Volume 21 - Issue 9 - September, 2009

Assessment of Left Main Coronary Disease: Does it Matter Which Road One Takes?

V. S. Srinivas, MBBS and Sangita-Ann J. Christian, MD

Assessment of intermediate severity left main coronary artery (LMCA) lesions is often performed in the cardiac catheterization laboratory because obstructive disease in this location is associated with a worse long–term prognosis.1–3 Some studies also suggest that the passage and delivery of interventional equipment through a diseased LMCA accelerates disease progression in this segment.4,5 Although traditionally considered a surgical disease, an increasing body of evidence supports percutaneous revascularization with drug-eluting stents, particularly in isolated LMCA disease.6 As a result...

Patient Satisfaction is Comparable to Early Discharge versus Overnight Observation after Elective PCI (see full title below)

FULL TITLE: Patient Satisfaction is Comparable to Early Discharge versus Overnight Observation after Elective Percutaneous Coronary
Intervention

aRuchira Glaser, MD, MSCE, bZachary Gertz, MD, dWilliam H. Matthai, MD, cRobert L. Wilensky, MD, dMark Weiner, MD, bDaniel Kolansky, MD, bJohn Hirshfeld Jr., MD, bHoward Herrmann, MD

ABSTRACT: Background. Previous investigation has suggested that early discharge after percutaneous coronary intervention (PCI) is feasible and safe, but these studies have utilized largely radial approaches or been conducted in non-U.S. cohorts. We sought to assess patient satisfaction, safety and cost of a strategy of selective early discharge in U.S. patients undergoing PCI via a femoral approach with contemporary adjunctive pharmacologic and hemostasis agents. Methods and Results. Patients with stable coronary artery disease undergoing elective PCI were prospectively recruited and randomize...

Peripheral Chronic Total Occlusions Treated with Subintimal Angioplasty and a True Lumen Re-Entry Device

*Hazim Al-Ameri, MD, †Victoria Shin, MD, †Guy S. Mayeda, MD, †Steven Burstein, MD, ‡Ray V. Matthews, MD, *,‡Robert A. Kloner, MD, PhD, †,§David M. Shavelle, MD

ABSTRACT: Objective. We sought to verify how effective the Pioneer catheter (Medtronic, Inc., Minneapolis, Minnesota) is in overcoming the complexity of re-entry during subintimal angioplasty and provide a case series describing the technique. Background. Subintimal angioplasty is effective in treating peripheral chronic total occlusions (CTO). However, this technique is often limited by the inability to re-enter the true lumen after subintimal crossing of the occluded segment. The Pioneer catheter was the first device to address this difficulty associated with subintimal angioplasty. Methods....

Effect of Radiographic Contrast Media on Markers of Complement Activation and Apoptosis (Full title below)

Spyridon Deftereos, MD, Georgios Giannopoulos, MD, Charalampos Kossyvakis, MD, Konstantinos Raisakis, MD, Andreas Kaoukis, MD, Metaxia Driva, MD, Olga Ntzouvara, MD, Vasiliki Panagopoulou, MD, Ilias Rentoukas, MD, Dimitrios J. Nikas, MD, Vlasios Pyrgakis, MD,
*Martin A. Alpert, MD

Effect of Radiographic Contrast Media on Markers of Complement Activation and Apoptosis in Patients with Chronic Coronary Artery Disease Undergoing Coronary Angiography

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ABSTRACT: The effects of radiographic contrast media on markers of complement activation and apoptosis in patients with chronic coronary artery disease (CAD) are unknown. The purpose of this study was to assess the comparative effects of ionic high-osmolar and non-ionic iso-osmolar radiographic contrast media on plasma markers of complement activation and apoptosis in patients with chro...

Structural Heart Disease Interventions: An Emerging Discipline in Cardiovascular Medicine

Roberto J. Cubeddu, MD, Ignacio Inglessis, MD, Igor F. Palacios, MD

ABSTRACT: Within the past decade, we have witnessed the exponential growth of novel percutaneous transcatheter therapies for the treatment of valvular and congenital heart disorders among others. Consequently, a new field has emerged in the world of adult cardiovascular medicine known as “structural heart disease interventions.” We herein provide a contemporary review highlighting many of the important historical landmarks that have set the stage for the development of this new and exciting subspecialty, and introduce a comprehensive overview of the structured training and challenges that ...

Post-Traumatic Ventricular Septal Defects — Review of the Literature and a Novel Technique for Percutaneous Closure

Payam Dehghani, MD, *Réda Ibrahim, MD, §Nicholas Collins, MD, David Latter, MD, Asim N. Cheema, MD, PhD, Robert J. Chisholm, MD

ABSTRACT: Post-traumatic ventricular septal defect (VSD) is infrequent, with clinical sequelae ranging from imminent death to complete spontaneous resolution. The most appropriate management strategy is unclear. Careful observation has been advocated in the management of these patients. We demonstrate this concept by reporting two different approaches in two patients with traumatic injuries to the chest and review the English-language literature of both spontaneous and percutaneous closure of these lesions. In our case of percutaneous closure, we report a novel technique involving a transsepta...

Very Late Drug-Eluting Stent Thrombosis Related to Incomplete Stent Endothelialization: (Full title below)

Santiago Jiménez-Valero, MD, Raúl Moreno, MD, Angel Sánchez-Recalde, MD

Very Late Drug-Eluting Stent Thrombosis Related to Incomplete Stent Endothelialization: In-Vivo Demonstration by Optical Coherence Tomography

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ABSTRACT: Very late drug-eluting stent (DES) thrombosis is a rare but potentially life-threatening event that has become a major cause of concern. Delayed arterial healing with incomplete endothelialization is probably a pivotal factor related with DES thrombosis. Optical coherence tomography (OCT) is a new high-resolution intracoronary imaging technique that allows detailed evaluation of stent neointimal coverag...

Physician-Hospital Alignment: Finding the Sweet Spot

David E. Steckler, JD, LLM, Fielding Epstein, MHSA, JD, Ronald N. Riner, MD

Many group practices, specialists and primary-care physicians are having their practices assessed in order to determine whether the practice should: (a) remain independent; (b) merge with another practice; or (c) agree to become employed by a hospital.

We believe that these alternatives widely miss the mark. In order for a medical practice to navigate successfully in today’s economic mean streets, you have to reprogram your GPS: your “destination-goal” is no longer simply whether to stay independent, merge or seek hospital employment, since these are now just short-term decisions, and...

Consistent Door-to-Balloon Times of Less Than 90 Minutes for STEMI Patients Transferred for Primary PCI

Bina Ahmed, MD, Stefan Lischke, MD, Faye Straight, RN, Prospero Gogo, MD, Stephen Leffler, MD, Marc Kutler, MD, David J. Schneider, MD, Harold L. Dauerman, MD

Myocardial Infarction — Fusion or Confusion?

Sivakumar Ardhanari, MD, Ashok J. Shah, MD, Ranjan K. Thakur, MD, MPH

From the Thoracic and Cardiovascular Institute, Sparrow Health System & Michigan State University, Lansing, Michigan.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted February 12, 2009, provisional acceptance given March 3, 2009, final version accepted March 11, 2009.

Address for correspondence: Ranjan K. Thakur, MD, MPH, Thoracic and Cardiovascular Institute, 405 West Greenlawn, Suite 400, Lansing, MI 48910. E-mail: [email protected]

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ABSTRACT: A...

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