Volume 15 - Issue 2 - February, 2003

Editor's Message (January 2003)

Richard E. Shaw, PhD, FACC, Editor-In-Chief

Dear Readers,

This issue of the Journal of Invasive Cardiology begins another exciting year for the publication of the Journal and includes original research articles, case reports, reviews, articles from the Journal special sections “The Electrophysiology Corner” and “Interventional Pediatric Cardiology”, and a summary of the discussion on intracranial intervention from the International Andreas Gruentzig Society Meeting held in February of 2002.

The first research article, by Dr. Flavio Airoldi and collaborators from the multi-center Crosscut Study representing seven Italian ...

A Randomized Comparison of Direct Stenting Versus Stenting with Predilatation in Native Coronary Artery Disease: Results from th

1Flavio Airoldi, MD, 1,2Carlo Di Mario, MD, PhD, 1Giorgio Gimelli, MD, 3Antonio L. Bartorelli, MD, 4Francesco Bedogni, MD, 1Carlo Briguori, MD, PhD, 5Arian Frasheri, MD, 6Luigi Inglese, MD, 5Nino Rubino, MD, 1Angela Ferrari, PhD, 7Bernhard Reimers, MD, 1,2Antonio Colombo, MD

In the last decade, coronary stenting has evolved from a bailout procedure following balloon angioplasty into an elective strategy for the treatment of all lesions located in vessels with an angiographic reference diameter larger than 3.0 mm.1,2 The standard procedure for stent implantation includes balloon predilatation to facilitate positioning of the stent delivery system at the target lesion; more recently, however, the strategy of stenting without predilatation has become possible due to the availability of new generations of flexible stents, securely crimped on low-profile balloons. This...

Miniaturization of the Equipment for Percutaneous Coronary Interventions: A Prospective Study in 1,200 Patients

Wolfgang A. Schöbel, MD and *Manfred Mauser, MD

The area of the peripheral puncture site is decreased by 31% with 5 Fr sheaths compared to 6 Fr sheaths (2.2 mm2 vs. 3.1 mm2, respectively), by 49% in comparison with 7 Fr sheaths (4.3 mm2), and by 61% in comparison with 8 Fr sheaths (5.6 mm2). Previously used small guiding catheters (6 Fr and smaller) did not allow stent insertion because of an inner lumen of less than 0.058´´.2–6
New 5 Fr guiding catheters with an inner diameter of 0.058´´ (Z2, Medtronic AVE) allow the use of standard balloon catheters and the insertion of recent commercially available stents with a diameter of ...

The Smaller They Come

Bernhard Meier, MD

Percutaneous coronary angioplasty (currently summarized under the term PCI) started 25 years ago with roughly 10 French (Fr) guiding catheters that left no room for contrast medium injection. The actual angioplasty gear (ballon catheter with or without stent) has been miniaturized considerably more than the guiding catheters, which in many centers, still are 7 French. The gained space for contrast medium injection, in conjunction with the advent of digital angiography, has relegated difficult visualization to the non-issues.
Do we take full advantage of this development in favor of the patie...

A Novel Percutaneous Technique for Accessing the Normal Pericardium: A Single-Center Successful Experience of 53 Porcine Procedu

*Dongming Hou, MD, PhD and †Keith L. March, MD, PhD

The pericardium is a two-layered fibro-serous sac that encloses the heart and the roots of the great vessels. The potential space normally contains only a small amount of fluid, approximately 15–30 ml, comprised mainly of an ultrafiltrate of plasma and possibly some overflow of myocardial interstitial fluid and lymph drainage.1 Recently, emerging data progressively suggested that the normal function of pericardial fluid serves not only to prevent friction from occurring when the heart beats, but perhaps also to provide for a particular biochemical microenvironment that bathes the epicardial ...

