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.

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A Comparison of Arterial Closure Devices to Manual Compression in Liver Transplantation Candidates Undergoing Coronary Angiograp

Lee A. MacDonald, MD, Nirat Beohar, MD, Norman C. Wang, MD, Lisa Nee, MD, Raj Chandwaney, MD, Mark J. Ricciardi, MD, Keith H. Benzuly, MD, Sheridan N. Meyers, MD, Mihai Gheorghiada, MD, Charles J. Davidson, MD

Coronary artery disease is common in adult patients with end-stage liver disease who are candidates for orthotopic liver transplantation.1 Patients with end-stage liver disease are predisposed to spontaneous bleeding complications due to thrombocytopenia, reduced synthesis of coagulation factors and increased fibrinolytic activity.2–4 The impaired immunity has been shown to lead to a higher frequency of bacteremia and subsequent increased mortality.5,6 Vascular access site hematomas and infections are well known complications of cardiac catheterization.7 Several trials have reported similar ...

Contemporary View of the Acute Coronary Syndromes (Part I of II)

Ali Moustapha, MD and *H. Vernon Anderson, MD

Acute coronary syndromes (ACS) represent a clinical spectrum that extends all the way from unstable angina presenting with worsening episodes of chest pain, to non-ST segment elevation myocardial infarction (NSTEMI) with more prolonged chest pain and biochemical evidence of myocardial injury, to ST-segment elevation myocardial infarction (STEMI) with more extensive myocardial damage and usually the formation of Q-waves on the surface electrocardiogram, and finally to sudden cardiac death. Pathophysiologic correlations in ACS include minor plaque ulceration and transient thrombus formation in u...

Contemporary View of the Acute Coronary Syndromes (Part II of II)

Ali Moustapha, MD and *H. Vernon Anderson, MD

The dilemma of invasive versus conservative strategies. After patients with unstable angina and NSTEMI have been stabilized with medical therapy, a decision must be made regarding risk stratification. Several randomized trials have compared outcomes with early conservative versus early invasive management in ACS. Results of these trials were conflicting and most antedated the use of platelet GP IIb/IIIa receptor inhibitors and coronary stenting (Table 3). These include TIMI-IIIB,60 VANQWISH,61,62 MATE,63 FRISC II,64,65 and TACTICS-TIMI 18.66
The TIMI-IIIB trial60 used a 2 x 2 factorial...

Obliteration of a Competitive Forward Flow from the Ventricle After a Bidirectional Cavopulmonary Shunt with an Amplatzer Duct O

Carlo B. Pilla, MD, Valmir F. Fontes, MD, Carlos A.C. Pedra, MD

The early and mid-term results of the Amplatzer Duct Occluder (ADO) (AGA Medical Corporation, Golden Valley, Minnesota) for obliterating flow through a patent arterial duct are highly encouraging.1,2 High occlusion rates, low complication rates and application even in small children have made the percutaneous occlusion of arterial ducts with this device an attractive alternative to surgery.
The ADO has also been used in other clinical situations, such as closure of coronary artery fistula,3 surgical conduit,4 left ventricle to aorta tunnel5 and muscular apical ventricular septal defect.6 All ...

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...

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Editorial Correspondence
  • Laurie Gustafson, Executive Editor, JIC
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