Volume 21 - Issue 5 - May, 2009

Pre-PCI White Blood Cell Count: Should We Care?

Numerous epidemiologic and clinical studies have shown leukocytosis to be an independent predictor of future cardiovascular events.1 While a causal mechanism has yet to be determined, the relationship remains consistent, temporal and dose-dependent in a wide array of patients, ranging from those free of coronary heart disease to those presenting with acute myocardial infarction (MI).2 In the era of percutaneous coronary intervention (PCI), an elevated preprocedural white blood cell (WBC) count has been associated with worse clinical outcomes in patients undergoing angioplasty with or without b...

IVUS-Guided Management of Late Stent Malaposition with Peri-Stent Restenosis with Coronary Artery Aneurysm (full title below)

*Charan P. Lanjewar, MD, DM, *Amit Sharma, MD, DM, §Tej Sheth, MD, FRCPC, FACC

From *Mumbai University, Seth G. S. Medical College and KEM Hospital, Mumbai, India, and §McMaster University, Hamilton Health Sciences, Hamilton General Hospital, Hamilton, Ontario, Canada.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted November 7, 2008, provisional acceptance given February 17, 2009, final version accepted February 20, 2009.

Address for correspondence: Charan Lanjewar, MD, DM, Associate Professor, Cardiology, Seth G.S.Medical College and KEM Hospital, Parel(E), Mumbai, India. E-mail: charanlanjewar@hotmai...

Impact of Thrombus Aspiration Use for the Treatment of Stent Thrombosis on Early Patient Outcomes

Gilles Lemesle, MD, Axel de Labriolle, MD, Laurent Bonello, MD, Tina L. Pinto Slottow, MD, Rebecca Torguson, MPH, Kimberly Kaneshige, BS, Daniel H. Steinberg, MD, Probal Roy, MD, Zhenyi Xue, MS, William O. Suddath, MD, Lowell F. Satler, MD, Kenneth M. Kent, MD, PhD, Joseph Lindsay, MD, Augusto D. Pichard, MD, Ron Waksman, MD

From the Washington Hospital Center, Washington, D.C.
Disclosures: Dr. Waksman has received speaker honoraria from Medtronic, Inc., is a consultant to that company, and has received research grants from the same.
Manuscript submitted November 19, 2008, provisional acceptance given December 30, 2008, final version accepted February 11, 2009.
Address for correspondence: Ron Waksman, MD, Washington Hospital Center, 110 Irving Street, N.W., Suite 4B-1, Washington, D.C. 20010. E-mail: [email protected]

ABSTRACT: Background. Recent data suggest a clinical benefit with the systematic use of thrombus aspiration (TA) for the treatment of ST-elevation myocardial infarction (STEMI). Nevertheless, the impact of TA as a treatment strategy for stent thrombosis (ST) is unknown. This study aimed to analyze the impact of TA use for the treatment of ST on patient outcomes. Methods. From 2003 to 2008, 91 consecutive patients who presented with a definite ST were included in this analysis. We compared procedural success rates and the incidence of the composite criteria death-recurrent MI-recurrent ST at 30...

An Unusual Complication of Transradial Coronary Angiography

Margaret B. McEntegart, PhD, MRCP, Jonathan R. Dalzell, MRCP, M. Mitchell Lindsay, MD, MRCP

From the Department of Cardiology, Western Infirmary, Glasgow, G11 6NT, United Kingdom.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted December 16, 2008, provisional acceptance given February 6, 2009, and final version accepted February 20, 2009.

Address for correspondence: Jonathan R. Dalzell, MRCP, Department of Cardiology, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, United Kingdom. E-mail: [email protected]


ABSTRACT: We report the ...

Stent Thrombosis Aspiration Thrombectomy: Is This Another Glimmer of Hope?

Chrisopher Lawson, MD and Lawrence A. Garcia, MD

From the Section of Interventional Cardiology and the Vascular Medicine Program, St. Elizabeth’s Medical Center, and Tuft’s University School of Medicine, Boston, Massachusetts.
The authors report no conflicts of interest regarding the content herein.
Address for correspondence: Lawrence A. Garcia, MD, FACC, FAHA, Chief, Section Interventional Cardiology, Associate Director, Vascular Medicine Program, St. Elizabeth's Medical Center, Associate Professor of Medicine, Tuft’s University School of Medicine, 736 Cambridge Street, Boston, MA 02135. E-mail: [email protected]

Percutaneous coronary intervention (PCI) has become the default therapy for obstructive coronary artery disease and invariably involves coronary stenting. Currently, stenting with a drug-eluting stent (DES) has become the default method for intervention, with few exceptions.1 The major drawback of this strategy is both acute and subacute stent thrombosis. The DES type, positioning, and lesion complexity may all contribute to stent thrombosis, the mechanisms of which are still under investigation.2 While there may be some debate as to the absolute occurrence of stent thrombosis, the complicatio...

