interventional Cardiology Program, Division of Cardiology, University Health Network, Toronto General Hospital in Toronto, Ontario, Canada report on their technique utilizing three guide wires to remove a fractured angioplasty guidewire. Dr. Tom Adriaenssens and colleagues from the Department of Cardiology, University Hospitals of Leuven, Belgium and Deutsches Herzzentrum Munchen, Germany describe their successful use of stenting to treat bilateral multiple renal arteries with ostial lesions in a patient with renovascular hypertension. In the next case report, Drs. Aqel, Hage and Zoghbi from the Birmingham VA Medical Center and University of Alabama at Birmingham in Birmingham, Alabama describe their management of a patient with aortic valve and coronary disease who was not a surgical candidate, but was successfully managed using percutaneous aortic valvuloplasty as a bridge to 3-vessel percutaneous coronary intervention. Drs. Pappy, Kalapura and Hennebry from the Cardiovascular Section of the Oklahoma University Health Sciences Center in Oklahoma City, Oklahoma describe their management of a patient presenting with anterolateral myocardial infarction induced by a coronarysubclavian- vertebral steal syndrome that was successfully treated with stenting of the subclavian artery. In the last case report, Drs. Mori, Otsuka and Kawamura from the National Cardiovascular Center in Norcross, Georgia report on their use of a new dual wire balloon catheter (SafeCut) that penetrates calcified lesions, allowing them to be subsequently treated with percutaneous techniques.

       It is my hope that the articles in this issue of the journal provide cardiovascular healthcare professionals with important information that assists them in the effective management of cardiac patients.

Sincerely,

Richard E. Shaw, PhD, FACC, FACA Editor-in-Chief