Volume 15 - Issue 2 - February, 2003

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...

Acute Stent Recoil in the Left Main Coronary Artery Treated with Additional Stenting

Kais Battikh, MD, Riadh Rihani, MD, Jean Michel Lemahieu, MD

Left main coronary artery (LMCA) disease is found in 3–5% of patients undergoing cardiac catheterization for ischemic chest pain, congestive heart failure or cardiogenic shock.1 Revascularization by coronary artery bypass grafting (CABG) has been shown to improve survival, whereas conventional balloon angioplasty was associated with a poor long-term prognosis. Elective stenting of LMCA stenosis should provide a reduction of abrupt closure risk, greater acute gain with a larger minimum lumen diameter (MLD), and a lower restenosis rate at follow-up compared to balloon angioplasty. The increase...

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...

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