Volume 20 - Issue 7 - July, 2008
Activated Clotting Time (ACT)-Guided Intravenous Dalteparin Dosing during Percutaneous Coronary Intervention
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The superiority of low-molecular weight heparin (LMWH) over unfractionated heparin (UFH) in the management of acute coronary syndrome (ACS) patients was demonstrated in the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE)1 and Thrombolysis in Myocardial Infarction (TIMI) 11B2 trials, and since then, LMWH has become a mainstay of management for these patients. However, LMWH has not become a preferred anticoagulant in the context of percutaneous coronary intervention (PCI), in part because the Superior Yield of the New Strategy of En
Pharmaceutical Interventions for the Management of No-Reflow
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Percutaneous coronary intervention (PCI) for atherosclerotic coronary artery disease is an effective therapy for restoring vessel caliber and improving blood flow to ischemic myocardium. At least 1.25 million PCIs are performed annually in the United States, and it has been estimated that nearly 2 million procedures are performed annually worldwide.1 The growth in the number of PCIs has occurred in tandem with technological refinements and advances in peri- and postprocedural medication, which have reduced procedural risk, improved success rates and dramatically changed the progn
Extravascular Closure for Patients with High-Risk Femoral Anatomy
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Percutaneous femoral access is utilized for 7.5 million patients per year worldwide and vascular closure devices are used in approximately 2 million patients annually. All current vascular closure devices (VCDs) have been associated with adverse events, but VCDs appear to have a similar or somewhat reduced rate of overall complications compared to manual compression.1–4 The risks associated with the use of VCDs in high-risk patient subsets, such as those with non-ideal femoral anatomy, is unclear, as these patients have been excluded from the pivotal studies leading to FDA app
Isolated Acute Iatrogenic Aortic Dissection during Percutaneous Coronary Intervention without Involvement of the Coronary Arteri
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Case Presentation. A 63-year-old Caucasian male with multiple cardiovascular risk factors including hypertension, dyslipidemia, history of smoking and a positive family history experienced an antero-apical myocardial infarction (MI) 12 years ago followed by a clinically stable and uneventful course. Approximately 6 months before the actual event, the patient presented with increasing anginal symptoms and underwent percutaneous revascularization. At that time, ventriculography documented a hypokinetic apex and a global ejection fraction of 62%. Coronary angiography revea
Clinical and Angiographic Outcomes in Diabetic Patients following Single or Multivessel Stenting in the COSTAR II Randomized Tri
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The prevalence of diabetes has reached epidemic proportion in many sectors of the world.1 Atherosclerotic cardiovascular disease has been correlated with the presence, duration and severity of diabetes.2,3 In addition, both clinical and angiographic outcomes following percutaneous coronary intervention (PCI) are worse in patients with diabetes when compared with their nondiabetic counterparts.4,5 Although coronary stent implantation improved the outcomes of diabetic patients compared with balloon angioplasty due to a reduction in periprocedural and late (res
Long-Term Survival Using Intra-Aortic Balloon Pump and Percutaneous Right Ventricular Assist Device for Biventricular Mechanical
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Patients with cardiogenic shock resulting from acute myocardial infarction (MI) experience greater than 50% in-hospital mortality despite aggressive invasive and medical management.1 Right ventricular (RV) ischemia or infarction has been demonstrated in up to 50% of acute inferior-posterior left ventricular (LV) infarctions2 and is clinically manifested as profound hypotension, atrioventricular block, supraventricular tachyarrhythmias and bradycardia.3 Depressed RV function causes decreased LV preload, reduced cardiac output and increased RV size and pericardia
Vascular Closure Devices — One More Truth to Immediate Closure
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Vascular closure devices (VCDs) provide simple, painless and reliable hemostasis following endovascular procedures performed via femoral arterial access. Their use has enhanced patient comfort and satisfaction, shortened the time to ambulation and preserved valuable catheterization laboratory resources.1–3 Despite these desirable results, however, VCDs are used in 20–25% of all catheter-based procedures performed worldwide.4–5 The reason for this gap has historically been attributed to two major issues: cost considerations and the lack of level-I data
Unintentional Extraction of a Coronary Stent Deployed 4 Months Earlier during Cutting-Balloon Angioplasty for In-Stent Restenosi
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Coronary stents dislodged or embolized prior to complete expansion in the target vessel may be retrieved with special devices such as snares, baskets and embolization protection devices.1,2 Rare cases of partially expanded or fractured stents extracted by an endovascular snare have been reported.3,4 However, once adequately deployed in the coronary artery with complete stent expansion, removal of the stent appears to be virtually impossible. In the following unique case, the blades of a cutting balloon used to treat in-stent-restenosis of a coronary stent deployed 4 month
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