Volume 21 - Issue 12 - December, 2009

Predictors of Distal Embolization in Peripheral Percutaneous Interventions: A Report from a Large Peripheral Vascular Registry

Nicolas W. Shammas, MD, MS, Gail A. Shammas, BS, RN, Eric J. Dippel, MD, Michael Jerin, PhD,
Waheeb J. Shammas

ABSTRACT: Background. Distal embolization (DE) commonly occurs during peripheral percutaneous interventions (PPI) of the lower-extremity arterial vessels. In this study we evaluate the predictors of DE in a large cohort of patients undergoing PPI at our center. Methods. Patients who experienced clinically significant DE (requiring further mechanical or pharmacologic therapy as per operator judgment) were extracted from a peripheral vascular registry that prospectively tracks demographics, clinical, procedural and outcome variables on patients undergoing PPI at our medical center and compared t...

Atheroemboli during Peripheral Arterial Interventions

Subhash Banerjee, MD, Tej Thatthi, BA, Neeraj Badhey, MD, Emmanouil S. Brilakis, MD, PhD

Atheroemboli during percutaneous peripheral arterial interventions (PAI) complicate about 1–2% of procedures, with serious adverse outcomes, although their true incidence is estimated to be much greater.1 In the era of increasing number and complexity of percutaneous peripheral arterial revascularization procedures, it is important to provide operators with guidance regarding the predictors of this rare though serious complication. The rarity and often unpredictability of atheroembolic complications during PAI makes this article by Shammas et al extremely relevant to today’s endovascular s...

Optimizing of Transcoronary Pacing in a Porcine Model

Konstantin M. Heinroth, MD, Justin M. Carter, MD, Michael Buerke, MD, *Dirk Mahnkopf, MD,
Karl Werdan, MD, §Roland Prondzinsky, MD

ABSTRACT: Background. Transcoronary pacing for the treatment of bradycardia during percutaneous coronary intervention (PCI) is not well established, but may be a useful technique in interventional cardiology. We developed a porcine model to examine the feasibility and efficacy of transcoronary pacing during PCI. Methods and Results. Eight pigs under general anesthesia underwent unipolar transcoronary pacing with a standard floppy guidewire in a coronary artery (as the cathode) and a skin patch electrode (as the anode). We examined the effect of skin-patch position (groin vs. anterior or poster...

A Regional System for Delivery of Primary Percutaneous Coronary Intervention (Full title below)

Richard Aplin, MD, Daniel Tiede, MD, Cheryl Lovitz, RN, Mark Gartner, RT(R)(CV), †David Robinson, PhD, †Hui Xu, PhD, Philip Martin, RN, BSN, Bernard Erickson, MD, Wade Schmidt, MD, Jamie Pelzel, MD,
David Wendt, AAS, John Mahowald, MD

A Regional System for Delivery of Primary Percutaneous Coronary Intervention in ST- Elevation Myocardial Infarction: STEMI-St. Cloud

ABSTRACT: Background. Strategies of emergency care in the treatment of ST-segment elevation myocardial infarction (STEMI) have evolved rapidly over the past two decades to include primary percutaneous coronary intervention (PPCI) when possible. Most U.S.-based transfer programs still use complicated protocols that include fibrinolytic therapy often resulting in transfer delays, inappropriately applied therapy (wrong diagnosis) and bleeding and strok...

Primary PCI for STEMI — Pushing the Limits

Robert J. Applegate, MD

The optimal management of patients with ST-elevation myocardial infarction (STEMI) has been the subject of ongoing clinical investigations for the past several decades. When it became apparent that primary angioplasty was not only feasible, but superior, to thrombolytic therapy in randomized clinical trials,1 there was universal adoption of primary percutaneous coronary intervention (PCI) for those centers that perform PCI. The belief that primary PCI was superior to thrombolytic therapy as the initial treatment of STEMI is so strong that many centers that previously administered thrombolytic ...

X-Ray Angiography and Magnetic Resonance Imaging to Distinguish Interarterial (Full title below)

Ravi V. Desai, MD,§* Ritesh Gupta, MD, MPH,§* Silvio H. Litovsky, MD,£ Hrudaya Nath, MD,∞
Himanshu Gupta, MD,§ Satinder P. Singh, MD,∞ William T. Evanochko, PhD,§ Johnnie E. Knobloch, RT,§
Steven G. Lloyd, MD, PhD§

X-Ray Angiography and Magnetic Resonance Imaging to Distinguish Interarterial from Septal Courses of Anomalous Left Coronary Artery: An Ex Vivo Heart Model

ABSTRACT: Objective. We sought to demonstrate the distinguishing features between interarterial and intraseptal courses of an anomalous left coronary artery from the right sinus of Valsalva (RSV) on X-ray angiography, using an ex vivo model. Background. An anomalous left main coronary artery (LMCA) arising from the RSV can take prepulmonary, retro-aortic, interarterial (IA) or intraseptal (IS) courses, of which only the IA cours...

Avoiding Intelligence Failures in the Cardiac Catheterization Laboratory (Full title below)

Jonathan D. Marmur, MD, Renee P. Bullock-Palmer, MD, Shyam Poludasu, MD, Erdal Cavusoglu, MD

Avoiding Intelligence Failures in the Cardiac Catheterization Laboratory: Strategies for the Safe and Rational Use of Dalteparin or Enoxaparin during Percutaneous Coronary Intervention

ABSTRACT: Low-molecular-weight heparin (LMWH) has been a mainstay for the management of acute coronary syndromes (ACS) for almost a decade. However, several recent developments have seriously threatened the prominence of this drug class: (i) the adoption of an early invasive strategy, frequently leading to percutaneous coronary intervention (PCI) where the dosing and monitoring of LMWH is unfamiliar ...

Late-Acquired Stent Malapposition after Sirolimus-Eluting Stent Implantation (Full title below)

*Sudhir Rathore, MD, §Mitsuyasu Terashima, MD, §Takahiko Suzuki, MD

Late-Acquired Stent Malapposition after Sirolimus-Eluting Stent Implantation following Acute Coronary Syndrome: Angiographic, IVUS, OCT and Coronary Angioscopic Observation

ABSTRACT: Drug-eluting stents (DES) have been shown to significantly reduce the incidence of restenosis and target lesion revascularization in a wide variety of clinical situations. DES have also been shown to significantly reduce neointimal hyperplasia as compared to bare-metal stents. However, the antiproliferative properties of DES also delay vascular healing and have been associated with stent malapposition,...

Late Sequela of Kawasaki’s Disease: Optical Coherence Tomographic Finding

Jin-Man Cho, MD, Il-Suk Sohn, MD, †Ik-Kyung Jang, MD, PhD

Case Description. A 24-year-old male without coronary risk factors came to our office for recent-onset exertional angina associated with shortness of breath. His medical history was notable for Kawasaki’s disease at the age of two. A stress test showed anterior ischemia. Subsequently, he underwent computed tomography (Figure 1) and coronary angiography, which revealed a calcified tubular narrowing of the proximal left anterior descending (LAD) and chronic total occlusion in the proximal right coronary artery (RCA), with bridge collaterals (Figures 2A and B). Optical coherence tomography (OCT...

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