Journal of Invasive Cardiology

July 2013

Original Contributions
Stent Thrombosis with Second Versus First Generation Drug-eluting Stents in Real World Coronary Percutaneous Intervention (Analysis of 3806 Consecutive Procedures from a Large Volume Single Center Prospective Registry)
Helder Dores, MD, Luís Raposo, MD, Rui Campante Teles, MD, Carina Machado, MD, Sílvio Leal, MD, Pedro Araújo Gonçalves, MD, Henrique Mesquita Gabriel, MD, Manuel Sousa Almeida MD, Miguel Mendes, MD

Commentary
Stent Thrombosis Through the Generations
Lawrence Rajan, MD and David J. Moliterno, MD

Safety and Efficacy of the Frontrunner XP Catheter for recanalization of Chronic Total Occlusion of the Femoral-Popliteal Arteries
Ranjan Shetty 1, G. Vivek1, Ashok Thakkar2, Rajaram Prasad1, Umesh Pai3, Krishnananda Nayak3
From 1KMC, Manipal, Karnataka, India, 2Sahajanand Medical Tech. Pvt. Ltd., Surat, Gujarat, India, and 3MCOAHS, Manipal, Karnataka, India.

Plaque Composition and Dynamics/original contribution
Decrease in Coronary Flow After Consecutive Injections of Contrast Media During Coronary Angiography
Ana Maria Krepsky, MD1, Marcelo Arndt, MD2, Vitor Osório Gomes, MD PhD3, Paulo Caramori, MD PhD3
From the 1 Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil, 2 Department of Cardiology, Hospital Bruno Born, Lajeado, Rio Grande do Sul, Brazil, 3 Department of Interventional Cardiology, Hospital São Lucas, Porto Alegre, Rio Grande do Sul, Brazil.

Radial Access Technique/original contribution
Angiographic Evalution of the Radial Artery Diameter in Patients Who Underwent Coronary Angiography or Coronary Intervention
Hzir Okuyan, MD1, Fatma Hzal, MD2, Gülten Taçoy, MD1, Timur Timurkaynak, MD3
From the 1Gazi University Faculty of Medicine Cardiology Department, Ankara, Turkey, 2Numune Hospital, Cardiology Department, Sivas, Turkey, 3Bayındır Hospital, Cardiology Department, İstanbul, Turkey.

Clinical Characteristics and Reperfusion Times Among Patients With an Isolated Posterior Myocardial Infarction
Stephen W. Waldo, MDa, Ehrin J. Armstrong, MD, MScb, Ameya Kulkarni, MDc, Kurt S. Hoffmayer, MDa, Priscilla Hsue, MDa, Peter Ganz, MDa, James M. McCabe, MDd
From the aDepartment of Medicine, Division of Cardiology, University of California, San Francisco, California; bDepartment of Medicine, Division of Cardiovascular Medicine, University of California, Davis, California; c Department of Medicine, Division of Cardiovascular Medicine, Massachusetts General Hospital, Boston, Massachusetts; and dDepartment of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts.

Long Term Clinical Outcome and Routine Angiographic Follow-up After Successful Recanalization of Complex True Chronic Total Coronary Occlusion With a Long Stenting Length. A Single Centre Experience
Karl Isaaz, MD, Norbert Mayaud, MD, Antoine Gerbay, MD, Mohamed Hassan Sabry, MD,
Laure Richard, RN, Alexis Cerisier, MD, Michel Lamaud, MD, Hazem Khamis, MD, Ahmad Abd-Alaziz, MD, Antoine Da Costa, MD, PhD
Division of Cardiology, University of Saint Etienne, Saint Etienne, France.

Evolution in the Management of Post Infarct Ventricular Septal Defects from a Surgical to a Percutaneous Approach: A Single Centre Experience
Janarthanan Sathananthan, MBChB, PGDipPH1 and Peter Ruygrok, MBChB, FRACP, MD
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand

Radial Access Technique
Treatment of Recurrent Radial Artery Pseudoaneurysms by Prolonged Mechanical Compression
Babak Nazer, MD and Andrew Boyle, MD, PhD
Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, California.

