Volume 15 - Issue 2 - February, 2003

Triple Wire Technique for a Bifurcation Lesion and a Subtotal Occlusive Lesion

M.H. Jim, MD, R.H.W. Chan, MD, S.W.L. Lee, MD

Chronic total occlusion (CTO) is always a challenge to the interventional cardiologist. The successful recanalization rate is only about 50–70%.1–5 Guidewires always prefer to go to the channel that has the lowest resistance. As a consequence, selective guidewire canalization of sidebranches coming out just before the occlusion site or repeated selection of a false channel that has been erroneously created are commonly encountered during the procedure. These phenomenan significantly prolong the procedure time and lower the success rate. This problem may be solved by deliberately blocking t...

Successful Transradial Coronary Angioplasty and Stenting Using a Self-Expandable RADIUS Stent to the Anomalous Left Main Coronar

Kazuharu Sunami, MD, Shigeru Saito, MD, Shinji Tanaka, MD

The incidence of major anomalies of the coronary artery is 0.3–0.8% of the population undergoing coronary angiography.1 There are only a few cases in the literature describing successful percutaneous coronary intervention (PCI) to the anomalous coronary arteries from the femoral2 or brachial approaches.3 The transradial approach has been getting more and more popular because of its equal feasibility and less frequent bleeding complications compared with the femoral approach.4 Although one case with the anomalous right coronary artery lesion treated by transradial coronary intervention (TRI) ...

Extensive Dissection Requiring Multiple Stents Following Balloon Angioplasty for Non-Specific Aorto-Arteritis

S. Ramamurthy, MD, DM, K.K. Talwar, MD, DM, S. Sharma, MD

Non-specific aorto-arteritis (NSAA) results in stenosing, occlusive and dilatational or aneurysmal lesions involving the aorta, its major branches and the pulmonary arteries in varying combinations and extent.1 Percutaneous balloon angioplasty became an important modality of treatment for stenotic lesions of the aorta in NSAA after it was first reported in 1984.2 Short segment and concentric stenoses are known to respond better to balloon dilatation.3 Small intimal tears following balloon inflation are common in such cases. However, extensive dissection is unusual.
Case Report. An 1...

2002 IAGS Proceedings: Intracranial Interventions (Part I of II)

Moderator: Jim Zidar, MD
Panel Members: Max Amor, MD, John Anderson, MD, Doug Cavaye, MD, Michael Lawrence-Brown, MD

John Anderson: In the U.S. and in Australia, stroke is the third leading cause of death and the leading cause of disability. Yet despite this, there is an air of therapeutic nihilism about stroke. Patients who present to the emergency room with a stroke are often considered beyond help. Unfortunately, Nick is correct: Where neurologists are with stroke today is essentially where cardiologists were with acute coronary syndromes in 1980, and treatment is not progressing very quickly. General physicians today seem unaware of the fact that things can be done for stroke patients. Unfortunate...

2002 IAGS Proceedings: Intracranial Intervention (Part II of II)

Moderator: Jim Zidar, MD
Panel Members: Max Amor, MD, John Anderson, MD, Doug Cavaye, MD, Michael Lawrence-Brown, MD

Richard Myler: I have always believed that you don’t read history, you repeat it. You may never have heard about Richard Schneider who was the chief of Werner Forsmann in Germany. In 1929, a 24-year-old man who worked with Schneider had the idea to catheterize himself. Richard Schneider recognized the genius of this young — and perhaps crazy — man’s idea. Schneider stood behind him and interventional cardiology was born. Don Effler stood behind a young man from Argentina who didn’t even have a license to practice medicine in the U.S. Then René Capalero performed his first int...

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 ...

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    Amanda Wright
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