Volume 15 - Issue 3 - March, 2003

Early and Late Reactions Following the Use of Iopamidol 340, Iomeprol 350 and Iodixanol 320 in Cardiac Catheterization

A.G.C. Sutton, *P. Finn,  P.G. Campbell, D.J.A. Price, J.A. Hall,  M.J. Stewart,  A. Davies, N.J. Linker, A.A. Harcombe, M.A. de Belder

ABSTRACT: Goal. To investigate the incidence of early (< 24 hours) and late (> 24 hours to 7 days) reactions to 3 contrast agents commonly used in cardiac catheterization. Methods and Results. A total of 2,108 patients undergoing cardiac catheterization in a Regional Cardiothoracic Unit were randomly assigned to receive 1 of 3 commonly used contrast agents in a prospective, double-blind study.

 ...

IAGS 2002: The Intractable Angina Patient

Panel Members: Howard Cohen, MD, Philip Walker, MD, Gary Roubin, MD

Some Patients Can’t Be Revascularized with PCI or CABG

Despite the advances that have occurred in coronary revascularization, there is a growing population of patients who are not candidates for either coronary artery bypass grafting (CABG) or conventional percutaneous coronary intervention (PCI). This population is heterogeneous and includes patients with diffuse coronary disease, comorbid conditions or multiple previous bypass operations resulting in no remaining suitable conduits.
The majority of such patients present with anginal symptoms that are unresponsive to both conventi...

Selective Coronary Artery Fistula Embolization with Hystoacryl During Percutaneous Coronary Angioplasty

Ramón Villavicencio, MD, Raúl Marenco, MD, *Marco A. Zenteno, MD, Jorge Gaspar, MD

Coronary artery fistulae (CAF) are anomalous communications between coronary arteries and a cardiac chamber, great vessel or other vascular structure bypassing the myocardial capillary bed.1,2 The frequency has been reported to be approximately 0.2% of the adult population that has been subject to coronary angiography.3 CAF are usually congenital in origin, although they can rarely be acquired, either after coronary artery bypass grafting, mitral valve replacement4,5 or endomyocardial biopsy procedures.6
The clinical importance of CAF varies depending on the magnitude of the arteriovenous shu...

Treatment of Iatrogenic Aortic Dissection by Percutaneous Stent Placement

D.A. Gorog, MD, *A. Watkinson, MD, D.P. Lipkin, MD

Aortic dissection is a rare but recognized complication of coronary angiography. In early series, angioplasty-induced dissection and other acute events associated with abrupt vessel closure complicated percutaneous transluminal coronary angioplasty in 4–5% of cases.1 The reported frequency of angiography or angioplasty-induced dissection in peripheral vessels varies in the literature. In the series by Gardiner et al., the frequency of dissection due to iliac angioplasty was stated to be 1.3% (3 of 224).2 In the largest published series of 15,500 angiographic procedures conducted in three cen...

Stenting Through a Portacath for Totally Occluded Superior Vena Cava in a Case of Non-Hodgkin’s Lymphoma

Tejas M. Patel, MD, DM, Sanjay C. Shah, MD, DM, Alok Ranjan, MD, DM, MRCP, Hemant Malhotra, MD, DNB, Rajnikant Patel, MD, Anoop K. Gupta, MD, DM, DNB

Superior vena cava syndrome (SVCS) is a distressing manifestation of benign or malignant disease obstructing return of blood flow through the superior vena cava (SVC).1 Patients with this syndrome can be extremely uncomfortable or may develop life-threatening complications such as laryngeal or cerebral edema. Percutaneous delivery of metallic stents into the vena cava has been used with success to relieve obstruction to blood flow quickly and completely.2–4 We describe a patient with totally occluded SVC secondary to portacath implantation for non-Hodkin’s lymphoma in whom a wallstent was ...

Aortocoronary Dissection Complicating a Percutaneous Coronary Intervention

Jeffrey A. Goldstein, MD, Ivan P. Casserly, MD, William T. Katsiyiannis, MD, John M. Lasala, MD, PhD, Megumi Taniuchi, MD, PhD

Small intimal dissections occur frequently after percutaneous coronary intervention (PCI), but are usually associated with a benign course. Following balloon angioplasty, coronary dissection is detected by angiography in 20–40% of cases1–3 and by intravascular ultrasound (IVUS) and angioscopy in 60–80% of cases.4,5 Considering the mechanism of lumen enlargement after percutaneous transluminal coronary angioplasty (PTCA) is predominately stretching of the vessel wall and plaque fracture, non-flow limiting dissections should not necessarily be considered a complication since they are easil...

Intracardiac Echocardiography and Transcranial Doppler Ultrasound to Guide Closure of Patent Foramen Ovale

Mario Zanchetta, MD, Gianluca Rigatelli, MD, *Eustaquio Onorato, MD

Patent foramen ovale (PFO) is increasingly recognized as a mediator of Patent foramen ovale (PFO) is increasingly recognized as a mediator of paradoxical embolism,1,2 refractory hypoxemia3,4 and platypnea-orthodeoxia syndrome.5–7 Many specialists are involved in PFO patient care, such as vascular surgeons, neurologists, respiratory physicians, and cardiologists; an interdisciplinary working group assumes special importance in the management of this disease.
For a long time, transthoracic (TTE) and transesophageal (TEE) echocardiography were considered the main imaging tools for diagnosing P...

Platelet Glycoprotein IIb/IIIa Inhibition in Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: Application of

John J. Young, MD, Joseph K. Choo, MD, Dean J. Kereiakes, MD

Introduction. Over the past decade, appreciable reductions in mortality, reinfarction and length of hospital stay have been reported in large-scale trials of patients with acute coronary syndromes (ACS). Every year, approximately 1.5 million patients are admitted to hospitals in the United States with unstable angina (UA) and non-ST segment elevation myocardial infarction (NSTEMI). In the last few years, there have been many advances in the evaluation and management of this patient population, including effective medical treatments such as antiplatelet, anticoagulant and cholesterol-low...

February 2003

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

Dear Readers,

This issue of the Journal of Invasive Cardiology includes original research articles, case reports, a CME offering, articles from the Journal special sections “Acute Coronary Syndromes” and “Interventional Pediatric Cardiology”, as well as Part VIII of the discussion series from the International Andreas Gruentzig Society 7th Biennial Meeting held in February of 2002.

In the first original research article, Dr. Lee A. MacDonald and colleagues from the Divisions of Cardiology and Hematology in the Department of Medicine at Northwestern University Medical Scho...

Post-Cardiac Catheterization Access Site Complications and Low-Molecular-Weight Heparin Following Cardiac Catheterization

Lee A. MacDonald, MD, Sheridan Meyers, MD, Charles L. Bennett, MD, PhD, Dan Fintel, MD, Neal Grosshans, MS, RPh, Raffy Syegco, RN, Charles J. Davidson, MD

No consensus has emerged on the periprocedural anticoagulation regimen of patients receiving long-term oral anticoagulation.1 Enoxaparin, a low molecular weight heparin (LMWH), is often used following percutaneous invasive procedures in patients on long-term anticoagulation who undergo temporary periprocedural discontinuation of warfarin. From 1993 through 1998, the Food and Drug Administration (FDA) received reports of 43 patients who developed spinal or epidural hematomas following the use of enoxaparin in the setting of neuraxial blockade.2 Many of these patients developed severe neurologic...

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