Transcatheter Aortic Valve Replacement
The Buddy Balloon for Transcathter Aortic Valve Replacement: Insights from Computed Tomographic assessment of the Aortic Valvular Complex
Kazuaki Okuyama, MD, Hasan Jilaihawi, MD, Raj R. Makkar, MD
Cedars-Sinai Medical Center, Heart Institute, Los Angeles, California

Coronary Angioplasty After Self-Expandable Transcatheter Aortic Valve Implantation
Gabriel Greenberg, MD and Ran Kornowski, MD
Rabin Medical Center, Cardiology, Petach-Tikva, Israel

Brief Communication
Histopathologic Validation of Neointimal Coverage of Nonapposed Struts Overlying Side-branch Evaluated by Optical Coherence Tomography in Porcine Coronary Arteries
Ae-Young Her, MD1,*, Jung-Sun Kim, MD2,*, Yong Hoon Kim, MD1, Dong-Ho Shin, MD2, Byoung-Keuk Kim, MD2, Young-Guk Ko, MD2, Donghoon Choi, MD2, Yangsoo Jang, MD2,3 and Myeong-Ki Hong, MD2,3,
1Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea; 2Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea; 3Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea

New Technique
The Double AngioSeal Technique for Arterial Closure Following Large Bore Access
Nidal Abi Rafeh, M.D.1; Henry C. Quevedo, M.D. 1; Kevin B. DeAndrade, M.D. 1; Ethan A. Yalvac, M.D. 1; Hossein Dehghani, M.D.2; Salman A. Arain, M.D1.
1 Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana; and the 2 Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, California

Clinical Images
Optical Frequency Domain Imaging for Guidance of Optimal Stenting in the Setting of Recanalization of Chronic Total Occlusion
Milosz Jaguszewski, MD1, Giulio Guagliumi, MD2, Ulf Landmesser, MD1*
1Cardiology Department, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland; and 2Cardiovascular Department, Division of Cardiology, Ospedali Riuniti di Bergamo, Italy

Left Main Coronary Thrombotic Occlusion Due to Secondary Polycythemia in a Normal Sinus of Valsalva
Yukari Kobayashi, Atsushi Hirohata, Yuhei Kobayashi
Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan

Letter to the Editor
X-ray Dose Delivered During Coronary Angioplasty
Jean-Louis Georges, MD and Bernard Livarek, MD
Centre Hospitalier de Versailles. Le Chesnay, France.

Online Exclusive
Successful Intravascular Ultrasound-guided Re-entry from Iatrogenic Coronary Arteriovenous Fistula Related to Wire Perforation Following Wiring of a Totally Occluded Vessel
Hidefumi Ohya, MD, Eisho Kyo, MD, Osamu Katoh, MD
From the Division of Cardiology, Kusatsu Heart Center, Shiga, Japan

Transvenous Intravascular Ultrasound-guided Percutaneous Coronary Intervention for Chronic Total Occlusion: A Novel Strategy
Yasuhiro Takahashi, MD*, Hirotake Okazaki, MD1, Kyoichi Mizuno, MD, PhD2
From the 1Department of Cardiology, The Fraternity Memorial Hospital, Tokyo, Japan
2Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan

Coronary Stenting in a Patient with Single Coronary Artery with Double Vessel Disease
Soumen Devidutta, MD,DM, Gautam Sharma, MD, DM1, Priya Jagia, MD2
From the 1 Department of Cardiology, and 2 Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India.

Transcatheter Right Ventricular Outflow Tract Stenting in Children with Post Operative Infundibular Stenosis and Preserved Pulmonary Valve Function
Bhavesh Thakkar MD, DM, Tarun Madan MD, DNB, A.J. Ashwal, MD
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre

Stingray Balloon Used in Slender PCI for CTO
Eugene B Wu. MRCP MD1 and Yuji Ikari. MD2
1Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong; and 2Department of Cardiovascular Medicine, Tokai University School of Medicine, Kanagawa, Japan

Spontaneous Coronary Artery Dissection: A Case Series Highlighting Diagnostic Challenges and the Potential for Underestimating the Incidence of this Presumed Rare Disorder
Michael Pfeiffer, MD, Giselle Baquero, MD, Mark Kozak, MD
From the Department of Cardiology, Penn State Heart and Vascular Institute, Penn State College of Medicine, Hershey, Pennsylvania.

