Volume 15 - Issue 5 - May, 2003
Aortic Root and Extensive Coronary Dissections Complicating Recanalization of Chronic Right Coronary Artery Occlusion: Refrainin
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The incidence of chronic total occlusions (CTO) is between 20–40% in patients with angiographically documented coronary artery disease.1 Percutaneous coronary intervention (PCI) for chronic total occlusion is associated with a significantly lower success rate and a higher complication rate compared to PCI for subtotal stenoses. Despite improved procedural success and the development of new interventional devices, CTOs remain the lesion subset with the lowest success rate because of the inability to cross the lesion with a guidewire.2 Difficulties during advancement of the guidewire beyond th
Direct Stenting May Limit Myocardial Injury During Percutaneous Coronary Intervention
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There has been a dramatic increase in the use of intracoronary stents as the primary percutaneous treatment strategy for coronary lesions. This shift was supported by evidence demonstrating improved acute and long-term outcomes with stenting compared with balloon angioplasty alone.1,2 Direct stenting (DS), without balloon predilatation, has reportedly led to a reduction in overall cost, contrast volumes, procedural and radiation exposure times.3–9 However, there has been no demonstrable difference in the majority of studies comparing DS and conventional stenting with balloon predilatation (P
Subacute Development of a Coronary Artery Pseudoaneurysm After Primary Angioplasty and Stenting for Acute Myocardial Infarction
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The pharmacological and mechanical coronary angioplasty environment extensively enhances the immediate outcome so much that acute procedural complications seem to belong to the past. Other than restenosis, the management of which is now well codified and the future of which might be “compromised” by rapamycine and/or paclitaxel coated stents, long-term post-angioplasty results are now essentially dependent on atherosclerosis progression. Nevertheless, rare complications such as pseudoaneurysm can still occur.
Case Report. A 76-year-old woman was admitted during hour 5 of an ac
Direct Stenting: Good for the Patient, Good for All?
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Conventional stenting techniques initially incorporated routine target lesion predilatation with a balloon catheter to permit easy, uncomplicated stent passage prior to stent deployment. With extensive experience in stenting, cardiac interventionalists have simplified and economized the procedure. Direct stenting, or stenting without balloon predilation is the next step in approaching percutaneous revascularization.1 This technique results from technologic advancements that include premounted stents (well-secured), low crossing profiles (0.035´´ or less) and enhanced flexibility. Direct ste
Results of the Companion Trial — Another Breakthrough in Electrophysiology
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Recently, the Companion Trial was terminated via the Safety and Monitoring Board for that trial. This was a breakthrough trial in which patients with moderate to severe congestive heart failure (New York Heart Association class III and IV), left ventricular ejection fraction less than or equal to 35%, and a QRS duration of 120 milliseconds were randomized to either optimal medical therapy, optimal medical therapy plus biventricular pacing, or optimal medical therapy plus biventricular pacing with a back-up implantable defibrillator. The ratio of the randomization was 1:2:2, respectively. The s
Practice and Outcomes of Percutaneous Coronary Intervention in the Community Before Drug-Eluting Stents: A Report from the HCA D
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Rapid advancements in percutaneous coronary interventional (PCI) techniques have changed the manner in which we treat coronary artery disease.1 Clinical trials have demonstrated the efficacy of coronary stents in preventing abrupt vessel closure and restenosis, the most common adverse outcomes of PCI procedures.2–7 In addition, advancements in stent technology (flexibility, improved delivery systems and reduced profiles) have increased the number and types of lesions that can be successfully treated using stent techniques.8–9 Developments in adjuvant pharmacology, including a focus on plat
Mechanical Reperfusion of Acute Right Coronary Artery Occlusion After Radiofrequency Catheter Ablation and Long-Term Follow-up A
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Radiofrequency catheter ablation (RFCA) has become the most effective and safe method for treating Wolff-Parkinson-White (WPW) syndrome in children and adolescents. Accessory pathways (APs) located in the postero-septal region account for up to 28% of all these APs. Despite the fact that children are smaller than adults, leading to smaller coronary arteries and shorter distances between these vases and posterior septum, and also the growth aspect of these small coronary arteries, coronary artery injury is rarely reported.3,4 Furthermore, long-term consequences of radiofrequency lesions in deve
Taxol-Based Eluting Stents — From Theory to Human Validation: Clinical and Intravascular Ultrasound Observations
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Reduction of restenosis remains an important goal of percutaneous coronary interventions. Although coronary stents reduce the rate of primary restenosis compared with balloon angioplasty,1–3 20–30% of treated vessels still develop recurrent in-stent restenosis.4,5 Initial studies with intracoronary radiation therapy showed promise as a treatment for both primary restenosis and recurrent in-stent restenosis,6,7 but recent studies have reported shortcomings, namely, edge restenosis and late thrombosis.8–10 While the treatment of in-stent restenosis is important, a therapeutic strategy to p
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