Volume 22 - Issue 3 - March, 2010

Anticoagulation during Percutaneous Coronary Intervention in Diabetics — Is Simpler Always Better?

Pascal Meier, MD and Hitinder S. Gurm, MBBS

Bivalirudin is theoretically a promising alternative to unfractionated heparin (UFH). It is a direct thrombin inhibitor and has the ability to block circulating and clot-bound thrombin and prevent thrombin-mediated platelet activation.1 Glycoprotein IIb/IIIa inhibitors (GPI), such as the selective antibody abciximab or the small molecules tirofiban and eptifibatide on the other hand, are not alternatives to heparin but can, in addition to UFH, inhibit platelet aggregation by directly blocking their GPIIb/IIIa receptor. Either of these two strategies is used during most percutaneous coronary pr...

Successful Interventional Treatment of a Retrosternal Pseudoaneurysm of the Ascending Aorta with an Amplatzer Vascular Plug II

Werner Scholtz, MD, Smita Jategaonkar, MD, Nikolaus A. Haas, MD

ABSTRACT: Pseudoaneurysm of the aorta is a rare, but potentially dangerous complication after cardiac surgery, trauma or infective aortitis. Potential fatal risk of rupture with severe hemorrhage exists, so that treatment is necessary. Surgical management carries a high morbidity and mortality rate. Using an endovascular transcatheter method seems to be a promising option for treatment of aortic pseudoaneurysms. We report a case of ascending aortic pseudoaneurysm, which was diagnosed 11 years after cardiac surgery and treated successfully by implantation of an Amplatzer Vascular Plug II...

Right Coronary Artery Anatomical Variants: Where and How?

Pallavi Solanki, MD, Christine Gerula, MD, Preet Randhawa, MD, Michael Benz, MD, James Maher, MD, Bunyad Haider, MD, Marc Klapholz, MD, Jack Palmaro, MA, MPH, Diane Alfano, RN, Edo Kaluski, MD

ABSTRACT: Background. Ectopic origin of the right coronary artery (RCA) occurs in ≈1.0% of studied populations. We investigated the prevalence and location of ectopic RCAs among patients undergoing coronary angiography (CA) and assessed its effects on resource utilization. Methods. Cases of ectopic RCAs were prospectively collected over 21 months among patients undergoing cardiac catheterization at a University Hospital. “Ectopic RCA” was defined as a RCA originating outside the posterior two-thirds of the right coronary sinus. Results. The study population included 2,120 patients, of wh...

Coarctation of Distal Thoracic Aorta — The Middle Aortic Syndrome in an Elderly Female with Severe Coronary Artery Disease

Sandhya Kommana, MD, Siddharth A. Wartak, MD, MRCP, John Joelson, MD, FACC

ABSTRACT: Coarctation of the distal aorta or middle aortic syndrome is a segmental stenosis of the middle portion of the aorta, between the arch and the terminal bifurcation. Middle aortic syndrome is a rare disease of infants and young adults presenting with hypertension, lower limb claudication and renal insufficiency and is diagnosed by aortography or magnetic resonance angiography.
Our case is unique because this condition was an incidental finding diagnosed during cardiac catheterization in a 70-year-old patient with hypertension in the absence of lower limb claudication. Recognit...

Clinical Utility of B-Type Natriuretic Peptide (Full Title Below)

Joshua M. Stolker, MD and ‡Michael W. Rich, MD

ABSTRACT: Background. B-type natriuretic peptide (BNP) and echocardiographic tissue Doppler indices (TDI) predict elevated filling pressures, but few data exist comparing these methods while adjusting for clinical variables. We hypothesized that BNP would provide incremental value for estimating left ventricular end-diastolic pressure (LVEDP). Methods. Clinical data, echocardiograms, and BNP levels were obtained in 182 geriatric patients undergoing diagnostic left-heart catheterization. Patients with severe valvular disease or acute myocardial infarction were excluded. LVEDP and standard echoc...