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June 2013 • in Press

Editor’s Message
The Advancement of Knowledge Comes From What Works and What Doesn’t

Richard E. Shaw, PhD, FACC, FACA,
editor-in-chief

The dramatic evolution of invasive cardiology, like many other fields in medicine, has been driven by discoveries of what works, but also by what we find that doesn’t work. This issue of the Journal of Invasive Cardiology includes articles reporting positive findings for new devices and approaches, but also studies that fail to confirm approaches that were thought to be promising or raise important shortcomings where some success is demonstrated. Jeffrey Mandell and collaborators report on their evaluation of a cryoablation balloon that appears to work as well as standard radiofrequency ablation in the treatment of both paroxysmal and persistent atrial fibrillation, with the major downside being cost of the cryoablation balloon. Martin Brueck and colleagues conducted a prospective, randomized, double-blind, placebo-controlled trial to determine if the use of N-acetylcysteine and ascorbic acid could prevent contrast-induced acute kidney injury in cardiac catheterization patients with impaired kidney function, but were unable to find a benefit. Yoav Turgemen and associates showed that the transradial approach can be effectively used in the diagnosis and treatment of patients with supraaortic arterial vessel atherosclerotic disease. Drs Chaudhry, Pappy and Hennebry present a study concerning the use of the Trellis device in the management of deep vein thrombosis. We’ve included a report showing promising results for new-generation drug-eluting stents in the treatment of unprotected left main disease and one that demonstrated the potential role of percutaneous treatment in the management of patients with postinfarction ventricular septal defects. All of these studies provide valuable information that advances our knowledge about treatments that are effective and also approaches that may not be productive or have significant limitations.
In the Plaque Composition and Dynamics section, Maini et al evaluate lipid core plaque modification through near-infrared spectroscopy, showing that the lipid core burden index decreased after intervention and troponin elevation was associated with axial shifting of the lipid core plaque, while Wong and colleagues use OCT to gain insight into in-stent thrombosis. The first TAVR article explores the effects of the SAPIEN prosthesis implantation on atrioventricular conduction, demonstrating that most disturbances are infranodal and temporary. The second TAVR selection presents cases showing the use of the buddy balloon technique to address failed aortic valve crossing. Also, Stephanie Meller and colleagues from Yale have provided a review focusing on the role of metabolic factors and endovascular therapy and the link between vasculogenic erectile dysfunction, coronary artery and peripheral vascular disease. Don’t miss the thought-provoking piece in the Invasive Thoughts section from Dr Adhir Shroff on the need for continuing procedural training for practicing physicians in the years following fellowship.
Articles published in our Online Exclusive section this month cover an array of interesting topics, including a case looking at the relationship between patent foramen ovale and migraine headache, a case showing the importance of stent design, the use of radiofrequency ablation to treat hypertrophic septum in a patient with hypertrophic cardiomyopathy, the successful treatment of multiple thromboemboli following myocardial infarction, and a rare case of PCI in achondroplasia. I hope that this issue of the Journal demonstrates the evolution of our knowledge about what works and what doesn’t in advancing the approaches used by invasive cardiologists dedicated to advancing the treatment of cardiac patients.

Original Contribution
Anomalous Left Circumflex Artery from the Right Coronary Cusp: A Benign Variant?
Ghassan A. Mohsen, MD1, Khaja G. Mohsin, MD2, Michael Forsberg, MD1,2,, Eric Miller2, Megumi Taniuchi, MD, PhD1,2 , Andrew J.P. Klein, MD1,2
1Department of Internal Medicine, Saint Louis University Hospital, St. Louis, Missouri; 2Department of Internal Medicine, Division of Cardiology, St. Louis VA Healthcare System- The John Cochran VA Medical Center, St. Louis, Missouri.

Early Experience with the Cryoablation Balloon Procedure for the Treatment of Atrial Fibrillation by an Experienced Radiofrequency Catheter Ablation Center
Jeffrey Mandell, Frank Amico, DO, Sameer Parekh, MD, Jeffrey Snow, MD, Joseph Germano, DO, Todd J. Cohen, MD
Department of Medicine at Winthrop University Hospital, Mineola, New York.