Electrophysiology 2009: Making Practical Decisions in Difficult Economic Times

Guest Editor:
Todd J. Cohen, MD, FACC, FHRS

Electrophysiology continues to make advances. However, we have to place these advances in the context of an economy that has slipped into a deep recession (both in the United States and worldwide). For years, electrophysiology has seen double-digit growth in both the number of devices implanted as well as the number of catheter ablation procedures performed. This growth has been unprecedented and coincided with the growth seen on Wall Street and in technology over the past thirty years. As companies like Microsoft and Intel continued to grow and expand, so did the cardiovascular technology com...

Comparison of the Clinical Characteristics of Apical and Non-Apical Variants of “Broken Heart” (full title below)

Refat Jabara, MD, Radhika Gadesam, MD, Lakshmana Pendyala, MD, Nicolas Chronos, MD, Spencer B. King, MD, Jack P. Chen, MD

From the Saint Joseph’s Cardiovascular Research Institute/Saint Joseph’s Hospital of Atlanta, Georgia.
The authors report no financial relationships or conflicts of interest regarding the content herein.
Manuscript submitted November 18, 2008 and accepted December 30, 2008.
Address for correspondence: Refat Jabara, MD, FACC, Saint Joseph’s Cardiovascular Research Institute, Saint Joseph’s Hospital of Atlanta, GA, 5673 Peachtree Dunwoody Road, Suite 675, Atlanta, GA 30342. E-mail: [email protected]

ABSTRACT: Objectives. The present study was designed to delineate and compare the clinical characteristics of patients with apical and non-apical takotsubo syndrome in a high-volume U.S. hospital. Background. A comparison between apical and non-apical variants of the “broken heart,” or takotsubo syndrome, has not been performed in the United States. Methods. From 2004 through 2007, patients with takotsubo syndrome were identified according to the following criteria: acute chest pain with electrocardiographic changes or elevation of cardiac enzymes, absence of significant coronary narrowing...

Takotsubo Syndrome: An Opportunity to Better Understand Post-Infarction Myocardial Recovery?

George Vetrovec, MD

From the Kimmerling Professor of Medicine and Chair of Cardiology at VCU Pauley Heart Center, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia.
The author reports no conflicts of interest regarding the content herein.
Address for correspondence: George W. Vetrovec, MD, Box 980036, VCU Medical Center, Cardiology Division, Room 607, West Hospital, Richmond, VA 23298-0036. E-mail: [email protected]

In this issue of the Journal, Jabara et al1 provide an intriguing summary of differences between apical and non-apical Tako-tsubo syndrome based on case summaries of individuals with most often stress-induced ischemic events in the absence of major coronary vessel obstruction. The apical-type disorders are associated with larger defects, and not surprisingly, more severe complications. The apical patients probably show more intense ischemia with greater amounts of jeopardized muscle, and thus, the consequences of the ischemic insult are greater. Non-apical events appear more benign, presumably...

Adjunctive Intracoronary Antithrombotic Therapy: Time to Revisit an Old Strategy?

Manivannan Srinivasan, MBBS, MRCP and Abhiram Prasad, MD, FRCP

From the Division of Cardiovascular Diseases and Department of Internal Medicine Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted September 29, 2008, provisional acceptance given December 11, 2008 and final version accepted December 18, 2008.
Address for correspondence: Abhiram Prasad, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Email: [email protected]

There have been major advances in the field of percutaneous coronary intervention (PCI) since its introduction 30 years ago. The improved safety and outcomes can be attributed to increasing operator experience, advances in device technology and the pivotal role of adjunctive pharmacotherapy. Despite these advances, challenges remain that require further research and development. One such challenge is the treatment of thrombotic lesions. Coronary artery thrombus commonly develops following rupture of an atherosclerotic plaque and undergoes modifications in terms of size and composition over tim...

Update on Laser Lead Extraction

Jeffrey S. Snow, MD and *Sameer Parekh, MD

From Winthrop-University Hospital, Mineola, New York, and *New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
The authors report no conflicts of interest regarding the content herein.
Address for correspondence: Jeffrey S. Snow, MD, Winthrop-University Hospital, Mineola, NY. E-mail: [email protected]

In recent years, lead extraction has become an increasingly common procedure which has moved from the realm of cardiothoracic surgery to interventional cardiac electrophysiology. This article reviews indications for lead extraction and briefly discusses the common approaches currently employed to remove leads.


Several converging trends have driven the increase in lead extraction procedures. Twenty years ago, most patients needed to survive a cardiac arrest twice before implantable cardioverter-defibrillator (ICD) implantation would be considered. Today, most implantati...

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