Volume 14 - Issue 11 - November, 2002
The Constant Search for Indices of Coronary Flow and Perfusion
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Assessment of coronary flow is an important task for diagnosis and assessment of interventions in ischemic heart disease. Since the early days of coronary catheterizations, a reliable index of epicardial coronary flow and myocardial perfusion has been sought by the cardiologists and concepts such as “slow flow” or no flow has been primarily based on the angiographic appearance of the injected dye in its passage through the epicardial arteries and the myocardial perfusion bed.
In a search for better tools for assessment of coronary flow, perfusion and the effect of coronary stenosis on co
Diabetic Retinopathy as a Predictor of Late Clinical Events Following Percutaneous Coronary Intervention
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Coronary artery disease is frequently encountered in diabetic patients.1 Previous reports showed that 15–25% of patients undergoing coronary revascularization had diabetes mellitus (DM).2–4 Although the initial success and in-hospital complication rates in diabetic patients after percutaneous coronary intervention (PCI) were similar to those in nondiabetic patients, diabetic patients had less favorable long-term clinical outcomes.2,5 Large randomized trials showed that the 5-year mortality rate in diabetic patients who had undergone PCI was 15–25%.4,6
Recent data suggested that proteinu
Supplemental Value of Troponin I Combined With a Clinical Risk Model to Predict In-Hospital Events in Intermediate- and High-Ris
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The term “acute coronary syndrome” (ACS) is applied to a broad spectrum of clinical presentations of chest pain, thus rendering accurate risk stratification crucial to rational decision making. Several clinical characteristics known at presentation have been shown to be particularly efficacious in predicting in-hospital risk, including electrocardiographic changes and post-infarct angina.1–3 Additionally, numerous recent studies have shown that troponin levels effectively differentiate between low and high risk without correction for other clinical parameters.4–10 The new ACC/AHA guide
Coronary Vasospasm-Induced Ventricular Tachyarrhythmias
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In 1959, Prinzmetal et al. first described a syndrome of “variant” angina occurring at rest with ST-segment elevations, often associated with arrhythmias. He also noted that the syndrome often coexisted with typical angina and was associated with atherosclerosis.1–3 The exact prevalence of variant angina is unknown; however, it is considered to be far less common than either typical, exertional angina or unstable angina. We present a patient with coronary vasospasm-induced arrhythmia and review the prevalence, mechanism, prognosis and management of this problem.
Case Report.
Acute Myocardial Infarction in a Patient with von Willebrand Disease: Pathogenetic Dilemmas and Therapeutic Challenges
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Von Willebrand disease (vWD) results from deficiency of von Willebrand factor (vWf), an essential element needed for initial platelet adhesion and subsequent thrombosis.1 The presence of atherosclerotic coronary lesions without occlusive arterial thrombi has been demonstrated in patients with vWD at autopsy as well as in experimental animal models.2,3 The occurrence of arterial thrombotic events including acute myocardial infarction (MI) is exceedingly rare in patients with vWD. In this report, we present a case of acute anterior MI in a patient with vWD and describe the therapeutic challenges
Percutaneous Femoral Artery Angioplasty with Stent-in-Stent Technique and Tirofiban Administration
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Percutaneous transluminal angioplasty (PTA) of the femoral artery is one method that has been used for many years, especially for patients with a high level of surgical risk. The use of stents alongside the traditional balloon techniques has further improved the results. In spite of this, patients with multiple risk factors (such as smoking, hypertension, diabetes, dyslipidemia, etc.) still demonstrate very high rates of restenosis. The traditional pharmacological structure (pentoxiphylline, aspirin, heparin, ticlopidine, etc.) cannot guarantee reliable prevention against restenosis. We descri
Significant Atheromatous Debris Following Uncomplicated Vein Graft Direct Stenting: Evidence Supporting Routine Use of Distal Pr
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Massive particulate atheromatous material was observed on histological examination of debris from a Percusurge embolization containment device, used in clinically uncomplicated direct stent coronary vein graft intervention. This is provided first to illustrate the severity of distal embolization that can go clinically unnoticed after direct stenting and second to support the case for routine use of distal protection devices for vein graft intervention
Case Report. A 72-year-old male underwent percutaneous coronary intervention to a 95% lesion in a right coronary artery (RCA) vei
Percusurge Guardwire Balloon-Associated Thrombus — A Limitation of the Percusurge Distal Protection System
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Within ten years of coronary artery bypass surgery, up to 66% of saphenous vein grafts either occlude or demonstrate significant atherosclerosis.1 This necessitates either repeat coronary artery bypass grafting or percutaneous coronary intervention for relief of recurrent angina. Distal embolization is a frequent complication of percutaneous coronary intervention in saphenous vein grafts. No reflow, Q-wave and non-Q wave myocardial infarction and death can result from graft embolization. The threat of embolization is unpredictable and has not been mitigated by device selection. Embolization is
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