Usefulness of N-Acetylcysteine or Ascorbic Acid versus Placebo to Prevent Contrast-Induced Acute Kidney Injury in Patients Undergoing Elective Cardiac Catheterization. A Single-Center, Prospective, Randomized, Double-Blind, Placebo-Controlled Trial
Martin Brueck1, MD, Huelya Cengiz1, MD, Reinhard Hoeltgen2, MD, Marcus Wieczorek2, MD, Rolf-Hasso Boedeker3, PhD, Christine Scheibelhut3, Andreas Boening4, MD, PhD
1Department of Cardiology, Clinic of Wetzlar, Wetzlar, Germany; 2Department of Cardiology, St. Agnes-Hospital Bocholt, Bocholt, Germany; 3Institute of Medical Statistics and Informatics, University of Giessen, Giessen, Germany; 4Department of Cardiothoracic Surgery, University Hospital Giessen, Giessen, Germany.

Transradial Diagnosis and Intervention of Supra-Aortic Vessels
Yoav Turgeman, MD, Khalid Suleiman, MD, Alexander Feldman, MD, Limor Ilan Bushari, MD
From the Heart Institute, Ha'Emek Medical Center, Afula. Affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel.

New Generation drug Eluting Stents experience in the percutaneous Treatment of Unprotected Left Main Coronary Artery Disease: The NEST Registry
Chiara Bernelli, MD1, Alaide Chieffo, MD1, Gill Louise Buchanan, MBChB1, Matteo Montorfano, MD1, Mauro Carlino, MD1, Azeem Latib, MD1,2, Filippo Figini, MD1,2, Kensuke Takagi, MD1,2, Toru Naganuma, MD1,2, Davide Maccagni, RT1, Antonio Colombo, MD1,2
From the 1 Department of Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy, 2 EMO GVM Centro Cuore Columbus, Milan, Italy

Review
The Link Between Vasculogenic Erectile Dysfunction, Coronary Artery Disease, and Peripheral Artery Disease: Role of Metabolic Factors and Endovascular Therapy
Stephanie M Meller, BA, Erik Stilp, MD, Charles N Walker, MD, and Carlos Mena-Hurtado, MD
Yale University School of Medicine, New Haven, Connecticut

Plaque Composition and Dynamics
In Vivo Lipid Core Plaque Modification with Percutaneous Coronary Revascularization: A Near Infrared Spectroscopy Study
Aneel Maini, Larisa Buyantseva MD, Brijeshwar Maini MD
PinnacleHealth Cardiovascular Institute, Wormleysburg, Pennsylvania.

Instent Thrombosis Due to Neo-atheroslerosis: Insight from Optical Coherence Tomography
Dennis TL Wong 1*, Siang Y Soh 1, Yuvaraj Malaiapan 1
1 Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre)Monash University and Monash Heart, Southern Health, Clayton, Australia

Transcatheter Aortic Valve Replacement
Electrophysiological Evaluation of Atrioventricular Conduction Disturbances in Transcatheter Aortic Valve Implantation With Edwards Sapien Prosthesis
Abdurrahman Eksik, MDa, Mehmet Gul, MDa, Huseyin Uyarel, MDb, Ozgur Surgit, MDa, Aydin Yildirim, MDa, Nevzat Uslu, MDa, Huseyin Aksu, MDa, Selahattin Turen, MDa, Fazih Uzun, MDa, Hulusi Satılmısoglu, MDa, Mustafa Kemal Erol, MDa, Ihsan Bakir, MDc.
aIstanbul Mehmet Akif Ersoy Thoracic - Cardiovascular Surgery Training and Research Hospital Cardiology Department, Istanbul/Turkey; bBezmialem Vakif University, School Of Medicine, Cardiology Department, Istanbul/Turkey; cIstanbul Mehmet Akif Ersoy Thoracic - Cardiovascular Surgery Training and Research Hospital Cardiovascular Surgery Department, Istanbul/Turkey

Percutaneous Transcatheter Valve-in-valve Implantation With the Balloon-expandable Valve for the Treatment of a Dysfunctional Tricuspid Bioprosthetic Valve – A Pediatric Case Report
Baher Matta Hanna, MD1, Josep Rodés-Cabau, FRCPC2, Nagib Dahdah, MD1
1Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal; and 2Department of Cardiology, Québec Heart & Lung Institute, Laval University, Quebec,