Impact of Gender on the Incidence and Outcome of Contrast-Induced Nephropathy After Percutaneous Coronary Intervention

Ioannis Iakovou, MD, George Dangas, MD, PhD, Roxana Mehran, MD, Alexandra J. Lansky, MD, Dale T. Ashby, MD, Martin Fahy, MSc, Gary S. Mintz, MD, Kenneth M. Kent, MD, PhD, Augusto D. Pichard, MD, Lowell F. Satler, MD, Gregg W. Stone, MD, Martin B. Leon, MD

Contrast-induced nephropathy (CIN) may occur after percutaneous coronary interventions (PCI), particularly in patients with baseline chronic renal failure (CRF) and diabetes mellitus.1–3 We have reported on the adverse impact of CIN post-PCI in patients with CRF (creatinine rise of at least 25% from baseline within 48 hours after PCI).4 In the present study, we analyzed the impact of gender on development and outcome of CIN in a large cohort of PCI patients (with or without CRF).

Methods

Patient population. From a total of 8,628 consecutive patients undergoing PCI (angioplasty,...

Radiocontrast Nephropathy: A Time for Affirmative Action

Abdallah G. Rebeiz, MD, David E. Kandzari, MD, Andrew Wang, MD, Michael H. Sketch, Jr., MD

Contrast-induced nephropathy (CIN) is a well-recognized risk of coronary angiography and percutaneous coronary intervention (PCI), with an overall estimated incidence up to 15% and less than 1% incidence of severe CIN requiring dialysis.1 Although the pathogenesis of CIN is not entirely clear, several mechanisms for dye-induced renal injury have been proposed, including alterations in renal medullary perfusion,2 direct cytotoxicity,3 and oxygen-free radical generation.4 Despite major advances in catheter-based technology and adjunctive antithrombotic therapy, the risk of CIN has remained uncha...

Transcatheter Closure of Patent Ductus Arteriosus in Chinese Adults: Immediate and Long-term Results

Chi-hang Lee, MBBS, MRCP, *Yim-lung Leung, MBChB, MSc, †Nim-pong Kwong, MBChB, MRCP, On-hing Kwok, MBBS, MRCP, Alex S. B. Yip, MBBS, FRCP, Wing-hing Chow, MBBS, FRCP

Patent ductus arteriosus (PDA) is a common congenital cardiac anomaly. Depending on the size of the PDA, patients may be asymptomatic or in heart failure. Treatment is recommended because of the risk of infective endocarditis and congestive heart failure in the long term. The traditional treatment approach is surgical ligation under direct vision. However, surgical approach is invasive and associated with morbidity. In the past decade, transcatheter closure of PDA has been established as a safe and effective treatment alternative.1–5 The transcatheter approach is less invasive, associated wi...

The Prognostic Value of QT Dispersion in Patients Presenting with Acute Neurological Events

Jason Lazar, MD, *Stephanie Manzella, ANP, Joe Moonjelly, MD, *Ella Wirkowski, MD, Todd J. Cohen, MD

QT dispersion (QTD), the difference between the maximum and minimum QT interval on the 12-lead electrocardiogram (ECG), is a marker of heterogeneity of ventricular repolarization.1 Previous studies have shown increased QTD to be a predictor of adverse outcomes in various cardiac disease states. Increased QTD has been found to be associated with cardiac arrhythmias and sudden cardiac death in patients with myocardial infarction, left ventricular hypertrophy, congestive heart failure, coronary artery disease, diabetes and end-stage renal disease.2–10 Acute brain injury has been shown to result...

Thrombectomy with Rescue Percutaneous Thrombectomy Catheter: Our Initial Experience

C.G. Bahuleyan, DM, K. Sunitha, DM, K. Sivaprasad, Mathew Iype

Extensive thrombus in native coronary arteries is relatively rare. Percutaneous revascularization of thrombus-containing lesions has an increased incidence of adverse events, such as abrupt vessel closure and myocardial infarction. The two approaches to this problem are pharmacological treatment with thrombolytic agents or platelet glycoprotein IIb/IIIa blockers, or mechanical devices such as transluminal extraction atherectomy, rheolytic thrombectomy with Possis Angiojet and the Rescue Thrombectomy Catheter.
Case Report.A 63-year-old male was admitted to the intensive coronary care...

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