Evaluation of Balloon Withdrawal Forces (Full Title Below)

Marvee Turk, Vishal Gupta, MD, MPH, Tim A. Fischell, MD

Evaluation of Balloon Withdrawal Forces with Bare-Metal Stents, Compared with Taxus™ and Cypher™ Drug-Eluting Coronary Stents: Balloon, Stent and Polymer Interactions

ABSTRACT: Background. There have been reports of serious complications related to difficulty removing the deflated Taxus™ stent delivery balloon after stent deployment. The purpose of this study was to determine whether the Taxus SIBS polymer was “sticky” and associated with an increase in the force required to remove the stent delivery balloon after stent deployment, using a quantitative, ex-viv...

The Sticky Story of Stuck Stents

James C. Blankenship, MD and Catriona O. Kerr-Wilson*

We now know what was long suspected. In fact, interventionists suspected it for years, dating back to 2004 when the Food and Drug Administration first investigated Boston Scientific’s TAXUS drug eluting stent for “stickiness of the balloon during withdrawal.”1,2 But nothing was ever proven. Until now.

In this issue of the Journal, Turk et al report their tests on several stent/balloon delivery systems to determine whether the TAXUS stent delivery balloon is more difficult to withdraw after stent deployment than other stent balloons.3 Their ex vivo setup included silastic tubes in a he...

Restenosis Rates following Vertebral Artery Origin Stenting: Does Stent Type Make a Difference?

Christopher S. Ogilvy, MD,a,b,d Xinyu Yang, MD, PhD,a,e Sabareesh K. Natarajan, MD, MS,b,d
Erik F. Hauck, MD, PhD,b,d Luona Sun, BS,b,c Laura Lewis-Mason, MS, ANP-C,b,d L. Nelson Hopkins, MD,b,c,d
Adnan H. Siddiqui, MD, PhD,b,c,d Elad I. Levy, MDb,c,d

ABSTRACT: Objectives. To compare our experience with sirolimus- and paclitaxel-eluting stents (drug-eluting stents [DES]) and non-drug-eluting stents (NDES) for treatment of vertebral artery (VA) origin stenosis and review the literature. Methods. A retrospective review of our prospectively collected database was performed. Clinical and radiologic follow up was obtained by reviewing office records and radiology. Data collected included demographics, comorbidities, presenting symptoms, stenosis severity, contralateral VA stenosis and/or carotid stenosis, type of stent used, angioplasty before o...

The Twin-Pass Dual Access Catheter for Assessment of the No-Reflow Phenomenon

David Meerkin, MBBS, Jonathan Balkin, MBBCH, Joseph Shaheen, MD, Dan Tzivoni, MD

ABSTRACT: The absence of antegrade flow in a coronary artery during an intervention is an ominous finding requiring diagnosis of the underlying cause and rapid treatment to limit myocardial necrosis. The Twin-Pass dual access catheter allows for distal coronary contrast injection without loss of wire position. The aim of this analysis was to determine the opacification and flow features of patients with abrupt arrest of antegrade flow to determine the underlying pathology. Methods. Coronary angiograms of patients with abrupt arrest of antegrade flow during an intervention that underwent distal...

Initial Experience of Removal of 10-French Sheaths Using the 8-French Angio-Seal Vascular Closure Device

Arzhang Fallahi, MD and Michael Kim, MD

ABSTRACT: Objectives. We studied the use of 8 Fr Angio-Seal in closure of access sites up to 10 Fr. Background. The use of larger French catheters for procedures such as valvuloplasty and percutaneous valve replacement has required the use of better methods for arterial closure. The use of 6 and 8 Fr Angio-Seal hemostatic devices (St. Jude Medical, St. Paul, Minnesota) has been well described and are routinely used for diagnostic and interventional procedures up to 8 Fr in size. However, no data are available for the use of an 8 Fr Angio-Seal device in the closure of access sites up to 10 Fr. ...

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