Brief Communication
Use of the Trellis Device in the Management of Deep Vein Thrombosis: A Retrospective Single Center Experience
Muhammad A. Chaudhry MD1, Reji Pappy MD2, 3Thomas A. Hennebry M.B. B.Ch. B.A.O.,
1Scripps Green Hospital, Department of Cardiology, Heart failure Recovery and Research, La Jolla, California; 2University of Oklahoma Health Sciences Center, Department of Internal Medicine, Section of Cardiovascular medicine ,Oklahoma City, Oklahoma; and 3 Oklahoma Heart Hospital, Oklahoma City, Oklahoma

Reducing Air Embolism and Improving Accuracy During Pediatric Wedge Measurements
Gareth J Morgan MB BaO, BCh, MPhil, MRCPCH1 and Lee Benson MD2
1Bristol Congenital Heart Centre; Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK. 2Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Canada.

Clinical Images
Full Metal Atrium
Rodrigo Estévez-Loureiro MD, Olaf Franzen MD, Carlo DiMario MD, PhD
Royal Brompton Hospital, London, United Kingdom.

Invasive Thoughts
Is it all Downhill After Fellowship? Continuing Procedural Training for Practicing Physicians
Adhir Shroff, MD, MPH, University of Chicago, Chicago, Illinois

Online exclusive
Stent Concertina: Stent Design Does Matter
On-Hing Kwok, MBBS, Cardiology Center, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong

Migraine Headaches Following Mitral Valvuloplasty: Koch’s Postulates Finally Satisfied?
Abraham Abernathy, MD, Richard A. Krasuski, MD, Ernesto Ruiz-Rodriguez, MD
Cleveland Clinic Foundation, Cleveland

Successful Primary PCI in Patient with Single Coronary Artery
Krzysztof Pawlowski MD, Waldemar Dorniak MD, Jacek Klaudel MD
Cardiology Department Sw. Wojciecha Hospital, Gdansk, Poland

Ablation of Hypertrophic Septum Using Radiofrequency Energy – An Alternative for Gradient Reduction in Patient with Hypertrophic Obstructive Cardiomyopathy?
Lucie Riedlbauchová, Jan Janoušek, MD, PhD, Vojtěch Suchánek, MD, Josef Veselka, MD, PhD
* Clinic of Cardiology, 2nd Medical School of the Charles University and the University Hospital Motol, Prague, Czech Republic.
† Children's Heart Centre, University Hospital Motol, Prague, Czech Republic
‡ Clinic of Imaging Methods, University Hospital Motol, Prague, Czech Republic

Successful Endovascular Treatment for Simultaneous Multiple Thromboemboli Following Myocardial Infarction
Hidehiko Hara, MD, Akiko Sakai, MD, Masato Nakamura, MD
Toho University Ohashi Hospital, Dept. of Cardiovascular Medicine, Tokyo, Japan

May 2013: Current Issue

Editorial Message

Showcasing Lessons From Around the World

In the May issue of the Journal of Invasive Cardiology, we continue our focus on methods to improve percutaneous aortic valve replacement, including a nice report from Bern, Switzerland on emergency procedures for decompensated aortic valve stenosis. A group of physicians from Brussels, Belgium reports on predictors of improvement in left ventricular function after balloon aortic valvuloplasty. It is great to see research in balloon valvuloplasty blossom, as this line of evidence is critical to the field of percutaneous valve replacement. Also in this issue, in the online version, is a fascinating case report from Bonn, Germany on using alcohol septal ablation to treat an intracavity pressure gradient that developed after percutaneous aortic valve replacement. Rounding out the articles on structural heart disease is an elegant review of closure of secundum atrial septal defects from Dr. Ziyad M. Hijazi’s group at Rush University in Chicago.

Cavender and colleagues from Cleveland Clinic explore the very interesting question of culprit versus multivessel intervention in patients with acute myocardial infarction complicated by shock. Investigators from Rome, Italy examine primary percutaneous coronary intervention in nonagenarians – this is an increasingly common scenario that interventionalists are facing as the worldwide population ages. Investigators from Texas Heart Institute evaluate what a high or low activated clotting time means with bivalirudin – I had often wondered about that myself in the catheterization laboratory. Dr. Steven L. Goldberg from the University of Washington Medical Center in Seattle, Washington has authored a provocative piece and asks whether we should abandon femoral access for acute myocardial infarction. I imagine that viewpoint will generate a great deal of discussion among our readers.

Also in this issue ofthe Journal of Invasive Cardiology, a group from Monash University in Australia uses optical coherence tomography to provide insight into the role of neo-atherosclerosis in stent thrombosis. This new technology is providing clear pictures and unraveling mechanisms of disease. In this case, it turns out some of what we were blaming stents for is really due to progression of underlying atherosclerosis and not a failing of the stent per se.

There are several other articles in this issue of the Journal of Invasive Cardiology that should be of great interest to the practicing interventionalist. We continue to try and showcase lessons learned from leading centers located around the world.

Deepak L. Bhatt, MD, MPH
Senior Associate Editor
Journal of Invasive Cardiology

Original Contribution
Recovery After Balloon Aortic Valvuloplasty in Patients with Aortic Stenosis and Impaired Left Ventricular Function : Predictors and Prognostic Implications
Joelle Kefer, MD PhD, Jean-Marie Gapira, MD, Sophie Pierard, MD, Christophe DeMeester, Olivier Gurne, MD PhD, Patrick Chenu, MD PhD, Jean Renkin, MD PhD
Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Division of Cardiology, Brussels, Belgium.

Clinical Manifestations of Heart Failure Abate with Transcatheter Aortic Paravalvular Leak Closure Using Amplatzer Vascular Plug II and III Devices Grzegorz Smolka, MD1, Piotr Pysz, MD2, Wojciech Wojakowski, MD1, Andrzej Ochała, MD1, Ewa Peszek-Przybyła, MD1, Tomasz Roleder, MD2, Marek Jasinski, MD3, Zbigniew Gasior, MD2
(1)3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland; 2Division of Cardiology, Medical University of Silesia, Katowice, Poland; (3) 2nd Division of Cardiac Surgery, Katowice, Poland.

Primary Percutaneous Coronary Intervention in Nonagenarians: Six-Month Outcomes from a Single Center Registry
Stefano Rigattieri, MD, PhDa, Maria Cera, MDa, Alessandro Sciahbasi, MDa, Cristian Di Russo, MD, PhDa, Silvio Fedele, MDa, Giuseppe Ferraiuolo, MDb, Giuliano Altamura, MDc, Francesco Rocco Pugliese, MDd, Paolo Loschiavo, MDa
aInterventional Cardiology Unit, bIntensive Cardiac Care Unit, cDivision of Cardiology, dEmergency Department, Sandro Pertini Hospital, Rome, Italy.

The Feasibility, Safety and Mid-term Outcomes of Concomitant Percutaneous Transluminal Renal Artery Stenting in Acute Coronary Syndrome Patients at High Clinical Risk of Renal Artery Stenosis
Chieh-Shou Su, MD1,2, Tsun-Jui Liu, MD1,2, Chen-Rong Tsau, MD1,2, Kae-Woei Liang, MD1,2, Wei-Chun Chang, MD1,2, Chih-Tai Ting, MD1,2, Wen-Lieng Lee, MD1,2
From the 1Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; 2Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.

Outcomes of Culprit versus Multivessel PCI in Patients With Multivessel Coronary Artery Disease Presenting With ST-Elevation Myocardial Infarction Complicated by Shock
Matthew A. Cavender MD1, Jeevanantham Rajeswaran MSc1, Linda DiPaola BA1, Penny Houghtaling MS1, Michael S. Kiernan MD2, Melanie M. Maytin MD3, Andrew N. Rassi MD1, Venu Menon MD1, Patrick W. Whitlow MD1, Stephen G. Ellis MD1, Mehdi H. Shishehbor DO, MPH1
1Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; 2Division of Cardiology, Tufts University, Boston, Massachusetts; and the 3Division of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts.

Evaluation of QT, QT Dispersion and T Wave Peak to End Time Changes After Primary Percutaneous Coronary Intervention in Patients Presenting with Acute ST Elevation
Vahid Eslami, MD1 Morteza Safi, MD1, Maryam Taherkhani, MD1, Ali Adibi, MD1, Mohammad Reza Movahed, MD, PhD2,3
1Shahid Beheshti University of Medical Sciences. Cardiovascular Research Center, Tehran, Iran; 2CareMore, Tucson, Arizona, and 3University of Arizona, Tucson, Arizona.

Radial Access Technique
Transradial Versus Transfemoral Approach for Primary Percutaneous Coronary Interventions in Elderly Patients
Gioel Gabrio Secco1-2 *, MD, Lucia Marinucci1, MD, Lucia Uguccioni1, MD, Rosario Parisi1, MD, Stefania Uguccioni1, MD, Rossella Fattori1, MD, PhD.
1) Interventional Cardiology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, Pesaro, Italy; 2) Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy

Transcatheter Aortic Valve Replacement
Emergency Transcatheter Aortic Valve Implantation for Decompensated Aortic Stenosis
Thomas Pilgrim, MD; Bernhard Meier, MD; Peter Wenaweser, MD
Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

Review
Transcatheter Closure of Secundum Atrial Septal Defects
Suhaib Kazmouz, MD; Damien Kenny, MD; Qi-Ling Cao; MD; Clifford J. Kavinsky, MD, PhD and Ziyad M. Hijazi MD, MPH, Rush Center for Congenital & Structural Heart Disease, Departments of Medicine and Pediatrics, Rush University Medical Center, Chicago, IL

Brief Communication
Evaluation of Bivalirudin Hyper- and Hypo-ACT Responses in The Setting of PCI
Phillip A. Weeks, PharmD, BCPS1. Haider M. Alkhateeb, MD2, Stephen E. Michaud, PharmD, BCPS1, Jose G. Diez, MD3
Departments of 1Pharmacology, 2Internal Medicine, 3Cardiology: St. Luke’s Episcopal Hospital, Houston, Texas; Texas Heart Institute, Houston, Texas

Clinical Images
Transcatheter Closure of Left Coronary Cameral Fistula with Amplatzer Duct Occluder II
I. B. Vijayalakshmi , MD, Chitra Narasimhan, MD, Ashish Agarwal , MD,
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India

Invasive Thoughts
Should We Abandon Femoral Access for STEMIs?
Steven L. Goldberg, MD, University of Washington Medical Center in Seattle, Washington

Online Exclusive
Severe Thrombocytopenia Complicating Transcatheter Occlusion of a Patent Ductus Arteriosus
Po Zhang, MD, PHD, Xian-yang Zhu, MD, PHD
Department of Congenital Heart Disease, Cardiovascular Research Institute of PLA, General Hospital of Shenyang Military Command, Shenyang City, Liaoning Province, China

A Coronary Pseudoaneurysm within a Restenotic Stent Treated by Implantation of a Pericardium Covered Stent and Drug Eluting Balloon
Marco Vaghetti MD and Cataldo Palmieri MD
Invasive Cardiology Department, Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy

Trans-Collateral Approach for Percutaneous Revascularization of Complex Superficial Femoral Artery Chronic Total Occlusion
Zaheed Tai, DO
Dept. of Cardiology, Winter Haven Hospital, Winter Haven, Florida.

The Clinical Spectrum of Longitudinal Deformation of Coronary Stents: From a Mere Angiographic Finding to a Severe Complication.
Stefano Rigattieri MD PhD, Alessandro Sciahbasi MD, Paolo Loschiavo MD
Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy

Carotid Artery Thrombosis Treated with Catheter Intervention using Proximal Occlusion and Flow Reversal
Khaldoon Alaswad, MD, RVT, FACC, FSCAI, FSVM
Appleton Heart Institute, Cardiology Department, Appleton, Wisconsin

Percutaneous Repair of Aortic Puncture with Amplatzer Closure Device During Attempted Transseptal Puncture
Matthew R Webber1 MBChB, FRACP, Martin K Stiles1 MBChB, PhD, FRACP, Sanjeevan Pasupati1 MBChB, FRACP
Waikato Hospital, Hamilton, New Zealand

Customized Covered Stent Graft for Percutaneous Closure of Fontan Baffle Leak
Ronald K. Binder, MD, Fabian Nietlispach, MD, Ronald G. Carere, MD
Division of Cardiology, St. Paul’s Hospital – University of British Columbia, Vancouver, Canada.